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Psychotherapy: That'll Be $100,000. Sorry, No Warranty

3 years ago
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My colleague Mary C. Curtis writes that Betty Draper has returned to the therapist office. "Mad Men" is set in the 1960s, and there's a good chance Draper's health insurance picked up 80 percent of that tab, if not the whole shebang.

Ah, those were the days. Now, you're more likely to get three visits a year. That is, if you're still employed and even have insurance at all.

With real unemployment soaring near levels last seen in the 1930s, I doubt people will be able to pay the premiums offered by private companies. (Public Option, was it something I said?) My colleague Delia writes about the ways talk therapy can help. But she lives in England, land of health care for all.

Maybe it's just as well therapy goes the way of the carrier pigeon. A long time ago, I figured out that therapists fell into three distinct categories: 1) He/she is creepy. 2) He/she is sane, but a dim bulb. 3) He/she doesn't take your insurance.

And marriage counseling was little more than a personal Judge Judy. When some friends of mine were having problems, I asked the standard: Have you seen a marriage counselor? Can't afford it, she said. Doesn't your insurance pay part of the cost? She laughed. "We're too complicated for Maxicare."

Oh, aren't we all? Besides, no matter whom you see or how long you go, marriage counseling really boils down to three sentences: Be nice to each other. Can't? Here's the name of a lawyer.

As for individual therapy, that too can be neatly summed up: Get over yourself! Here's some meds. Now, go out there and have fun.

Of course, it's not in the therapist's interest to help you connect those dots, or to realize that he/she is little more than a rented friend who echoes back to you what you'd like to hear, but maybe with a little more edge to it, so you'll feel like you're getting bang for your buck.

Some people never tire of forking over their cash. Witness Daphne Merkin, who spent 40 years in therapy.

In a long thoughtful essay in the New York Times, Merkin stated, "I failed to grasp that there was no magic to be had, that a therapist's insights weren't worth anything unless you made them your own and that nothing that had happened to me already could be undone, no matter how many times I went over it."

Take that, therapy. And there's more. Merkin reported that Ferenczi, a friend of Freud, observed: "Neurotics are a rabble, good only to support us financially and to allow us to learn from their cases: psychoanalysis as a therapy may be worthless."

After four decades, Merkin wised up and quit. Her daughter, coming on the heels of the world-weary "Avenue Q" generation, never bought the idea of therapy in the first place. Merkin writes that her daughter once "referred to therapy as 'emotional prostitution,' and although I thought the term a bit reductive, there was a piece of unpleasant truth to it."

Among the comments Merkin got on her opus was: "The entire experience described here seems like endless squirrel caging." Another commenter wondered why Merkin didn't just make some friends, noting that they're "cheaper than highly trained doctors. They tend to be better listeners and even help you get things done, like moving, picking out an outfit or meeting you at the airport."

A friend costs nothing. Same with Alcoholics Anonymous, which is where one young woman ended up, but only after her parents paid $21,000 per month for her stay at Yellowbrick, the country's only "emerging adult" residential treatment center, located in Evanston, Ill.

You could have a lot of fun with $21,000. Like . . . oh, you know . . . live.

Times are hard. If the economy remains on its current trajectory, Yellowbrick may find they've run out of emerging adults to treat. Adults will emerge as naturally as butterflies from cocoons once parents start plowing the back 40 and ordering their teenagers to go slop the hogs. The road will beckon, as it always has.

As for the other House of Pain therapy dispensaries, tumbleweeds will blow through their corridors any day now, and therapists will hit the soup lines with the rest of us. That's the way the fortune cookie crumbles.

Click here to follow Donna Trussell on Twitter.

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I'm curious what makes Donna an expert on this topic. I'm also curious what makes her such an informed cynic regarding therapy. In referencing Mad Men, she is talking about psychoanalysis, and she's also talking about psychoanalysis when she refers to Merkin's case from the New York Times. Not all therapy is psychoanalysis, which would have been a keen distinction to make. She's correct to point out that therapy has a spotty track record for empirical success and that it's costly, but she should have directed her readers toward therapy approaches that have scientific evidence to back them up (cognitive-behavioral methods) or, perhaps, she should have crafted instead an indictment of an insurance system that does not place mental health (or, really, health) at the forefront of its mission.

August 26 2010 at 1:27 PM Report abuse +3 rate up rate down Reply

Of course, one can write anything. There is no requirement that it be truthful, informed or honest. If that were the case, this article would not have been written. It's perspective has been expressed before, been exposed and then forgotten only to rise again. Psychotherapy is effective; there is empirical evidence to that effect. So anecdotes don't quite cut the mustard. Only more serious and informed minds should enter this type of discussion.

August 26 2010 at 9:54 AM Report abuse +3 rate up rate down Reply

Mental illness is just illness. I wonder if this author would be making the same snide comments if someone had spent 21,000 on a cancer drug to prolong the life of their child. Yes, 21,000 buys a heck of a vacation...but some of us have other things to spend our money on. Like health care of someone who is ill...with bipolar disorder, depression, schizophrenia. These are chonic conditions and will take years of therapy...just like AIDS, Cancer, Muscular Dystrophy....I can go on. The attitude of this article is beyond offensive; it is cruel to anyone who has had mental illness themselves or in their family and have to deal with the stigma and callousness of some short sighted individuals--as demonstrated by the author.

August 25 2010 at 11:16 PM Report abuse +5 rate up rate down Reply

I'm a Ph.D. student in a clinical psychology program, and I counsel clients in several local clinics. I'm quite perplexed by the author's stance on psychotherapy. Perhaps Ms. Trussell has never met a returning veteran with Post-Traumatic Stress Disorder or a young adult with OCD. Maybe she's never had a close friend who couldn't get out of bed in the morning because the depressive symptoms were just too crippling. Are we really back to the days where people are told that they should be able to overcome mental illness on their own? With the current economic difficulties in this country, mental health professionals are in need now more than ever. I'll take my chances with the "soup line." Being a poor, "worthless" therapist seems far more attractive to me than being the cynic who writes about the problems in this country but snipes away at those who are trying to make a difference.

August 25 2010 at 8:12 PM Report abuse +6 rate up rate down Reply

Sorry but friends do cost a lot. Tell me where you can get a friend that will cost you nothing. I need some.

August 25 2010 at 7:24 PM Report abuse +3 rate up rate down Reply

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