Yep, it’s a big problem. People with Serious and Persistent Mental Illness (things like schizophrenia, severe bipolar, severe recurrent depression etc.) can’t find a therapist who will agree to work with someone with SPMI or take their Medicare/Medicaid insurance. Meanwhile, people with nothing more than the normal dilemmas of life (Should I have a 3rd child? Should I quit my “golden handcuffs” job? Why do I clash so often with my MIL?) spend years in therapy.
Base on what she was paying for therapy for it sounds like she was paying for someone to talk to that had no emotional connection to her or her problems. I probably have a rather jaded attitude towards that kind of therapy. I have my family, wife, friends, church etc. that I can discuss issues with and they with me. Is therapy of this sort kind of like the newest diet or superfood? I’m not sure. I realize that there are some who have mental health issues and need a therapist but I’m not sure a therapist is best for dealing with day to day stresses, sadness, or just decisions to be made.
Don’t people with SPMI see psychiatrists rather than a psychologist? (article is paywalled for me so not sure this is addressed) I do know that plenty of psychiatrists don’t accept any type of health insurance for a number of reasons which can create/complicate access issues.
This seems to be a personal decision. Not everyone has family/friends that they can talk to/want to talk to about personal problems/stresses/etc. If someone wants to see a therapist long term for life coping skills, etc. because that’s what works for them, it seems they should do that.
I’ve only done therapy for very short term spurts and found much value to having support and guidance from a professional, that wasn’t emotionally involved.
I didn’t see a psychiatrists (who would be treating patients with severe illnesses mentioned above) and the counselors were geared to my needs (bereavement counselor and marriage/family counselors).
IMO, quitting long term therapy where there isn’t progress being made doesn’t devalue the profession as a whole. Sometimes we need outside support and shoring up, especially if the issue is within our own family.
I was a psychotherapist with several clients with serious mental health diagnoses (schizophrenia, severe PTSD, etc.) at a community mental health clinic. My clients saw a psychiatrist or psychiatric nurse practitioner monthly and saw me weekly. I worked closely with the prescriber. These clients were fortunate to have such a clinic available to them; very very few prescribers in private practice see clients with Medicaid much less commercial insurance, and most therapists avoid them as well, not having expertise. I did an internship at a day program for clients with serious mental illness where I learned a lot, but of course I always learned the most from my clients.
I’ll bet we all have “that friend” (or two) who sucks all the oxygen out of the room because they are so used to turning to friends or family members to deal with day to day stresses, sadness and decisions to be made. I know from my own experience trying to gently suggest that they get some professional, outside perspective 'I don’t need therapy, that’s for people with serious mental illness" that it’s tough to break through that mindset.
But truthfully- I’ve got a couple of close relationships in my past that I’ve let lapse (Covid was a big help) because every social event, phone call, or cup of coffee turned into a makeshift therapy session. And you just find yourself itching to get out of it.
One friend- just once, in many years, called to say thank you. Problematic relationship with an in-law child, I gave advice, and to my astonishment, she took it. And things are- in fact- getting better. But I don’t have the emotional bandwidth to be life coach, therapist, support system and friend in a relationship which is supposed to have a modicum of reciprocity to it. And I certainly don’t want to engage in the “misery olympics” where we compare notes on whose life has more challenges.
So if you are that person who believes they don’t need a therapist because they are so good at relying on friends and family… maybe take a moment to reconsider.
There are people who do need that constant support, mostly people who have mental conditions that cannot be be resolved, only managed. Also people who have issues which have been building up for many years - a person who has issues that have been going on for 20 years is not going to solve them in six months.
There is also an issue that there needs to be a match between therapist and patient, otherwise things can be static and go nowhere, but the patient remains in need of therapy. There are also therapists who are good for a while, but reach a plateau, and the patient needs to change their therapist.
And some people just need somebody who can be patient while the patient talks through there issues. Some people just need to talk about their issues out loud to a person, so that they can solve their own problems. That is not the best use of time spent with friends and family on a regular basis.
People with SPMI are shown to do best when they see both a psychiatrist (for meds) and a therapist (for coping skills.)
Both are in short supply for people with SPMI. Often those with the worst mental illness end up with the least experienced team. For example, they may not get assigned a psychologist but rather a “case manager” with nothing beyond an undergrad degree, or not even that.
At the agency where I worked, and with all licensed community based mental health clinics in NYS including those affiliated with hospitals/hospital networks, a client sees a prescriber, a psychotherapist, and, if they consent, a case manager.
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