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What If Mental Health Care Came With Money-Back Guarantees?

If your rocket misses the moon, should you blame the moon?

Key points

  • Mental health service users should be apprised of what mental health professionals reasonably can and can't do.
  • If a mental health professional claims to be able to do something, like "treat depression," should he be held responsible for his claims?
  • Prospective clients and mental health service users should be better informed about what outcomes they can expect.

In the hard sciences, if you build a rocket to land on the moon and it misses the moon by a hundred thousand miles, you don’t say, “What a bad moon!” Obviously, you are trying to shift the blame for that misfire away from you and toward anyone and anything, including the poor, innocent moon.

In the field of psychology, the moon is nearly always blamed. Too many mental health professionals are indifferent to outcomes.

Imagine if a psychologist with a specialty in performance anxiety had to repay his clients if they remained anxious on stage? Because what is he being paid for, if not to successfully reduce his clients’ experience of performance anxiety? If he can’t do that, he should say that he can’t. His website should come with the disclaimer, “I miss the moon more often than I hit it. If you’re happy with that, please make out your check.”

Wouldn’t everything change if psychiatry came with a money-back guarantee? If psychotherapy came with a money-back guarantee? If couples’ counseling came with a money-back guarantee? Of course, that’s ridiculous: a mental health professional ought not to be blamed if you decide to divorce or if you have a hard-wired anxious nature. But wouldn’t a maybe more limited guarantee accomplish something? Something like, “I guarantee to listen and I guarantee to respond, but beyond that, who can say? And if I don’t really listen, by all means, ask for your money back!”

Mental health services should likewise come with a warning label along the lines of, “We don’t fully understand the following: human nature, the human brain, or the human heart. We do try treatments, some of which seem to help, and some which seem to do nothing much. If that works for you, please sign up for my eight-session package.”

Currently, it is too easy for everyone involved in psychology, from doctoral students running studies, to psychotherapists, to test-giving psychologists, to pill-dispensing psychiatrists, really, to anybody with some initials after his or her name to blame the moon. What expertise are they claiming, if not the ability to actually help?

Is it absurd to imagine mental health services coming with guarantees and disclaimers? Yes, of course. But that something is absurd doesn’t make it ridiculous. It would be a significant improvement for the field if mental health professionals began to explain what they can and can’t do, and then held themselves responsible—or were held responsible—for doing what they say they can do. If you claim that you can “treat my depression” and all you do is give me a chemical that may or may not be effective, is that really your best effort?

More from Eric R. Maisel Ph.D.
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