to all psychotherapists out there..there is alot of negative stuff on here. what exactly do you do??

Question

there seems to be some here who bash psychotherapists. some claim that psychotherapy should be avoided for religious reasons. others point out their bad experiences and feel that all therapists are "mind terrorists". some think that all you people want to do is push drugs because of some kind of financial kickback from the pharmacuetical companies. or that you dole out drugs because of some goverment conspiracy that wants the mentally ill numb so that they are easilly controlled. so the question is, is this what really happens? what do you people really do? do you really feel that what you do really improves a persons quality of life?
could you please share your actual credentials in your reply as it would help illuminate differences between different discilines.

Answer 1

Hey Eddie,
I'm glad you posted this question as it gives folks a chance to clear up any misunderstandings and I will admit that some of the bashing that goes on here is frustrating, though fortunately it is not the bulk of what happens as most people give really thoughtful and insightful answers and positive feedback.

I'm an LCSW-R which stands for licensed clinical social worker with R privilege (it means that I have met the criteria and testing requirements needed to bill insurance).
My job these days is largely administrative and involves establishing and monitoring CQI (Continuous Quality Improvement) for the non-profit agency that I work for in all of our clinical programs, but I also continue to supervise other clinicians and I am fortunate enough to be able to maintain a small caseload. Prior to this I worked as an out-patient therapist in a non-profit mental health clinic for 14 years and as a residential counselor before that in a transitional living service for folks with mental illness.

Psychotherapy differs from psychiatry in that we do not prescribe medication, however we work very closely with psychiatrists in a collaborative fashion so that a working knowledge of medication is imperative. I also consult with PCP's who currently prescribe a large proportion of the psychiatric meds, especially anti-depressants, but who often lack the specialized training to make accurate psychiatric assessments, particularly involving illnesses beyond depression. Personally, I have an interest in psychopharmocolgy and have studied it more than most social workers and I actually train our agency staff on what they need to know as clinicians and I feel strongly that good clinicians need to be very familiar with this area as so many clients benefit from a combined approach of meds and therapy. I have never received "kickbacks" from a pharmaceutical company (nor has it ever been offered to me, LOL). I absolutely recommend meds in many instances and I have seen first hand the remarkable difference they can make in many cases and I have also seen them fail miserably in a number of instances. I've also seen ridiculous examples of polypharmacy (and gotten my clients re-evaluated by referral to a competent psychiatrist or helped them to discontinue meds in situations where they aren't needed), usually the result of hasty and poor diagnosis, but there are times when multiple meds from different classes are necessary to adequately control symptoms. There is no standard rule, just good practice and a parsimonious approach regarding the number of meds as the synergistic effects increase with multiple meds. Overall, I have seen far more benefit than harm from meds and truthfully each case needs to be evaluated uniquely and only the client themself can determine whether outcomes justify side effects. As far as a political agenda to control people? That strikes me as raging paranoia as most of the therapists I know, myself included, have no need to keep clients in treatment beyond what is necessary since waiting lists and caseloads are huge. No doubt there are therapists who do get off on others' dependency, but I am not one of them and I actually don't know any professionally. I will add, however, that I got the nickname of being the "chronic queen" because I truly like the cases that require long term work and I have never been one to support "fast-food" therapy no matter how much pressure we get from insurance companies. I wouldn't support inadequate treatment for mental health anymore than I would support drive-thru mastectomies. To really impact a person's life, you need to "teach a man to fish" for himself so that he doesn't become a revolving door client who depends on therapy for each crisis.

With meds or without, the treatment I provide is psychotherapy which employs a number of modalities and really requires a very eclectic approach in order to suit the therapy to the unique characteristics of the individuals being treated. I utilize a psychodynamic approach primarily which deals with both intrapsychic motivations and conflicts as well as interpersonal object relations and often the most successful therapy, particularly with folks who were traumatized, involves providing a corrective interpersonal relationship where they can safely share feelings and negotiate boundaries as well as process horrendous past hurts in an atmosphere of safety and validation. The goal is always to help people change what they need to in order to be happier, more functional and less disabled as well as to accept those things they cannot change or control in their lives and to make healthy decisions on how to cope with the cards they are dealt. It's real hard to explain this without being so wordy, so forgive me, but that only highlights the scope of psychodynamic therapy. I also draw heavily on cognitive-behavioral techniques, including DBT as well as more traditional CBT techniques, and I also use a lot of communication techniques for direct skill teaching for folks who have had poor models growing up. I am certified in Level I EMDR and hypnotherapy, but I use it less frequently as many of my clients were not stable enough to use it without increasing risks of abreaction (I tend to work primarily now with severely traumatized individuals who are dissociated or self-harming and that is the bulk of the supervision issues as well).

As far as the religious piece, I try to understand and respect the role that religion plays for the client, but I never interject my own beliefs. I will occasionally encourage a client to explore what spirituality means to them and to refer to religious professionals for spiritual matters.

Do I feel that what I do improves quality of life for those I treat? Absolutely, or I wouldn't continue to do it. That doesn't mean that I consider every case to be successful; I wish that was the case. But all of my clients are voluntary and are free to switch counselors, agencies or drop out at any time. Overall, my "drop-out" rate is very low compared to colleagues and in 20 years I can honestly say I have only had 3 clients ask to see another therapist (one of whom came back in 2 months after getting the male counselor they were seeking) and I admit that I am extremely proud of that as I consider myself flexible and willing to go to whatever lengths required to make a difference. I am proud of my profession and grateful for all the things clients have taught me that have helped me more effectively help others and I am awed over and over again at the strength and resilience they demonstrate.

The people here who bash psychiatry and mental health in general really get to me and I know it shouldn't, but I'm working on letting it go!

Whew! Probably way more than you needed or wanted to know, but I sort of can't help myself. My profession is something I am very passionate about! Thanks for giving me an opportunity to share it with you!

Answer 2

I'm not a psychologist, but I will have my doctorate in psychology (PsyD) in 2 months.
It is frustrating to work so hard in a field you love and believe in, just to have someone bash it. But I wouldn't be in this field if I didn't have a thick skin. I know what I have been taught and I know what I believe, so I try not to let the bashing get to me.
But, you asked to address the reality of the job, so I thought I'd do that. Keep in mind that I can't speak for everyone in this field, only from my experiences.
Psychotherapy is a choice. If you don't want therapy due to religious reasons, don't get therapy. When I meet with people that would like to "let God" cure their problems, I may suggest a pastoral counselor or psychologist who has training in both religion and psychology. That usually helps.
I don't think I'm a mind terrorist and I've never had anyone say that I'm a brain washer. Psychologist can NOT read minds. If I could read minds, I would be in a different field. I've heard some people complain that psychologists control your mind. I emphasize choices and when I make suggestions to people, I remind them that it is their choice whether or not they want to follow my suggestions. If they don't follow my suggestions, I may want to know why, but they aren't punished for that. Then I'll usually ask them for their input about what else might work. Therapy should be collaborative, not just a psychologist telling a patient what to do.
Since I am going to be a psychologist and not a psychiatrist, I get absolutely no kickback for pushing drugs. And again, its about choices. I can make suggestions towards medication, but ultimately, it is the patient's decision to take them.
I love how people say that medication does more harm than good. Anyone who has ever seen someone with schizophrenia off their meds for 3 months will know how helpful the medication is. But, everyone is entitled to their own opinions.

Here is what I currently do: I do psychological testing. No one has been harmed from that. If anything, the testing has helped people figure out their treatment. With kids, testing has helped them get additional services to help them do well at school. I also do counseling and therapy. Again, no one has ever complained that I damaged them during therapy. It does happen. Otherwise, I wouldn't have malpractice insurance. Out of all the people I've seen, maybe 5 have said therapy didn't help. For the most part, people have said it was very helpful. Whenever anyone terminates from therapy, I always ask them what worked, what didn't worked, and what changes they would have like to have seen. Again, its collaborative.

Answer 3

Hi Eddie
thanks for the question it was one that was very well thought through and well needed. I am currently studying to be a therapist. I also have a whole list of mental health illnesses in fact there is more labels on me then I have letters in my name lol. without therapy and meds I would be on lock down 24/7 I for one think that there is nothing wrong with meds or therapy, the right meds with good therapy will help a lot of people. I wish that those that bash people for taking meds and getting help could just live one day in my mind then maybe they would understand why these things are so needed. All people like me want is to lead a normal and happy life with out stigma. take care

Answer 4

I am not a psychotherapist.

I have been seeing one for over nine years and if it wasn't for him I would not be here. He does not prescribe drugs. I have the greatest respect for him professionally and personally.

Answer 5

I am a therapist...licensed clinical social worker for over 25 years, currently working in an inpatient psychiatric hospital. I work with patients and families doing individual, family and group psychotherapy. I'm very familiar with other disciplines too from working with them on a daily basis.

First of all, there's a lot of negative stuff on therapists but there's a lot of negative stuff on other professions too (ex: lawyers, medical doctors, salesmen, priests, cops, insurance agents, etc.) All professions have their share of brilliant, caring and capable practitioners, also some who are just marking time until retirement, and some who are frankly awful. Most, I think, are pretty good but not brilliant; try to do their best most days, experience much success, but come up short on occasion.

I think if someone choses to assume that an extremely negative stereotype is an accurate description of the whole profession, well, first off it's not accurate, and second of all, it says more about the person making the statement than it does about the profession. One of the things we know about people who are chronically depressed is that they tend to have a "black or white" view of the world when most of life is "grey". Therefore it is not surprising to see therapists made into superpowerful gods or demons by some people as their depression may be causing them to look for either a savior or a scapegoat.

If you are working with people with psychological problems, when you are early in your career, you are hoping to make people happy and you hope to get positive responses from them. Then reality sets in; people with problems are likely to lash out at the people who are trying to help them, which means you are often yelled at, cursed at, villified and blamed. Sometimes that includes threats of violence or actual violence to the therapist. Those people who enter the profession primarily to feel people's gratitude toward them pretty quickly move on.

I work with severely mentally ill people, many are either suicidal, violent or psychotic. Occasionally they express gratitude for help but it's not an expectation of mine that they will. In order to last in this line of work one has to take satisfaction from doing a professional, ethical and effective job.

I think it should be evident to you that when someone's hospitalized for a suicide attempt or physical attack on someone or a delusional belief, the therapist has had nothing to do to cause that situation to happen. However, we are expected to turn the situation around. Our goals are safety for the patient and others, a change of perception on the patient's part, and then a successful return to the community with a plan for further effective treatment. Medication and therapy are usually part of the outpatient treatment plan.

Medication is not a panacea; it's not always as effective as we'd like it to be. None-the-less, research studies have consistently shown better long term results for severe mental problems if the patient uses both medication and therapy, instead of just one or the other. Wouldn't you expect a professional to recommend a course of treatment that has the highest possibility of success?

Most people don't understand the differences between the mental health professions, and I think that leads to confusion and disappointment. I'm going to try to summarize them for you below.

Psychiatrists are medical doctors (MD or DO) who have specialized training in the treatment of mental illness. In the old days they were heavily trained as therapists but now I think it's fair to say that relatively little of their current training is in how to do psychotherapy. Their specialty is psychiatric medication, and that's a full time job keeping up with the latest medication research and new meds. Psychiatrists use to receive heavy training in psychoanalysis but no more, for two reasons 1) biological psychiatry and medication options have become very complex compared to 40 years ago, and 2) insurance companies no longer pay for psychotherapy from psychiatrists, and certainly don't pay for analysis...it's cheaper for them to pay lower paid therapists for therapy and authorize 15 minute medication check visits with psychiatrists to suppliment therapy. Any MD can call themself a psychiatrist, but to be sure you have a properly trained psychiatrist I'd look for one who is board certified in either adult psychiatry or child and adolescent psychiatry.

Psychologists have nonmedical doctorate degrees (either PhDs or PsyDs...the difference there is that the PhD is more research oriented and the PsyDs have less research experience). They are trained as therapists and are the only profession well-trained in psychological testing. They cannot prescribe medications. All have training in individual therapy but not all have training in marital/family therapy. Their hourly rates are less than psychiatrists but more than social worker/marriage and family counselors.

Licensed Clinical Social Workers (what I am) have a two years masters degree (MSW or MSSW) as well as several years of post masters training and supervision in order to be licensed. Training includes individual, family and group therapy with an emphasis on how the individual interacts with the social environment. We can't prescribe medication and most of us don't know much about psych testing. We are paid less than psychologists and about the same as marriage/family counselors. In the United States, clinical social workers provide more mental health treatment than any other mental health discipline.

Marriage and Family Counselors have different qualifications in different states, but they should be licensed by the state they practice in. They typically have a masters degree that takes 1-2 years, as well as a period of time (1 or more years) where they practice under supervision. Their training is in doing therapy with individuals and families; some programs may emphasize marriage counseling skills more than others. Although social workers and marriage counselors see themselves as pretty distinct I think the average consumer wouldn't find those differences terribly important. Marriage and Family counselors make about the same amount as social workers.

Psychiatric nurses: Some states license nurses with masters degrees as competent to practice psychotherapy, but at this point in time that's not a huge number of them. Psychiatric nurses without masters degrees often work in a therapeutic capacity in psychiatric hospitals but there isn't really much of a training standard for the therapy skills they have; most pick it up "on the job".

There are alcohol and drug counselors who are generally not licensed who have been through a one year junior college training program. At least in my state (CA) they are not able to perform as therapist but they can be an adjunct to therapy to help with sobriety issues. They aren't psychotherapists, however.

Good questions to ask!

Answer 6

i don't think they will answer - basically it is cheaper to treat any illness with drugs then to get to the bottom of it and yes there are pharmaceutical kick backs.

no money is made from cures - maintenance is what it is all about.