Thoughts on the Mental Health Profession and What's Next

[puporing]

Lately I have been reflecting on my own experience dealing with mental health professionals - the benefits as well as negative outcomes of my various relationships with therapists. I want to get very real and honest about my feelings on this profession as a whole, the way our society is treating mental health "problems" through the reliance of therapists, as well as share/discuss proposals as to what might be better alternatives in the near/far future. 

I think this is worth pondering as many people seem to have little resources when it comes to dealing with their mental/emotional health.

(I won't go into the spiritual aspects where therapists are clueless about and therefore misguide people in general)

One of the biggest problems I see with this profession is its very transactional nature. That someone experiencing emotional hardship (almost always through no fault of their own but their circumstances) is at the mercy of paying large sums of money to be listened to and empathized with, with no way of telling if such listening and empathizing is even genuine or simply as an exchange for payment. This very structure goes against the nature of what ailed the person in the first place – that most mental health issues stem from a lack of unconditional love/quality relationship in that person’s life. And thus, to then slab an artificially created relationship that is not out of genuine care (because there’s simply no way to know when money is involved, especially at large sums), further reinforces the idea that unconditional love does not exist and the person can only “buy” it.

The relative cost of therapy matters. Most psychologists and counselors charge somewhere between $150-$200 per a 50 minute session, while minimum wage are roughly $10-15/hr, a more than 10x rate than a minimum wage worker, who makes up the majority of the population. 

Myself and others who have tried therapy can agree that the very structure of seeing someone once a week for an hour (or less) actually helps to create a cycle of “addiction” rather than resolution. The problem is that it is much more profitable for a therapist to drag things out with a client in drip feed than to just sit and talk to them for a whole afternoon – which may be enough to set them on their way/point them to the right directions, than to keep them feeling stuck and in an emotionally vulnerable state. More and more I have come to realize that the scheduling nature of psychotherapy induces dependence rather than independence. Even if the goal was independence, this is not how most therapists today practice their craft. Every therapist I have encountered tries one way or another to “drip feed” so that I would keep coming back week after week, months after months. What simply would’ve worked better I realized, was just one very long and honest conversation to set me on my path again.

This may or may not be common, but sometimes a therapist can use their ability and position of authority to make someone emotionally dependent on them by subtly or unsubtly discourage the formation of other relationships. And then refuses to form a real connection with the client outside of their practice – thereby creating a literal hook for someone to keep paying them and coming to see them – as a friend/confidant. This is highly unethical to say the least, but I have seen this and heard about from others.

When all is said and done, therapy cannot replace real connections outside. And this is one of the main traps emotionally vulnerable and socially isolated people can fall into, and this nature makes therapy highly exploitative on the vulnerable. I do not think it an exaggeration to call it "wolf in sheep skin".

With all that said... what could possibly be the alternative? 

My proposal is simply.. that we need more training and awareness on non-violent, two-way communication, active listening, and basic “therapy” like skills, for everyone. That psychologists and therapists can only exist because we have not equipped ourselves with the ability to give and receive. My dream is that one day, we will no longer need to pay someone criminal amounts of hard-earned money for them to listen to us when we experience difficulty in our lives, that we can simply connect with one another. Is that too idealist of me? 

Perhaps meanwhile, a "transitional" phase would be more realistic, where we could work to make therapy-like services much less exploitative in nature, more accessible and affordable.

Edited May 11, 2022 by puporing

[Raze]

I’m not sure about other countries but in the USA the future of mental health is grim. There is a over-reliance of prescription drugs used often recklessly. Unfortunately backlash to this is showing in forms of anti science and toxic agendas further worsening the profession. 

[puporing]

@Raze That's another issue I didn't touch on. My view on medication is that it should be the last resort or used sparingly to help someone get to a place where they can start helping themselves. But ultimately I respect individual choices.

Edited May 11, 2022 by puporing

[Bobby_2021]

These days everything is monetized. So even talking to people about your problems is a service that has to be paid for is absurd. 

Mental health issues has a grave individual side that is often ignored. Not to dismiss the graveness of the matter, but you are the only being in the world, so why bother sharing anything with anyone. Not only that you can't share, you cannot absolutely share anything with anyone at all.

With that said, regularly exercising not watching Netflix and social media, having a purpose even if it is small, can work wonders for mental health. 

People are just too caught up in their own heads. It's mostly self inflicted.

[puporing]

17 minutes ago, Bobby_2021 said:

Not to dismiss the graveness of the matter, but you are the only being in the world, so why bother sharing anything with anyone. Not only that you can't share, you cannot absolutely share anything with anyone at all.

Not to state the obvious but what are you doing making posts here then?  And the obvious that most people I'm referring to are not at that kind of understanding.

[aurum]

@puporing

I feel part of it is that we just need higher quality mental health professionals.

I get the structural critique, but I’ve also met therapists who did not fall into this category. There are therapists who foster healthy independence and encourage clients leaving once they’re done.

And therapy in general can be a long, messy process. Some people may go but not even be willing to talk about their real issues for months or maybe even years. So I don’t think it can all be put on a corrupt mental health field.

As far as pricing, I wouldn’t say it’s ideal, but I don’t really have a better solution either. What would be the alternative? Perhaps government sponsored therapy could work, but otherwise I don’t see how you’re going to cut down on the price. Most therapists are not banking millions of dollars like a CEO. Most are just looking to fully book their practice so they can afford the basics.

So yes it’s a transactional nature, and I can see how that could become “cold” so to speak. But just about everything in modern society is a transaction. Housing is a transaction, food is a transaction, clothing is a transaction, it’s all transaction.

Transaction itself is not the problem. All healthy relationships still have an element of transaction in them. Transaction only becomes a problem when it becomes exploitative, unconscious, and generally lacks love/connection/gratitude.

It is possible in my experience to have love and transaction. The question is how do we get both? How do we have transactions based in love / gratitude / reciprocity? This is not easy and I don’t have the answer.

[puporing]

@aurum Lots of things there to address:

25 minutes ago, aurum said:

There are therapists who foster healthy independence and encourage clients leaving once they’re done.

That would seem to be the exception and not the norm. And it still doesn't address that people have such a small amount of time to go through things in each "session" - of which the length is dictated by the profession.

25 minutes ago, aurum said:

Some people may go but not even be willing to talk about their real issues for months or maybe even years.

This is about exceptions again, most people I see who are ready to see a therapist want to talk about things, but it is artificially dragged out for months and years when it could be done in much shorter time frame, and be more beneficial to that person's life if they can address things in a shorter time frame if they're ready for it.

25 minutes ago, aurum said:

As far as pricing, I wouldn’t say it’s ideal, but I don’t really have a better solution either. What would be the alternative? Perhaps government sponsored therapy could work, but otherwise I don’t see how you’re going to cut down on the price. Most therapists are not banking millions of dollars like a CEO. 

Two pronged approach would be ideal, both more public funding and, therapists charging a more reasonable sliding scale that is inclusive of low-income individuals or ones without insurance. 

25 minutes ago, aurum said:

Most are just looking to fully book their practice so they can afford the basics.

I'm really skeptical of this statement. Therapists just need an office which is often shared with others (some don't even have that and go virtual), they don't require specialized equipment or tools or input costs other than their office. 

Yes I recognize they had training and probably student debt, but that's a whole other issue that also goes with other professions.

25 minutes ago, aurum said:

Transaction itself is not the problem. All healthy relationships still have an element of transaction in them. Transaction only becomes a problem when it becomes exploitative, unconscious, and generally lacks love/connection/gratitude.

With most other things it may not be a problem, and if you are not having "mental health problems" it would be less of a problem. But someone on the brink of suicide or in a deep state of depression, it may very well have been the thing that led them to that state, that almost everything in their life has been transactional/conditional. Which is why we have hotlines and stuff but it doesn't go far enough. 

Edited May 11, 2022 by puporing

[zurew]

49 minutes ago, puporing said:

Two pronged approach would be ideal, both more public funding and, therapists charging a more reasonable sliding scale that is inclusive of low-income individuals or ones without insurance. 

Yeah its interesting to see, that in most European countries we have a Health insurance but that only covers physical issues mostly, and leaving out the mental health aspects which is just as much important.

I don't think they should charge less, but i agree with the public funding idea. If that mental health professional is good and well trained and suitable for their job, he/she should get their money. Basically they are mental doctors, and when we are talking about doctors, we know, that all doctors generally earn a very high income.

The reason why public funding or why government funding would be really good, is beacause low income people (which are mostly needed for mental health therapy) could access therapy more easier, and the second point is that psychologists and psychiatrists life and income wouldn't depend on the toxic dynamic where they need more and more mentally unwell people to get their money, they could get it automatically from government as a yearly or monthly income.

With the monthly or yearly income solution we can solve some problems that you mentioned above, the "dragging out as much hours as they possibly can, without saying anything or without really working on your problems" and the "low income people can't access therapy" problem.

Also other big problem you probably already recognised, that it lacks a holistic approach. If we take depression as an example , we can know, that it can stem from 1000 different things and sometimes it can't be find in the mind, but for example coming from having a really bad diet or bad genetics or whatever. Finding out what the root of the problem should be done in a more better way, but as you have said, therapists are not incentivised to do so, they are incentivised to exploit money from the patients.

Edited May 11, 2022 by zurew

[Bobby_2021]

With regards to pricing, I don't think brokies should be concerned with mental health when they haven't gotten their basics of life handled yet. 

Money is probably your problem, which is in turn affecting your mental health. Simply talking them out of it isn't the solution. Just find ways to make money and then worry about mental health.

Also hears about government funding therapy should not be entertained. The basics of life like nutritious food and shelter, and basic medical care need to be implemented first.

Then go into the mental health therapy subsidised by the government. 

 

[zurew]

1 hour ago, Bobby_2021 said:

Money is probably your problem, which is in turn affecting your mental health. Simply talking them out of it isn't the solution. Just find ways to make money and then worry about mental health.

 For anyone to have enough money to go to a therapist for several weeks or month you need to have a lot of money stacked up.

Most people can't afford a psychologist nor a psychiatrists even though they are working somewhere. Its a systemic problem, you try to make these problems way too simplistic. Also you don't take into account those people with severe mental health issues, who can't work that much or can't work at all, and i could list other examples too, where "just find ways to make money" won't work.

We are talking about mostly poor people. Why do you think, that people who can't afford therapy are the ones who need it the most? Just because they don't have what it takes to earn enough money to go to a therapist, or we can find some stuff systematically?

1 hour ago, Bobby_2021 said:

With regards to pricing, I don't think brokies should be concerned with mental health when they haven't gotten their basics of life handled yet. 

Good luck with getting your life ready, when you don't have any motivation, you have several mental problems, and you are depressed as hell.  This advice is okay for people who are not clinically depressed. But for people who have severe mental problems this won't work.

In some cases you need to solve the mental health issues part first, and then you can be able to do and get your other basics ready. Proper mental health is essential to get your basics handled. Also we are talking about mostly people who don't have the capability to get their basics handled on their own yet, without outside help.

1 hour ago, Bobby_2021 said:

Also hears about government funding therapy should not be entertained. The basics of life like nutritious food and shelter, and basic medical care need to be implemented first.

For countries that don't have that already in place ,sure. But those countries who have that already, they should implement it and focus on mental health too. Because nowadays you can clearly see the growing number of mental issues, and the growing number of suicides

 

You seem to focus only on the individual responsibility part, which of course is important, but we can't forget about the systemic problems.

Edited May 11, 2022 by zurew

[Gidiot]

Government-sponsored therapy and mental health services should be as common as anything and ideally would come in a package but its still an important topic, people could get a lot more out of life with the right attitude and professionals/guidance.

[zurew]

4 minutes ago, Gidiot said:

Government-sponsored therapy and mental health services should be as common as anything and ideally would come in a package but its still an important topic, people could get a lot more out of life with the right attitude and professionals/guidance.

Yeah, i agree. Its all in one package. We need more individual responsibility, but we also need to work on the systemic issues part too.

Ideally, we would want a society where most people are okay on their own, but if they need help, they should be able to get it without much friction.

[Bobby_2021]

Mental health crisis is a problem in hyper individualistic cities were people have isolated themselves despite being surrounded by lots of people.

We are supposed to live dependent on each other.

To solve this we need to bring back communities and mutual support systemically. Even right now most of the homes in Europe in many suburbs are empty simply because such homes are their second homes. Here is India, a good number of homes are empty as they migrate to US/Europe. 

The point is that we have to design cities in a different way that would enable interaction with people.

Super blocks are one solution.

All services you need like hospitals shops etc will be at a walking distance. Cars won't be entertained too much. 

Children will have more grounds to play with etc... instead of being glued to a flickering screen checking out how other lives.

You rarely see kids in the country side suffering from mental health issues. It's not as prevalent as in the cities.

[Ulax]

I think that approach may be useful for non-trauma focused therapy.

However, trauma focused therapy requires a lot of training, and specific approaches that sometimes require talk therapy and sometimes don't. Sometimes its counter-productive to talk through an issue, i.e. retraumatising. So, trauma therapy I don't think could be generalised.

And, ye the state of therapy is absolutely fucked. But unless there's a very strong shift to democratic socialism, most countries aren't going to change. Its not really the fault of the therapy industry, its a result of the governmental systemic failings.

Its v fucking tough to get a good therapist too. Lot of charlatans out there. Also, at the beginning, a lot of folks are attracted to toxic folks too, so don't act on red flags or even identify them, when its most useful too.

I don't think all therapists are clueless re spirituality. Transpersonal, psychosynthesis and IFS all incorporate spirituality. 

Some therapies are a joke tho. Like they'll help, i.e. cbt. But they aren't a long term solution by any means. Anecdotally, i had a friend who im pretty sure had npd do cbt claiming he'd been saved. Safe to say he certainly was not lol.`

 

[zurew]

31 minutes ago, Ulax said:

However, trauma focused therapy requires a lot of training, and specific approaches that sometimes require talk therapy and sometimes don't. Sometimes its counter-productive to talk through an issue, i.e. retraumatising. So, trauma therapy I don't think could be generalised.

I think, that the point is not to make trauma therapy generalised, but to make a system that can correctly recognize the root problems.

There should be a system made, which is more holistic and taking into account a lot of stuff in order to recognize where the problems are coming from, once the problem is correctly recognized, the solution is 50% on its way.

And i also agree with you, that there are aspects to this problem that can't be solved by any therapy but must be solved on a systemic level (in politics, and in economics and in education etc)

[Philipp]

Instead of blaming therapist, you could also blaim the care drain which led to the fact, that many did not get enough care in society and are now so needy. 

Of course the transactional nature is not perfect, but it is still a high quality service that demands a lot of ressources from the therapist. I don't think it is an easy job to listen and empathize with someones deep problems multiple time per day. You wouldn't do it yourself on full time basis for people you don't know, if you would not charge a decent price. For many I also believe that they need therapy in weekly basis instead of a one time thing, but I get you dependency issue, which seems problematic. 

Therapy could definitely be improved, but that counts for almost all professionals. 

In Europe I found trained therapists who only charge 60€ (~70 $) and psychotherapy shool is not paid here either, but I am sure it costs less than in the US. 

[puporing]

9 hours ago, zurew said:

I don't think they should charge less, but i agree with the public funding idea. If that mental health professional is good and well trained and suitable for their job, he/she should get their money. Basically they are mental doctors, and when we are talking about doctors, we know, that all doctors generally earn a very high income.

Most in my experience are really mediocre at the job, and don't even really understand depression (like it's possible you could do it better judging by the way you respond to posts). I think it's similar to that if someone hasn't had a direct experience it's hard for them to really "get it".

The good ones are super rare and only those I would say perhaps give the kind of value they are charging people. I also doubt that the kind of schooling is really necessary (undergrad + grad). In actual practice therapy requires a lot of creativity, and other characters like empathy, big picture thinking, mediation skills, almost none of that is something you get from an undergrad education but through your own perosnal growth, and practice with people.

8 hours ago, zurew said:

Ideally, we would want a society where most people are okay on their own, but if they need help, they should be able to get it without much friction.

Yes that pretty much sums up the lot of the deficiencies we should be addressing collectively. 

5 hours ago, Philipp said:

Instead of blaming therapist, you could also blaim the care drain which led to the fact, that many did not get enough care in society and are now so needy. 

I'm saying that the current way we're using therapists to address mental health issues is very poor and miss most people who can't afford, and ones who can still struggle with them. Of course it's a bigger issue altogether, Gabor Mate talks about that in such a holistic way. That stress on parents gets passed on to their children, which stem from survival struggles, intergenerational trauma, etc.

6 hours ago, Ulax said:

Its v fucking tough to get a good therapist too. Lot of charlatans out there. Also, at the beginning, a lot of folks are attracted to toxic folks too, so don't act on red flags or even identify them, when its most useful too.

I don't think all therapists are clueless re spirituality. Transpersonal, psychosynthesis and IFS all incorporate spirituality. 

Yes it is.
 

And I guess I'm talking about mostly the "conventional" therapists, where most people end up with. I think you would have to search beyond your physical location (usually) if you were to find someone trained in that/versed in spirituality.

Edited May 11, 2022 by puporing

[zurew]

12 minutes ago, puporing said:

Most in my experience are really mediocre at the job, and don't even really understand depression (like it's possible you could do it better judging by the way you respond to posts). I think it's similar to that if someone hasn't had a direct experience it's hard for them to really "get it".

The good ones are super rare and only those I would say perhaps give the kind of value they are charging people. I also doubt that the kind of schooling is really necessary (undergrad + grad). In actual practice therapy requires a lot of creativity, and other characters like empathy, big picture thinking, mediation skills, almost none of that is something you get from an undergrad education but through your own perosnal growth, and practice with people.

Yeah, the education part should definitely be corrected. Creativity is a big element to it, because in mental health we don't see any "laws" like in physics that would seem really consistent, we mostly have models  that are built upon a lot of empirical evidence. So, because of the lack of laws to rely on, it leaves a big room for creativity to how to solve certain problems, and even how to approach them. There is no one way how it could be done, and most likely everyone should find their own therapist and its good that there are different kind of therapists, because one category couldn't fit all, imo.

But there should be a system, that can connect people to the right therapists that are most likely will fit them the most.

[puporing]

50 minutes ago, zurew said:

There is no one way how it could be done, and most likely everyone should find their own therapist and its good that there are different kind of therapists, because one category couldn't fit all, imo.

Yes exactly. Seems that one has to find someone compatible or at/above their level of growth to find it helpful. So the key to have better therapists is that they themselves be committed to growth and practice what they "preach".. 

[ZenSwift]

Here's my thoughts. 

 

Most people in the mental health profession don't even have their own mental health sound. Having low integrity with getting their own shit together, while trying to help others get their shit together. 

Most therapists suck. An actually good therapist will get rid of 100 pounds off your shoulders in the first session. Getting way more than your moneys worth. 

It's really shitty with the society structure, that people that need it the most, can't afford it, or have their life too chaotic to even make the time. 

 

On another note, many people that see a therapist assume that they don't have to do any of the work and don't lean in. Having a fantasy that they can solve all their problems by just showing up once a week, assuming that's 99% of the work when it's actually 1%.

In practice, a therapist will be a catalyst, and then the other 99% of the work is your own integration. Just like a psychedelic trip.

 

Personally the way I like to go about it is as follows: I would see a therapist specifically for a trauma release, to identify those really tough sticking points, like EMDR. Then I do a deep psychedelic trip about that point in my own time, then I would get a life coach for everything else.