There’s an interesting alternative to the student loan model of financing education floating around: In essence, sell stock in yourself.
Training in mental health is unreasonably long
Just as a quick thought experiment, go over to this piece at Slate discussing medical training, and every time it references “medicine” change that to “mental health.” (Accordingly, change “physicians” and “doctors” to “therapists.”) You’ll find most of it applies perfectly. To wit:
Over the past century, there have been additions to, but few subtractions from, the training process. Residency and fellowship programs became longer and longer … and longer.
and
The long process doesn’t just weed out the incompetent and the lazy from the potential pool of physicians—it deters students who can’t pay for so many years of education or who need to make money quickly to support their families. That introduces a significant class bias into the physician population, depriving a large proportion of the population of doctors who understand their background, values, and challenges.
and
The fundamental problem here is that the argument between traditionalists and reformers [debating the appropriate length of training] is essentially theoretical — we are in an evidence vacuum.
In the time I’ve been in academia, I’ve watched as the requirements for training in mental health have increased dramatically. Family therapist training in California increased from 48 to 60 units based not on science but on workplace competitiveness. (MFTs were fighting clinical social workers for some of the same jobs, and since LCSWs need 60 units of training, MFTs couldn’t really argue that their training at 48 units was equivalent.) I’ve also watched as education in general has gotten much more expensive, and loans harder to come by. And I’ve been enlightened by learning that our 3,000-hour supervised training requirement is based entirely on tradition, and is in virtually no way linked to the science that we now have available (though admittedly, it isn’t much) on how therapist skill develops over time.
Our old apprenticeship model is broken. It’s as true in therapy as it is in medicine. It will be interesting to see how experimentation with medical training goes, as it can blaze the trail for similar efforts in other health care professions like ours. I’m just not sure we should be waiting for doctors to do it first. # # # Your comments are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.Wisconsin legislature supports mental health — just not therapy
One of the more disturbing trends I’ve seen in the mental health landscape lately is policymakers voicing support for mental health care, but not actually providing funding for anything but medication and crisis intervention.
Lots of states reduced their funding for psychotherapy during the economic downturn, and now that the economy is slowly churning back to life, there seems little appetite to restore that money so that people struggling with mental illnesses who may not be actively in crisis can be seen regularly by a therapist.
Case in point: Wisconsin, where the state’s legislature this week sent Governor Scott Walker fully a dozen bills under the banner of promoting and expanding mental health care in the state. The bills will spend a total of $4 million over two years, and the Milwaukee Journal Sentinel report on the mental health bills begins by saying the money will be spent on “treatment,” among other things, which sounds great at first. But the details of the article make clear where the money’s going, and it isn’t to psychotherapy.
Many of the bills don’t actually spend much money at all. One bill, for example, would allow “children with severe emotional disabilities to get in-home treatment through taxpayer-funded Medicaid programs without first requiring them to fail in outpatient treatment, as currently required.”
That’s certainly laudable, and as is the case with most of these bills, I do think they’re important and worthy of support. (The only ones I’m less sure of policy-wise are those that make involuntary commitment easier.) Just pointing out that the state is focusing its money on just about everything but psychotherapy, in spite of reams of evidence that therapy works.
What are they actually spending those millions on? These:
- $250,000 in grants for mental health crisis intervention teams of law enforcement officers.
- $1.5 million in grants for physicians and psychiatrists to practice in rural areas.
- $250,000 in grants for “respite centers” run by (non-therapist) peers, for those in a mental health or substance abuse crisis that warrants attention but not hospitalization.
- $970,000 to expand a state program that helps find jobs for people with mental illnesses.
- $250,000 a year for mobile intervention teams to respond to mental health crises in rural areas.
There you have it: More than $3 million on mental health care (expenses from the other bills bring the total to about $4m, according to the Journal Sentinel), spent entirely on crisis intervention, law enforcement, medical practitioners, and peer supports. Those are all worthy expenses, but psychotherapists get nothing? That seems sort of like building a house without a place to sleep: Missing not just a key component, but arguably the most essential component.I’m not from Wisconsin, so it may well be that therapists in the state are doing just fine, thankyouverymuch. But I doubt it. I would welcome Wisconsinites to weigh in.
# # #
By the way, there’s of course a reasonable debate to be had about the overlap between “crisis intervention” and “therapy.” Psychotherapists do a fair amount of crisis work. My point is that no money is being put into even short-term psychotherapy beyond an immediate crisis, which typically means something life-threatening.
Your comments are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.
The four biggest MFT Progress Notes posts of 2013
New documentary tackles the divorce industry
DivorceCorp opens in January. It looks great — with one little caveat.
Divorce is big business. Many people can have a hand in the divorce process: lawyers, mediators, custody evaluators, therapists, court systems, and others all say they want to help divorcing couples. And all want to be paid for their services. The entire system can suffer from what might rightly be called perverse incentives — strong pulls for people to act in ways that are more out of self-interest than the true long-term best interest of the couple they claim to be trying to help.
This is the thrust of the documentary DivorceCorp, opening in major cities January 10. The movie looks good and important. Dr. Drew narrates, and it features interviews with some well-known law experts, including Gloria Allred. Here’s the trailer: More information on the film, including local theaters showing the film when it opens, can be found on the official DivorceCorp website. One cautionary note, though: The opening statement in the trailer, “50% of all US marriages end in divorce,” is wrong. As you can read about in more detail over at the excellent DivorceSource web site, the US divorce rate probably never topped 41% and has been declining for several years. As Tara Parker-Pope documented quite well in her book For Better, divorce rates are especially low among those with at least a college education. Over Twitter, the film’s reps have said that there were bigger fish to fry, so to speak. I get that. They’re looking at an entire divorce industry, and my caution is with one statistic. I believe the social conversation about the divorce rate is one specific part of the larger social conversation about divorce that especially needs to change, for reasons I’ll save for a separate post, but don’t let that take you away from the big picture. I’m happy to support the film and eager to see it. # # # Your comments are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.