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

Enrico Gnaulati, PhD
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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. You unabashedly revealed on The Late Show with Stephen Colbert: “I pushed myself into psychotherapy, and I’ve gotta tell you—I’m the poster boy for psychotherapy. I think it’s terrific, and I got in touch with a lot of things I didn’t like. It was quite a journey.” You even stuck your neck out in an interview with CNN’s Anderson Cooper, claiming that your friend, President Trump, was traumatized by his childhood and has a high level of narcissism, as well as trouble with empathy, such that he would do well to locate professional help: “I wish he’d go into psychotherapy. I’d be so proud of him if he did. He’d flourish.” 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.

Case in point is what is occurring within the Kaiser Permanente mental health care delivery system. Recently the National Union of Healthcare Workers (NUHW) announced that some 4,000 Kaiser psychologists, therapists, social workers and psychiatric nurses were prepared to go on strike across California to improve patient access to quality mental health care. A newly released NUHW survey found that due to understaffing and high-volume caseloads, 77 percent of Kaiser mental health professionals have to schedule return appointments further into the future than is clinically appropriate, with over 60 percent reporting that their first available return appointment was more than a month away. A Kaiser mental health administrator I interviewed for my book a couple of years ago summed the situation up: “It has become a medication-management, crisis-intervention model, not a real psychotherapy model where patients get the time and space they need to build a relationship, address the real issues that trouble them, and emotionally unload.” But, Kaiser is not alone in skimping on quality psychotherapy services.

In March, ruling on a class-action lawsuit against United Behavioral Health (UBH), a subsidiary of UnitedHealth Group, the nation’s largest health insurer, Judge Joseph Spero of the U.S. District Court of Northern California drew the conclusion that UBH adopted treatment guidelines that focused on cost savings through limiting the treatment being approved to the management of acute mental health episodes. In essence, he faulted UBH for denying their subscribers mental health treatment of sufficient duration to get to the heart of their psychological difficulties and achieve long-lasting change. Can you believe it Howard, he busted UBH for only covering short-term, crisis-management therapy, lessening some mental health symptoms, but not leading to the sort of life-enhancing benefits you recently told ABC News’ George Stephanopoulos you derived from psychotherapy: “I have learned through therapy, maybe I could love myself a bit and love what I’m doing and really throw myself into it . . . learning how to be a man . . . having successful relationships . . . listening more on air.” If you would allow me a professional speculation, I surmise that psychotherapy rid you of your shock-jock persona and helped you express sorrow, envy, regret, shame, and rage you didn’t consciously know you had, making you a more loveable version of yourself!

You once quipped to your radio audience that your main goal in psychotherapy was to cut back to two sessions a week from your years-long customary three. Setting aside how legions of readers might see this as an obscene amount of therapy, you will be appalled to discover that most Americans are receiving a fraction of the psychotherapy they actually need to get better. Scientific analysis of over 10,000 psychotherapy cases conducted by Endowed Chair in Psychology at Brigham Young University, Michael Lambert, and his co-researchers, strongly suggests that it takes 20 or more sessions for most clients to manifest real behavioral progress. Yet, in a study looking at national trends in psychotherapy usage by Mark Olfson in the Department of Psychiatry at Columbia University, up to 50 percent of patients drop out after the first or second visit, and only about 9% of those entering treatment attend twenty or more sessions.

The main reason people in emotional need discontinue psychotherapy before it is of sufficient duration to attain real improvement is that too much of the cost is shifted over to consumers by insurance companies. Milliman Inc., released a report a few years ago charting how mental health services are four to six times more likely to be provided out-of-network than general medical or surgical services. In a nutshell, what is occurring is that droves of psychotherapists are unwilling to contract with insurers because of low reimbursement rates, leading to a sizable number of clients paying out-of-pocket for needed care, which pressures them to underutilize it for affordability reasons. The American Psychological Association estimates that about a third of psychologists refuse to take insurance, primarily because of low reimbursement rates.

If I may, it sounds to me that psychotherapy has equipped you with a newfound capacity to be tactfully honest, instead of your old tendency to be tactlessly so. Perhaps then you will respect my candor in suggesting that you team up with fellow celebrities who have gone on record about the lifeline psychotherapy can be—Jay-Z, Brad Pitt, Katy Perry, Gwyneth Paltrow, Halle Berry, Jennifer Aniston, Jon Hamm, Emma Stone, to name but a few—and leverage your collective cultural status to address the underfunding of mental health services by insurers, lest quality talk therapy be more out of reach for the average American and available only to Hollywood types and those with means.

10 COMMENTS

  1. Not a recent thing: Long before 2012, when I retired from running a treatment foster care program, I saw seriously traumatized foster children getting monthly med management where even psychiatrists at nationally known institutions took 10 minutes with their nose buried in laptops (sometimes not even facing the child) asking pro-forma questions to foster parents about the child’s “behavior”. At best, these were sessions for harassed foster parents to unload a few grievances – not accurate updates on what was going on with the child. Multiple psych. Rx’s were then written and the child was out the door. Psychiatrists seldom paid attention to the input of our social workers; they almost never advised foster parents of drug adverse effects. Our advocacy for weaning children off the drugs almost always went nowhere.

    Meanwhile, we were able to get psychotherapy for children that mostly consisted of bi-weekly, or even monthly, sessions. Exactly what was this going to do for children who had been monstrously traumatized (including the trauma of having been removed from the only family and community they had ever known and placed at the tender mercies of the foster care system)?

    I lobbied long and hard for small caseloads (of 7) for our masters level licensed social workers. They were the ones who saw the children anywhere from at least twice a month to 3 times a week. They often spent hours with children – not minutes – and often an equal amount of time with foster parents. The goal was to treat every moment of these encounters as opportunities for in vivo “therapeutic interventions” – usually the best thing was just to listen, listen, listen without trying to play “expert.” Often enough – especially on long car rides in which children didn’t feel they were being put under a microscope – children would open up about things conventional therapists would be thrilled to hear in office sessions.

    The takeaway? A) Still further evidence of the damage done by psychiatry; B) Dr. Gnaulati is surely right about the lack of availability of meaningful therapy for most people (although it is a tribute to clients and therapists that even bi-weekly therapy can work for some); C) People are hungry to be listened to, can open up and move toward better lives if someone in their lives takes the time to really listen, to express confidence in their goodness, intelligence and basic humanity, and to stay calm and positive when people show their pain. We need more creative ways to encourage this between people in our daily lives. The peer support movement seems to me an excellent start in this direction.

  2. I have wondered for some time of the true reason insurers are reluctant to pay for “mental health” services is because they know the dismal facts about the “medications” as well as knowing that there is no real legal definition of what psychotherapy entails. The quality of services provided from one practitioner to another is not in any way similar. I’ve personally gone months at a time – several days a week – and talked about current events, the weather, politics. Medicare and Medicaid will pay the practitioner regardless of whether they actually help you get better. But private insurance expects medical care to actually do something to make you better and to follow some kind of evidence base.

    It will be very interesting to see how this plays out if Medicare For All is enacted. I know that the time and quality of therapy that Stern got will still not be available to all of us. There is nowhere in the world that I know of where the government controlled single payer healthcare system pays for this kind of care.

    There is also the underlying assumption that the ways the person is behaving are dysfunctional. Howard Stern made an awful lot of money being a professional a$$hole. Would he have been such a colossal Jerk if that hadn’t been so lucrative? I’m sure he can make money just off of his fame now so the old Jerk routine wasn’t needed. Did he really need thousands of hours of therapy to learn how to be nice? I think we should be very careful not to conflate the seriously traumatized who could benefit from intensive contact with a caring listener with sociopathic people who profit off of harmful personalities and then play mea culpa while advertising on talk shows for their professional guru. If Alex Jones suddenly started touting the benefits of therapy, I’d be similarly skeptical of what he was receiving and why he was promoting it. These people are essentially actors after all. And famous. I don’t think anything they say is applicable to the average person.

  3. It took only one appointment for a pathological lying gossip, according to black Sharpie marked out medical records I later read, masquerading as a psychologist, to convince my husband I needed to be psych drug poisoned forever.

    That psychologist’s real goal, according to my child’s medical records, which were eventually handed over, was to cover up the sexual assault of my child. I learned the hard way that covering up child abuse has, for over a century, been the primary actual function of our psychologists.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo

    And none of today’s DSM billing code “bible” believing “mental health” workers can EVER bill ANY insurance company to help ANY child abuse survivor, or their concerned parent. Because child abuse is NOT a billable DSM disorder, thus child abuse survivors MUST be misdiagnosed with the billable DSM disorders, prior to receiving “help.”

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    Today, “the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012).” Wow, that’s huge percentages of child abuse survivors misdiagnosed with the DSM disorders.

    https://www.madinamerica.com/2016/04/heal-for-life/

    Perhaps, prior to asking for more money for psychotherapy services, the “mental health” workers should fix the problems with your DSM billing code “bible,” and make it possible for you to bill insurance companies for honestly helping the majority of your clients?

    By the way, among those DSM5 problems is that this line should be put back in the DSM, but include the ADHD drugs, in addition to the antidepressants.

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

    https://www.alternet.org/2010/04/are_prozac_and_other_psychiatric_drugs_causing_the_astonishing_rise_of_mental_illness_in_america/

    The DSM should also include the fact that the antipsychotics/neuroleptics can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

    And the antipsychotics can also create psychosis and hallucinations, the positive symptoms of “schizophrenia,” via antidepressant and/or antipsychotic induced anticholinergic toxidrome.

    https://en.wikipedia.org/wiki/Toxidrome

    Or better yet, perhaps the DSM should be flushed by all the “mental health” workers, since all the DSM disorders were confessed to be scientifically “invalid” and “BS” years ago.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
    https://www.wired.com/2010/12/ff_dsmv/

    I do agree, talk therapy theoretically should be better than drugs. But it’s not, when the primary actual function of our psychological industries, historically and still today, is profiteering off of covering up child abuse. Our society should be arresting the child molesters instead.

    America now has huge pedophilia and child sex trafficking problems, in part thanks to our “mental health” workers’ systemic aiding, abetting, and empowering of the child molesters and traffickers, by turning millions of child abuse survivors (and their concerned parents) into the “seriously mentally ill” with the psychiatric drugs.

    https://www.cbsnews.com/news/trump-signs-online-sex-trafficking-bill-live-updates/

    Can the psychologists and psychiatrists get out of the child abuse denying and neurotoxic poisoning business?

  4. Enrico Gnaulati, let me ask you a question:

    Is psychotherapy a medical act or a cultural act?

    If we take the trouble to think about it, we will see the problem differently.

    Does “mental illness” exist? Can an illness be “mental”? As an antipsychiatrist, I say: “no”.

    So what is psychotherapy? What can a psychotherapist and his client do well together?

    Psychotherapy is a cultural act. The therapist and his client speak together according to a particular cultural mode, which has a particular cultural meaning.

    In this, psychotherapy is not distinguished from cartomancy, Christian confession or shamanism. It occupies the same social place, according to a different cultural mode. Psychotherapy is steeped in a scientific philosophy, but it is rarely scientific, and its effectiveness is not science-based: psychotherapy is effective because it corresponds to the culture of the client and the therapist, and because the therapist and his client are in phase through this special cultural trait.

    Finally, cultural acts also relate to power, that is, culture imposed by the state. If psychotherapy is reimbursed, it is partly controlled by the state, which is unacceptable. The state uses culture for repressive purposes, and psychotherapy is associated with state university, psychiatric hospitals, and public servants. Psychologists are a corporation that obeys orders.

    That’s why, as a psychotherapist, I am against reimbursement, and for liberal psychotherapy; the psychotherapist must stop presenting himself as a doctor, stop presenting his client as ill and his acts as medical. He is not a doctor, his client is not sick and his actions are not medical. All this is cultural, and nothing else.

    If you want to make psychotherapy accessible, drastically reduce your fees; psychologists, like siberian shamans and african marabouts, think they have come out of Jupiter’s thigh.

    Low and adapted to client fees = more clients.

  5. Interesting – I had pretty crappy healthcare overall, including “mental health” care via Kaiser Permanente (east coast branch, though). I’d hate to single them out re: the “mental health” care – in retrospect, it was (nearly) all pretty ridiculous no matter the “provider.”

  6. Erinco, interesting writing but you seem to be blinded by Mr. Stern’s intelligence and verbal skills. His case is a great example of surface cure. And this has been the blaring siren song of psychotherapy. If not done well and if there is a power differential say starpower the analyst is just as much a prisoner as the patient.
    For all his so called” insight” Mr. Stern has not owned up to or expressed sorrow and guilt over his decades long verbally abusive radio show. When he was not part of the problem he was aiding and abetting others in their isms of all kinds say like maybe birtherism?
    I have heard no true apology. I have heard no OMG ephiphany of true insight.
    So yeah the three times to five times a week can change people in some ways but ah the concept of social justice, equality, and the concept of common good – the image of one as a human in a planet in crisis – there are other ways to help oneself and see how interconnected we all are.
    BTW one free way of doing psychoanalysis sign up to work with a Clinic who trains folks. Like other professions the student analysis is free.
    So thanks for the economic lesson but old stuff and when one picks a subject make sure the subject actually fits the definition of cured. My guess he has not been able to learn empathy and like a kindergartener can use the vocabulary but has no idea of the real meaning behind them.

  7. A personal review ATMC (Alternative to Meds Center, Sedona, AZ) to madinamerica.com:

    “Please note, the Alternative to Meds Center has been in business since 2006, and has treated more than 1,600 clients since opening its doors. Assuming that not all of their clients experiencing serious psychological and dependency challenges had success in ending such reliance on the pharmaceutical industry, I felt compelled to advise them upfront (as I do with all clients) that there was a possibility the results might not statistically show they were making a significant positive difference.” (Taken from attached article)

    This quote above was taken from the article that was trying to use statistical data to prove that treatment center (ATMC) does show significant difference to many of the programs and outcomes to other available programs. It is interesting to note that I was unable to share my personal comment.

    Three years ago, Ryan entered ATMC, with very few or no other choices; suffering for years with mental health issues due to psychotropic drugs; very little hope for his future, and no other choice, but to put all he had into a holistic treatment program to give him hope to overcome this debilitating life he was living.

    Ryan has been medication free for three years, has not had any psychiatric treatment since 2016, nor any sign of recidivism whatsoever. ATMC can help anyone that wants to live a better life, get off their medication protocol with a very conservative approach using “ortho molecular therapy,” the treatment of disease by varying the concentrations of substances normally present in the human body” through chelation of holistic and organic supplements with intense sauna treatment, is an understatement! No one doctor, no medication, and nothing could have saved our son from ending his life, we owe a lot to this center and will continue to sing our praises, refer others to ATMC, and promote their efforts for as long as they are in existence.

  8. Just because this celebrity comes out and says it helped him doesn’t mean we should all flock to psychotherapy. I have been going to psychotherapy (seen the best in the world) for 15 years now (half my life) and I feel have steadily gotten worse. By worse, I mean I am more mentally unstable and feel worse about myself and am objectively lower functioning. I don’t know how much of this is on me as I would be on this path regardless or maybe therapy has helped me not to steer off the deep end but if I were to guess, it hasn’t really made a big difference. It’s a friend to talk to and they usually reinforce what you think. It becomes a dependency. And an expensive one in that! I am not saying I endorse the biomedical model but just because this celebrity says in a few interviews how powerful it has been for him, it’s disingenuous for therapists to say “see, I told you.” Who knows, he could be going thru a “manic” phase.