Third Party Invasions Into Private Conversations - Revisited

There was a comment from an anonymous NY Clinician concerning my statement about “available to make decisions about loans for your house…(1)” That prompted me to ask myself, “Where did I get that idea? Then, I remembered that I was listening to a internet radio show with the host, John A. Riolo PhD (2), on the Psychjourney website (3).

I listened to his program with his guest, Susan Frager (4), called “Managing Managed Care.” During the program, John asked, “Say you want to buy a house. Most people need to buy a house. They need to get life insurance to cover the mortgage. The bank expects it. I’m wondering. I do not know of a particular case. But I am sure there are certain situations. Where if you go apply for life insurance to cover your mortgage and you have a diagnosis, that is not exactly real, you may be denied that life insurance and the mortgage company may not want to cover your mortgage. I am guessing at that. I honestly do not know of a particular case but is it a plausible situation?” Susan replied, “I do not know about the house part. Being that I just bought a house and nobody asked me about life insurance. But certainly life insurance companies will deny you or increase your premium and reduce your benefits.”

Afterwards, I went to the interview program that John had with guest, Michael Freeny (5), called “How Private Are Your Records.” During the program, Michael stated, “Its how your medical record link up with other elements of your life and the impact that has on, for example, things that you think would be pretty unusual. Like, getting a loan, getting a credit rating, getting into college, getting a job. Things that you would think your medical record would not even be a component of it.”

I would like to thank the NY Clinician for bringing this issue to the forefront in genuine hopes of increasing our understanding. I appreciate how the NY Clinician’s comment enabled a chance at dialogical collaboration in hopes of increasing all of our possibilities for ongoing understanding of what is happening to privacy in the mental health field. This shows the true spirit of this weblog called “Collaborative Possibilities.”

Footnotes:

1) Refer to blog on September 22, 2004

2) http://www.moosemeals.com/labyrinth.htm

3) http://www.psychjourney.com/

4) http://www.otr-therapy.com/

5) http://www.clinicalceu.com/

The Medical Model Monopoly

I am going to be very critical of the Medical Model (1) and their attempts at domination within the mental health field. I do believe that medications and diagnosis may be one appropriate way consumers want to go when it comes to treatment. However, I think that what is more appropriate is getting accurate information to the public as a form of informed consent. In my opinion, the Medical Model's attempts at domination in order to monopolize mental health as "their way is best practice" has to be confronted.

I constantly get bombarded with fear tactics when I go to ethics courses that are mandated to keep my licensure. A better suited title for these ethics courses should be called "How to cover your ass when sued." I keep hearing the ridiculous catch phrases of the day which include: "Best Practices and Standards of Care." Then comes the scare tactics about how lawsuits are on the increase. Instead of learning from the lawsuits in order for the profession to change and grow, we learn, "Document, document, document." You will be safe, as long as you follow the Medical Model procedure and document it well. It does not matter if the client has been harmed as long as you have documented what you did and most of all "Cover your ass." Your license to practice will be revoked if you do not follow the Medical Model Monopoly with the appropriate documentation. In other words, using a Star Trek "Borg" analogy, "You will be assimilated, resistance is futile."

The Medical Model's attempts at holding mental health hostage will be discussed further in the upcoming blogs. Due to time constraints, I have to start writing one blog per week. I look forward to continuing to spread the awareness about what I perceive as happening within the mental health field. Feel free to write your comments about any of these blogs. Thank you for reading.

(1) Refer to blog on September 15, 2004

Third Party Invasions Into Private Conversations

There was a day in which counselors/consumers were protected by priviledged confidentiality. Now that is all starting to change.

At first, I thought the change was very good idea for society in some cases. For instance, having the duty to warn if someone states that they are out to kill someone or reporting child abuse/neglect.

Now comes the extreme invasion of privacy disguised as a consumer protection law. This new law is called The Health Insurance Portability and Accountability Act of 1996 (HIPAA). I believed HIPAA was designed to allow for electronic billing to be more accessible with your informed consent. Most people believed that it adds more protection to their privacy. What is not commonly known is that HIPAA has opened the floodgates for the invasion of your privacy. Insurance companies can get your mental health diagnosis. Then your information is available to make decisions about loans for your house or ability to get affordable life insurance. Those were just a couple of examples about the devastating effects this invasion to your privacy could be.

I will include some links that you can explore for a more detailed picture of your privacy rights being invaded.

The National Coalition of Mental Health Professionals and Consumers, Inc.

The Myth of Confidentiality

HIPAA applauded for mandating uniform electronic transmissions, but raises privacy and security concerns

The War On Mental Health: Outcome Research

Third party payers of your mental health needs are demanding that there are good outcomes in mental health counseling. This all makes sense. You should get good quality services when you go to a mental health counselor. However, their approach to quality research and sound information appears to be highly flawed with a definite agenda in mind. The Medical Model (1) ,with all its money, is attempting to limit the legitimate choices of what therapy consumers receive. The Medical Model is attempting to justify that medications and Cognitive Behavioral Therapy (2) combined is the best approach to your mental health.

I received a newsletter in the mail that was sent from the Washington State Department of Health (WSDH). The WSDH is the entity that licenses all the mental health disciplines. In this newsletter, the following was stated:

Avoiding the Medical Model

Faced with the complexities of informed consent, standard of care, note taking, etc., some therapists have tried to opt out of these requirements by simply taking the position that they do not believe in, or endorse the medical model, and therefore they should not be held to it. This has the same effectiveness as reporting to the Internal Revenue service that you do not believe that the tax laws are valid, and that you should not have to comply with them. The medical model will generally be imposed with or without your agreement.
Brandt Caudill Jr., Clinical Social Work Federation Newsletter, November 2003.

It appears that the mental health field has gone to war over research protocal for informed best practice. It is time for the heroes to emerge in order to start leveling the battlefield. There is a book available called "The Heroic Client: Doing Client-Directed, Outcome-Informed Therapy"(3) that confronts false claims in the mental health field. The authors of this book have websites that you may want to explore (4) and (5). This grassroots organization seek to take back the field of mental health and finally give the consumers a voice along with truly ethical work with mental health counselors.

Footnotes:
(1) refer to September 15, 2004 blog

(2) refer to September 16, 2004 blog

(3) http://www.amazon.com/exec/obidos/ASIN/0787972401/qid=1095789424/sr=ka-3/ref=pd_ka_3/002-1802842-2709649

(4) http://www.talkingcure.com/

(5) http://www.heroicagencies.org/

Therapies of Social Construction (Postmodern Therapies)

I guess you could look at the Medical Model (1) and Individualized Therapies (2) as a first wave in mental health. Family Systems Therapies (3) can be viewed as a second wave. It appears that consumers are rarely informed about a third wave of mental health counseling. This third wave I refer to is Postmodern Therapies as described by Lois Shawver (4).

After many years of working in the mental health field, I have come to appreciate the many ways that we can story our problems and develop our solutions. Social Constructionism is about how we story the world we live in. Social Construction Therapies work with the clients to explore stories that may have a better fit for them and their lives.

These models include Solution Focused Brief Therapy (5) , Narrative Therapy (6) , and Collaborative Therapy (7). Harlene Anderson has a wonderful paper that compares and contrasts these three models (8).

These models reflect my work better than that of the first two waves of mental health counseling. However, consumers are rarely aware of any differences in how therapy can be conducted.

Footnotes:
(1) Refer to September 15, 2004 blog

(2) Refer to September 16, 2004 blog

(3) Refer to September 17, 2004 blog

(4) http://www.newtherapist.com/lois6.html

(5) http://apt.rcpsych.org/cgi/content/full/8/2/149

(6) http://www.massey.ac.nz/~alock/virtual/narrativ.htm

(7) http://www.harleneanderson.org/writings/postmoderncollaborativeapproach.htm

(8) http://www.harleneanderson.org/writings/postmoderntherapieschapter.htm

Family Systems Perspective

I made a startling discovery as I continued my studies in college about the different approaches to counseling. I wanted to make sure that I would be able to work in the in the counseling field so I decided to take some substance abuse courses. I wanted to become a substance abuse counselor if I was not accepted into graduate school. I was exposed to the Family Systems Perspective during one of the substance abuse courses. Later, I was accepted into a very good graduate program and received my Master's degree in Marriage and Family Therapy that taught me the Family Systems Perspective.

This perspective viewed individual behavior and emotional symptoms in relation to the family interactional patterns as well as a larger context. No longer was an individuals symptoms viewed as only existing within the individuals cognitions, emotions, and behaviors viewed in isolation. The Family Systems Perspective brought forth another world view as to how to approach human problems such as mental illness, marital, children, and family problems.

Click on this link (1) for more information about the Family Systems Perspective. Also, the different Family Systems models include Structural Family Therapy (2) , Bowenian Family Therapy (3), Strategic Family Therapy (4), and the Satir Model Family Therapy (5) .

Footnotes:
(1) http://www.aamft.org/faqs/index_nm.asp

(2) http://ccp.colstate.edu/balt/Structural%20MFT_files/frame.htm

(3) http://www.psychpage.com/learning/library/counseling/bowen.html

(4) http://www.psychpage.com/learning/library/counseling/strategic.html

(5) http://satircentresingapore.tripod.com/

Cognitive Behavioral Therapy: Best Practice?

When a student learns to become a mental health counselor, he/she has to study many different models of therapy. When I was a student, I remember watching a 1950's study called "The three approaches to Gloria." Gloria was a woman looking for counseling and volunteered to be interviewed by the three dominant therapy models at the time which were: Client-Centered Therapy (1) , Gestalt Therapy (2), and Rational-Emotive Behavior Therapy (3). Many therapy models have been developed since the Gloria interviews.

The Medical Model folk have been working diligently to corner the market of mental health. They have funded many studies to show that Cognitive-Behavioral Therapy (4) has the cornerstone of effectiveness. They are actively lobbying the government, insurance companies, and managed care to try to demonstrate the need for everyone to be treated with Cognitive-Behavioral Therapy. Cognitive-Behavioral Therapy and its proponents claims of being a superior method indicates a very dubious plan that may be harmful to many consumers.

I will introduce to you many other effective models and approaches to therapy that may be just as well, if not better, suited to meet your needs. Consumer awareness, consumer voice, and appropriate outcome information needs to come to the forefront before we are led into a direction that may be disastrous for many consumers.

Footnotes:
(1) http://world.std.com/~mbr2/cct.html

(2) http://www.aagt.org/html/chapter.HTM

(3) http://www.rebt.org/

(4) http://www.nacbt.org/whatiscbt.htm

The Famous Medical Model

I am almost certain that most of you have heard about the Medical Model. The Medical Model is famous for the invention of the Diagnostic and Statistical Manual (DSM) that is currently available in its fourth revision. The DSM is where you find the famous diagnoses such as Major Depressive Disorder, Social Anxiety Disorder, Bipolar Disorder, Schizophrenia etc... The Medical Model is based on the theory that problems which bring you to therapy are organic in nature. Thus, our environment along with our genetic make up can trigger our brain chemicals to get out of balance which create symptoms that, when clustered together, become mental disorders. The idea is to treat those consumers who have to get those brain chemicals back into balance in order to be in normal working condition which means the reduction of symptomology.

Out of the five major mental health professions (Psychiatry, Psychology, Social Work, Mental Health Counseling, and Marriage and Family Therapy), the psychiatrist is the only professional that can prescribe (psychotropic) medications for DSM disorders. Recently, psychologists have been lobbying for prescription rights and have been able to prescribe these medications in some areas of the United States.

Pharmaceutical Companies have been developing famous medications such as Prozac, Zoloft, and Ritalin. The popularity of these medications have grown over the years and many of them are now household names. The pharmaceutical companies, psychiatrists, and the other mental health professions have gone to many lengths to convince the public of the truth about the legitimacy of the Medical Model. Upcoming blogs will explore these claims , introduce other possibilities, and discuss the politics within the mental health professional discipline.

Background of Collaborative Possibilities

I am really excited to introduce the inspiration behind the creation of this weblog. I have a deep passion for giving service to people who have psychological and/or interactional difficulties in their lives that lead them to get help from outside professionals. There are many success stories that come from relationships with professionals who seek to help others in psychological and interactional pain. However, I believe that there has been a lack of informed consent to the consumer of these professional services that has led to consumer detriment. As a Licensed Mental Health Counselor, I would like to inform the consumer of the political implications towards how they are treated within the mental health system. I want to assist in creating an atmosphere that would inform more thought towards how mental health is viewed in our culture and to deepen our explorations to further the possibilities of really getting the genuinely effective/ethical services that all consumers of mental health deserve. With your awareness and voice, the services by mental health providers can be even better than ever before. I look forward to taking this journey with you all.