Tuesday, August 9, 2022

Comments by A_Psychologist

Showing 6 of 6 comments.

  • I can’t imagine why anyone looking for a good therapist would seek out a psychiatrist. There are good psychotherapists everywhere. Many advances in psychotherapy have occurred in the last twenty years. The good therapists are clinical psychologists, clinical social workers and marriage and family therapists. A few good therapists are licensed as psychiatrists, but not many.

    Everyone but Robert Berezin seems to understand this. Psychiatric medication also has a place, and some people desperately need it. And, of course, some people need psychiatric medication AND psychotherapy. Psychiatric medication is sometimes helpful, sometimes not. Same goes for psychotherapy. The current system has been well-established for about twenty-five years.

    Psychiatrists try to make about $400 per hour for writing prescriptions. Therapists try make $50 to $150 per hour for doing therapy. (Most therapists get $50 to $75 per hour from health insurance.) Everybody seems to understand this except Robert Berezin.

    This might not be the ideal system, but it’s not the catastrophe that Berezin makes it out to be. If he wants to practice psychotherapy, he’s free to do it. No one will stop him. Maybe he’s a good therapist… He probably won’t make $400 per hour, though.

    I wonder if Berezin believes that only psychiatrists are smart enough to be really good therapists. If so, this would represent inexcusable arrogance. Berezin was apparently trained to be a psychoanalyst. Psychoanalysis is still available in every major city. It’s too expensive, and controlled trials have demonstrated that it is not an effective treatment. For these reasons, psychoanalysis is much less popular than it used to be, and health insurance won’t pay for it, nor should they. Health insurance won’t pay for other ineffective, overly expensive and obsolete forms of treatment.

    Fifty years ago, most psychoanalysts were psychiatrists. That has changed. Today, psychoanalysts are more likely to be clinical psychologists, and possibly some other licenses, or lay analysts. This depends on the training institute.

    I really don’t understand Robert Berlin’s main concern. C’mon, Dude. State your case in a reply!

  • No one knows why some people have emotional or mental problems, while others don’t. Depression, OCD, anxiety disorders, schizophrenia… Take your pick. No one knows. This author doesn’t know, psychiatrists don’t know, drug companies don’t know, and I don’t know. It’s not likely that any of these problems have a single cause. Given that human brain is the most complex piece of matter in the known universe, with other animal brains not far behind, it might be a long time before we understand these important questions. It might be centuries, and maybe never.

    What we do know is that some forms of “talk therapy” help to some degree, also depending on the diagnosis. In addition, some drugs help to some degree, also depending on the diagnosis. Drugs also harm, and talk therapy might also do harm, though that is likely. There is nothing wrong with providing forms of treatment that help more than they harm. In fact, it would be immoral to withhold such treatment, even if it is less than ideal.

    Speaking of empirically supported treatments, tested in controlled clinical trials, psychoanalytic psychotherapy, the form of treatment supported by the author, generally doesn’t work much better than placebo treatment.

  • I know many psychiatrists. Most have a sincere desire to help their patients, just like doctors in any other medical specialty. They also want to make money, just like anyone else, in any occupation or profession.

    Most stockbrokers, bankers and lawyers are “in it for the money.” This is also true of some doctors, but only a minority.

    The health care system in the U.S. is irrational and needs fundamental reform, but individual doctors of any specialty, are not the enemy.

  • Psychiatrists don’t actually put $250 to $400 per hour in the bank. Just like other doctors, they have quite a lot of overhead. In addition, their medical training is exhausting and they usually leave medical school with huge debts. Psychiatry is already the least lucrative of all medical specialties, and the least popular medical specialty among medical students. Psychiatrists are medical doctors. They expect to earn incomes comparable to other medical doctors.

    The problem is that the author assumes that psychiatrists are more intelligent, more capable, or more knowledgeable about psychotherapy for children than other mental health professionals. There is no reason to think so, and in my opinion, it just isn’t true.

  • This article seems misinformed or misguided. Very few psychiatrists are trained to be psychotherapists, for child or adults. The average clinical psychologist and even the average Marriage and Family Therapist or Clinical Social Worker has had more training, and better-quality training in psychotherapy than almost any psychiatrist. I admit there are a few exceptions to this rule, but not many.

    In addition, psychiatrists generally expect to make $250 to $400 per hour for their services. The average psychotherapy session is about an hour long. No health insurance company is willing to pay for psychotherapy at this rate. Very few individuals are willing and able to pay out of pocket for psychotherapy at this rate. Some child psychiatrists are willing and able to have occasional brief therapy meetings with children or their parents, but there’s no reason to believe they will be more effective than other professions. They will probably be less effective.

    Child psychiatrists are pretty good at making diagnoses, given that the diagnostic categories for childhood mental disorders are a dreadful mess. They are pretty good at choosing the right psychiatric medication, at the right dose, for the right reason. There is nothing wrong with this. Thirty years ago, very few psychiatric medications were routinely prescribed to children. Now, a couple of dozen medications are routinely prescribed. This is a difficult task, which requires a well-trained child psychiatrist.