It is time for a revolution for mental health.

This is my common sense plan to improve the mental health of the American Community.

  • We need to apply common sense mental health analysis to all conditions and reject political correctness.
  • We need to implement positive psychology mental health promotion approaches starting in childcare and at every facet of community life. It is easy. It is not psychobabble. It is inexpensive and it works.
  • We should dramatically overhaul the community mental health and VA systems, eliminating the psycho-social assessment, treatment planning, and discharge planning monstrosities. They add no value, they destroy productivity, and they burn out providers.
  • We need to end the reliance on psychiatrists because the value they are adding is not worth the cost. Many other common sense reforms should be done. The mental health system is a dinosaur. It is time for a revolution in community mental health.
  • All professional counseling services should be pushed down ladder from psychiatrists and psychologists, which are very expensive to masters level providers and in some cases lower. The goal should be that every person can have access to affordable psychotherapy from an effective psychotherapist.
  • We need to give clinicians the tools to be maximally effective, which means we need to prioritize therapist factors (interpersonal wisdom) instead of therapy models.
  • We need real researchers to shine the light on the pharmaceutical scandal so that we can move people to non medical remedies for mental health conditions.
  • We need to adopt the Finland psycho-social supports model, which commences when a person is first diagnosed with a serious mental health condition. It is working well there.
  • We need a grass roots positive person development, nationwide initiative to combat the negative effects of entertainment, drug abuse, sports addiction, gambling, smoking, overeating, commercialism, video gaming, and internet abuse. The movement would promote and encourage healthy lifestyles. It would cost nothing. (This is my most controversial proposal but as a communitarian, I believe it is the most important.
  • Finally we need to attend to the spiritual needs of Americans by strengthening religious institutions and humanistic institutions like arts organizations and community groups that also provide meaning and purpose. We need to demand that churches and secular organizations abandon their divisive social justice creeds and work for all Americans.

We are at a pivotal place in American history. Change is in the air as we have a new administration and reform-minded people in positions of influence all over the United States. The time is now for a revolution to improve the mental health of the nation.

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Saving Psychotherapy

I wanted to recommend a great new book that should be must reading for anyone who cares about the psychotherapy profession. Author Benjamin Caldwell, Psy.D., has just released a book entitled Saving Psychotherapy that is certain to change the field. Caldwell presents eye-opening data about psychotherapy education and psychotherapy practice that defies conventional wisdom about the talking cure.

I believe the recommendations I offer in my Interpersonal Wisdom workshops dovetail nicely with the recommendations Caldwell makes in this ground-breaking work. We need dramatic reforms. Caldwell emphasizes what he believes individual practitioners can do to create a better profession. I do some of the same, but I also suggest systems reforms that must be stimulated by policy-makers and leaders in the helpers community.

Later this year, I hope to organize a positive disruptors conference that will feature some of the leading psychotherapy reformers. Stay tuned for that.

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Psychotherapy Networker is singing my song about wisdom

“Even if all interested parties only want symptom relief, ignoring the cultivation of wisdom may still be a problem. Focusing exclusively on empirically supported techniques runs the risk of failing to develop the primary instrument of treatment—us. Even as much of the therapy literature, modeled after double-blind pharmaceutical research, has tried to eliminate the therapist as a variable, metanalyses like those of Bruce Wampold and others keep showing that we can’t take ourselves out of the equation. Again and again, we learn how much the therapeutic relationship matters.”

http://www.psychotherapynetworker.org/magazine/currentissue/item/2093-wisdom-in-psychotherapy

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Is it time for psychiatry to lose its monopoly?

There was a fascinating May 11 New York Times article that should be of interest to those of us who work in the mental health field. The article was written by Allen Frances, MD, who was chairman of the task force that produced DSM-4, which is widely known as the bible of mental health disorders. Dr. Frances has concluded that it is time for psychiatrists to lose their century long monopoly on defining mental illness. Dr Frances wrote this:

I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. It is no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy.

Wow. This would indeed produce a revolution in mental health care if it were to happen.

When I was in my Masters program in 1988, the professor often quipped that the course was about insurance companies, and the insurance companies were about the Diagnostic and Statistical Manual of Mental Health Disorders. Our job was to learn how to get paid properly by insurance companies and to do that we needed to understand the language they spoke. Seemed cynical, but true at the time. The professor had an existential bent by the way and we always knew he believed the system was arbitrary and ridiculous, but it was the system in which we were forced to work.

I had another professor of child psychotherapy who argued that the child section of the DSM should have about seven broad categories instead of the dozens of diagnoses that were included in DSM-3 at the time. That also seemed to make a lot of sense to me.

Then, I went to a Scott Miller workshop and heard for the first time that there was essentially no way to effectively select a specific treatment model that would produce any better results than any other model or technique, based solely on the psychiatric diagnosis assigned. In other words, the diagnosis does not matter as much as we like to think it does.

I took these factors to heart when I synthesized the Interpersonal Wisdom approach. But I have a more radical idea that even this brave physician who is sure to take a lot of heat from his colleagues, would find hard to fathom.

All treatment is about relationship and resilience. What is the capacity of the human being in front of us to withstand environmental or physiological attacks on his best functioning? How can we be in relationship with that human being in such a way that we can help that person be his/her best self? Sure, we provide a lot of information and engage in a whole bunch of behaviors to try to help, but essentially what we are doing is containing, loving, and encouraging. Uh, Oh, I let my hippie alter ego out again. Oh, well.

I admire Dr. Frances for his courageous stance, and believe a change such as he is suggesting would turn the mental health field upside down – in a good way. But there is a deeper paradigm shift already occurring out here in the talk therapy community that contains even more possibilities for human flourishing.

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The psychotherapist

It is time that we ask the hard questions about who we are and what we do.  Health care reform is upon us.  Change is here.  How do we want to be known?  This is from my paper, Interpersonal Wisdom, the capacities and characteristics of the best talk therapists:

Let it Flow, The Philosophy of Becoming (1996).

“Whitaker the man and the teacher will continue to flow into the story of
our knowledge about human beings. His life, his thought, and his rapport
with human suffering will continue to be appreciated by new generations of
family therapists. As they grow tired of the endless models, new
approaches, and super techniques, in the end, they will yearn to find human
beings and their qualities in the real world and not in the microscope.
Whitaker’s legacy will be revealed even by those who kept their distance
during his lifetime, labeling him as “bizarre” and “irrational.” Carl was
a pioneer in family therapy, a giant, who did not allow himself to be
seduced into creating a myth around his personality. He died without any
official disciples, but he trained a multitude of therapists around the
world, sometimes unbeknownst to them, with the power of integrity and
coherence. He taught us more about life than about techniques. He taught
us about the search for ourselves and our own spiritual essence, through
the experience of suffering and solitude.

More soon…

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Continuously Maneuvering

One of the hallmarks of interpersonal wisdom is what I call continuously maneuvering within the evolving (therapeutic) relationship.  Scholars talk about this capacity as part of emotional or social intelligence.  I think some people are born with the ability to do this while others have to learn the capacity.  Simply put, this capacity is the ability to discern and know what your client needs in the moment and being courageous and creative enough to provide it.  But the trick is in the knowing.  And to know is to see.

Change agents that have this capacity are deeply attuned to their clients on a moment by moment basis and they have high intuition.  When we speak about intuition we often think about the emotional “felt sense”.  I like to think about intuition as a learned means of knowing that has been finely tuned over years of interpersonal practice.  Sometimes folks that have this skill are interpersonal extroverts who thrive in person to person energy exchanges.  Others may be observers who grew up feeling like outsiders in their relational communities and thus developed a strong capacity to see and know.  Others may be from family situations where there was conflict or interpersonal tension and as a result of that experience they learned how to anticipate response patterns in order to protect themselves.  There are many ways that people hone this capacity, which may be one of the most important that change agents possess.

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When a prospective client asks…..

How do we know family therapy works with any type of presenting problem? I would try to answer honestly this way based on the available research.

1.  We know that people who receive psychotherapy tend to be better off than people that do not and the statistical difference is significant.

2. There is no evidence to suggest that any particular model or approach, or any therapist type or school of thinking produces results that are superior to any other.  There is evidence to suggest that therapists matter and that therapeutic relationships matter (most clients seem to get this better than we do).  Since we in MFT are relationship specialists we believe that we do a pretty good job at offering the types of therapeutic relationships that a lot of clients need, but we don’t yet know if we are any better than anyone else.  That research has not been done.

3. The decision to use family therapy seems to have to do with client preference.

4. If you are seeking couples therapy you should be aware that most therapists and many family therapists have received little training in that modality.

5. There is some research that has attempted to show that certain models of family therapy are effective with certain presenting problems.  I find that research suspect and believe, based on later studies that when unique therapist factors are controlled the differences between approaches disappear.  The truth is that all models are effective when they match what clients are seeking in a therapeutic style.

5. Hence, my style is thus………..

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