Tag Archives: therapy

Anger Control

anger

We have all experienced anger in one form or another. However, some people may find themselves feeling angry more often than the people around them.
Here is an article that may help you, or even someone you know, to manage anger.

*Please keep in mind that here at Apex Behavioral Health Western Wayne we have staff that may be able to help you overcome your anger. Please call us at 734-729-3133 to schedule an appointment.

Talk doesn’t pay, so psychiatry turns to drug therapy

Via the New York Times

Doylestown, PA – Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.

But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

Like many of the nation’s 48,000 psychiatrists,  Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy. Instead, he prescribes medication after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist.

Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday. Like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart.

Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

Dr. Levin has found the transition difficult. He now resists helping patients to manage their lives better. “I had to train myself not to get too interested in their problems,” he said, “and not to get sidetracked trying to be a semi-therapist.”

A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients. Apex Behavioral Health provides both psychiatry (medication management) and psychologists (counseling) to our clients. Clients are able to see both the psychiatrist and therapist in the same building; often, our psychiatrists will refer their patient to a therapist and vice versa.

Recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression, which is why it is really beneficial to see a therapist. Insurance company reimbursement rates and policies that discourage talk therapy are part of the reason. A psychiatrist can earn $150 for three 15-minute medication visits compared with $90 for a 45-minute talk therapy session.

Competition from psychologists and social workers — who unlike psychiatrists do not attend medical school, so they can often afford to charge less — is the reason that talk therapy is priced at a lower rate.

Of course, there are thousands of psychiatrists who still offer talk therapy to all their patients, but they care mostly for the worried wealthy who pay in cash. In New York City, for instance, a select group of psychiatrists charge $600 or more per hour to treat investment bankers, and top child psychiatrists charge $2,000 and more for initial evaluations.

When he started in psychiatry, Dr. Levin kept his own schedule in a spiral notebook and paid college students to spend four hours a month sending out bills. But in 1985, he started a series of jobs in hospitals and did not return to full-time private practice until 2000, when he and more than a dozen other psychiatrists were shocked to learn that insurers would no longer pay what they had planned to charge for talk therapy.

“At first, all of us held steadfast, saying we spent years learning the craft of psychotherapy and weren’t relinquishing it because of parsimonious policies by managed care,” Dr. Levin said. “But one by one, we accepted that that craft was no longer economically viable. Most of us had kids in college. And to have your income reduced that dramatically was a shock to all of us. It took me at least five years to emotionally accept that I was never going back to doing what I did before and what I loved.”

He could have accepted less money and could have provided time to patients even when insurers did not pay, but, he said, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.”

“Nobody wants to go backwards, moneywise, in their career,” he said. “Would you?”

Dr. Levin would not reveal his income. In 2009, the median annual compensation for psychiatrists was about $191,000, according to surveys by a medical trade group.

Dr. Louisa Lance, a former colleague of Dr. Levin’s, practices the old style of psychiatry from an office next to her house. She sees new patients for 90 minutes and schedules follow-up appointments for 45 minutes. Therapists at Apex Behavioral Health see clients for 45 minutes to an hour. Everyone gets talk therapy. Cutting ties with insurers was frightening since it meant relying solely on word-of-mouth, rather than referrals within insurers’ networks, Dr. Lance said, but she cannot imagine seeing patients for just 15 minutes. She charges $200 for most appointments and treats fewer patients in a week than Dr. Levin treats in a day.

“Medication is important,” she said, “but it’s the relationship that gets people better.”

Dr. Levin’s initial efforts to get insurers to reimburse him and persuade his clients to make their co-payments were less than successful. His office assistants were so sympathetic to his tearful patients that they often failed to collect. So in 2004, he begged his wife, Laura Levin — a licensed talk therapist herself, as a social worker — to take over the business end of the practice.

Ms. Levin created accounting systems, bought two powerful computers, licensed a computer scheduling program from a nearby hospital and hired independent contractors to haggle with insurers and call patients to remind them of appointments. She imposed a variety of fees on patients: $50 for a missed appointment, $25 for a faxed prescription refill and $10 extra for a missed co-payment.

As soon as a patient arrives, Ms. Levin asks firmly for a co-payment, which can be as much as $50. She schedules follow-up appointments without asking for preferred times or dates because she does not want to spend precious minutes as patients search their calendars. If patients say they cannot make the appointments she scheduled, Ms. Levin changes them.

“This is about volume,” she said, “and if we spend two minutes extra or five minutes extra with every one of 40 patients a day, that means we’re here two hours longer every day. And we just can’t do it.”

She said that she would like to be more giving of herself, particularly to patients who are clearly troubled. But she has disciplined herself to confine her interactions to the business at hand. “The reality is that I’m not the therapist anymore,” she said.

Ms. Levin, 63, maintains a lengthy waiting list, and many of the requests are heartbreaking. On a January day, a pregnant mother of a 3-year-old called to say that her husband was so depressed he could not rouse himself from bed. Could he have an immediate appointment? Dr. Levin’s first opening was a month away.

“I get a call like that every day, and I find it really distressing,” Ms. Levin said. “But do we work 12 hours every day instead of 11? At some point, you have to make a choice.”

Initial consultations are 45 minutes, while second and later visits are 15. At Apex, initial consultations are 30 minutes, while the second visits are also 15 minutes. In those first 45 minutes, Dr. Levin takes extensive medical, psychiatric and family histories. He was trained to allow patients to tell their stories in their own unhurried way with few interruptions, but now he asks a rapid-fire series of questions in something akin to a directed interview.

In 15-minute consultations, Dr. Levin asks for quick updates on sleep, mood, energy, concentration, appetite, irritability and problems like sexual dysfunction that can result from psychotropic medications.

“And people want to tell me about what’s going on in their lives as far as stress,” Dr. Levin said, “and I’m forced to keep saying: ‘I’m not your therapist. I’m not here to help you figure out how to get along with your boss, what you do that’s self-defeating, and what alternative choices you have.’ ”

Dr. Levin said that the quality of treatment he offers was poorer than when he was younger. For instance, he was trained to adopt an unhurried analytic calm during treatment sessions. “But my office is like a bus station now,” he said. “How can I have an analytic calm?”

And years ago, he often saw patients 10 or more times before arriving at a diagnosis. Now, he makes that decision in the first 45-minute visit. “You have to have a diagnosis to get paid,” he said with a shrug. “I play the game.”

In interviews, six of Dr. Levin’s patients — their identities, like those of the other patients, are being withheld to protect their privacy — said they liked him despite the brief visits. “I don’t need a half-hour or an hour to talk,” said a stone mason who has panic attacks and depression and is prescribed an antidepressant. “Just give me some medication, and that’s it. I’m O.K.”

Dr. Levin expressed some astonishment that his patients admire him as much as they do.

“The sad thing is that I’m very important to them, but I barely know them,” he said. “I feel shame about that, but that’s probably because I was trained in a different era.”

I Think I’m Depressed – What Now?

Many people have a hard time accepting that they may be depressed. They feel some level of shame or embarrassment, which is unfounded considering that depression is a disease. If you had cancer, wouldn’t you go to a doctor?

Depression hits people of all ages and races. Currently, there are an estimated 15 million people in the US suffering from depression. Realistically, that number is probably higher than what’s reported. Regardless, 2/3 people don’t get any sort of treatment for depression, which is a waste because depression is a treatable illness.

Nobody knows what causes depression. You may be able to identify a trigger, or a stressful event like divorce or death of a loved one as causing your depression, but it may have existed prior.  There is no one reason why depression sets in; however, stress, hormones, and genetics can increase the risk. 

The longer depression lasts, the worse your symptoms may get and the harder it will be to treat.

Without treating depression, people can struggle for months or years feeling absolutely miserable. If you do decide to seek treatment, there are a lot of effective and proven ways to treat depression. Doctors will try psychotherapy or antidepressant medication. Studies have found that combined treatment of therapy and medication works better than medication on its own.

Lifestyle changes can help depression, which is something you and your therapist can talk over. Managing stress, getting enough sleep, eating healthy, and exercising have all been shown to help. The important thing is that there are many options out there.

Some people are appropriately apprehensive when it comes to taking medication. Common worries include if the drugs will change one’s personality, or concerns regarding the side effects. The doctor will inform you about potential side effects. Regarding altering your personality, depression has already put you in a fog and the medication may help you return to your original self.

For those that are interested, antidepressants work by making the nerve cells form stronger and healthier connections to specific parts of the brain. The most common antidepressants are called SSRIs. These types of drugs can take weeks or months to be effective.

Therapy has been shown to have more lasting benefits than medication. Talking to a stranger about the problems bothering you may make you feel uncomfortable. It’s important to remember that therapists are a skilled professional and they will not judge you. Everything is confidential!

Cognitive behavioral therapy helps you see how your own thought patterns can contribute to your depression and it teaches practical ways to change them.

Many people seek a holistic approach to treat depression. There’s the view that if it comes from the Earth, it is natural, and therefore less harmful. However, natural supplements have side effects as well. You should talk to a doctor or do extensive research before taking them. The evidence is unclear if natural herbs actually work or not. Supplements like fish oil and folic acid may have some benefits, but other supplements really don’t do anything.

So how does one start treatment? You can get a referral from your family doctor or call the 1-800 number on the back of your insurance card and they will find you a mental health provider. The American Psychological Association and the American Psychiatric Association also have online locators. Some family doctors prescribe antidepressants but finding a psychiatrist (someone who specializes in mental disorders as opposed to general medicine) will be more beneficial for treatment.

Physical symptoms of depression can include: headaches, back pain, muscle aches, joint pain, chest pain, digestive problems, exhaustion & fatigue, sleeping problems, change in appetite or weight, dizziness or lightheadedness.

Benefits of treating depression include: better sleep, better libido, pain or discomfort relief, improved health, better work performance, better memory, happier home life, healthier lifestyle, increased sense of control, decreased future depression, and stronger ties with family.

Some people avoid getting treatment for the following reasons:

  • “I’ll snap out of it if I give it time.”  You can’t snap out of being depressed. Having the blues may pass, but clinical depression will linger and get worse if it is not treated.
  • “‘I don’t want to take antidepressants.” Psychotherapy is always an option. Cognitive behavioral therapy deals with your thoughts and feelings now; it works to improve your thought pattern and your quality of life.
  • “I don’t feel sad all the time. Why do I need treatment?” Sometimes, people with depression see their clinical physician for ailments like muscle pain or sleeping problems, not knowing that they are symptoms of depression. You don’t need to be crying all the time to be depressed.
  • “I’m embarrassed to talk to my doctor about it.”  Depression is not something to be ashamed of, it is a common medical condition. Your doctor has already treated patients just like you.

You can always voice your concerns to your therapist or doctor and they will work with you to make you feel more comfortable. Apex Behavioral Health is always available to help treat your depression. Make an appointment and help yourself!