To all psychotherapists out there..there is alot of negative stuff on here. wha!

To all psychotherapists out there..there is alot of negative stuff on here. what exactly do you do??

there seems to be some here who bash psychotherapists. some claim that psychotherapy should be avoided for religious reasons. others point out their bad experiences and feel that all therapists are "mind terrorists". some think that all you people want to do is push drugs because of some kind of financial kickback from the pharmacuetical companies. or that you dole out drugs because of some goverment conspiracy that wants the mentally ill numb so that they are easilly controlled. so the question is, is this what really happens? what do you people really do? do you really feel that what you do really improves a persons quality of life?
could you please share your actual credentials in your reply as it would help illuminate differences between different discilines.

Hey Eddie,
I'm glad you posted this question as it gives folks a chance to clear up any misunderstandings and I will admit that some of the bashing that goes on here is frustrating, though fortunately it is not the bulk of what happens as most people give really thoughtful and insightful answers and positive feedback.

I'm an LCSW-R which stands for licensed clinical social worker with R privilege (it means that I have met the criteria and testing requirements needed to bill insurance).
My job these days is largely administrative and involves establishing and monitoring CQI (Continuous Quality Improvement) for the non-profit agency that I work for in all of our clinical programs, but I also continue to supervise other clinicians and I am fortunate enough to be able to maintain a small caseload. Prior to this I worked as an out-patient therapist in a non-profit mental health clinic for 14 years and as a residential counselor before that in a transitional living service for folks with mental illness.

Psychotherapy differs from psychiatry in that we do not prescribe medication, however we work very closely with psychiatrists in a collaborative fashion so that a working knowledge of medication is imperative. I also consult with PCP's who currently prescribe a large proportion of the psychiatric meds, especially anti-depressants, but who often lack the specialized training to make accurate psychiatric assessments, particularly involving illnesses beyond depression. Personally, I have an interest in psychopharmocolgy and have studied it more than most social workers and I actually train our agency staff on what they need to know as clinicians and I feel strongly that good clinicians need to be very familiar with this area as so many clients benefit from a combined approach of meds and therapy. I have never received "kickbacks" from a pharmaceutical company (nor has it ever been offered to me, LOL). I absolutely recommend meds in many instances and I have seen first hand the remarkable difference they can make in many cases and I have also seen them fail miserably in a number of instances. I've also seen ridiculous examples of polypharmacy (and gotten my clients re-evaluated by referral to a competent psychiatrist or helped them to discontinue meds in situations where they aren't needed), usually the result of hasty and poor diagnosis, but there are times when multiple meds from different classes are necessary to adequately control symptoms. There is no standard rule, just good practice and a parsimonious approach regarding the number of meds as the synergistic effects increase with multiple meds. Overall, I have seen far more benefit than harm from meds and truthfully each case needs to be evaluated uniquely and only the client themself can determine whether outcomes justify side effects. As far as a political agenda to control people? That strikes me as raging paranoia as most of the therapists I know, myself included, have no need to keep clients in treatment beyond what is necessary since waiting lists and caseloads are huge. No doubt there are therapists who do get off on others' dependency, but I am not one of them and I actually don't know any professionally. I will add, however, that I got the nickname of being the "chronic queen" because I truly like the cases that require long term work and I have never been one to support "fast-food" therapy no matter how much pressure we get from insurance companies. I wouldn't support inadequate treatment for mental health anymore than I would support drive-thru mastectomies. To really impact a person's life, you need to "teach a man to fish" for himself so that he doesn't become a revolving door client who depends on therapy for each crisis.

With meds or without, the treatment I provide is psychotherapy which employs a number of modalities and really requires a very eclectic approach in order to suit the therapy to the unique characteristics of the individuals being treated. I utilize a psychodynamic approach primarily which deals with both intrapsychic motivations and conflicts as well as interpersonal object relations and often the most successful therapy, particularly with folks who were traumatized, involves providing a corrective interpersonal relationship where they can safely share feelings and negotiate boundaries as well as process horrendous past hurts in an atmosphere of safety and validation. The goal is always to help people change what they need to in order to be happier, more functional and less disabled as well as to accept those things they cannot change or control in their lives and to make healthy decisions on how to cope with the cards they are dealt. It's real hard to explain this without being so wordy, so forgive me, but that only highlights the scope of psychodynamic therapy. I also draw heavily on cognitive-behavioral techniques, including DBT as well as more traditional CBT techniques, and I also use a lot of communication techniques for direct skill teaching for folks who have had poor models growing up. I am certified in Level I EMDR and hypnotherapy, but I use it less frequently as many of my clients were not stable enough to use it without increasing risks of abreaction (I tend to work primarily now with severely traumatized individuals who are dissociated or self-harming and that is the bulk of the supervision issues as well).

As far as the religious piece, I try to understand and respect the role that religion plays for the client, but I never interject my own beliefs. I will occasionally encourage a client to explore what spirituality means to them and to refer to religious professionals for spiritual matters.

Do I feel that what I do improves quality of life for those I treat? Absolutely, or I wouldn't continue to do it. That doesn't mean that I consider every case to be successful; I wish that was the case. But all of my clients are voluntary and are free to switch counselors, agencies or drop out at any time. Overall, my "drop-out" rate is very low compared to colleagues and in 20 years I can honestly say I have only had 3 clients ask to see another therapist (one of whom came back in 2 months after getting the male counselor they were seeking) and I admit that I am extremely proud of that as I consider myself flexible and willing to go to whatever lengths required to make a difference. I am proud of my profession and grateful for all the things clients have taught me that have helped me more effectively help others and I am awed over and over again at the strength and resilience they demonstrate.

The people here who bash psychiatry and mental health in general really get to me and I know it shouldn't, but I'm working on letting it go!

Whew! Probably way more than you needed or wanted to know, but I sort of can't help myself. My profession is something I am very passionate about! Thanks for giving me an opportunity to share it with you!