The therapist is free to violate that implicit understanding of confidentiality under certain conditions. Occasionally, a lawsuit will be brought regarding a violation of confidentiality and an organization may file an amicus brief to offer reasons why it has not been violated and information was appropriately released.

The American Psychological Association has listed a number of these amicus briefs on their website. Additional examples of confidentiality issues may be found here. A good overview of therapy and how it works has been provided by the APA.

Besides confidentiality, there is something called privilege and that is information that is left to the sole discretion of the patient whether or not to permit a therapist to release it. The patient controls privilege.

Exceptions to privilege include child abuse cases, mental health at issue cases, disputes between co-patients, disputes between patient and therapist, crime or fraud, and duty to warn. The latter refers to the 1976 case of Tarasoff v. Regents of the University of California, in which a patient informed his therapist that he was having violent thoughts about a young woman he had been dating.

Prior to this killing, there doesn’t seem to have been a legal duty to warn but the “future crimes” standard releasing a therapist would seem to have been the standard of practice. The therapist at UC thought he took appropriate steps, but never warned the identified victim, and she was murdered. The murderer was found guilty, spent a short time in prison, and was then deported to his homeland.

In the above-mentioned instances, the therapist is not only free to release privileged information, but required by law to do so. In the Tarasoff case, curiously, the therapist’s supervisor ordered him to destroy all his therapy notes. The laws vary by state and there is a chart providing each state’s requirements regarding duty to warn.

An exception to the duty to warn (the third-party informant) came up in a case in California where a young man, who had broken off with a young woman who began to date another man, indicated to his father that he wanted a gun and he wanted to kill the other young man.

The father went to the patient’s therapist and informed him of this. The therapist told him to take his son to the hospital, where he was voluntarily admitted overnight and released. The next day he killed the young man and himself.

A court in Ewing v. Goldstein and Ewing VA Northridge Hospital Medical Center found the therapist was liable for the death of the young man. The California Court of Appeals indicated that the young man’s father had told the therapist of his son’s threats, and there was a duty to protect, which the therapist failed to follow through on, which resulted in the death of both the young man and the patient. The “failure” hinged on the therapist’s failure to tell the hospital of the impending danger the young man posed if permitted to be released after one day.

The court indicated that the therapist should have been aware of the patient’s state of mind and the dangerousness which he presented and revealed this to prevent his hospital release; he did not. This, then, indicates that even if a third party tells a therapist about the patient’s potential danger to someone or the community, there is a requirement to report it.

What about prior criminal activity or prior crimes committed by a patient? Does a therapist have to report them? The answer to these questions remains vague, and it appears there is no current law requiring therapists to report. Therefore, Tony Soprano was in the clear when he told Dr. Melfi about his criminal actions.

I was in a group session in my doctoral studies where one student revealed that a patient told him he murdered someone five years previously. The student asked what he should do. Neither the professor nor the group had an answer, and the professor told him to seek guidance from his professional association. After he did contact the association, guess what happened? They told him to talk to his supervisor. And so it went.

A good overview of the situation may be read here. There are still grey areas that legal scholars and laws must address. In the meantime, anyone entering therapy should consider current legal protections for themselves as well as problematic areas.

Some mental health professionals have questioned this believing a discussion of legal releases of information will prevent either full disclosure in therapy or lead to an individual not attending therapy, even when they need help.

The post Patient/Therapist Confidentiality Has Its Limits. What Are They? appeared first on Medika Life.

During 2015–2018, 13.2% of Americans aged 18 and over reported taking antidepressant medication in the past 30 days. Antidepressant use was higher among women than men in every age group. Use increased with age in both men and women. Almost one-quarter of women aged 60 and over (24.3%) took antidepressants.

Over the past several decades, as antidepressant use increased, patients (and the healthcare profession) have believed that depression was due to “a chemical imbalance” of the neurotransmitter serotonin. With that thought in mind, researchers concocted numerous antidepressants to manipulate serotonin actions in a patient’s nervous system by enlisting a pattern of blocking (antagonist) or facilitating (agonist) the neurotransmitter’s exertion.

The belief in serotonin’s ability to control depression was further facilitated by flawed research that cherry-picked results, didn’t publish failed efforts on its behalf, and the marketing needs of pharmaceutical companies. To say that depression was produced by “a chemical imbalance” served several purposes.

The first factor was the wish of patients to believe they were victims of their biology, not their negative cognitions or lifestyle choices, or other factors. The second major factor was to produce blockbuster medications.

Prozac was incredibly successful (read “Listening to Prozac ”) because of efforts to promote it. Its problems, however, were understated or not stated at all during prescribing. After the introduction of Prozac into the pharmaceutical armamentarium, several groups of medications were based on similar theoretical beliefs with slight chemical changes.

Authors quickly jumped on the bandwagon and began producing books and articles that ingrained this chemical imbalance belief further. The writers offered ways to reverse it with foods, exercises, or natural products.

A New View of the Theory

Thanks to a meta-analysis research project, the cat may be out of the bag. But, after all these years and before this research, didn’t people wonder why their antidepressant wasn’t working? Was serotonin not the culprit it had been viewed as in the past?

And why did placebos work when antidepressants didn’t? The new effort at seeking out more about serotonin and whether it was the culprit in depression has been eye-opening.

Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity. Most studies found no evidence of reduced serotonin activity in people with depression compared to people without, and methods to reduce serotonin availability using tryptophan depletion do not consistently lower mood in volunteers.

While the review would seem to set the serotonin theory aside, there may still be individuals who could benefit from these medications. As one supervisor I had during my internship once told me, even a sample of ONE is sufficient for research. If someone, anyone, benefits, it’s the proper medication for them.

Dispensing millions of pills must surely hit one patient or more with a special need. Depression remains a serious, misunderstood disorder that ravages lives and results in suicide for too many. WHO notes that up to 280 million people worldwide suffer from depression.

In 2016, suicide ranked as the 10th leading cause of death among Americans. It is the second leading cause of death for those under 35.

Bringing some control over the illness/disorder remains a primary goal for anyone in healthcare because of the millions who suffer from depression and die because of the emotional pain it causes.

The post Flawed Research, Clever Marketing, and the Failure of a Depression Theory appeared first on Medika Life.

Look in the back of the book, and you’ll find those for future consideration, many of them cultural in nature. This point indicates that the prior diagnoses in the earlier editions of the manual could too heavily load on American culture.

An interesting, unacceptable previously diagnosed in the “to be considered” category was nightmare deaths of Laotian men. How did they diagnose it? Perhaps some form of psychosis? In the Philippines, it is known as bangungut. And it has also been categorized as Oriental nightmare death syndrome. Is it a psychiatric disorder or a cultural belief?

The team that worked on the latest iteration of the DSM indicated that “more than 200 subject matter experts” worked on the book, including ethnocultural and racial concepts.

Questions arise regarding the reason these cultural and racial elements were missing in prior editions and whether they stigmatized patients in the past. The number of experts does not strengthen the book’s content, just as the number of subjects in a protocol doesn’t necessarily increase its validity. It’s illusory. Numbers alone are not magical.

Are there many as-yet-undiagnosed mental illnesses waiting to be discovered and treated, or is there too fervent an eagerness to find the obscure and plump-up, already burgeoning manual? One has to wonder at the expense of sounding skeptical of both motives and medicine.

Over the past few decades, psychiatry has undergone a seismic change from analytic practice to biological concerns and research. In the DSM, the specialization tends more toward psychology than biological medicine. We know thousands of healthcare personnel use the tome without medical degrees.

I recall working in psychiatry research where we saw psychiatry residents who were disillusioned because they thought they would learn how to practice psychotherapy, not look at blood draws or medication side effects. The department began to select only those interested in biological psychiatry, and any who found this unacceptable had to find substitute residency programs. To my mind, it seemed there should be a melding of the DSM and the then-current Physicians’ Desk Reference, now known as the Prescribers Digital Reference.

Perusing the DSM will quickly reveal no biological diagnostic indicators for a psychiatric diagnosis other than behavioral symptoms. There are no required blood tests, no serologic tests, and no imaging (even for Alzheimer’s). So, is this medicine in the true sense or psychology?

One point that also contributes to the existence of this manual is that insurance companies wished to have something on which to rely for reimbursement. And reimbursement may play a role in giving patients diagnoses other than the evident one. In family therapy, the mother may be the IP (identified patient). Should she be placed in that role, or is the diagnosis being skewed for the insurance?

There were two categories of physicians in a psychiatric hospital where I once worked: medical doctors and psychiatrists. All psychiatrists are medical doctors, so why the dichotomy? I never did get an answer because I don’t believe anyone knew how it came to be.

And when medical doctors in the hospital noted a sharp uptick in diabetes in patients on the units, there was little to no discussion with psychiatrists about psychotropics playing a role in its incidence. It did have a role they later discovered. Some patients on specific drugs gained an inordinate amount of weight without an intake of additional calories.

One voice calling out against what he indicates is the “medicalization” of normal life is the eminent psychiatrist, Dr. Allen Frances, once the chairman of the committee to establish the DSM in its overall position of power of diagnosis. His concern regarding the current issues resulted in writing “Saving Normal: An insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, big pharma, and the medicalization of ordinary life.”

The book was a shot over the bow of those promoting the DSM as the ultimate text for diagnosis. But this isn’t the only area where Dr. Frances has expressed his concern because he believes that the diagnosis of ADHD in kids is far too common.

We’ve seen the prior wave of diagnosis of children with bipolar disorder begun by Dr. Joseph Biederman, a well-known child psychiatrist. “Dr. Biederman’s work helped to fuel a fortyfold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder and a rapid rise in the use of powerful, risky and expensive antipsychotic medicines in children.” Would most of us question, without a medical degree, the use of powerful drugs that act on a child’s developing brain?

I wonder what Dr. Frances thinks about the latest diagnosis of Prolonged Grief Disorder (PGD) added to the current edition known as DSM5-TR. The new addition is described as “the bereaved individual may experience intense longings for the deceased or preoccupation with thoughts of the deceased, or in children and adolescents, with the circumstances around the death. These grief reactions occur most of the day, nearly every day for at least a month. The individual experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

The concern among some healthcare professionals is that this new inclusion will be the tipping point for pharmaceutical interventions in a process that should be permitted its normal action. One research project for grieving consisted of a specific 16-week protocol with an antidepressant. The researchers believe that the new PGD disorder applies to about 4% of the population, but the pandemic may have increased the numbers.

While mental health professionals may wish to see PGD as treatable with medications for depression and anxiety and psychotherapy, there is agreement that little is known about the biology of grief. The missing pieces in the puzzle would seem to present a major impediment to effective care of those engaged in prolonged grieving. Where research exists, it has found a formidable negative connection with the immune system.

Additional protocols noted the increased mortality of spouses after the death of their spouse and the relationship between depression and cardiovascular disease. Undoubtedly, grief includes degrees of depression which can be long-term in nature. It affects an individual’s ability to function normally and may not wane sufficiently without intervention, but which persons need the intervention and for how long still requires investigation. Most will see grief gradually lessen over a six-month period without intervention, but others may take one to four years. The question is one of serious impairment in daily life.

Besides adding a new diagnostic category, there needs to be a proviso about combining medication with psychotherapy, not simply medication alone. The reverse is also true; psychotherapy without medication where it may be indicated.

The post The Time Is Now to Closely Question Psychiatry’s “Bible” — the DSM appeared first on Medika Life.

A therapist or, more appropriately, a psychotherapist, in this case, is a word we never associate with evil. The word evil is reserved for use in the religious realm as is the concept of the Devil (see Elaine Pagels’ “The Origin of Satin” or Bart Ehrman’s “God’s Problem”).

With the popularization of therapy, possibly related to its extolling by the wealthy and famous and availability of health insurance, change has come. Psychiatrists even considered whether or not if “evil” exists in anyone. Were there evil people (like Jeffrey Dahmer, John Wayne Gacy, and Dennis Rader) or were they exhibiting a form of mental illness or a personality disorder?

The question is no mean feat of theory consideration but one that has medical and legal implications. Does evil exist, or are we reverting to a less enlightened age where religion explained all for us in our wish to have answers?

Psychotherapy is dependent on introspection but if evil exists in some persons, is this concept relevant? An evil drive pushing toward acts concomitant with it wouldn’t seem open to change by careful inspection of one’s psyche.

If someone, with a predilection toward skirting the rules of ethics related to psychotherapy, were to be in a position of power, what would they do? Could they harm us in some way? If so, what would the harm be?

We need only to read some of the newspaper reports of questionable or unethical behavior of famous therapists such as Freud. What did Freud do? For one thing, he pressured patients to contribute to his own therapy association. Then, too, Freud considered his patients “riff raff” and convinced a man that he was a homosexual, urged him to divorce his wife and marry another of his patients.

Urging his patients to rid themselves of their neuroses, Freud failed to heal himself from the serious anxiety that stopped him from facing patients (he sat in a chair at the head of his famous couch), and his enuresis.

What about the equally famous Albert Ellis, the father of Rational Emotive Behavioral Therapy, who “Like Kinsey, Ellis is not the monogamous type. He has admitted to having sex with patients, though only after treatment had ended.”

Depending on state licensing laws, therapists may have a relationship with a former patient under certain circumstances. Some states this is never condoned, others say it’s fine two years after therapy ended. All licensing authorities, too, have a code of ethics by which licensees must abide.

Anyone engaged in the mental health field as psychiatrists, psychologists, social workers or counselors of any stripe need to do it be truthful to themselves and their patients. But there are those who are in the field for reasons which, if revealed, would lead to professional sanctions.

Famous or infamous?

The question of evil in a psychiatric setting would seem to have been settled by an editorial in one of the psychiatry journals.

As the editorial indicated, “Psychiatrists are medically trained in the scientific method, not in the diagnosis and treatment of evil.… (This) is the province of the philosopher and theologian and… Introducing the concept of evil into forensic psychiatry hopelessly complicates an already difficult task.”

The editorial writer indicated that evil is an exclusively human quality, and one not observed in animals. He was attempting to address one psychiatrist’s formulation of a “Depravity Scale,” which was to standardize measures of evil to provide some guidance for other psychiatrists.

In the context of this article, I am not attempting to categorize evil as anything other than a therapist’s wishes to optimize power, prestige, individual desires, or money. I do not believe they are genuinely evil, but some are not what I would see as sterling characters. Most try their utmost to deserve the trust their clients’ place in them.

However, some of the most famous names in mental health have been accused or have committed the most egregious actions. For some, it was a casual concern with their academic preparation (Erik Erickson); for others, it is ethical violations, sexual deviancy, murder case involvement, or drug use. Some engaged in unethical research. All of them are human with feet of clay.

The media is rife with the more sensational stories of therapists who have engaged in non-professional behavior. For example, they have slept with their patients, borrowed money, were involved in business relationships, controlled their patients’ lives as in the case of one famous music star, and generally allowed themselves to freewheel their lives as they wished. Of course, none of this is acceptable and violates ethical guidelines for all of the mental health professions.

Psychotherapists are supposed to help us deal with the difficulties in our lives, but that’s not always the case. Too many therapists are unqualified to practice as they do, are not licensed, got degrees from unaccredited schools, lack the training required, or are in it for the money.

Freud detailed his own love of money in his letters where he referred to it as “laughing gas.” Others may have more nefarious reasons for hanging out their shingle.

According to Dr. Jeffrey Masson, Freud denied the sexual abuse of children. ‘’The silence demanded of the child by the person who violated her (or him) is perpetuated and enforced by the very person to whom she has come for help,’’

The shingle designating a professional may also be deceptive as it indicates the person is “Doctor…” Does that mean MD, Ph.D., or what? And what type of Ph.D. did they receive? Honesty in this profession, as in others, is not a strong suit for all. How do you tell who to avoid? No one provides guidelines.

The knaves with degrees

Some therapists are so taken with their alleged ability to perform “semi-miracles” in their patients’ lives that they have stated things which are more than unacceptable. For example, one therapist who, in violation of ethics, encouraged group members to socialize and date. I know of this having heard it from others.

This licensed individual also told one of the patients that if she discontinued therapy with her, the patient would commit suicide within one year. The patient went on to work with another therapist.

In a few years, she earned her master’s degree and then went on to study for a doctorate in psychology. Thoughts of suicide never entered her mind. The therapist remained in practice and, seemingly, no charges were filed. The patient wanted to walk away and forget about it entirely.

A psychologist, who had a young man referred to her, began to engage in what she called therapeutic sex with the young man. The sessions went on for almost a year. After each sexual encounter in her office, he gave her a check for $150 and scheduled their next session. One of my professors told our class, “I have never heard of a therapeutic erection” when he heard about this.

The unethical behavior continued until he worked up the courage to discuss it with his parents. They reported the woman to her licensing board, and the board suspended her license.

One of the problems with suspension is that these individuals often return to practice in the future. During the period of supervision, they do nothing untoward, but afterward, we have to wonder. The system, in general, relies on the patient pool and the public to report.

Active violators of ethics or who engage in illegal activities are not sought out by investigators because there are so few who are hired to perform this work. Many states have only two people to look at all the licensed persons within that state.

This ongoing surveillance does not include those in the medical profession since they perform their own investigations, but, here too, it is left to someone to report. Often these persons are not reported for a variety of reasons which may include intimidation, blackmail, or threats of being cut off from treatment or being sued.

Steps to protect yourself

A short guide to assist in therapist selection is needed. Here is a list of suggested questions to ask and places to find help should you need it.

1. Do not depend on ads for therapists. Big ads mean that a person is willing to pay for these displays. They will expect to recoup the funds in therapy fees. Ads=no assurance of anything.

2. No one can guarantee you anything. It is against ethical guidelines for psychologists to provide any assurance of results or a guarantee.

3. Ask all the questions where you need answers. Don’t permit anyone to intimidate you. You are paying for a service, and you are a customer no matter whether they call you a patient or a client.

4. Some questions: What degree do they have and in what discipline? A school administration doctorate is not a doctorate in psychology. A doctorate or a Ph.D. needs explanation. Do not skip over this one. Where did they go to school, and where did they do their internship? Plaques on the wall are meaningless. Too many wall decorations can be bought.

5. What license do they have? Being “certified” is not equivalent to being licensed.

6. What is their theoretical orientation? Have them explain it to you. Take notes. Google anything you don’t understand if they tell you something unusual.

7. What is the treatment plan, and what is the timeframe for your therapy?

8. In what do they specialize? Examples: medical illness, anxiety, stress reduction, family therapy, cognitive-behavioral techniques, etc. Is a specialist someone who treats anyone who comes through the door? No, they’re not. We are not dealing with a Chinese restaurant menu here.

9. To which professional organizations do they belong? Google that one, too.

10. What is their cancellation policy? Insurance cannot be billed for missed sessions.

11. Check online with their licensing board to see if there are any actions pending currently or past violations. Also, check for lawsuits online.

If you need more assistance in deciding whether to report a therapeutic transgression or not, where do you go? The usual course would be to your state’s licensing board.

An internet search for “(state) licensing board for (psychologists, psychiatrists, social worker, counselors)” should return the result you seek. At this time, there is no national licensing board for the professions.

AI is getting in on the act

As in so many things, technology is being brought into the realm of therapy, but is it free of the problems we’ve seen in artificial intelligence (AI)? Large data sets are not devoid of major issues of bias, miscalculation, and assumptions.

The construction of an AI algorithm that would help to select a good candidate as your therapist remains problematic. Some data sets are heavily loaded in terms of bias. Hidden bias includes ageism, sexism, and racism.

For persons with specific wishes, such as someone of a similar ethnic background or religion or any other particular, the program may select only those individuals. At the same time, it will exclude individuals who might be better suited in terms of forming a therapeutic relationship.

The therapeutic relationship

The therapeutic relationship is the basis of all successful therapies. It is here that you must be most attuned to how you feel when you are in the company of that person. Of course, this assumes that you will have a screening or initial consult after you have made a selection for a therapist.

Would selecting a therapist based on shared demographic features result in a good match? The belief may be that this individual has shared life experiences which would make them more apt to understand the individual’s life experiences.

Often, a person who seeks a therapist with a similar racial or ethnic background as a preferred provider may delay therapy while waiting for a “match.” But an analysis that looked at individuals matched in terms of background and those who weren’t matched indicated the treatment outcomes were similar. Therefore, the therapist doesn’t have to share a collective life experience, ethnicity, or other background feature. But AI might skew the results in that direction.

The selection of a therapist is of utmost importance because they are dealing with your life and assisting you to make needed changes. As you would with any significant decision, check carefully, be satisfied, and never hesitate to question. It is your life.

The post Beware the Strike of an “Evil” Therapist appeared first on Medika Life.

Psychiatrist

A psychiatrist is a medical doctor (M.D) who specializes in mental health, including substance use and disorders.

Psychiatrists are multi-faceted. They’re able to diagnose underlying medical and complex psychiatric conditions, to prescribe medications, and administer somatic therapies (e.g., electroconvulsive therapy or ECT). There is a common misconception that psychiatrists only prescribe meds. The falsehood is mainly due to the current set up of the health care system.

Psychiatry.org provides a more in-depth overview of the profession:

psychiatrists are qualified to assess both the mental and physical aspects of psychological problems, prescribe medications, and they spend much of their time with patients on medication management as a course of treatment.

Education

In North America, the total amount of schooling required is between 12–15 years, including four years’ undergrad in science, two years prep for medical school, and an additional four years in medical school. The psychiatric student must have a postgraduate education certification before applying for a Postgraduate Residency. Postgrad takes another four years for a psychiatrist to train in diagnosis, psychopharmacology, mental health treatment, and other aspects of medical care.

Types of Psychiatrists and Disorders Treated 

1. Adolescent psychiatrists care for youth under the age of 18. They focus on disorders such as attention deficit hyperactivity, major depression, and autism, asperger syndrome.
2. General adult psychiatrists focus on the age group between 18–65 and treat schizophrenia, disorders such as anxiety, attention, personality, adjustment, psychotic, and bipolar.
3. An Addiction psychiatrist treatsdrugs, alcohol, sex, gambling addictions, eating disorders such as bulimia, anorexia, compulsive overeating.
4. Disaster psychiatrists aid patients who have post-traumatic stress disorder (PTSD), stress, and major depressive disorders. Patients can be witnesses of violent crimes, such as sex crimes, murders, terrorist attacks or mass shootings
5. Geriatric psychiatrists center their work withelderly patients who experience dementia, depression, anxiety, schizophrenia, and also practice in hospice and palliative medicine.

Integration of Other Practices

A psychiatrist sometimes combines psychotherapy or modes of “talk therapy” to build the therapist-patient relationship in parallel with prescribing medication and making behavioral observations.

Average Cost Per Session — $100 to $300 USD

Psychologist

Psychologists focus extensively on treating emotional and mental suffering in patients using behavioral intervention. They often work in medical settings; however, they are not physicians and cannot prescribe medications. The National Center for Biotechnology Information provides a concise overview of the role of a psychologist as someone who can:

assess, diagnose, and treat the psychological problems and the behavioral dysfunctions resulting from, or related to physical and mental health. In addition, they play a major role in the promotion of healthy behavior, preventing diseases and improving patients’ quality of life.

In addition to the above explanation, the Canadian Psychological Association describes a psychologist as an individual who studies:

how we think, feel and behave from a scientific viewpoint and apply this knowledge to help people understand, explain and change their behavior.

Education

The amount of training required to become a psychologist depends upon the field of study. (See focus areas below). For example, a clinical psychologist requires an undergraduate degree of four to five years. A doctorate is then required ranging from an additional four to seven years of graduate school. On average, psychologists must attend 8–12 years of university education.

Types of Psychologists and Focus Areas

While many varieties of psychologists exist, the following shortlist is specific to human health and well-being.

1. Clinical psychologists aid clients in their identification of emotional, mental, and behavioral challenges in their lives. Through observation, interviews, and tests, the psychologist will diagnose existing or potential psychological, emotional, or behavioral issues.
2. Cognitive psychologists investigate how people think, including topics such as decision-making and problem-solving. This type of psychologist is interested in how the brain processes, learns, stores, recognizes, and utilizes information. Specializations include memory, language development, attention, problem-solving, or learning disabilities.
3. Developmental psychologists study how and why human beings change throughout their life. Initially concerned with infants and children, the field has expanded to include adolescence, adult development, aging, and the entire lifespan. Developmental psychologists aim to explain how thinking, feeling, and behaviors change throughout life. This field examines change across three major dimensions: physical development, cognitive development, and social-emotional development.
4. Health psychologists study how biological, psychological, and social factors affect overall health and wellness. Many practitioners focus their skills further in subspecialties, including behavioral assessment and intervention, pain management and illness prevention, or health care reform.
5. Personality Psychologists help patients with personality disorders. They look at how a patient’s personality affects the way they deal with the world around them. This branch of psychology researches how various characters cause people to act in social situations, how they react to other people, how they cope with problems, and how they handle the stress in their lives.

Integration of Other Practices

Similar to psychiatrists, psychologists also combine psychotherapeutic practices with their clients to enhance the bond between therapist and patient.

Average Cost Per Session — $80 to $150 USD

Psychotherapist

A psychotherapist offers clients a range of treatments to help with mental health problems, emotional challenges, and some psychiatric disorders.

The modality enables patients to understand their feelings, develop a mind-body connection, and to know when and why they feel positive, anxious, or depressed. Psychotherapy equips people to cope with stressful situations in a more adaptive way. A psychotherapist can utilize experiential or experimental modes of treatment. Medicalnewstoday.com further depicts the process:

Sessions may be one-to-one, in pairs, or in groups. Techniques can include other forms of communication, such as drama, narrative story, or music.

Education

While requirements differ slightly between the United States and Canada, in general, an individual must have an undergraduate degree of three years. Next, an additional four to five years of graduate studies is necessary. For example, to become a certified psychotherapy practitioner within Ontario, Canada, an individual must have 1000 clinical hours completed to apply to the College of Registered Psychotherapists of Ontario (CRPO). Similar requirements exist in the United States and other provinces and territories in Canada.

Types of Psychotherapists and Disorders Treated

1. Cognitive-behavioral therapists (CBT) is a common type of talk therapy. CBT helps clients to become aware of inaccurate or negative thinking and view challenging situations more clearly and learn skills to respond in practical ways. CBT is a useful tool to address emotional challenges. Three examples are: treating mental illness when medications aren’t a good option, learning techniques for coping with stressful life situations and identifying ways to manage emotions.
2. Gestalt psychotherapists help clients integrate the mind and body, to learn the skills to take personal responsibility for their lives and to live in the present moment. Therapy is a method of self-exploration, a mode of truth-telling, and for patients to see themselves as real, physical beings. This new way of being will allow the individual to think more broadly and expand his or her expression of being alive. One key objective is for the psychotherapist to work with clients to improve the quality of their interactions with others.
3. Psychodynamic therapists workwith a variety of methods such as psychoanalysis, hypnosis, and uncovering techniques. These types of psychotherapies interpret unconscious processes and provide insights into the root causes of a client’s difficulties. The client will speak freely about their thoughts and feelings, and the psychotherapist delves into memories that may yield an understanding of present problems. Clients with a wide range of challenges undertake this type of therapy.
4. Interpersonal psychotherapists (IPT) take clients through a brief, attachment-focused treatment that centers on resolving interpersonal problems and symptomatic recovery. It is an empirically supported treatment that follows a highly structured and time-limited approach and is intended to be completed within 12–16 weeks. It has been demonstrated to be an effective treatment for depression and has modified to treat other psychiatric disorders such as bipolar disorder, bulimia nervosa, post-partum depression, and major depressive disorder
5. Group Psychotherapists lead a group of five to 15 patients for an hour or two each week. This type of psychotherapy allows clients to work through their challenges by interacting with a therapist and a group of individuals with similar struggles. Group therapy is held in a safe, confidential setting where members share personal experiences, feelings, and receive feedback and support from the rest of the participants. Clients benefit from developing communication, own awareness, and socialization skills, and learn how to express their issues and accept criticism from others. Many groups target a specific challenge, such as depression, obesity, panic disorder, social anxiety, chronic pain, or substance abuse. Other groups focus more generally on improving social skills, helping people deal with a range of issues such as anger, shyness, loneliness, and low self-esteem.

Integration of Other Practices

Psychotherapists are not doctors and, in general, do not diagnose, nor can a practitioner prescribe drugs to patients. Some psychotherapists are trained in specific areas of psychology and provide both services. Since psychotherapy has a wide range of modalities, in general, psychiatrists and psychologists borrow from the psychotherapy field.

Average Cost Per Session — $100 — $300 USD

Additional Resources

Offsite Links
Please note that the links below are to information and materials not hosted on Medika’s servers and are as such, not subject to our Terms of Use

• psychiatry.org
• angieslist.com
• wikipedia.org — Psychiatrist
• psychologytoday.com — Four Things to Know About Psychiatry
• verywellmind.com — 20 Psychologist Specialties and Job Descriptions
• allpsychologyschools.com — Clinical Psychology Job Description: What You’ll Do
• cpa.ca — What is a Psychologist?
• wikipedia.org — Developmental Psychology
• psychology.org — What is health psychology?
• psychologyschoolguide.net — Personality Psychologist Career Guide
• National Center for Biotechnology Information — The Role Of Psychologists In Health Care Delivery
• medicalnewstoday.com — What is psychotherapy?
• College of Registered Psychotherapists of Ontario
• mayoclinic.org — Cognitive behavioral therapy
• health.usnews.com — What Kind of Therapist — and Which Type of Therapy — Is Right for You?
• apa.org — Understanding Group Therapy

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