In Therapy

A user's guide to psychotherapy

A Psychotherapy Wish List

How would you improve the talking cure?

Q: Magic 8 Ball, is therapy dying? A: Reply hazy, try again

After more than a century as a profession, therapy is in need of a little remodeling. In this season of lists and resolutions, I decided to come up with ten wishes for the therapy profession as a whole so I'll be prepared when I stumble upon that genie (or Jeannie) in a bottle. Without further ado:

1. Reduced Stigma - People don’t have a problem telling friends that they have a dentist appointment or a checkup with their physician, but they still hide their therapy appointments. We still get the “you’re crazy, you need therapy!” jokes and “tell your therapist!” slams. Not everyone goes to therapy to treat a mental illness, but if they do, mental illness is nothing to be ashamed of. It strikes one in four of us and is no more shameful than physical illness. If we reduced stigma people might feel comfortable seeking the help they want or need.

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2. More Client Empowerment - In the medical model, patients come in, report their symptoms, and treatment is administered to them. In therapy, clients are an integral part of their own healing. Asking questions, voicing concerns, examining the therapy relationship, vocalizing fears and fantasies; this is all an important part of the process. I wish all clients felt like an active participant in their treatment, as the work would progress faster and clients would feel a greater sense of accomplishment while they help resolve their own issues.

"How does that make you...hold on...cramp!"

3. Treadmill Therapy - We sit and talk. Recent research shows that we need to be up and moving every 20 minutes or so, which traditional psychotherapy historically does not. Many clients enjoy sinking into a comfy couch, and I do enjoy my chair, but if cardiovascular health is at risk, why not find a healthy solution? I’ve had plenty of good talks on a walk, how about we treadmill our way through therapy? Wouldn’t it be cool for clients to say: “I figured out how to confront my boss, and I walked 3 miles”? I’m only half joking about this. I’d love it if someone more creative than me found a solution to the Sedentary Psychotherapist Syndrome (SPS™).

4. A Coherent Third Party Payment System - It takes me about 8 seconds to see a high-resolution photo taken this morning from the surface of a planet 140 million miles away. That’s how far we’ve come with (2.5 billion dollar) intergalactic technology. When contacting a client’s insurance company, it takes a 90-minute nagivation through the phone labyrinth to reach the right person, hours filling out paperwork, and weeks to months waiting to receive payment, which is often a fraction of standard rates. That’s how far we’ve come with our (884 billion dollar) health insurance industry.

5. A Realistic TV Therapist - I loved Newhart, Dr. Leo Marvin, and Dr. Katz as much as the next guy. There’s no doubt that therapists with quirks and neuroses are entertaining. But I’d like to see a therapist on TV who resembles the many caring, ethical, and balanced therapists I’ve known through the years. Some folks thought Paul from In Treatment was this representative, but he touched on virtually every possible ethical gaffe in those three seasons. The Hoarders crew does solid work, but they’re so CBT heavy they seem to overlook significant attachment and existential issues each week. Just show us a therapist who does solid, meaningful work and isn’t a total buffoon. It might not be as riveting as the oafs, but it might help people trust the process a bit more.

6. More Consultation Groups - We work behind closed doors with no supervision, consultation, or therapy required after licensure. With continuing education requirements skewing toward online classes, it’s actually possible for a private practice therapist to have fewer than 10 hours of interaction with colleagues per year. Professionals isolated from people who speak their jargon may lose objectivity, develop burnout, and/or deliver sub-par services. Much of this could be prevented if therapists gathered in small groups for an hour a week to share ideas and camaraderie.

7. Improved Funding for Community Mental Health - Wouldn’t it be nice if the people who need therapy could receive it whenever they need it? If therapy were as accessible as food stamps or emergency medical care? These low- or no-fee clinics exist, but often struggle with limited funding, understaffing, session limits, and waiting lists that are months long. Let’s make government, corporate, and public contributions to CMHC’s as common as it is for other well-known causes.

8. Widespread Acknowledgement of Therapy’s Effectiveness - There are a boatload of studies that show therapy to be as effective as medication, with a longer lasting impact. Unfortunately, not many know about these studies, particularly (surprise) the physicians who prescribe the meds. Can you imagine MD's asking "Have you tried therapy? It's effective without physical side effects" before reaching for the prescription pad?

9. A Visible National Campaign - Therapists spend lots of money on professional websites, advertisements, and therapist finding services to compete with one another for client’s business. But who is uniting therapists and clients to promote the profession as a whole? Where are the commercials, billboards, Internet ads, and radio spots?  If only we had a unified national promotional campaign. If only.

10. Corporate Endorsement? - We have furniture. We have magazines. We have sound machines. For goodness sake, we have facial tissue. If NASCAR can advertise everywhere for sponsorship dollars, why not us? Come on Kleenex, I’m still entertaining offers.

Any other ideas for improving the profession? Let’s talk about it in the comments section. You're also welcome to hop on your treadmill and take a stroll through my website and facebook page. Happy New Year!

Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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