Eideard

The event reminder on Melissa Weinblatt’s iPhone buzzed: 15 minutes till her shrink appointment.

She mixed herself a mojito, added a sprig of mint, put on her sunglasses and headed outside to her friend’s pool. Settling into a lounge chair, she tapped the Skype app on her phone. Hundreds of miles away, her face popped up on her therapist’s computer monitor; he smiled back on her phone’s screen.

She took a sip of her cocktail. The session began.

Ms. Weinblatt, a 30-year-old high school teacher in Oregon, used to be in treatment the conventional way — with face-to-face office appointments. Now, with her new doctor, she said: “I can have a Skype therapy session with my morning coffee or before a night on the town with the girls. I can take a break from shopping for a session. I took my doctor with me through three states this summer..!”

Since telepsychiatry was introduced decades ago, video conferencing has been an increasingly accepted way to reach patients in hospitals, prisons, veterans’ health care facilities and rural clinics — all supervised sites.

But today Skype, and encrypted digital software through third-party sites like CaliforniaLiveVisit.com, have made online private practice accessible for a broader swath of patients, including those who shun office treatment or who simply like the convenience of therapy on the fly…

Still, opportunities for exploitation, especially by those with sketchy credentials, are rife. Solo providers who hang out virtual shingles are a growing phenomenon…

Other questions abound. How should insurance reimburse online therapy? Is the therapist complying with licensing laws that govern practice in different states? Are videoconferencing sessions recorded? Hack-proof?

Another draw and danger of online therapy: anonymity. Many people avoid treatment for reasons of shame or privacy. Some online therapists do not require patients to fully identify themselves. What if those patients have breakdowns? How can the therapist get emergency help to an anonymous patient? “A lot of patients start therapy and feel worse before they feel better,” noted Marlene M. Maheu, founder of the TeleMental Health Institute, which trains providers and who has served on task forces to address these questions. “It’s more complex than people imagine. A provider’s Web site may say, ‘I won’t deal with patients who are feeling suicidal.’ But it’s our job to assess patients, not to ask them to self-diagnose.” She practices online therapy, but advocates consumer protections and rigorous training of therapists.

RTFA. Some of it is hilarious. Yes, I realize we’re discussing mostly legitimate needs and mostly legitimate practices designed to sort them.

If I didn’t have so much fun blogging I might wander into the shrink-wrapped Skype therapy trade. Though I’d hate the record-keeping required to keep the IRS and insurance companies happy.

He is a good Christian, Michael is telling his two therapists. He goes to church most Sundays. He’s a devoted husband and father of two daughters.

“But when I would leave on business trips,” he says, “I knew I was going to get to be someone else.”

“Prostitutes, porn – I took anything I wanted.”

Sitting on a comfortable, worn couch, Michael glances out the window and sees a reflection of himself set against the parking lot of this suburban Atlanta office building. He fidgets, runs his fingers over his closely cropped blond hair and straightens his green tennis polo. He clears his throat.

Above his head hangs a poster covered in words describing feelings – angry, anxious, sad. On it is a big yellow cross.

Therapists Richard Blankenship and Mark Richardson wear solemn but empathetic expressions. Certified counselors and Christian ministers, they tell him they know how to listen and nod for him to continue.

“I’ve had a record of purity since March when I confessed to my wife,” says Michael, whose name has been changed by CNN.com to protect his privacy. “No porn, no masturbation.”

“Awesome,” Richardson says, leaning forward in his chair. “God knows you’re trying.”

This is Michael’s second week at “Faithful and True – Atlanta” a 16-week counseling program that, like dozens of others like it around the country, combines traditional psychotherapy with the Bible in an attempt to treat addictive behavior…

He says he has helped people achieve what he calls “sobriety,” which means resisting porn and lustful thoughts.

Though controversial in secular circles, much of the evangelical Christian world has been cheering this relatively new kind of therapy. Many believers, including many Christian leaders, consider it a powerful tool for fighting what they say is one of the modern church’s biggest problems: porn addiction.

A crusade is born.

There ain’t nuthin’ a fundamentalist Christian loves better than a good crusade. “Good” meaning any number of things, of course. Could mean killing furriners. Or even Americans who are the wrong color. Could mean condemning your kids to a lifetime of neurotic behavior and ignorance – sentenced to a belief in Old Testament shari’a.

I can’t get angry about such loony behavior. These fools are laughable in their beliefs, self-destructive in their solutions.

Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help.

But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.

Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients. And no specialty has suffered this loss more profoundly than psychiatry.

Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday.

Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names. Then, his goal was to help his patients become happy and fulfilled; now, it is just to keep them functional.

I hold no brief for Freudian analysis; but, what I’ve learned over time about psychotherapy – especially in a clinical environment – leads me to conclude this is just one more modality, one more method of treating human ills that is being crushed into a tidy little profit center by hospital corporations, insurance companies and medical associations that are little more than trade groups and lobbyists.

RTFA for details. Decide who is worthy of more contempt. Corporate medicine or the politicians taking a payoff as obedient toadies?

Thinking about having a nose job or facelift? You may be more pleased with the results if you’re older–or if you’re being treated for depression, a new study suggests…

To learn more about what makes patients pleased (or not) with the results of their surgery, cosmetic surgeons at the University of Michigan surveyed 35 women and 16 men before and after they underwent facial surgery. The researchers assessed a range of patient characteristics, such as marital status, education, medical history, and personality.

Two-thirds of the patients said they were very satisfied with the results of their surgery, ranking their satisfaction an 8 or above on a scale of 1 to 10. Nearly one-quarter judged the results to be a perfect 10. (Interestingly, the surgeons tended to rate their work slightly lower than the patients did.)

The 20 patients who were taking antidepressants or in therapy for depression rated the surgery results a full point higher, on average, than those who weren’t–the opposite of what the researchers expected.

“I’m not sure exactly what that means,” says the lead author of the study, Dr. Jeffrey Moyer, M.D., a cosmetic surgeon at the University of Michigan at Ann Arbor. “I think it speaks to how complex depression is.”

Dr. Steven B. Hopping, M.D., past president of the American Academy of Cosmetic Surgery, says that most of the patients he sees at his practice in Washington, D.C., are on antidepressants.

Well, that gives you a clear picture of the state of healthcare for the American middle class.

Or at least what’s modulating their brains.

Treating clinical depression on the telephone is nearly as effective as face-to-face consultations, a new Brigham Young University study finds.

The trial run included 30 people newly diagnosed with major depression. Instead of eight scheduled visits to the clinic, the participants covered the same material during a series of phone calls with the therapist. Calls varied in length, ranging from 21 to 52 minutes. The patients did not receive antidepressant medication.

At a six month follow-up, 42 percent of participants had recovered from depression. For comparison, similar therapy conducted in person has a 50 percent recovery rate.

“Offering a phone or webcam option for psychotherapy does appear warranted from an efficacy point of view,” said Diane Spangler, a BYU psychology professor and a coauthor on the study. “It’s more user- friendly — no commutes, more flexibility of place and time — and has no side effects…”

Though a sample of 30 people is not large, the BYU researchers cite a previous antidepressant drug trial that happened to include a telephone counseling component. In that trial, the added benefit from phone counseling matched the results attained by the new BYU study.

Shows you how important that face-to-face couchside manner just may be. Or not.

George Finley is a pedophile and says he wants help.

Even after a harsh sentence three years ago for luring boys online, he couldn’t stay away from the computer or gaming sites where he contacted boys.

Yesterday, when a judge was about to sentence him to 10 more months in jail for Internet luring and child pornography possession, Finley asked for more time “so I can get help quick.”

Finley wanted to be sent to the Ontario Correctional Institute in Brampton where there is intensive sexual therapy programs — and he needed a sentence of 13 months to go there.

“This is one for the books,” said Justice Lynda Templeton before agreeing to Finley’s request “on an urgent basis.”

Well – good for you, dude. Recognizing how screwed up you are is half the battle.

Not that we don’t have enough contradictions and confusion in society already

U.S. breast cancer cases have dropped in women aged 50 to 69 in recent years because many women have stopped taking hormone therapy. In fact, a study in the New England Journal of Medicine suggests long-term use of hormone therapy causes breast cancer.

The report is the best evidence to date that the breast cancer drop is indeed due to a decline in hormone use, rather than changing rates of mammograms or other factors, experts said.

The good news: The study found that breast cancer risk in women who took hormones dropped back down to normal soon after they quit.

The bad news: In the last decade in which it was still widely used (1992–2002), long-term hormone therapy probably caused breast cancer in 200,000 women, said Dr. Rowan T. Chlebowski, a medical oncologist at the Los Angeles Biomedical Research Institute…the study’s lead author…

Some experts have argued that breast cancer rates declined because fewer women were getting mammograms (so fewer cancers were being detected), and that the drop-off in cancer rates could not have happened so soon after women quit taking hormones.

But the current study showed that, in fact, it did.

Within two years of quitting, breast cancer risk for women who had been taking hormones was the same as that for women who never took them. Mammogram rates were nearly identical in both groups of women.

This is another one of those times when I feel like shouting about medical idiots who devote their careers to finding magic bullets. They believe all the crap fed into their heads by Pharmcos.

A healthy dose of skepticism coupled with constantly staying in touch with peer-reviewed research is turning this disaster around.

World’s largest yacht – this year

While it is difficult to pinpoint the number of patients or practitioners, experts in psychology and financial planning say the number of professionals offering to treat money disorders has multiplied in the last few years.

Although there are many self-help books on how to become rich, the fields of psychology and financial planning have been slow to link money and emotion. And money is still a great cultural taboo that is rarely discussed openly in this country, experts say.

Among the problem financial behaviors identified by psychologists in recent years are: overspending, underspending (a k a Depression mentality), serial borrowing, financial infidelity (“cheating” on a spouse by spending and lying about it), workaholism, financial incest (lording money over relatives to control them), financial enabling (throwing large sums at, say, adult children who then are not motivated to support themselves), hoarding, and plenty of guilt and shame around poverty and wealth…
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