In this morning’s New York Times magazine, former journalist Lori Gottlieb wrote a feature titled The Branding Cure, My so-called career as a therapist, about the dying practice of psychotherapy. As a newly minted psychotherapist, she sat in her empty office awaiting patients to flock to her door for her help. They neither flocked nor walked. They stayed away in droves.
No more traditional psychotherapy?In an effort to find out why, Gottlieb discovered that according to Dr. Katherine C. Nordal in a 2010 American Psychological Association paper titled “Where Has all the Psychotherapy Gone? that psychotherapy as we know it – or at least I know it as 50 to 60 minute face-to-face sessions with a caring and knowledgeable psychiatrist or psychologist – is quickly becoming archaic.
Meanwhile, as “managed care” has declined dramatically, “pharmaceutical companies spent $4.2 billion on direct to consumer advertising and $7.2 billion on promotion to physicians, nearly twice what they spent on research and development,” Gottlieb reported from Nordal’s paper. Increasingly more and more patients are receiving medication only – 57.8% in 2007 or 30% more than 10 years before.
I find that shocking and sad, but I know it’s true.
Having lost my only kidney (yes, I was born with one) to carelessly monitored Lithium Carbonate back in the 1970s and 1980s – iatrogenic acute endstage kidney failure – I know that unmonitored medication can be perilous.
Nordal admits at the outset that “while medication is an appropriate part of a treatment plan for many mental health disorders, psychotherapy has been documented as the preferred treatment for many common psychological disorders.” I have learned that medication PLUS psychotherapy is the best route, but that is my experience. My psychiatric experience started in the 1960s, its dark ages with precious few pharmaceutical choices.
You know about my psychiatric/psychological history – including my many medications. Monitored medications – for the most part – which means seeing a psychiatrist at least once every month or two “for an oil check,” and in most cases more – about once a week. These days, the frequency varies depending on ebb and flow of my life. And ebb and flow, it does, and not only for me, but for everyone. We do not live linear lives. We’re all hit by illnesses and hardships and psychological side balls that come out of nowhere, for no reason. It really helps to have someone to talk to, someone who is not personally invested in those soul crushing events.
You’ll find no insight in a pill bottleFor years, I’ve been saying there’s no insight in a pill bottle. And there isn’t. But it seems people don’t want insight these days. They want fast food solutions to specific problems.
Gottlieb consulted a number of branding experts and branded therapists, including Casey Truffo – “You are called to be a therapist. Are you also called to poverty?” Truffo told her that over the last 18 years, she “saw a shift from people who were unhappy and wanted to understand themselves better to people who would come in ‘because they wanted someone else or something else to change.’ Fewer people came in saying they wanted to change.”
Insight takes too much time and effort with no guaranteed time or result. Gottlieb discovered, to her horror I sensed, that an “entirely new specialized industry had cropped up: branding consultants for therapists.”
From traditional to branded psychotherapyWhat Gottlieb describes is her personal passage from traditional psychotherapist to niche psychotherapist. Branded. She had to market herself and her specific skills to prospective patients so they could find her and she could offer them what they wanted.
She balked at the idea of texting therapy, or tweeting it, or blogging it, or instant messaging it. On the other hand, if a patient can read and reread and reflect upon a message, whether in 140 characters, or a blog post or even an instant message, if that’s the way of the world, perhaps it’s worth considering, she pondered.
Gottlieb found herself consulting with therapists who were able to guide her in developing a website – here it is. She was daunted by the experience, and found herself insisting on “no bells and whistles,” but this pained process and the product, as you will see, offers a rather specific gamut of her unique services. As a “consultant” she can offer “therapeutic services” to help you “now,” plus “private” consultations “in person, by phone or by Skype,” and “reproductive counselling” as well as “executive coaching.”
Either branding or starvingGottlieb couldn’t bring herself to call herself a “Life Coach,” and I don’t blame her. After six years of rigorous psychotherapeutic training and a Masters in clinical psychology from Pepperdine University, why jump on a bandwagon of virtually anyone who’s taken a six or eight week course. So, she succumbed. She branded herself a “consultant,” had a professionally designed website put online, with Facebook, Twitter and LinkedIn feeds. She even promotes herself as a public speaker.
And you know what? I can’t blame her. She grappled with the process, found a way that she can live with herself ethically and professionally, and make a living. She doesn’t do text therapy or email therapy, I don’t think. At least, I hope not. Communicating is very different from connecting. I share Sherry Turkle‘s concerns about our need to control our lives with our thumbs and keyboards in virtual time instead of talking face-to-face with each other in real time.
There’s no tone in texting. It’s not like talking and it never will be.
Furthermore, problems take time to develop. Shouldn’t they take time to resolve?
Illustration: The Institute for Rapid Resolution Therapy