Tuesday, January 26, 2010

How to Be a Good Mental Health Consumer

Here is a response I just posted elsewhere to someone's question about how to decide on a particular therapist or mental health treatment, after the person objected that a particular website describing various treatments had not made specific recommendations:

The CEBC website is written in a way that consumers can understand, with clearly written summaries of each intervention. That is the point. Legally and professionally, I believe that they would get into trouble if they gave advice to people they had not personally assessed about recommending any one particular therapy, so what they do is provide information in a way that is understandable to people who are not mental health professionals, rather than recommend any particular intervention.

You see, evidence-based practice is not authoritarian and in my opinion, this is a good thing. Damage has been done by certain presumed authorities in the mental health profession (see Scott Lilienfeld's 2007 article in Perspectives on Psychological Science on therapies that harm, for examples and details). While some authorities on mental health practice have undoubtedly done a great deal of good for people, others, even though well intentioned, have ended up doing more harm than good because they used procedures that had not been properly tested with randomized controlled clinical trials tested for safety and efficacy. There's a very interesting series of articles about that topic in this month's American Psychologist, by the way.

Again, using the MD analogy, I would have to ask you, if someone wearing a white coat with a fully credentialed MD advised you to use a drug that had not undergone proper randomized clinical trials but had many positive client testimonials, would you do it? I realize that in the US this is regulated, but if it weren't and an MD made such a suggestion, would you follow it? While true that we do have to rely on MDs as authorities to an extent, because they have knowledge that those of us who are not MDs obviously do not have, at the same time, we can at least ask basic questions about the amount of evidence that exists for what they recommend. This holds true even moreso for the mental health profession because there is nothing in the law that would forbid a mental health professional from using a therapy that has not been properly tested with randomized clinical trials and all too often, claims are made not based on scientific evidence.

I do not give advice to people over the internet who I do not know about what specific treatments someone should choose. I do not know you. I can only recommend good sources of information so people can make informed decisions for themselves as mental health consumers and that is what the website I recommended does. It shows people what their options are.

As for a list of therapists, there are reputable professional organizations such as ABCT that provide those lists, but again, there is no foolproof way to make guarantees about professionals listed. Hence, the disclaimers. Consumers need to ask good questions of any provider. Margaret Singer in her book, Crazy Therapies had some excellent suggested questions consumers can and should ask any mental health professionals they are considering hiring as their therapist. Consumers do have the ability to ask questions and consider the answers they receive or lack thereof and other reactions of the therapist to questions.

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