For the last few weeks, a small group has been meeting weekly at Methodist Medical Center in Peoria, Ill. They've discussed bipolar disorder, depression, obsessive compulsive disorder; they've talked about medications, coping with mental illness and preventing relapses.
Don Wells, a facilitator of the education/support group, Peer-to-Peer, calls participants "mental health consumers."
"The concept behind the term," Wells says, "is that we, as consumers, should have the opportunity to buy the best, most effective services we need."
The natural follow-up question leads to one of the oldest, toughest debates in the field of mental health: Does talk therapy work? And one of the newest, toughest debates in the field is: What's best, talk therapy or drugs?
"It's an issue, a highly controversial issue," Wayne Evens says of the first question. Evens, director of social work programs at Bradley University, also is a licensed clinical social worker with a doctorate in sociology.
According to Tim Bruce, a clinical psychologist and co-director of the Anxiety and Mood Disorder Clinic at the University of Illinois College of Medicine at Peoria, the answer to either question generally depends on what kind of professional therapist you're talking to:
A psychiatrist, the medical doctor/therapist licensed to prescribe drugs; a psychologist, the therapist with a doctoral degree who specializes in diagnosing and treating emotional disorders; or a licensed clinical social worker, the therapist with at least a master's degree in the field.
"This is a contentious topic," Bruce says, but what's most interesting is how few people have access to the best available so-called talk therapies.
After 45 years of living with bipolar disorder, Wells has earned the right to call himself a consumer of mental-health therapies. He's been hospitalized, he's undergone some talk therapy and he can list brand names and judge side effects of mood-stabilizing medications he's taken over the years the way Consumer Reports rates cars.
Peer-to-Peer, an education/support group for people with mental illnesses, is sponsored by the local chapter of the National Alliance for the Mentally Ill, or NAMI. From Wells' perspective, as well as NAMI's, self-help groups such as Peer-to-Peer, similar to 12-step programs, should be considered in the range of consumer choices for treating mental illness.
"I should be retired, but I feel my work is therapeutic," says Wells, 69, who also is a case manager at Human Service Center. He has been stable for almost 20 years.
Forget Freud and his theories and his couch. The scene of the patient lying down while a psychologist psychoanalyzes his subconscious feelings about his mother is more extinct than the term "patient."
Most psychologists no longer use the term "talk therapy" either. Instead, Bruce says, they refer to specific types of therapies, such as behavioral therapy. Modern treatment techniques recognize changing behavior is the first step to changing emotions and thought processes. Many psychologists basically help patients or "mental health consumers" develop and follow through on homework assignments, or tasks, designed to foster behavioral changes.
While the general public was still hung up on Freud's couch, a new generation of mood-altering medications transformed the mental health field. The rise of Prozac and Paxil, along with lesser-known medications designed to change brain chemistry, suddenly forced psychotherapists to defend the profession against insurers and government funding cuts, which called for measurable results and accountability.
Bruce says the advent of evidence-based therapies -- therapy techniques researched and tested similar to the Food and Drug Administration's testing of medications -- eliminates the reliance on professional and/or client opinions. "The science is way ahead of the actual practice," he says, which means many patients are not getting the best treatment because therapists aren't practicing it.
Numerous studies confirm the findings of Consumer Report's 2004 survey of CR readers who had sought treatment for depression or anxiety: A combination of drugs and talk therapy produces the best results.
Typically, once therapists figure out the right dosage of the right prescription, medications alone stabilize symptoms faster, Bruce says, but the average relapse rate is 50 percent. "So people are just encouraged to stay on them." Progress is slower with talk therapy, but relapse is less likely.
The mental health field is better than ever at diagnosing specific conditions and tailoring specific treatments. "But the question, 'Does therapy work?' is not a simple question," Evens says.
Source: State Journal Register. Powered by YellowBrix, Inc.
