Episode AI notes
- Public perception of therapy is often shaped by the media, leading to a focus on CBT and medications, despite people’s main goal for therapy being self-understanding and addressing root causes of issues.
- Demonstrating long-term cost effectiveness of therapy to insurance companies can lead to significant savings by reducing medical costs through proper therapy and care.
- Therapy takes time to be effective, but insurance companies often limit sessions due to financial motivations, creating a conflict between professionals advocating for quality care and insurance providers focused on cost-cutting.
- Nonprofit organizations rely on pro bono work, with studies showing that people primarily seek therapy to address root causes of issues rather than just managing symptoms.
- Majority of individuals prefer therapy targeting root causes over just managing symptoms, valuing learning coping strategies, understanding themselves, and feeling heard and cared for.
- Patient preferences in mental health treatment prioritize coping mechanisms, support systems, and therapy over medication, despite the current trend of medication-centric treatments conflicting with patient preferences.
- Mental health is more complex than simple chemical imbalances, with public perception influenced by messaging and marketing, leading to individuals defining themselves based on a disease narrative approach.
- Uncovering deep-rooted issues in therapy requires time and guidance, with patients acknowledging the need for professional help in understanding unconscious reasons behind behaviors.
- Therapists need to be proactive and supportive to encourage patients to engage in therapy, showcasing the impact of encouragement on therapy outcomes.
- Deep-rooted issues may require long-term therapy, especially for individuals with attachment wounds stemming from early experiences or trauma.
- Recognition of different therapy modalities varies, with psychoanalytic therapy and CBT being the most recognized, while terms like psychodynamic therapy are unfamiliar to the public.
- Communication about depth therapy to the public should focus on key elements like the need to feel heard, the opportunity for change and choice, and the value of the therapy. (Time 0:00:00)
Public Perception of Therapy Public perception of therapy is often shaped by what is portrayed in the popular media, leading many to believe that the only available treatments are CBT and medications. However, a market research study conducted with the general public revealed that people’s main goal for therapy is to better understand themselves and address the root causes of their issues. Transcript: Speaker 1 What does that even mean? But if you’re in the general public and you are reading the popular press, you would think the only thing that exists these days are CBT and meds because that’s really the only two things That are ever mentioned in the popular press. So we wanted to go straight to the public and ask them. My colleagues Santiago de Bois and I both have kind of parallel interesting career paths. We were both in the business consulting world before and did a lot of market research and consulting to companies to help them understand consumers. That of course was all with the purpose of trying to market goods and services to these people. But we wanted to use those same tools to understand the public. And so we did a market research study with the public using the qualitative and quantitative research tools that we were really familiar with from our business careers. And when we just asked people what do you want, I mean it was kind of amazing because their answers really centered on the things that the benefits you can really get from adept therapy. They said the majority of people said the main goal of therapy for them is to better understand themselves and get to the root of their issues. (Time 0:03:38)
Emphasizing Long-term Cost Effectiveness of Therapy The insight highlights the importance of demonstrating the long-term cost effectiveness of therapy to insurance companies. Providing data on the reduced medical costs with proper therapy and care can lead to significant savings in the long run, emphasizing the need for proper dosages and adequate medical care. Transcript: Speaker 2 Yeah, I read that in your in your right up here. It was talking about how like the finance department notes or something or the audio was actually something that was released in the case. And it’s like, that’s the decision point. And then there were some doctors that were signing off on like 50,000 or so denials. Is that where you’re finding? Speaker 1 I think the 50,000 denials was yet another example from a different. Oh, that was a different case. Speaker 2 Okay. I don’t want to mix them up. Speaker 1 There are unfortunately a multitude of examples, you know, and we’ve tried to approach insurance companies and talk to them about the long term cost effectiveness of therapy because There’s tons of data that show, you know, if somebody gets like you’re saying the right dosage, the right amount of therapy, the medical care, the surgical medical costs that that they Incur go way down. (Time 0:14:49)
Therapy Takes Time and Insurance Companies Have Different Priorities Therapy usually takes more time to have the intended impact on clients, but insurance companies often fail to acknowledge this by limiting the number of sessions they are willing to cover. This discrepancy arises as insurance companies have financial motivations influencing their approval processes, leading to a conflict between professionals aiming to deliver effective therapy and insurance providers focused on cost-cutting. This conflict necessitates professionals to navigate tricky situations and advocate for adequate treatment duration when dealing with insurance companies, ensuring that the quality of care and patient well-being are prioritized amidst financial constraints. Transcript: Speaker 1 So it’s horrible. And they’ve, yeah, evaluated the patient how many times in person that and I’ll say that sometimes to the person. Speaker 2 I’m like, so, you know, can I record this call? Um, can I put you down as taking the responsibility of something bad happens to this patient? You know, can I get your full name? Who, who’s your supervisor? You know, who do I write a complaint to? Um, you know, and, and there are things that can be done and I’m going to be talking about this more in, in future episodes. But I think that the gist of what we’re talking about though is that therapy takes time usually, like to get the effect size, the result that we need with most clients. It takes more time than insurance companies want to pay. Right. Speaker 1 Right. And you know what we found in our research, um, in our study that’s published in the book is actually people get that. People get that it takes time for a couple of reasons. (Time 0:17:32)
Value of Pro Bono Work in Nonprofit Organizations Nonprofit organizations often rely on pro bono work from volunteers to carry out important tasks and research. In this case, a nonprofit dedicated to psychotherapy operates on a pro bono basis, including conducting a qualitative and quantitative study to understand what people want from therapy. The study revealed that people primarily seek to better understand themselves and address the root causes of their issues. Transcript: Speaker 2 Oh, OK. And so this is why you raise money for your nonprofit so you can afford. I afford things like this. And I read that everyone else was volunteering. You volunteered your time for this or something like that. Speaker 1 Everyone involved with. Yes, I do all of this pro bono as does everyone else. The Santiago and I worked on this for a long time pro bono and we wrote it up and analyzed it and everything. And actually everyone involved with psychotherapy action network does so on a pro bono basis, which is really amazing. We’ve been around for six years and just in January of this year, we made our first hire. So everyone up until now has been doing volunteer. Yeah. Yeah. Speaker 2 So OK, so you did this, this qualitative study. You asked a lot of questions, look for commonalities, built the survey, sent out the survey, quantitative study. And what do people want from therapy? Let’s start with with some of the details on that. Like what? What do people want? Speaker 1 Yeah, the main things that people want are they top of the list. They want to better understand themselves and get to the root of their issues. (Time 0:22:11)
Prefer Therapy Addressing Root Causes 91% of individuals prefer therapy targeting root causes rather than just managing symptoms, even if it takes longer. People value learning coping strategies, understanding themselves, sharing feelings without judgment, and feeling heard and cared for. Transcript: Speaker 2 Yeah, get to the root of the issues. 91% say they prefer a therapy that addresses root causes of symptoms, even if it takes longer, rather than only providing ways to manage symptoms. That was really that’s an impressive amount of people. It was so very. Speaker 1 That was that blew us away. I mean, we in retrospect might have phrased that question a little bit differently, but we were astounded by, yeah, over 90% of people signing up for a longer term therapy that’ll get To the root as opposed to something that’ll just help with symptom management, which of course is what, you know, many medications are are aimed at symptom management, short term therapy Is aimed at symptom management, you know, and people are saying, no, that that’s not good enough. That’s not what I want. Speaker 2 Yeah. Like 70% said learning skills and coping strategies. 70% said better understanding yourself and the roots of your issues. 66% said sharing your feelings and thoughts without being judged or shamed. 60% said feeling heard and understood by someone who cares about you. (Time 0:23:33)
Patient Preference in Mental Health Treatment A significant percentage of individuals prefer coping mechanisms such as seeking support from friends and family, staying active, remaining optimistic, and considering therapy over medication for mental health treatment. However, in reality, the majority of mental health treatments primarily involve medication rather than therapy, which contradicts the concept of evidence-based treatment that should prioritize patient preferences alongside clinician expertise and relevant research findings. Transcript: Speaker 2 I think this is the data that says, you know, 60% would go to friends and family. Mm hmm. 57% said they would keep themselves active or busy as a coping mechanism. 52% said they would try to try to remain optimistic and think positively. About 50% said they would consider going to see a therapist. Right. And 23% said they would consider taking a medication. Speaker 1 Right. Right. Right. Yeah. And right, the medications are, you know, people have a strong preference for trying non-medication experiences first. Right. Speaker 2 Which is not the reality of what happens. Right. I would say the majority of treatment does not have therapy involved. It’s mostly medication. Right. Speaker 1 Right. Right. And which is really backwards from a couple of different perspectives. I mean, both from the perspective of what do people actually want. And, you know, we think about what is the true actual definition of evidence-based treatment. It incorporates and should include the patient’s preferences. Right. That’s one of the three components of evidence-based practice is what is the patient want. Plus what is a clinician? You know, what is their wisdom and experience? Dictate. And then the third element is what’s the relevant research on this issue. But yeah, patients do not prefer to take medication. (Time 0:28:17)
Complexity of Mental Health Narratives The understanding of mental health as solely a serotonin deficiency needing more serotonin is oversimplified. Public misconception is being addressed as mental health is significantly more complex. Messaging and marketing have influenced people’s perception of mental health, treatment, and even their own identities. Individuals sometimes define themselves based on the idea of a chemical imbalance, reflecting a disease narrative approach. This narrative contrasts with other health issues like physical pain related to bones, showcasing the distinct ways people perceive mental and physical health. Transcript: Speaker 2 Yeah. And for 20 years in psychiatry, we’ve known that it’s not just like a serotonin deficiency and you need more serotonin. But that kind of stuck. And so now people in the public are learning like, oh, that’s not the case. It’s a, it’s, and in my mind, it’s like a lot more complicated. It did an episode on it. It’s like really complicated. Right. Speaker 1 Very complicated, but speaks to the power of messaging and marketing. Yeah. And that unfortunately has kind of overlapped and, you know, certainly pervaded people’s understanding of themselves, of mental health care, of treatment. I’ve had people walk into my office and sit down and say, well, I have a chemical imbalance. I mean, that’s just how they define themselves. Speaker 2 I call that, I call that a disease narrative. They believe that it’s like the same thing if the person walks in and they’re like, oh, I’m on bone on bone on my knee. (Time 0:35:22)
Uncovering Roots Requires Time and Guidance Exploring one’s deep-rooted issues in therapy necessitates time and digging through layers of unawareness. People acknowledge that certain behaviors stem from unconscious reasons and value the guidance provided by therapists in uncovering these roots. A significant portion of individuals seeking therapy rely on physicians for recommendations, which emphasizes the influence physicians have in recommending therapy over medication management. Internists prescribing the majority of antidepressants in the country may tend to treat patients themselves rather than recommending therapy. Transcript: Speaker 1 Which by definition will take time. I mean, the root, it’s buried. Yeah. It’s under the surface. You got to dig through some dirt, some layers to get to the root. And that’s just by definition. And intuitively, I think people grasp that. And they appreciate that, that there may be some things that they’re doing. And that’s the reasons why are outside of their awareness. And I think they understand that. Of course, you know, they need to work with a therapist to help guide them through all of that. But I think people are, you know, for those people who are willing to go to therapy, like we said, half of our sample said so. You know, that’s the kind of therapy that they’re looking for. Okay. Speaker 2 So there was, there was one area in the survey that was kind of interesting. If you were to consider therapy, how would you go about doing so? 60% said they would ask their physician for recommendations, highlighting the gatekeeping role that physicians play, you know? And so if that physician is very medication management driven, biological model, you know, they may not recommend therapy. Absolutely. Speaker 1 Right. That’s right. And we don’t really, well, we know a few things. We know, right, that internists prescribe about 80% of the antidepressants in the country. So they probably just treat many of these patients themselves. (Time 0:36:49)
The Impact of Encouragement in Therapy Engagement Doctors can play a crucial role in therapy by encouraging patients to engage in care. By being proactive and supportive, doctors like Dr. Pro can motivate patients to believe in treatment, leading to positive outcomes. Sometimes, just encouraging someone to begin treatment can be sufficient, showcasing the importance of a dose response in therapy outcomes. Transcript: Speaker 2 I think some doctors are the pied pipers of partial and good therapy and some are not, right? And there was a physician, Dr. Pro. She’s been on my podcast twice. She was on here for borderline personality disorder. She is so amazing at getting patients to actually engage in care. And probably one of the most, just keeping the ball going with people, you know, like, yes, this is going to help keep going. And people would believe her, you know, and they would go to partial and they would get better. And that was like, sometimes that was enough therapy wise was. So if you’re a psychiatrist, listen to this, it’s like, sometimes you just encouraging someone to engage treatment is enough and pointing and pointing out like, this is a dose response, Right? The studies on dialectal behavioral therapy, transverse focus therapy, mentalization based therapy, scheme of focus therapy, it was all like a year long, right? (Time 0:39:39)
Long-term Therapy for Deep-rooted Issues Deep-rooted issues stemming from early childhood experiences or trauma may require long-term therapy. For individuals with attachment wounds, a year of therapy is a worthwhile investment as it addresses decades of struggles and thousands of moments that contributed to their condition. Transcript: Speaker 1 But if you think of it in terms of, you know, if this is something that, you know, a person has been struggling with for their entire lives, you know, perhaps like an early childhood experience Of a trauma or something like that, you know, one year of therapy is actually not all that long. It’s probably for that person sounds like a pretty good deal to do a, you know, a year of therapy to kind of address something that’s been plaguing them for decades. Right. Speaker 2 If something, if you have attachment wounds, there’s tens of thousands of moments of contact that led to that, right? It’s not going to be an easy fix. (Time 0:41:04)
Limited Recognition of Psychotherapy Modalities In a study, participants were asked to identify various therapy modalities, revealing that the most recognized ones were psychoanalytic therapy and cognitive behavioral therapy (CBT). Other modalities like mindfulness based therapy and humanistic therapy were recognized as common names rather than understood concepts. Terms like psychodynamic therapy were unfamiliar to the public, with only 16% recognition, compared to 64% for CBT and 66% for psychoanalytic therapy. Transcript: Speaker 1 Yeah. Very interesting. Well, to start off, we gave them a list of a number of different kinds of therapy and different modalities and said, which ones do you recognize? And really out of the entire list, the only ones that people recognized were psychoanalysis or psychoanalytic therapy and CBT cognitive behavioral therapy. People also checked off mindfulness based therapy and humanistic therapy. But I really think that they check those off because they just are more common names. And they probably have heard mindfulness in a number of different contexts or meditation, for example, but, but really the only two therapies that people were aware of were psychoanalytic And CBT. And I will just say for some of the clinicians out there listening, even the term psychodynamic, which I think many clinicians use, the public does not know that term at all. That’s a word they’ve never heard of. So if you are out there saying you’re a psychodynamic therapist, you’re probably confusing a lot of people unnecessarily perhaps. Speaker 2 But 16% of people knew what that was in the sample, 16%, whereas 64% CBT, 66% psychoanalytic psychoanalysis. (Time 0:50:48)
Exploring Public Perception of Different Therapy Approaches Public perception of therapy mainly revolves around psychoanalysis and CBT due to exposure via reading and media. Psychoanalytic therapy is associated with self-understanding and problem root cause exploration, aligning with the primary benefit people seek from therapy suggests a qualitative interview exploring public perception of different therapy approaches. Transcript: Speaker 1 Yeah. And actually one of the qualitative interviews that I did with the woman early on, I asked her, she had heard of psychodynamic and she said, no, I’ve never heard that word before. I said, well, just what do you think it might be or what does that mean? What pops into your head when you think about that word? And she said, well, psycho dynamic movement motion. Oh, maybe it’s a dance therapy. I mean, so, you know, it’s really interesting. Speaker 2 I wonder if shedler practices it that way, you know, can see doing some dance therapy with some clients. Speaker 1 We’ll have to ask him. Speaker 2 Was that part of his frame or not? I don’t know. I have to ask him in a future episode. Speaker 1 Yeah. Yeah. Yeah. I’d have to check that out with Jonathan. But yeah, it’s very interesting. Right. You know, what the public actually thinks about what we say and what we do. Speaker 2 Yeah. So most people really only know psychoanalysis and CBT. That’s like, right. Speaker 1 Right. And generally, you know, a lot of their associations, of course, come from, you know, what they’ve read and, you know, of course, been exposed to, right? That’s how they develop ideas about things. And you know, they do associate psychoanalytic therapy with self understanding and getting to the root of their problems. And it’s very interesting because that’s, you know, at the beginning of the survey, what we talked about, that’s kind of the top benefit the main thing people want out of therapy. (Time 0:52:21)
Key Elements of Depth Therapy Communication In psychoanalytic therapy, there are various approaches and focuses, such as attachment-focused or insight-oriented. This diversity leads to confusion in the public about what psychoanalysis is. When communicating about depth therapy to the general public, four key elements should be highlighted: the need to feel heard, the opportunity for change and choice, and the value of the therapy. Transcript: Speaker 2 Right. And I think that, you know, psychoanalytic therapy also means different things to different people, you know, some are very attachment focused in it in psychodynamic therapy or psychoanalytic Therapy. And, you know, they’re really focused on the relationship, what’s going on in the room between the person and them, whereas some people are, you know, looking at more insight oriented, You know, what’s underneath everything. So even within psychoanalysis, it’s like, there’s so many schools, so many different ways of approaching it. Speaker 1 Right. Right. Which is probably, you know, contributed to some of the confusion and distortion that the public has about what actually is it. Yeah. Yeah. Speaker 2 Yeah. Yeah. Okay. So the framework grounded in research for key elements that we should make an effort to communicate with the general public about depth therapy. You want me to list them off or you want to go for it? Go for it. Go for it. Okay. So the four key elements here to feel heard, to have change in choice, it’s worth it. (Time 0:54:58)