Dr. Carole Lieberman

In this no-holds-barred interview, Dr. Lieberman tells it as she sees it. Want PC? Don’t read this interview!

Therapy Soup is fortunate enough to be able to speak with three-time Emmy award winning psychiatrist and author, Dr. Carole Lieberman. We wanted to discuss why the vast majority of psychiatrists no longer do psychotherapy and why Dr. Carole (who is a psychiatrist who does psychotherapy), believes this to be detrimental to the patient.  

Welcome, Dr. Carole. Can you tell us a little bit about the genesis of psychiatry and how it has changed over the years?

Before the advent of psychiatric medication, the influence of Sigmund Freud, the Father of Psychoanalysis, and his ‘talking cure’ was profound. Then medications became the ‘shiny new toy’ that caught the eye of psychiatrists and gradually distracted them away from getting at the underlying root of the problem through therapy. There is no doubt that psychiatric medications can be, literally, lifesaving for many patients, but they should not be used without psychotherapy given along with them. Otherwise, the medications are simply masking the symptoms and allowing the patient to pretend that he doesn’t have any underlying problems. If a patient has a problem serious enough to require medication, then he certainly needs psychotherapy, as well. Read on, fearlessly…here.

Stuck? Next Time Use a Mental Health Treatment Plan.

 

 

From Change…

As therapy progresses and as your therapist gets to know you better your treatment plan will almost definitely require minor amendments—and sometimes major changes. Recently, a British social work student, Adam, wrote with questions about this aspect of the treatment plan. He expressed reservations about doing a treatment plan as in his reading he learned that there could be patients/clients whose diagnosis wasn’t clear at the outset of therapy, and only later, during the course of therapy, was the real problem or issue uncovered.

Well, Adam, you are absolutely correct—more often than not, in fact, I would say virtually all the time, issues arise or are uncovered during the course of therapy that were not found during the initial evaluation. A well-trained and experienced clinician will be able to ask the right questions in order to get an accurate diagnosis. However, many issues can cloud an initial evaluation, something we will talk about in a later post. People are complicated and no matter how thorough a psychosocial evaluation is it simply cannot describe fully a living, breathing person. It is rather a sketch—a good sketch, perhaps—but nonetheless a sketch. Click here to read more.

From Other and Etc…Life rolls on while you are in therapy and a myriad of events can occur. Suppose you got a DWI? Or suppose you were recovering from being a former member of a cult? Or maybe you had just faced a new challenge—you lost the use, heaven forbid, of your legs in a workplace accident? These and a myriad of other challenges should be noted in your mental health treatment plan since they are a significant current part of your life. Click here to read more.

Read more, here.

Steven also has some experts blogging on his site, including John M. Kennedy, the medical director of preventative cardiology and wellness at Marina Del Ray hospital and other stress experts. I’m also blogging on StopStressingNow.com and I’m going to focus on a few things including: how to know if you might benefit from psychotherapy, how to get the best therapy if you decide to see  a therapist, and how stress and anxiety can be a stepping stone to substance abuse and addiction, (and how to avoid that dangerous spiral).

My first blog is called Assess Yourself and it helps readers identify if they have symptoms that might require therapy.

A treatment plan is like a personalized map of your therapy. The therapist can be thought of as your GPS system, guiding you step-by-step. First, you have to know your starting point. Knowing where you are starting out is defined in the problem statement, which is based (at least initially) on the evaluation.

The therapist should share his findings from the evaluation with you. Your individualized treatment plan will begin with a summary of your problems as they are presented in the evaluation (as well as in any subsequent conversations). It will be written in the form of a problem statement or statements. These problem statements might read something like: “Jennifer dropped out of school because of failing grades,” or “Mark exhibits signs of depression,” or “Tyler is angry and oppositional when speaking to his wife and children.”

Most people will have more than one problem, and generally between two and eight problems are listed in the problem statements section. That doesn’t mean that all these problems will be addressed during the course of therapy; these statements are simply stating that the problems exist. Problem statements that are not relevant initially can be deferred to a later time when the time is right to address them.

The Biopsychosocial History/Evaluation

Not too far into your first session, usually right after you tell the therapist why you came to see him, the therapist will begin to do an evaluation—an initial and/or ongoing assessment of a patient’s clinical status that will be used to develop a plan for treatment. The evaluation primarily includes a large body of information called the biopsychosocial history. This evaluation will help him gather specific information about you, including biographical, psychological, and social information (in far more detail than just general questions) and will help him understand you better. It will help him develop a detailed treatment plan based on your individual needs.

The therapist should write down your answers to the evaluation questions. Virtually any therapist who does not do a comprehensive written evaluation—unless you have given him permission to tape-record the information instead—or take detailed notes during sessions will be unable to remember important details about you. A psychotherapist is required to keep written treatment records of each patient. This is not only to facilitate treatment, but also for insurance reasons, in case he is asked by you to turn the case over to another doctor for medical reasons, or in case you want copies of your own records, which you are entitled to by law. If your therapist is not writing notes during (and after) your session, the chances are his treatment records will be sparse. Also, he will be unable to go over those all-important notes in order to refresh his memory before his next session with you. This will make treatment decisions very difficult.

Biopsychosocial History/Evaluation Checklist

Make sure that at least the following topics are included:

1. Identifying data/demographic data (social security number, date of birth, sex, race, emergency contact information, living situation)

2. Alcohol and drug history (including over-the-counter and prescription medications, herbal or nutritional remedies, and illegal drugs and alcohol; how drugs are administered; frequency of use; age first used; date last used;  progression of use; withdrawal symptoms; history of treatment programs/hospitalizations; symptoms and complications of alcohol and drug history)

3. Mental health history (including medication history and compliance, allergies to medications, history of treatment programs/hospitalizations, and symptoms and complications of that history, including harm to self or others)

 4. Medical history (including medication history and compliance, allergies to medications, hospitalizations, chronic and/or life-threatening illnesses, and symptoms and past and current complications of that history)

5. Other topics (sexual history, educational history, vocational history, financial history, legal history, social history, family/significant other, gambling history, nicotine history, eating disorders, spirituality, leisure, military history)

6. Reason for seeking treatment

7. Questions specific to present stage of life (childhood, adolescence, geriatric, etc., as needed)