Getting the most up-to-date treatment for an anxiety disorder can be a challenge. There is a big disconnect between what we know about how to swiftly and successfully treat anxiety disorders and what mental health professionals in your community may know. Count yourself a great consumer advocate or lucky if you have found a well trained CBT professional experienced in treating individuals with anxiety disorders. In fact, the existence of this disconnect is why I put time and energy into this website and blog.
Why are so many mental health professionals so very behind in their knowledge when there are extremely effective therapeutic treatment options that are proven in hundreds of studies to work? I have some hypotheses: firstly there are always differences in theoretical orientations that exert a powerful defining force on how any mental health practitioner works. If you are trained in psychoanalytic theory you conceptualize problems consistent with Freud’s beliefs that what heals people is making the unconscious conscious, therapist as a blank screen, with some interpretation of defenses all while free associating (saying whatever comes to mind in an uncensored manner), 4-5 days per week for many years duration. I know psychoanalysis well, I participated in it for 2 years when I was a young mother and do not feel that it was helpful except that it provided support, like a friend might. Still other orientations focus on object relations; the quality of current relationships and the healing quality of having a healthy relationship with the therapist. There are still other theoretical orientations under which therapists practice.
I generally have no problems with other orientations in most cases. Consumers are free to choose how long they wish to be in treatment, what type of therapy and therapist they prefer and how much money they wish to spend. But I do have a problem when a typical patient, who usually comes to a therapist in distress to receive a professional level of evaluation and treatment, is mislead or misdiagnosed because that particular therapist simply is operating with outdated knowledge. We therapists are in a position of great power when a patient comes to us in distress. They want help desperately and have come to us as experts. They are typically willing to take what we have to say to heart and work in the directions which we suggest. We are taught in graduate school to be mindful of this inherent power differential and to never abuse it. I believe that therapists do, indeed abuse this power when they dispense advice or services for which they are not qualified or about which they are not up to date.
Here is an example such a situation that I heard on a nationally syndicated self help radio show (Dr. Laura) last week. By the way, I generally think that she is helpful to many people and thousands of people buy her books and follow her recommendations without question. I would characterize Dr. Laura as eclectic in terms of her theoretical orientation. Whenever I hear a caller with what I can see is a clear anxiety disorder, I have to shut the radio off, because she almost always gets it wrong and I genuinely feel badly for the caller who is panting for her advice. The caller presented with what I would consider to be a diagnosis of Generalized Anxiety Disorder or possibly Obsessive Compulsive Disorder. Dr. Laura’s conceptualization and hence advice to the caller reflected a very dated and now inaccurate level of knowledge about these disorders. It was really a Psychoanalytic take on the disorders: the patient has repressed anger that is leaking out into consciousness in a mixed up way as excessive fear and worry about harm coming to a mother’s small child. The mother reported to Laura that she was tormented by what she considered “irrational fears” (the mother’s actual words)about harm coming to her daughter. She said she worried daily about this and other things, in spite of knowing that there were no solid reasons for the level or worry. Dr. Laura asked the mother what she resented about being a mother, what she resents having to sacrifice, etc. Then Dr. Laura continues to tell the mother that she has repressed hostility about being a mother that is coming out into consciousness as excessive worry. Poor mother, now she can figure out all of her repressed hostilities about being a mother (though she may have to invent some if she has none) maybe get a lot of reassurance form a therapist, maybe feel a little better after being reassured, but ultimately will not get better. I honestly believe that if Dr. Laura learned about CBT and specifically gained some knowledge regarding the advances in evaluation and treatment of anxiety disorders that have evolved over the past decade, she would be on board. She is dispensing advice that is outdated, potentially misleading and at worst harmful to the patient
This leads me to a second hypothesis regarding the disconnect in what we know in the field and what mental health professionals are prepared and able to provide. People are scared to stretch themselves and be in a learning position. When I retooled my practice over ten years ago, I had to essentially re do a post doctoral fellowship, for two years! Now, I am pleased and feel fortunate that several very well regarded mental health professionals in my city are learning from me. These are people who are at the very top of their games: renowned child psychiatrists and psychologists, currently. Perhaps they do so well because they recognize the need to keep abreast of what works best to treat their patients.
This disconnect was brought up at the Association for Behavioral and Cognitive Therapies conference several months ago, where the scientists who do all of this great research and really are in the trenches of figuring out what works and for whom convene every year. They are puzzled as well. There was talk of getting in front of first line practitioners, such as neurologists, pediatricians and general practitioners, who often make initial referrals for mental health treatment. In this regard, thanks to a vigorous push and a grant from NIMH to educate neurologists (they are typically consulted first when tic disorders are present) about how effective CBT is in treating Tourette’s Disorder, neurologists are now making much better referrals that, most importantly are helping their patients.
Whatever the reason for the disconnect, it is my mission to help bridge the gaps in any ways that I can, so that more people can get the appropriate treatment and get better quickly! That is why I do what I do: to help people. Thus, as readers, you are helping to bridge the gap because you are becoming more informed and hence can serve as better advocates in finding the appropriate, up-to-date mental health services when either you or a loved one needs it. Thank you for reading!