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How Patients Lose When Psychologists Are Not Involved in Medical Care

Health care costs are exploding and one silent factor in containing costs is rarely mentioned: the under-utilization of psychological services. The evidence is clear and has been for three decades. In many studies, people who see psychologists for symptoms are less likely to utilize medical services.

In other words, mental health treatment saves a lot of money.

But the problem goes deeper. As psychologists, we need physicians to refer patients. Fortunately, many do. But when physicians refer patients for psychological consultation or counseling they do so by staying within the confines of their own model of disease, their own “box.” What are the instructions of that box? Reduce specific symptoms, as fast as possible. Thus referrals are characteristically directed to psychiatrists or cognitive behavioral therapists.

Sadly, referrals for cognitive behavioral therapy do not benefit as many patients as you might believe. Cognitive behavioral therapy is great as long as you are one of the 20 percent of patients who benefits. Because CBT trials often include only patients with one disorder (such as depression without a co-existing anxiety disorder) they exclude patients with more complicated symptoms. A large percentage of people in the mental health population meet criteria for more than one diagnosis.

Patients experience illness, not disease. Illness means that symptoms alter relationships, sense of self, and the possibility of future planning. What illness means to a patient is deeply impacted by how dependence was tolerated, and care and support were offered throughout the patient’s life. The meaning of experience is what psychodynamically trained therapists focus on. These therapists, of course, are deeply concerned about the reduction of symptoms and they address how patients cognitively assess their problems and symptoms. But psychodynamic treatment’s effectiveness is broader and deeper in scope, which is why it is long lasting.

What we need is for physicians to ask different questions about illness: Why is this person so hopeless that he can’t even take in my treatment recommendations? What does it mean to her that she will experience partial, not total recovery? When these questions are asked, the physician will likely consider a referral to a well-trained psychodynamic therapist.

We don’t think that physicians should have to map the referral territory alone. We think that it behooves a major organization of psychological clinicians to delineate the signals and signs of the need for psychological referral.

Patients today know that illness is complicated. They search the web for alternative explanations and they seek out the help of alternative practitioners. Maybe we should ask why it is that patients feel so alone and on their own to seek out their own treatments and medial advice.

Physicians can help patients feel less alienated by working collaboratively with psychologists who think about the illness experience from a comprehensive and multi-faceted perspective.

A referral to a psychologist can feel like a blow to patients, who often worry that their symptoms are devalued in that they are sent to ancillary practitioners. The reality is, well-trained psychologists and those with analytic training can be just what patients need. Physicians just don’t have the time to do what psychologists can do. Often, though they appreciate the concept, they do not have the training to help people understand how the mind and the body interact in the face of illness.

(This post is also published on Mary-Joan Gerson’s Psychology Today blog site and Tamara Greenberg’s Huffington Post blog site. Co-written by Mary-Joan Gerson, Ph.D. and Tamara McClintock Greenberg, Psy.D., M.S. Associate Clinical Professor of Psychiatry, University of California, San Francisco.)

posted on October 03, 2011