All Treatment is Not Created Equal: the Price Tag for Mental Health Treatment

Dear Liz, thanks for your post. 
Like Ross in your comments section I only charge $40 hr. However I have the financial advantage of being retired from the hospital counseling center where I worked for 15 years and now have my own home-based practice. No office expenses. 
Insurance costs are high, training is expensive and Medicare and insurance companies won’t pay for up to nine months. A local doctor with an independent practice had to take out a loan to stay in business. Finally she gave up and is now working for the hospital. We’re all being forced to work for the corporation whose interests don’t always match our own.

I am an alternative mental healthcare practitioner and I could really see that there is a big difference in approach and technique when I was working in the hospital. 
Mainstream relies on drugs as a first option. 
The only actual therapy provided is CBT (cognitive behavioral therapy). CBT works best in the first twelve weeks of therapy, after that results trail off quickly. CBT is only effective for mild complaints and makes no attempt to get to the root of a problem.

‘Talk therapy’ which seeks to find out the ‘why’ of your behavior has limited value. If my car mechanic told me why my car wasn’t working but not how to fix it I wouldn’t be very happy with him. 
And in my experience “mainstream’ therapists haven’t a clue about resolving the cause of a problem.

Cathartic therapies have a bad rap only because when poorly administered they worsen the symptoms. When done right the traumatic event being addressed no longer has any power to upset you.

It’s sad that there is still a distinction between ‘alternative’ and ‘mainstream’. 
When I started out in the 1960’s we were all trying out the new therapies that were springing up, humanist psychology, gestalt and so on. 
We tried everything out on each other to see how it worked. After all we all have problems and you can’t trust a cook who won’t eat her own food.

Mainstream is like a field of GMO corn. You know what you’re getting but it may not be what you want. 
Alternative is like the jungle. Lots of choices but how do you know what will be good for you?

I will use one or more of about a dozen techniques I have come to know and trust over the years for someone who comes to see me for help. 
We’re all different and I like to have choices. If I had to recommend something I’d go with EFT (emotional freedom technique). 
It works, it is widely used, has a good track record and and is validated by a large number of studies.

I’ve got a funny story about my first experience with EFT.
About 15 years ago I came across this new way of treating trauma and phobias called Thought Field Therapy (TFT). It involves tapping on certain acupuncture points to calm the nervous system and dissolve trauma.
It sounded too good to be true, but I bought the manual anyway and read enough of it to get an idea of what to do.
That evening we went to a Thanksgiving party hosted by our friends who were our landscape architects. 
During the conversation it came up that I had this new ‘phobia cure’.
The host’s wife piped up: “I’ve got one for you, I’m terrified of mice and I’m visiting my in-laws this week-end, and it’s a farmhouse and its got mice all over the place and I don’t know if I’ll be able to go.” By now she was shaking and pale.
“So can you do something about it — or not?” her husband said in a friendly but challenging way.
I’m on the spot now and I had to accept the challenge. Everyone was watching.

The circumstances weren’t ideal; everyone was pretty drunk and noisy. I was crazy to try this for the first time in the middle of this setting and my guinea pig with the phobia had a beer in one hand ad a cigarette in the other.

“OK” I said, “Let’s do it.” I turned to face my mouse phobic friend.
“On a scale of one to ten, with one being perfectly happy with mice and ten totally freaked out be them — how would you rate your distress?”
“It’s a twelve” she replied in a loud but shaky voice.
“OK, and what is it about mice that makes it a twelve?”
“Its the dirty smell and the feeling of their little claws crawling all over me.”
“OK, now, for the next step, you’re going to have to put down either your beer or your cigarette as I’m going to ask you to tap on certain places on your body.”
She paused a moment to consider her options and then handed her cigarette to her husband and took a swig of beer. “OK, I’m ready.”

I had her tap about ten times on two places around her eyes, under her arm and on her collarbone. We did this routine a couple of times. It just took a minute or so and then I noticed that she had begun to relax, the color came back to her face and she was smiling.

“So how does this thing you have about mice seem to you now?” I asked.
“It’s down to a four.” She replied calmly.
“OK” I said “let’s do some more of this and get it down to a one.”
“Oh no you don’t,” she said, “I’m no longer afraid of the little buggers and when I get to the farmhouse I’ll be ready to knock them off. But I don’t want you to make me actually like them!”
She lit up another cigarette. The session was clearly over. She’d gotten what she wanted.

“Interesting” I thought, “I think we’ve got something here with this strange tapping business.”

Shortly after this they moved away and I thought that was the end of it.
But a few years ago, some ten years after this ‘party trick’, she called us.
I was out and Amy took the call and when I came home she said our friend had told her she has not been afraid of mice since that session — even likes them sometimes, and went with her granddaughter to a Mickey Mouse movie.

As a footnote to this story another mouse phobia came up a few years ago when I was working at the Behavioral Health Center. It was a quiet moment in the day, the waiting room was mostly empty of patents and we (the staff) were hanging around the front desk. Our psych nurse brought up the fact that she had a mouse phobia and could I help her?

“Of course” I said “let’s do it right now.” We traced her phobia back to a time when she was a little girl and she saw a bulldozer unearth a mouse metropolis. Seeing what seemed to her to be a million mice running around was the moment that was frozen into her mind. 
In a few minutes of tapping the incident became just another picture in her mind.

Therapy doesn’t have to take forever.

A client was sent to me. Diagnosed with OCD. He couldn’t stop checking that his front door was closed when he left the house. He’d get halfway to work and come home to check that the front door was locked. He was about to get fired for being late for work.

The meds weren’t working and he came to me looking like he’d had a stroke, slurring his words and unsteady on his feet. Over medicated I guessed. I asked the doctor to lower his meds. 
First session I told him to get a notebook and write down the date each day and tick the date when he locked his door so he had a record of locking his door. It’s easy to forget having done an action you do every day. Was it today I am remembering or yesterday?

Next session I asked him when this all started. It all started when he got robbed. We cleared the trauma of the robbery with EFT in the next two sessions and we were done.

Therapy doesn’t have to take forever.

Another technique I’d go with is TAT (Tapas Acupressure Technique).

I had a client who was horribly abused as a child. So much so that as a young adult she would go into a fugue state and wake up a few days later having driven a thousand miles to the other end of the country.
She was ‘non compliant’ in that she refused drugs but was determined to get better.

We did great together. In less than a year she was out of therapy and is doing fine. We used TAT to clear her trauma.

I do better with people like her than passively compliant patients who just sit there zonked out on meds waiting for me to do something.
The severity of a person’s condition is not as important as their desire to make things better.

Nor does therapy have to be for the rest of your life. Get it fixed and live life. If I had to take my car into the shop every week for the rest of my life I’d find another garage.

This brings up a couple of points. The rationale for medication is that the cause of your unhappiness is messed up brain chemistry. 
If that’s the case then therapy is a waste of time. That’s why clients who have been told it’s brain chemistry don’t try therapy.

Now drugs can help as a triage to stop the pain right now till we can really fix it. 
In cases like autism where the brain is different drugs are needed and I would go with Temple Grandin’s advice to carefully find exactly what works for you and take the minimum amount needed to have the desired effect.
We all need help. Unless you’ve lived your life in a coma bad things have happened to you that you’re still carrying around and which are affecting you adversly. 
And if you’ve been in a coma all your life, that’s a trauma right there.

I’ve had more therapy than most and it’s not because I’m so messed up. It’s because I want to be able to do life better and because I am curious to see how my mind works. When I understand me better I can help you better.

Burnout as Ross says can be a problem if you are on your own and see six clients a day as I used to. 
I tend to get energized with my clients if we’re doing well and things are popping along. 
If it’s a slog I’m going in the wrong direction or I’m the wrong person to be helping this client.

Every therapist needs a supervisor, someone to provide an exterior viewpoint.

I have my wife Amy as my supervisor and as another therapist. She knows as much if not more than I do. It’s good to have two of us. 
We’re all different and someone may do better with one of us than the other. 
Also it’s a bit of a stereotype thing. Men tend to want to fix it and women tend to want to talk about it; and to be listened to in a deep way is a profound experience there is no evaluation, no interpretation, no interruption and a space in which you feel free to say anything you want without even a raised eyebrow. 
Deep listening is the Zen of therapy and she is the master of it.

OK I’ve said more than enough.

Liz, I hope you find the help you require to lead the happy life you deserve.


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