How Patients Lose When Psychologists Are Not Involved in Medical Care

Improving medical care by working with psychodynamic psychologists.

Posted Sep 28, 2011 | Reviewed by Lybi Ma

Co-authored with fellow PT blogger, Tamara McClintock Greenberg, Psy.D.

Health care costs are exploding and one silent factor in containing costs is rarely mentioned: the underutilization of psychological services. The evidence is clear and has been for three decades. In many studies, people who see psychologists for symptoms are less likely to utilize medical services

In other words, mental health treatment saves a lot of money.

But the problem goes deeper. As psychologists, we need physicians to refer patients. Fortunately, many do. But when physicians refer patients for psychological consultation or counseling they do so by staying within the confines of their own model of disease, their own box. What are the instructions for that box? Reduce specific symptoms, as fast as possible. Thus referrals are characteristically directed to psychiatrists or cognitive-behavioral therapists.

Sadly, referrals for cognitive behavioral therapy do not benefit most patients. Cognitive-behavioral therapy is great as long as you are one of the 20 percent of patients who benefit from this. Most people require more complex forms of treatment.

Patients experience illness, not disease. Illness means that symptoms alter relationships, sense of self, and the possibility of future planning. What illness means to a patient is deeply impacted by how dependence was tolerated, and care and support were offered throughout the patient's life. The meaning of experience is what psychodynamically trained therapists focus on. These therapists, of course, are deeply concerned about the reduction of symptoms and they address how patients cognitively assess their problems and symptoms. But psychodynamic treatment's effectiveness is broader and deeper in scope, which is why it is long-lasting.

What we need is for physicians to ask different questions about illness: Why is this person so hopeless that he can't even take in my treatment recommendations? What does it mean to her that she will experience partial, not total recovery? When these questions are asked, the physician will likely consider a referral to a well-trained psychodynamic therapist.

We don't think that physicians should have to map the referral territory alone. We think that it behooves a major organization of psychological clinicians to delineate the signals and signs of the need for psychological referral. In other words, what the press has delineated as "evidence-based treatments" has misled a lot of physicians and patients who are looking for help. Both patients and physicians deserve more credit when it comes to choosing psychological approaches.

Patients today know that illness is complicated. They search the web for alternative explanations and they seek out the help of alternative practitioners. Maybe we should ask why it is that patients feel so alone and on their own to seek out their own treatments and medical advice.

Physicians can help patients feel less alienated by working collaboratively with psychologists who think about the illness experience from a comprehensive and multi-faceted perspective.

A referral to a psychologist can feel like a blow to patients, who often worry that their symptoms are devalued in that they are sent to ancillary practitioners. The reality is, well-trained psychologists and those with analytic training can be just what patients need. Physicians just don't have the time to do what psychologists can do. Often, though they appreciate the concept, they do not have the training to help people understand how the mind and the body interact in the face.

Co-authored with fellow PT blogger, Tamara McClintock Greenberg, Psy.D.