ORLANDO – Renowned psychiatrist William Glasser, M.D., was the top drawing card at the multi-disciplinary 2006 national conference of the American Psychotherapy Association and the American Association of Integrative Medicine held here in September.
In a day-long series of sessions, Glasser hammered home his message that drugs should be used only for medically diagnosed brain disorders, such as Parkinson’s disease, and that therapists should concentrate on mental health rather than mental illness.
Relationship difficulties – the chief problems that bring clients to psychotherapists – should be dealt with through talk therapies, such as Choice Therapy or the New Reality Therapy, the approaches he currently recommends, Glasser said.
He said in his opinion the disorders listed in the DSM-IV are largely inventions to create payment guidelines for therapists. “I’ve never, never identified anyone as having a DSM disorder.”
He theorized that the DSM-V revision currently under consideration will broaden categories of mental illness so much that “everyone will be in the book.” The new categories will include any relationship difficulties not covered in the current edition, he predicted.
“The only thing they’re waiting on is that they don’t have the medications to cure the relationship disorders they’re going to tell you that you have.”
The therapist should seek to improve the mental health of clients instead of trying to fit them into DSM definitions of mental illnesses, Glasser said, adding that everyone can benefit from that kind of therapy. “All of us in the world can learn to be mentally healthier than we are.”
Relationship problems involve how people deal with each other, such as the husband/wife, parent/child, child/parent or student/teacher relationships, he said, adding that diagnoses such as depression or ADHD do little to guide the therapist in helping with relationship problems.
“All of these are phony diagnostic categories,” he said. “The DSM was not written to help people; it was developed to help psychiatrists – to help them make money.”
Glasser said his book, Warning: Psychiatry Can Be Hazardous to Your Mental Health, stresses mental health rather than mental illness and leave brain disorders, such as Parkinson’s or Alzheimer’s, to neurologists.
“I believe there is only one main psychological problem in this world – getting along in relationships,” he said. Glasser urged therapists to adopt methods that deal directly with relationship problems and difficulties in the present rather that diagnosing symptoms or seeking causality in past experiences.
Rational Emotive Behavior Therapy, developed by Albert Ellis, Ph.D., or the cognitive therapy approach developed by Aaron Beck, M.D., can be as effective as Choice Therapy or the New Reality Therapy, Glasser said. “I’m not saying my way is the only way.”
Glasser was among a score of speakers from various disciplines during two days of instruction and discussion sessions. The two host associations were joined in putting on the conference by two other groups this year, the American College of Counselors and the Society for the Cure of Souls.
Michael Baer, Ph.D., chairman of the American Psychotherapy Association, said about 175 therapists attended this year’s gathering.
“This is my favorite of the many groups I belong to,” Baer said, adding that he enjoys the variety offered by the interdisciplinary approach. “I learn from all the psychotherapists here.”
Baer was among the panelists for a session entitled “Health Care Reform: Who Needs It?” Ronald Hixson, MBA, Ph.D., was moderator for the panel that also included Michael Krumper, LCSW, a diplomate of the American Psychotherapy Association.
The consensus was that reform is needed, particularly to meet mental health needs, but current efforts show little promise of success.
Hixson said part of the problem is a lack of motivation among practitioners to become active in reform efforts. “There’s apathy out there, not only in mental health but in the medical field.”
He said instead of pursuing reform, too many practitioners devote efforts to carving out turf areas in a dwindling market while payments for services decline to little more than half their worth.
The psychotherapy profession needs to be more active in health care deliberations of state and federal legislators where “reform” translates to reductions in Medicare and Medicaid payments that are quickly adopted as market rates by private insurers, Hixson said. “Every time they (payment guidelines) change, they take money from us.”
Therapists need not only to band together instead of dividing over turf issues but to enlist support from clients as well to inform lawmakers on the need for greater access to properly funded mental health services, Hixson said.
He said current reform efforts center around two themes, universal health care and single-payer reimbursement. He added that practitioners must develop a strong voice in those areas or they can expect a continuation of the changes other “reforms” have prompted over the past decade – decreasing reimbursements while costs increase.
Krumper said health care providers with true clout in legislatures, such as hospital associations, do not have the practitioner’s interest at heart. “I’m not optimistic that current reform efforts will be effective,” Krumper said.
Baer said statistics show that a third of the nation’s citizens will suffer severe mental illness at some point during their lives and it is the mentally ill who have suffered most under past reforms.
For example, he said, the deinstitutionalization movement of the 1970s was intended to free the mentally ill from being warehoused in state asylums with little treatment and return them to the community where the money from savings in closing the large institutions would fund individual care.
“But,” he said, “the money and the people somehow never quite got to the communities.” Instead, Baer said, jails, prisons and homeless shelters have become the new warehouses for the mentally ill.
“We pay tremendous health care costs and we’re not getting much bang for the bucks,” Baer said. He said society is paying the price for not adopting prevention methods proposed by George Albee, Ph.D., who died July 8 at age 84. Albee contended many mental illnesses could be alleviated by treating social ills, such as poverty, that create stress.
Mental health practitioners could do much toward those ends by encouraging beneficial lifestyle changes, Baer said. “Instead, nobody cooks a meal, nobody exercises and we’re still smoking,” he said. “And so we come full circle, back to George Albee and the ’70s.”