The Medicalization of Psychology and the Dilemma of Managed Care

As a professional community, psychologists have not adequately debated the pros and cons of managed care and the resulting medicalization of psychotherapy.  Because we have charged blindly towards medicalization and the complete adoption of the disease/symptom-based model of mental illness, we have sacrificed the focus on developmental approaches to mental health that involve integrating dissociated parts of the self and strengthening the whole person.  Since it's the model we're adopting, let's focus on the benefits of managed care and symptom reduction or the medical model.

There are clearly many positive aspects of this type of treatment.  First of all, because of the Affordable Care Act and Mental Health Parity, many people who did not have access to a mental health practitioner now do.  As long as you have identifiable, symptoms and can afford copays, monthly premiums, and deductibles, you can see a mental health practitioner who can help you reduce the severity of your symptoms.  So if you're depressed or have anxiety, for example, your insurance will pay for treatment until these symptoms no longer interfere with daily functioning.  It's very similar to the western medical model.  If you have an ear ache, you go to the doctor, they diagnose an ear infection based on observable symptoms, and you're given an antibiotic.  Treatment stops when symptoms go away,  The symptom management approach to psychology is useful in so many ways.  If you've ever had severe anxiety or depression, quick, effective, symptom reduction is what you need to return to your day-to-day life.

What if that's not enough?  What if you want to understand why you have these symptoms?  What if you want to make sure they don't recur?  What if you want to understand yourself better, and continue to grow and feel more whole as a human being?  What if you don't have any severely limiting symptoms, but feel generally unhappy, or find yourself in unhealthy behavioral or relationship patterns, or feel like you're not reaching your full potential? Where does that fit into this model?  Well, it doesn't.  And maybe it shouldn't, but it feels like a loss of what psychology can bring to enhancing the quality of people's lives.  Maybe this is just a problem of the priviledged. Maybe.  I will tell you this, though.  My daughter has allergies from October to April.  She goes to the doctor several times for ear infections.  They give her an antibiotic, it goes away, and she's back in a few months. She also takes allergy medicines, which probably help significantly.  The questions I have from a more holistic perspective are, is there something we can do to strengthen her immune system?  Should we be looking at changing her diet?  I don't feel like I understand or even have a framework to understand what's going on with her from a wellness/whole body perspective.

This reminds me somewhat of the differences between Eastern and Western Medicine.  I heard a story a while ago, that may or may not be true, but it's a model I like, so I'll include it.  Apparently, in communities in China, the doctor is paid regularly based on how well people are.  Her/his job is to keep people well by treating and healing the whole body.  Prolonged illness is a function of one or more of the body's systems being out of balance.  The goal is to restore balance.  Compare that to what we have here.  Antibiotics don't restore balance.  Not that I'm against them--I'm grateful.  But are we giving something up when we don't include the other?

Psychology, especially all the exciting work on attachment and brain development, has a lot to offer us in terms of our ongoing growth and well-being, as well as the quality and depth of our relationships.  Unfortunately, that is not being considered or even addressed in the larger community discussion.  It might be worth thinking about.

The Importance of Making Mistakes

If you haven't made many mistakes in your life, you haven't taken enough risks. And if you haven't risked much, you aren't reaching your creative potential.  The problem could be a fear of failure, because in our minds mistakes = failure, and all that comes with it.

A few years ago, I started thinking that I wanted to add another dimension to my practice. I thought through a number of ideas, read various articles and books, talked to colleagues, procrastinated, stalled out, felt confused, etc.  My goals at the time were vague.  I wanted to do more, take the work to another level, have a new creative challenge.  But what?  It was a time of false starts, dead ends, and disappointments. The process, though incredibly frustrating, has taught me a lot about how to learn from mistakes.

One of these mistakes was choosing to go on a local news show once/month to briefly talk about a psychological concept.  I feel embarrassed just writing about it.  I tried to keep it light (it was weekend morning news after all), but I was anxious, and I never got to communicate what I really wanted to, and it was very early in the morning, and it was awful.  But...what I realized through that experience was that I really do want to bring psychology to people where they live and work, not just wait for them to come to my office.  A big, uncomfortable step.

Fortunately, I have my share of these type of experiences that when sorted through make adding business consulting to my portfolio an obvious and exciting choice.  So join me in taking a risk. 


Fostering Creativity in the Workplace

How do we foster that creative edge among employees?   

Creative performance and productivity are directly related to the quality of the organizational culture.  A positive culture fosters clear, direct, open communication.  It increases job satisfaction which, in turn, contributes to employee investment and commitment.  

For it to be effective, organizational culture has to be created and maintained from the top, and has to be part of the mission statement of the company.  Employees need to believe they are valued to contribute at a deeper level.  

3 Key Steps:

  1. Fostering Communication:  Communication should be fostered in all directions both formally and informally.  Formal communication policies can include 360 degree performance evaluations, in which employees are also required to give constructive feedback to managers.  Managers can hold "office hours" on a regular basis to encourage drop in work-related conversations.
  2. Identifying and Nurturing Employee Strengths and Interests within the Company. 
  3. Explicitly Rewarding the Behavior You Want To See:  The culture of secrecy around rewards/incentives (raises, bonuses, promotions, etc.) doesn't foster motivation.   It is important to make the link between specific behaviors/outcomes and incentives explicit. Create clear pathways for people to follow, and make individual achievements and rewards public within the company.