Is Virtual Psychotherapy of Lesser Quality Than In-Person?

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Is Virtual Psychotherapy of Lesser Quality Than In-Person?

Now that online therapy, or its synonyms—teletherapy, behavioral telehealth, virtual therapy, internet therapy—is widespread in the mental health field, the treatment frame is often inverted such that instead of clients visiting the therapist’s room, the therapist is visiting the client’s room, or car, or favorite neighborhood walking route. What are the privacy implications of this? How inwardly honest and honestly inward—in a sustained, engrossed way—can clients get when there is fear of random breaches in privacy?

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Why Increased Psychological Freedom Should be the Main Goal of Psychotherapy

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Why Increased Psychological Freedom Should be the Main Goal of Psychotherapy

Psychotherapists who incorporate psychoanalytic thinking into their approach are trained to encourage clients to talk about their childhoods, yielding material to point out similarities between what occurred in the past and how it has shaped self and other expectations in the present: “Your father seemed so charming and laid it on thick with praise about how you could do anything with your life; yet, he was unreliable, uninvolved and frequently disinterested in what you did in your everyday life. Is it any wonder you are attracted to men who “love bomb” you, but fail to make plans, cancel at the last minute, and avoid getting together with you and your friends to have fun times.”

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The Clinical Uses of Stoic Acceptance

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The Clinical Uses of Stoic Acceptance

Stoic philosophy seems to be having a revival. I’m guessing that’s because many well-meaning people are looking for a life philosophy with which to approach the current deluge of seemingly insurmountable social problems—global warming, systemic racism, political tribalism, oppressive religiosity—with a measure of realism and control that prevents them from becoming perpetually demoralized. The concept of “stoic acceptance” pivots on distinguishing between things that we have no control over whatsoever and things over which we have some, but not complete control, and marshalling our energies around the latter.

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Meaningless Distractibility, or Meaningful Mind-Wandering?

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Meaningless Distractibility, or Meaningful Mind-Wandering?

What do we lose when we view boredom and curiosity as "symptoms" of ADHD? It seems we have become so casual about medicalizing and pathologizing off-task states of mind that we have forgotten that the mind often wanders for reasons having to do with boredom and curiosity, not because we were unluckily born with a “grass-hopper” brain.

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Lessons from the Pandemic: Panic Attacks Are Not Random

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Lessons from the Pandemic: Panic Attacks Are Not Random

Panic signifies a deeper psychological struggle requiring treatment that both manages and understands symptoms. Many clients who get flooded and overwhelmed by anxiety are unaware of the real sources of their distress, the knowledge of which would better inform them how to more effectively and productively turn their lives around. This has implications for how we best treat panic in clients during the Covid pandemic. If we stop short at just helping clients manage their panic, we run the risk of foreclosing deeper conversations about the underlying sources of their dread and side-stepping more on-target ways of dealing with it.

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The Ups and Downs of Online Therapy

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The Ups and Downs of Online Therapy

Almost overnight, given the Covid pandemic, therapists were compelled to make the switch to teletherapy to preserve continuity of care with their clients. The urgency of the situation dictated that we snap to it and quickly get up to speed on the latest digital platforms and alternative modes of offering therapy. There has been precious little time to reflect on the pros and cons of all this on the quality of therapy we offer. Now that the novelty has worn off and we are able to step back and analyze the situation, what does the switch to teletherapy portend for our profession?

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In Defense of Healthy Pride

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In Defense of Healthy Pride

Hands down, pride is the most controversial of all human emotions. There’s a longstanding history surrounding whether it is a virtue or a vice—whether it connotes justifiable self-satisfaction based on effortful accomplishment or inflated self-worth based on a sense of personal superiority. How are we to differentiate the sort of healthy pride that accompanies hard-won, noble pursuits and is emotional sustenance for a person’s self-esteem, and toxic pride, aimed at winning admiration from others as proof of one’s superiority, possibly evoking the desire to use aggression and exploitation to attain power and dominance?

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An Open Letter to Howard Stern, the “Poster Boy for Psychotherapy”

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An Open Letter to Howard Stern, the “Poster Boy for Psychotherapy”

Dear Howard Stern: People in my profession are utterly thrilled to witness you on the talk show circuit crediting psychotherapy as a life-transforming experience. What may come as a surprise to you is that the quality of talk therapy that was available to you—time-intensive, in-depth sharing of feelings, exploring childhood traumas, examining and changing difficult personality traits—is steadily becoming unavailable to the average American seeking mental health care.

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I'm Introverted, Not Depressed!

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I'm Introverted, Not Depressed!

Elizabeth (pseudonym), a middle-aged ER nurse, sat as far apart on the couch as possible from her retiree mother, Joanne, who leaned forward and spoke with utter conviction about her daughter’s presumed depression. Mustering all the energy she could to interrupt her mother’s unbroken stream of disclosures, Elizabeth blurted out: “I’m introverted, not depressed!”

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Real, Not Sham, Mental Health Coverage

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Real, Not Sham, Mental Health Coverage

A little-publicized legal decision was just issued by Judge Joseph C. Spero of the U.S. District Court of Northern California that anyone who plans to use their mental health insurance coverage to secure needed care will want to school themselves on. Ruling on a class action lawsuit brought against United Behavioral Health (UBH), a subsidiary of UnitedHealth Group, the nation’s largest health insurer, Judge Spero drew the conclusion that UBH had reneged on its fiduciary responsibility to policyholders by adopting treatment guidelines that focused on cost savings through limiting coverage to the management of acute mental health episodes.

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The Meaningfulness of Anxiety

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The Meaningfulness of Anxiety

According to one of the most reputable surveys of its kind, the National Comorbidity Study Replication (NCS-R), almost one in five Americans has met the criteria for an anxiety disorder over the past year, and an estimated one in three people will experience an anxiety disorder in their lives. Bearing in mind that in 1980, the Diagnostic and Statistical Manual of Mental Disorders (DSM) estimated lifetime prevalence rates of anxiety disorders in the 2 to 4% range, it is safe to say that the diagnosing of anxiety disorders has spiked in recent decades.

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Healthy Guilt and Doing Right by Those We Have Wronged

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Healthy Guilt and Doing Right by Those We Have Wronged

Not uncommonly, therapists tend to view guilt as a toxic emotion. They are often over-sensitized to the psychological effects of too much guilt—of unwarranted guilt—yet often under-sensitized to the interpersonal effects of someone having too little guilt—the absence of guilt when it is warranted, or someone prone to muddled outward expressions of guilt that achieve little interpersonal resolution.

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In Defense of Healthy Mania

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In Defense of Healthy Mania

Let me summarize for you a story told to me by the mother of a 14-year-old teen whom she thought had emotionally gone off the deep end. It centered around an Airsoft gun battle her son, Billy, had planned for days in advance. It was all he could talk about, morning, noon and night. He hogged discussions and rattled on in minute detail about the types of guns and ammo he and his friends would use and how he was going to redesign the back yard into a warzone. His excitement was palpable. It irritated Billy when family members failed to share his excitement. Anyone in the family who hinted at his plans being overly ambitious was fair game for being yelled at.

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In Defense of Healthy Depression

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In Defense of Healthy Depression

A recent Blue Cross Blue Shield report documented a 33% spike in diagnoses of depression in the United States from 2013 through 2016. It was concluded that depression ranks just below high blood pressure as the condition of greatest importance adversely impacting overall health.

It’s tempting to attribute the upsurge in diagnoses of depression to the push for primary care physicians to screen for depression. Non-psychiatrist physicians are not only becoming de-facto depression screeners, but front-line mental health practitioners. It is estimated that close to 80% of antidepressants are prescribed by non-psychiatrist physicians.

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Busting 7 Myths About the Practice of Psychotherapy

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Busting 7 Myths About the Practice of Psychotherapy

Confessing to a friend or family member that you were entering therapy used to mean something. It was akin to divulging that you were embarking on a quasi-spiritual endeavor to take an honest inventory of your past, to forge a truer self, to develop a greater capacity to love, to learn to live more intentionally. It also meant to better understand and productively express your emotions, and so alleviate anxiety and depression stemming from the suppression of self.

But we live not in the age of therapy, but of “mental health interventions.” The prevailing wisdom is that people are better off managing their mental health symptoms by turning to medications and availing themselves of short-term therapy aimed at speedily correcting thinking errors and changing unwanted behaviors. This is due to several pernicious myths about what treatment is effective and what kind of psychotherapy coverage is actually available under most health plans.

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The Woeful Underfunding of Psychotherapy by Health Insurers

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The Woeful Underfunding of Psychotherapy by Health Insurers

Americans are well aware that their health insurance premiums have increased steadily in recent years. The data substantiate it. According to Mercer’s 2017 National Survey of Employer-Sponsored Health Plans, large employers have absorbed a 3 percent annual increase in health insurance costs over the past five years, and will be hit by a 4.3 percent increase in 2018. What people aren’t privy to is that psychotherapy reimbursement rates have been stagnant or in decline for several decades, even though insurance premiums have risen sharply. This is mystifying given that the vast majority of people afflicted with anxiety and depression prefer psychotherapy over medications, science shows it rivals or even exceeds the benefits of medications, and it yields a “medical-cost offset,” or saves insurance carriers money on avoidable medical costs.

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The Ordinariness of Good Psychotherapy

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The Ordinariness of Good Psychotherapy

In the frenzy to establish and distinguish ourselves as psychotherapists, whether it be  acquiring a specialty in working with a newly-minted psychological condition, or becoming more fastidious practitioners of our chosen therapeutic paradigm, we overlook the ordinariness of what constitutes good psychotherapy.

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Promoting Emotional Literacy in Kids

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Promoting Emotional Literacy in Kids

To correctly label an emotion is to have mastery over it. Kids who are skilled at using words to express feelings are less likely to become overwhelmed in emotionally charged situations. Studies show that children as young as two, when shown facial expressions, are capable of discerning and naming the six basic emotions—happiness, sadness, anger, surprise, fear and disgust. Kids who have access to a variety of words for identifying these basic emotions, and are skilled at verbally elaborating upon them, experience a general sense of emotional control.

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The Ins and Outs of Psychoeducational Testing

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Upon becoming licensed ten years ago, I began scampering around in search of “gigs” to supplement the meager income I was making as a part-time community-mental health therapist and college lecturer. It was my good fortune to land a two-year position with Teri Solochek, an educational consultant in the San Fernando Valley who was well known for conducting psychoeducational testing with the wayward children of the upper-strata and placing them in high-end therapeutic boarding schools around the country.  I nodded politely and disguised my ignorance when she spoke of psychoeducational testing, assuming it was a of hybridization of the more regal psychodiagnostic testing that we are all trained to do in graduate school. Indeed, my stint with Teri Solochek proved to be auspicious and I incorporated psychoeducational testing as a dimension of my own private practice.

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