Ch15consumer

Editor's Notes

• #2: We focus in this chapter even more on the treatment process, with special emphasis on information most relevant to you, the consumer.
• #3: Professionals who work with people with mental disorders include psychologists, psychiatrists, psychiatric nurses, marriage and family therapists, social workers, and special education teachers. Paraprofessionals without advanced degrees may also work with special populations under supervision. Depending on the type of problem that needs to be addressed, and the type of service sought, a different kind of professional may be appropriate. In general, therapists need to be licensed in order to work independently. The type of license will depend on the therapist, but anyone who calls themselves a psychologist, psychiatrist, clinical social worker, or counselor, will be licensed by the appropriate state board.
• #4: Becoming a mental health professional first involves a decision-making process. If you think you would like to work in the field of mental health, I recommend you TALK to people in the field already. You can email me with questions, or approach other professors. If you know someone who is a counselor or social worker, you can talk to them. Take classes in the area, and see how you like them. Any kind of mental health professional is going to involve some training after college. A paraprofessional might just get some on-the-job training, but their career options are limited (direct care, etc). A social worker may go to school for three years or so, then spend time in supervised practice. Same for a master’s-level psychologist. Psychiatrists are M.D.’s. Go to medical school, then specialize in psychiatry later in residency. Psychologists can have a Ph.D. or a Psy.D. The primary difference is the Ph.D. requires more research training, and is really best for people who may want to become researchers or professors as well. The Psy.D. tends to take a year less or so, because less emphasis on research. Psy.D. may be appealing for people who just want to do therapy, BUT 1) less prestigious, so less flexible and 2) Ph.D. programs usually don’t require you to pay tuition, Psy.D.’s do. So graduate with debt.
• #5: Finding the right therapist involves asking many important questions and identifying someone that best fits your personal needs. If you’re looking for a psychologist, I have included two links to referral websites. However, usually your best first steps would be to either ask your friends if they’ve seen a therapist they like, or call your insurance company’s customer service line and have them help you find a therapist who accepts your insurance. Your book has a nice list of questions to ask a therapist when you call to set up a first appointment. You don’t have to commit to someone right away! Make sure they accept your insurance, have experience working with people like you or with the kinds of problems you have, and make sure you’re comfortable with them.
• #6: As we’ve talked about in other chapters of this book, there are number of different types of therapy out there. But, across most types of therapy there are some common active treatment ingredients: enhancing self-control, gaining mastery of symptoms, practicing new skills, exploring and gaining insight into problems, experiencing ongoing and reinforcing successes, and receiving therapist feedback.
• #7: Process variables are more general elements of therapy that can be helpful: these include client having a positive expectancy for therapy, therapist experience, warm and respectful therapy environment, reassurance, And effective therapist-client interactions
• #8: Does treatment actually work for clients? The overall answer is yes, as many types of psychotherapy seem effective and better than no treatment at all. Prescriptive treatment refers to specific therapies that match best with specific types of mental problems. These therapies have been extensively tested and been shown to be effective in treating these specific disorders.
• #9: Community psychology treatments focus on enhancing quality of life for people and their relationships with different social structures. Self-help groups involve people who share a common problem the group tries to address. Depending on the problem, self-help groups may be just as helpful as treatment with a professional. In particular, Alcoholics Anonymous has a good track record in helping people with alcohol dependence stay abstinent. However, just like with therapists, what a self-help group is like depends on the people in the group. So, if you try a self-help group and don’t like it, it does make sense to try a different group with a different group of people.
• #10: Aftercare services represent transitional help for people with severe mental disorders before they pursue independent living. People with pervasive developmental disorders have gradually moved to community-oriented and usually smaller facilities that more closely resemble normal life. These services are best thought of as chronic, long-term services, and not for the treatment of a disorder that’s in it’s acute phase.
• #11: Forensic psychologists address issues that intersect psychology and the legal system. Forensic psychologists do a lot of different things, including prisoner treatment, child custody evaluations, criminal profiling, jury selection, and assessment of dangerousness. My own experiences with forensic psychology have been with juvenile offenders, including doing assessments to recommend to a judge what kinds of services a kid might need, and doing therapy with kids who are on probation.
• #12: Treatment for mental disorders is generally effective, but not always. Ineffectiveness may be due to poor therapist client relationship, poor choice of treatment, treatment noncompliance, and therapist-client differences. In particular, clients are more likely to drop out of treatment if they feel like the differences between them and their therapist are blocking their ability to communicate. I try to be open with my clients and myself, and if I feel like there are fundamental differences between myself and my client that are keeping us from progressing (such as, my client is in an unhappy marriage but has the goal of being more submissive), I will discuss with the client whether they may be better served by a different therapist.
• #13: Increased use of managed care involves some pros and cons. Therapy is pretty expensive to pay for out of pocket, usually costing over a hundred dollars for a single 50-minute session. So, having an insurance company with a managed care option usually means the client only pays about $20 as a co-pay. The disadvantages is you can only choose a provider that’s approved by your insurance company. Usually this still leaves you options for different providers who have different treatment styles! Still, there is pressure on the provider to keep therapy brief. Usually I’m approved for 10-20 sessions with a client and if I think they need more therapy I have to apply for more. This does limit confidentiality to some degree. The clinician needs to submit a diagnosis and a brief description of therapy to the insurance company. BUT this information is kept brief, so the insurance company doesn’t get much detail, and they’re required to keep that info confidential as well.
• #14: Another way to be a consumer of psychology services is to be an educated consumer of research. A lot of the time you’ll see the statement, “studies show”… but there’s not enough detail given about those studies for you to tell if they were any good! A smart researcher can always find a way to design a study to make the results turn out the way they want, like if they want they can make it so their new treatment looks better than some older treatment. You need to look at the study and decide for yourself if it’s biased, or if you can really trust their results. Your book gives a list of things for you to look for in a study. If you decide to major in psychology, you will need to take a statistics or research methods course, that will also give you the background you need to determine if you can trust a particular research study or not.
• #15: Another important issue for psychologists is access to treatment. Many people who need help aren’t able to get it. Many people cannot afford therapy, do not have insurance to pay for therapy, cannot transport themselves to therapy, or have difficulty finding low cost services that are right for them or that are culturally sensitive. In particular, clients with low incomes, or who live in rural areas where there are few mental health professionals, may not get the help they need.
• #16: Psychologists are expected to adhere to a strict code of ethics in their clinical practice and their research. This code is based on several key themes surrounding fairness and respect. In particular, the psychologist needs to keep their client’s best interests in mind. If a psychologist violates any part of the ethics code, they may face disciplinary proceedings and could possibly lose their license.
• #17: Ethical requirements for assessment include the expectation that psychologists only use assessment instruments that they have training in. So, if you’ve never been trained in how to give a personality test, it would unethical for you to go ahead and give it anyway. Also, psychologists are required to provide adequate information in their feedback on assessment results, including the limitations of those results. For example, when I provide someone with their intelligence test results, I need to make sure that they understand what that number really means, and what kinds of factors might influence that result.
• #18: Psychologists are expected to provide informed consent to potential clients and research participants. This means, the client or research participant needs to fully understand the services they will receive and understand their rights. Also, therapists are expected to keep client information strictly confidential. The exceptions are abuse, suicide, homicide…
• #19: Psychologists must ensure that public statements are honest and not deceptive. Media psychologists, such as Dr. Phil, must also comply with ethical guidelines. They often seem to walk that line a bit, as they tend to simplify their assessment procedures and often don’t make the limitations of their recommendations clear.