Check Your Wallet

checkRecently, we were writing about the bias that practitioners have that the technique that they they have mastered is the most effective treatment for any condition.

We were reminded of this issue very vividly this morning when we met up with one of our favorite people, an older man who has been seeing us for a couple of years.

He had very severe depression that he developed beginning about five years ago, which he associated with retirement and the break-up of an important romantic relationship.

When he first started treatment with him, we had a very interesting experience.

We did our assessment, and it suggested that there were definitely some treatment options for his depression that had not been tried. We didn’t know it at the time, but he was nearly at the end of his rope and was trying to decide whether to commit suicide or not. He had come in to make “one last try” to find help.

He had gotten very little benefit from more than two years of treatment with his previous psychiatrist and therapist.

After the initial consultation, he was very reassured and decided to pursue treatment with us. At that point, he gave us consent to contacting his therapist and psychiatrist for records and information.

Often, it’s very hard to get information out of mental health professionals; it’s one of the things that we think is the most frustrating about the preoccupation with confidentiality, and at its worst, secrecy, in our profession.

In this case, however, we got a very prompt reply from his therapist.

She insisted that she wanted to talk to us right away, and we set up a phone appointment.

She told us that he was “in analysis” with her and asked if we knew that. It sounded like something that was almost religious, and the implication was that somehow we were breaking an important bond.

I said that I hadn’t known, and he had decided that he wanted to come and see us and I thought we might well be able to help him.

At that point, she insisted that intensive psychoanalysis with her was the only thing that could save his life and we were gambling with his life by offering him another option for treatment. I was stunned.

I must say, it gave me considerable pause, and I went back and reviewed the assessment carefully, and after much reflection I decided that we had been accurate in our estimation that there were some types of medications and psychotherapies that hadn’t been tried and that had a good chance of helping him.

He is now completely well, and has been for almost a year.

In fact he says he can’t ever remember feeling this good, and although one is inclined to wonder if that is hyperbole; in his case, it doesn’t seem to be.

A couple of months ago he called his former therapist to share a little bit about what had happened and what he was doing. She had absolutely no interest in hearing what he had to say. She insisted that her assessment was right (!)

All of this reminds us of one of our rules about healthcare:

If a healthcare provider tells you that what they do is the only thing that could possibly help your health problem, you should back away from that provider, check your wallet. Their interest in viewing what they do as “special” is very likely to be affecting their ability to provided you with the best. Someone who really is that knowledgeable about your illness must surely be aware that there are always other options worth considering.