Psychiatry 2011: No Sigmund Freuds Here

Via the New York Times, meet the new face of psychiatry. There's no more talk therapy, no more couches, no more 45 minute sessions where your shrink listens to your problems.

Insurance companies stopped paying for it. Instead, you book a 15 minute appointment and get....pills. The Times article profiles one doctor who switched from Sigmund Freud psychotherapy to pill prescriber, Dr. Donald Levin of Chicago. His interview is honest...to a point, and sad. He makes no excuses. It's all about money.

I miss the mystery and intrigue of psychotherapy,” he said. “Now I feel like a good Volkswagen mechanic.”


What Dr. Levin doesn't address is why his need for a lifestyle he and his wife have become accustomed to is so much more important to him than personal fulfillment and pride in his work. He sounds defeated and depressed, and like someone who has no joy in his life. The impression the article leaves is that he has too blithely succumbed to becoming an artifact of the past. Here's what he says about the insurance companies' change of reimbursement practices:

[O]ne by one, we accepted that that craft was no longer economically viable. Most of us had kids in college. And to have your income reduced that dramatically was a shock to all of us. It took me at least five years to emotionally accept that I was never going back to doing what I did before and what I loved.”

...He could have accepted less money and could have provided time to patients even when insurers did not pay, but, he said, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.” “Nobody wants to go backwards, moneywise, in their career,” he said. “Would you?”

I think he had a choice. Reduce his lifestyle, so he could continue to do what he loved and found fulfilling and which bettered peoples' lives, or keep his lifestyle and spend 50 hours a week at an assembly-line type job that provides no joy, no personal sense of fulfillment, and no stimulation. I certainly would not have made the choice he did. It's like he's punching a clock until his retirement.

Surely there are other outlets for his therapeutic talents. Couldn't he have reduced his caseload instead of eliminating it, and added other projects; A call-in talk radio show offering advice; writing a book; teaching. Another shrink mentioned in the article, whom Levin used to practice with, found a way to keep her psychotherapy practice going and survive.

And this just floored me. His wife, who used to be some kind of therapist (not a doctor though) is now his business manager, working at the office.

As soon as a patient arrives, Ms. Levin asks firmly for a co-payment, which can be as much as $50. She schedules follow-up appointments without asking for preferred times or dates because she does not want to spend precious minutes as patients search their calendars. If patients say they cannot make the appointments she scheduled, Ms. Levin changes them.

“This is about volume,” she said, “and if we spend two minutes extra or five minutes extra with every one of 40 patients a day, that means we’re here two hours longer every day. And we just can’t do it.”

And what compassion she has (not):

On a January day, a pregnant mother of a 3-year-old called to say that her husband was so depressed he could not rouse himself from bed. Could he have an immediate appointment? Dr. Levin’s first opening was a month away.

“I get a call like that every day, and I find it really distressing,” Ms. Levin said. “But do we work 12 hours every day instead of 11? At some point, you have to make a choice.”

What caring professional would not put in an extra hour to provide the pregnant mother with some names and phone numbers for doctors or organizations or medical centers that could provide help to her husband? How much trouble is it to keep a resource directory or rolodex on her desk?

By the end of the article I felt no sympathy for the Levins and doctors like them. My sympathies lie with the patients who are brave enough to call and seek help, only to be refused the chance to find a helpful ear. Read his description of how the abbreviation of his intake interview almost resulted in a misdiagnosis of one man who came in for ADD and turned out to be suicidal, and suffering not from ADD but an anxiety disorder. The author writes "The visit took 55 minutes, putting Dr. Levin behind schedule."

So how widespread is the problem? How many shrinks have switched from talk therapy to prescription writer?

A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since.

....Insurance company reimbursement rates and policies ...discourage talk therapy... A psychiatrist can earn $150 for three 15-minute medication visits compared with $90 for a 45-minute talk therapy session.

The result, according to Dr. Levin:

“And people want to tell me about what’s going on in their lives as far as stress,” Dr. Levin said, “and I’m forced to keep saying: ‘I’m not your therapist. I’m not here to help you figure out how to get along with your boss, what you do that’s self-defeating, and what alternative choices you have.’ ”

Some of Dr. Levin's patients say they like him. He responds:

“The sad thing is that I’m very important to them, but I barely know them,” he said. “I feel shame about that, but that’s probably because I was trained in a different era.”

What a rationalization. It's shameful, period, no matter when he was trained.

And where's the DEA? How is this not a pill mill? They have the gall, time and resources to go after doctors who prescribe pain medication to those in physical pain, but overlook shrinks like Dr. Levin who hand out scripts to 39 patients a day after a 15 minute consultation? Ask yourself what if Dr. Levin prescribed medical marijuana after a 15 minute consult to 39 patients a day? You think there would still be no enforcement action?

Sure there's a lot of blame to go around, beginning with the insurance companies. But I can't believe that every shrink chose psychiatry just to make money. Or that doctors close to retirement, like Dr. Levin, are still paying back their medical school loans. Or that they have no other option but to drop psychotherapy and become pill mills.

One possible remedy: Allow psychologists who provide talk therapy to prescribe medication, getting rid of the need for shrinks who limit their practices to script writing. It won't happen -- the DEA would never allow it -- but it seems like a cost-effective solution to me.

< Bradley Manning: Get Him a Nightshirt | Why Can't Death Row Inmates Donate Organs? >
  • The Online Magazine with Liberal coverage of crime-related political and injustice news

  • Contribute To TalkLeft

  • Display: Sort:
    As Samuel Goldwin put it (5.00 / 2) (#4)
    by Harry Saxon on Sun Mar 06, 2011 at 08:09:03 AM EST
    "Anyone who goes to a psychiatrist ought to have his head examined."

    And what you no doubt discovered (5.00 / 1) (#6)
    by Anne on Sun Mar 06, 2011 at 09:20:09 AM EST
    in your therapy - what many of us discover - is "what lies beneath" - the things that are the reason we feel and react as we do, what it means to us that we probably can't know without some serious, honest and professionally-guided exploration of who we are.

    Medication can have a role, but it shouldn't be the only one; just as we can feel bad without knowing the real reasons underneath the surface, medication can make us feel better without ever addressing our history, our patterns of behavior, the triggers that set us off.

    Some people don't want to have to work that hard to understand themselves, they just want to feel better NOW - and for them, I suppose assembly-line pill suppliers are just the ticket.  What no one apparently does these people the courtesy of telling them is that they may think all they want is to feel better, but without coming to some kind of understanding of why they feel the way they do in the first place, they are likely going to be hopping on the medication merry-go-round and creating a whole new universe of problems.

    So much for cognitive and behavioral therapy, huh?  And, boy those insurance companies...really going that extra mile, once again.

    What that guy needs is a (5.00 / 2) (#10)
    by the capstan on Sun Mar 06, 2011 at 10:45:52 AM EST
    good psychiatrist!

    I am too da-- tired after being sick for two weeks to read every word or every comment.

    But I need to say that my son has had problems in college and in 'real' life.'  (Growing up gay is not easy.)  For years, we'd suggest psychiatric help, hoping for someone to work with cognitive therapy.  He always got a pill.  Eventually all of us learned that any pill he got sent him totally off the rails, hating himself, the world, and everyone in it (except maybe me.)  Last episode someone took him to the ER at that point.  Now everyone who cares for him, and my son himself, is terrified of psychiatrists with pills.  

    A new approach at Kaiser in CA is to send patients to an office where there is one doctor in charge of medication only, and the other doctors do no prescribing at all.

    Sad (5.00 / 2) (#20)
    by Militarytracy on Sun Mar 06, 2011 at 01:42:02 PM EST
    Since anti-depressants don't outperform placebos (5.00 / 1) (#17)
    by Dadler on Sun Mar 06, 2011 at 12:22:30 PM EST
    ...I'd suggest a huge increase in talk therapy is required.  Won't happen, and neither will the genuine psychiatric recovery of millions of people who have been led to believe, as much of us have, that chemistry creates depression. Since placebos perform just as well in studies, it should be obvious that the chemistry first princliple doesn't hold water.  Depression creates chemistry.  Life creates depression.  Being a complex and highly emotional creature, as all humans are, create many things we still won't allow ourselves to accept or understand.

    Agree, but (5.00 / 3) (#22)
    by BackFromOhio on Sun Mar 06, 2011 at 04:12:59 PM EST
    some depressions are chemically-based, while in others, such as "reactive" depression -- reaction to divorce, death, etc. --, the depressed reaction changes the brain chemistry.  The key is to find someone who is qualified to make a proper diagnosis and distinguish situations when drugs are needed and when they are not.  Not all doctors who specialize in medication -- psychopharmacologists -- or all those in the therapy profession who are licensed to prescribed drugs, i.e., psychiatrists, are either so qualified or use the qualifications to make distinctions.  Trick is to find someone who is licensed to prescribe, but does not always do so.

    Freud (5.00 / 1) (#18)
    by MandT on Sun Mar 06, 2011 at 01:32:44 PM EST
    "Now I feel like a good Volkswagen mechanic." But Ya are Blanch; ya are.

    Doped up is roped up (5.00 / 1) (#19)
    by Kimberley on Sun Mar 06, 2011 at 01:33:43 PM EST
    I had no idea this was going, so thanks for clueing us in Jeralyn.

    My heart aches for patients being pushed through these mills though.

    I had a wonderful psychiatrist help me work through a traumatic childhood. In my case, scripts were used merely to put my head in the right place to get the real work of therapy done properly. But I was an intensely self-destructive mess and presenting in such a way that it would have been so easy--too easy--for a less ethical psychiatrist to just chemically lobotomize me in an attempt to quiet symptoms instead of address causes. This, of course, would have compounded my troubles by creating dependency, rather than help me set myself free.

    I'm still growing strengths I discovered I had while in therapy. I owe a talented psychiatrist some portion of every success I've had since.

    I guess I lucked out by needing help, and finding it, before insurance giants decided they knew better than psychiatric professionals what was best for patients.

    I wanted to add this (5.00 / 1) (#21)
    by Kimberley on Sun Mar 06, 2011 at 02:26:42 PM EST
    because I don't want to be misunderstood as being against the psychiatric use of medication for lifetime-commitment disorders and imbalances.

    In cases like schizophrenia and the like, prescriptions are no less important than a prothetic leg is to the stability and mobility of a victim of traumatic amputation. Used appropriately they can save lives and make hard lives easier to live in.  None of that is doping.


    I can't even imagine where I would be (5.00 / 1) (#23)
    by andgarden on Sun Mar 06, 2011 at 04:22:07 PM EST
    without having had oodles of talk therapy.

    As usual, the Times buried the lede (5.00 / 2) (#25)
    by scribe on Sun Mar 06, 2011 at 05:28:37 PM EST
    Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients' inner lives better than he knew his wife's; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

    In other words, he's effecting the insurance companies' desired result:  functional droids, not happy, fulfilled people.  Happiness and fulfillment are for the rich, who can afford to pay $600 an hour and $2,500 for an initial consult.

    Lisa Kudrow (none / 0) (#1)
    by lentinel on Sun Mar 06, 2011 at 06:03:47 AM EST
    has a very original and funny series on the internet in which she plays a therapist who gives 5 minute sessions over the internet.

    It is called "Web Therapy".

    I considered it a very funny put-on, a parody of therapeutic practices.

    Now, reading the article above, it seems much too close to reality for comfort.

    What has happened to our country?

    Web Therapy

    If "therapy" is no longer (none / 0) (#3)
    by Militarytracy on Sun Mar 06, 2011 at 07:37:32 AM EST
    of use, why would they cover counseling with phsychologists?  IMO people can't be receiving treatment that isn't risky at this point.  The insurance companies need their pants sued off.

    I hate to say it (5.00 / 1) (#8)
    by TeresaInSnow2 on Sun Mar 06, 2011 at 09:36:55 AM EST
    But if my guess about the rationale is correct, I agree with the insurance companies.

    Psychiatrists charge way more money and provide no better talk therapy than psychologists would.  And it's possible that the psychologists provide better care, less ego.  It makes sense in terms of costs of care if people go to a psychologist instead of a psychiatrist.  Good psychologists typically work closely with MDs to prescribe meds.  It works great.

    This guy is just bemoaning his loss of revenue due to competition/alternative care created by psychologists, and then justifying his slimy behavior because of it.


    Oy, my experience with soldier (none / 0) (#9)
    by Militarytracy on Sun Mar 06, 2011 at 09:45:12 AM EST
    families going through counseling due to deployment stress and also soldiers coming back with various anxiety disorders is that counselors do NOT work well side by side with prescribing shrinks.  I thought this was only a military type phenom though, and not one attacking the whole trade.  I completely disagree that therapists work well in unison with a prescribing psychiatrist.  That is another thing that would take time, and nobody is paying for the time anymore.

    Is it possible that the military approach (5.00 / 1) (#14)
    by Anne on Sun Mar 06, 2011 at 11:15:03 AM EST
    is designed to be too often not in the best interests of the patient, but in the best interests of the military?  Seems to me that back when the military started extending tours and deploying troops three, four and five times without the requisite time between deployments, we started hearing about military psychiatrists/counselors certifying as fit for deployment men and women who were anything but - sometimes with terrible results, with or without medication.

    Therapy works best when it is driven by the needs of the patient, not the needs of the provider of care, or the insurance company - or the military.


    Most of the services at Fort Rucker (none / 0) (#16)
    by Militarytracy on Sun Mar 06, 2011 at 11:55:43 AM EST
    are farmed out to the private sector.  So the family experiences here have been within the private sector.  Lyster military hospital here runs on a skeleton crew, and we have a copter crash here about once a month.  All injured soldiers go out to private sector healthcare services.  Even the soldiers needing mental health services are farmed out into the private sector, and then a flight surgeon approves the course of treatment that is chosen or doesn't approve it.  It was the flight surgeon addition that I thought was making such a difference.

    Other bases and forts have a different mix of available resources and probably don't farm it all out.  When you have a soldier come home though with an adjustment anxiety disorder (what they generally see in older soldiers who went with a more mature brain) or full blown PTSD, it is never a one person experience, it is a family experience.  So there are counselors involved along the way with the whole family as well as prescribing psychiatrists and you can't believe the horror stories and also the tragedy.  I know one guy who blew his friggin head off, and his wife couldn't get his shrink and the counselor on the same page even though she was working like mad.  What one "professional" thinks is important another can flippantly blow off during a 15 min writing of prescriptions and pushing them out the door.


    I don't know what the backgrounds (5.00 / 1) (#24)
    by BackFromOhio on Sun Mar 06, 2011 at 04:23:06 PM EST
    are of the private sector counselors, but I do know that backgrounds/training varies, and knowledge of the effects of PTSD and other disorders on brain chemistry and thus behavior is not necessarily common knowledge in the helping professions, nor are the symptoms and course of PTSD, etc. common knowledge.  Some therapists still think those who suffer from PTSD must just "buck up" and take it like a man.  The stress on families is also enormous.  

    Do you know what the source of the friction is?  Are the armed services Drs. annoyed by how much the private sector professionals charge? Are those in the private sector condescending to the armed services Drs?  

    Sounds so counterproductive.  I also don't get why the armed services would continue to refer patients to private professionals who can't get along with the military Drs.  


    There is a large office (none / 0) (#26)
    by Militarytracy on Sun Mar 06, 2011 at 05:56:03 PM EST
    of psychiatrists that have contracted with Tricare and IMO they are horrible, just flat out horrible with providing competent service and they can't be bothered with troublesome counselors giving input.  A local psychologist here that I know has quit working with them all together.  They have the Tricare contract though and they run their place like a mean business it would seem.

    There is a lack IMO of really good psychologists here though.  When we had difficulties with our daughter due to deployment stress and everything else on top of it, I had a very hard time coming up with anyone who was really a heavy hitter and had a lot of continuing education.  It was difficult because we left a counselor in Colorado who had actually been a military chaplain, but also a psychologist.  He retired out of the Air Force but he never quit learning.  He was constantly adding to his training and knowledge, and he was a flat out amazing help.  Then we moved here in the middle of it all and it was a desert.  And a majority of the counselors think that the fact that they are Christian based is the most important thing evah!  And I give such counselors a very wide berth.


    A glimpse into the future (none / 0) (#5)
    by jimakaPPJ on Sun Mar 06, 2011 at 09:01:43 AM EST
    "This is about volume," she said, "and if we spend two minutes extra or five minutes extra with every one of 40 patients a day, that means we're here two hours longer every day. And we just can't do it."

    As the number of Doctors go down and the number of patients go up that doctors will do the above should surprise no one.

    There aint no such thing as a free lunch.

    TANSTAAFL - Robert Heinlein circa 1950-52

    But it's not just the doctors (5.00 / 0) (#11)
    by dead dancer on Sun Mar 06, 2011 at 10:59:13 AM EST
    reaction to supply and demand. As the article states, the insurance companies have as much/more control over the issue.

    And of course is a player:
    DCA - Cancer Cure - (No profit = no research)


    Cont: (none / 0) (#13)
    by dead dancer on Sun Mar 06, 2011 at 11:00:16 AM EST
     ... of course "Big Pharma" is a ....

    They don't give people (none / 0) (#7)
    by TeresaInSnow2 on Sun Mar 06, 2011 at 09:33:20 AM EST
    quaaaludes to help them handle depression and other mental illnesses.  Where did you get that ridiculous notion?

    That's where your "good thing I had no meds" story fails.  

    Meds play a crucial role in treating diseases like clinical depression, bipolar, especially with people who have chemical imbalances causing the illness.  You weren't a good candidate for meds -- that is because you likely weren't clinically ill.  You were just having a bad year.

    People who don't suffer from depression or other mental illness think mental illness is something you can "snap out of".  It is not.  

    I don't agree with this psychiatrist.  He should go out of practice or refer his cases to psychologists who charge less if all he does is give meds.  But meds are tremendously important.

    And when brain chemistry is brought (none / 0) (#15)
    by Anne on Sun Mar 06, 2011 at 11:31:16 AM EST
    back into balance, the clarity and ability to think more rationally that come about allow the cognitive and behavioral aspects of therapy to move forward.

    Because regardless of how much better people feel on medication, not coming to understand one's behaviors and patterns often means that the dysfunctional way in which they dealt with life will continue - and they will be left wondering why their lives are still not better.

    Probably one of the hardest things to learn to do is to change the dysfunctional behavior, for one, because dysfunctional is the only normal people know, and because the co-dependent people around us have no idea how to react to this new way of doing things and may go to some length to maintain the old behaviors  - because that's what feels normal to them, too.  They think the only one who had a problem was their loved one or friend, and have no idea that their own behavior is just as badly in need of changing.

    Cognitive and behavioral therapy doesn't just open our eyes to ourselves - it's also quite revealing about the people around us.


    Bingo (none / 0) (#29)
    by gyrfalcon on Sun Mar 06, 2011 at 08:14:14 PM EST
    Just what I was thinking as I read Donald's story.  I don't know whether meds would have been useful for him, but the purpose of giving them to people who aren't bipolar or in major depression or whatever the case may be is not to cover up or avoid the harder work of therapy-- or even just some calm introspection-- but to quiet the panic and other stuff that's out of control long enough to make a start on the counseling or therapy that's needed.

    I haven't read the Times article yet, but as far as I know, it's not the case that insurance companies won't pay for therapy or counseling.  They do, just not at the exorbitant rates psychiatrists charge.  They will pay, if you have that kind of coverage, for non-physician therapists, particularly psychiatric social workers, in the couple of cases I'm familiar with.

    I'm happy to say I don't have direct experience with this, but have had friends over the years who have, and that's the way it's worked for them.

    Ideally, and again in the cases I'm familiar with, the psychiatric social worker or other therapist works with a prescribing psychiatrist, which may well be the kind of duplication of services we want to take a hard look at in reducing health care costs.

    The patient sees the therapist regularly, and when the therapist thinks the patient needs a change in meds, the patient has to go see the psychiatrist to get the prescriptions.  That's where the 15-minute appointment comes in.

    As a layman, that doesn't make much sense to me, but there may be things about it I don't know that make it necessary.

    Have insurance companies ever paid for that classic weekly 50-minute "hour" of therapy with a psychiatrist that goes on for years and years and years?


    they may (none / 0) (#30)
    by call me Ishmael on Sun Mar 06, 2011 at 09:05:08 PM EST
    allow for some talk therapy but the key thing with insurance companies is that they severely limit the number of allowable visits.  So unless you have a very good health care plan--and especially if you are in an HMO--the tendency is to get you on medication as quickly as possible for the simple reason that the talk therapy can't go on long enough to be effective.

    I believe (none / 0) (#27)
    by sj on Sun Mar 06, 2011 at 07:46:02 PM EST
    Meds play a crucial role in treating diseases like clinical depression, bipolar, especially with people who have chemical imbalances causing the illness.  You weren't a good candidate for meds -- that is because you likely weren't clinically ill.  You were just having a bad year

    that was his whole point.  And knowing that, I took his quaalude comment to be conscious hyperbole.


    Growth is not an illness! (none / 0) (#12)
    by dreamdoc on Sun Mar 06, 2011 at 11:00:05 AM EST
    The psychiatrist in the NY Times article clearly needs a therapist!

    Psychotherapy is not for mental illness, per se. For the most part, it is for personal growth and development. As long as it is for personal growth and not for mental illness, it will not ever pay well.

    Individuals have an intrinsic resistance to change. The unconscious clings tightly to the status quo, despite the semblance of unhappiness. This is why, for example, it is so hard for victims to leave their abusers and why we pick the same type of partner over and over again... Simply put, we are loathe to have to pay, to do the real work necessary to make change.

    If the insurance companies are expected to pay for that change, it isn't taken seriously by the individual.

    If the "symptoms" are treatable by a silver bullet, i.e. a medication. Everyone is happy: the insurance company pays for 15 minutes once a month instead of 50 minutes every week. The doctor makes more than he could with psychotherapy. And the patient never has to do the real work; he or she can take a passive approach to the problem. It is a group collusion, a group illusion that the problem is being addressed, when it isn't, not really. The patient will take the medication for a few months, the doctor will take the money and the problem will fade just enough, with the passage of time.

    Often the symptoms are reflective of a need to make a change in life, leave a wife or husband, change jobs, or end family contact with a destructive family member. These are the hard work that is needed for real change...,   hard change in one's life.

    Like the one Dr. Levin might want to consider...

    Superb comment. (none / 0) (#33)
    by observed on Mon Mar 07, 2011 at 06:42:42 AM EST
    Big Pharm (none / 0) (#28)
    by Lora on Sun Mar 06, 2011 at 08:01:11 PM EST
    "Sure there's a lot of blame to go around, beginning with the insurance companies."

    And ending with the drug companies.  Huge profits.

    As always, follow the money.

    Hidden Reefs (none / 0) (#31)
    by the capstan on Sun Mar 06, 2011 at 09:06:39 PM EST
    I was horrified all those years ago when I learned the fallout that so often occured when closet-dwellers finally acted on the truth.  My son knew many men who had walked off and left wives and children to enter the 'gay'! life.'  As a straight, I find it easy to point the finger at men and women who used marriage to hide from the truth.  As the mother of a gay boy, my deepest disgust was with a society that caused people to hide and blind themselves to lies and the harm lies do.  (Some parent/child relationships thrive after the lies are sorted out: gay men can make excellent parents.)

    My son is legally married in Mass., but his grief from years ago still surfaces sometimes.  I can imagine a bit of what it was like: he got on a train heading toward a job and a wife and family--but he got put off the train at the wrong stop, not knowing how to be a gay in a straight world.  I cheer each small step towards equality and civil rights for gays--espcially the right to be accepted for who they are.

    I am so sorry for what you went thru;I tried to raise my child so he would involve no one else in his misery then.  But I can see you found your way out and are no doubt a stronger, happier person.

    Look, it's not just that psychotherapy (none / 0) (#32)
    by observed on Mon Mar 07, 2011 at 06:42:11 AM EST
    wasn't economically viable; the problem is that is doesn't work!! Can one gain personal growth through therapy? Undoubtedly, just the same as reading literature or listening to great music enriches our lives.
    I'm no expert at all, but from my reading, only cognitive or cognitive-behavioral therapies have been proven effective by studies.

    Freudianism was a huge crock, and very damaging for many patients. Is there any clinical evidence supporting the benefits of Freudian therapy? The question is actually ridiculous on its face. It's similar to asking whether homeopathy has benefits, which is ridiculous, because there is no possible mechanism for it to use; likewise, Freudianism is based on a brilliant but fallacious understanding of the mind.

    IMO, it's perfectly correct that psychotherapy not be covered by insurance, with possible exceptions for short term grief therapy, etc.

    Wow - you're kind of all over the place, (5.00 / 2) (#34)
    by Anne on Mon Mar 07, 2011 at 07:12:42 AM EST
    aren't you?  But you have managed to reveal that you have a lot more reading to do on the state of the mental health field.

    So...psychotherapy doesn't work?  But cognitive/behavioral "therapy" does?  What do you think cognitive/behavioral therapy is? The "cognitive" part is all about becoming aware of one's patterns, the triggers for negative behavior or feelings; the "behavioral" part is about changing those patterns and changing the behavior.  It doesn't happen with a snap of the fingers or the clicking of one's heels - it takes a lot of hard, honest and often painful work.

    Is it enriching?  Yes, it can be.  But it's not in the same category as a good book or great music, and putting it there is barely indistinguishable from the "just get over it" school of thought.

    Do you think psychiatry is still working off the Freudian model?  Is that your assessment of what psychiatry is today?  [rolls eyes]

    Really, your last sentence told me everything I needed to know about what you really know about mental health and treatment options, and what you really think about the people who need mental health services; trust me when I tell you that I haven't seen that much ignorance in so few words in a long time.


    Ok, several points. (none / 0) (#35)
    by observed on Mon Mar 07, 2011 at 07:54:03 AM EST
    There are numerous kinds of psychotherapy. As far as I know, the ONLY kind which has a good reputation, from clinical studies, is cognitive-behavioral. I threw out Freudianism as one example, but there are others.

    I think you misunderstood the thrust of my comparison with literature---and in a philistine way, I might add. You think that reading great literature can't change a person's life? Really?
    Likewise, some kinds of therapy may change lives, but that doesn't mean insurance should cover the cost. Is that clear?


    And btw, I've seen a LOT of therapy over the (none / 0) (#36)
    by observed on Mon Mar 07, 2011 at 07:56:05 AM EST
    years, and have had a lot of friends who've had therapy and/or drug treatments.
    Much long term therapy has been repeatedly shown to be a crock, clinically. On the other hand, there are many more focused, shorter term therapies which can be beneficial.

    Oh, I see (5.00 / 1) (#40)
    by sj on Mon Mar 07, 2011 at 09:08:19 AM EST
    Some of your best friends have had therapy.  [Also rolls eyes]

    Final point. I believe in an evidence (none / 0) (#37)
    by observed on Mon Mar 07, 2011 at 08:00:45 AM EST
    based approach to medicine, including questions of caring for a person's mental well-being.
    Insurance companies can and should restrict benefits based on what the evidence says---that holds equally for cancer treatments and psychotherapy.

    "Evidence" is relative (5.00 / 2) (#41)
    by Lora on Mon Mar 07, 2011 at 11:06:55 AM EST
    There are good studies and bad studies.  There are no studies about a number of things that do good, because there is not the funding for them.  

    You need to look at who's paying for the research.  Guess what most of the "research" will be about, and what most of the "evidence" will support?  

    Drugs produced by Big Pharm to make huge profits.


    Really? Why? (none / 0) (#38)
    by vicndabx on Mon Mar 07, 2011 at 08:34:59 AM EST
    Sure there's a lot of blame to go around, beginning with the insurance companies

    The doc is getting paid $90 for 45 minutes work (I'm sure the article writers picked the lowest reimbursement scenaro possible for maximum outrage) and yet the insurers are the problem.

    the good doctor (none / 0) (#39)
    by pitachips on Mon Mar 07, 2011 at 08:44:49 AM EST
    has obviously never had to deal with Volkswagen service mechanics.

    Work Subsidized Habit (none / 0) (#42)
    by ScottW714 on Mon Mar 07, 2011 at 11:47:56 AM EST
    What the doctor above never addressed was how his new business model makes drug access extremely easy.  But not having the time to diagnose the issue, he is basically taking the word of the client that they actually suffer from the affliction.  When in fact, like a girl a dated a while back, she was saying what he needed to hear to validate the script.

    I would love to know how many ADD cases he had before, and how many now.  Ritalin is prescribed, which people say is the pharmaceutical equivalent to cocaine.  It's not hard to find I hear.

    This doctor is a drug dealer with a couple questions.  The really amazing thing is that this is all subsidized by work if you have insurance.  If you want pharmaceutical grade drugs, buck up and read about the symptoms on the web, and doctor shop, someone will hook you up, sooner than later.  I would imagine their are probably sites dedicated to the art of doctor shopping.

    But this isn't a mental health issue, this is a health issue.  They might not prescribe pain meds, but the process is the exact same.  Tell doctor you symptoms in less than 15 mins, get script.  If not, see another doctor.

    I will also mention this, the only way they track this non-sense is through insurance.  So the girl mentioned above went to several off the insurance doctors and was getting a lot of pills, some from insurance, some out-of-pocket.  She used a small pharmacy for that and a chain for the expensive meds.  Enough that she was reselling some of them to cover her costs.  It was my first exposure to this abuse and I couldn't believe how easy it was and how clever she was.

    It's a piece of cake... (3.00 / 0) (#43)
    by kdog on Mon Mar 07, 2011 at 11:56:49 AM EST
    Ritalin is everywhere...but I think it's way better than cocaine bro, love that stuff:) And you're right, there are street-corner pharmie resellers gaming insurance co's and doctors everywhere for profit.

    It all stems from the permission slip system...we wouldn't have these friendly doctor shopping/doctor as drug dealer issues if you could just walk into a pharmacy and buy whatever you want if you're 18...for medical reasons or just for fun.  Scrap the permission slip system and doctors & psychiatrists can be doctors & psychiatrists again, instead of sometimes doctor/sometimes drug dealer because of the requirement that free American adults get a permission slip to imbibe certain substances like 8 year olds asking for a bathroom pass in school.