Apr 01

It can be difficult to keep track of all the various forms of psychological help that are out there.  Each year seems to bring a new wrinkle, and reliable scientific validation is often hard to come by (and approaches backed by tightly designed studies often seem less amazing in real-life practice).  One approach that is pretty well accepted among mental health professionals and that also gets good reviews from patients/clients is Dialectical Behavior Therapy (DBT).  At this point, it’s been around for over 30 years and is certainly no longer a fad – but it’s harder work (for both therapist and patient) than many therapies and not so widely available.  Drawing upon elements of behavioral treatment as well as Buddhist-tinged concepts such as “radical acceptance,”  DBT can be conceptualized as a collection of learnable coping skills that are particularly useful for individuals who have a tumultuous emotional life.  People whose lives seem to be full of such “drama” are typically not choosing to make life difficult; their outer expression reflects their inner reality.  DBT accepts that and sets about building compensatory skills.  For an example of a case that might be applicable, see our column on page 3  of the March issue of MBA Lawyers Journal.

Jeff Fortgang, PhD

Mar 21

More than 20 years after Managed Care aggressively changed the world of health insurance, for better or worse, many people still believe that they are covered for “rehab” of the sort that they see Dr. Drew providing on cable TV.  I still have fond memories of the days when it was a fairly simple matter, when meeting with an alcoholic or addict whose personal and family life was in disarray, to get him or her a bed at places like Spofford Hall or Edgehill Newport – these were perhaps the premier rehab facilities in New England, and neither of them survived the advent of managed care.  I must admit a 28-day (inpatient) rehab was “overkill” for some of these cases, but at the time, that was the default clinical approach, and when an addiction counselor spoke of “treatment,” it usually referred to that type of program.

For years now, with the exception of a couple of nationwide insurance plans (which seem to cover facilities largely in Florida) as well as specially configured union plans for individuals such as pilots and pro athletes, health insurance covers very little in the way of inpatient treatment – generally limited to medically necessary detox (only when necessary to mitigate withdrawal symptoms).  Sometimes it is possible to get insurance to cover a subsequent couple of weeks in a “partial hospital” or “intensive outpatient” program (consisting typically of 3 to 5 clinic visits per week, each lasting from about 2 hours to about 6 hours), and in a few places one can also arrange to reside on site while attending a partial hospital program – these approaches are much less costly than rehabs, and provide a diluted version of some of the same benefits.

A more traditional rehab will cost over $30,000 for a month’s stay; do not expect your Blue Cross, Tufts, Harvard Pilgrim, etc. policy to cover it.  There are programs that cost somewhat less (e.g., with reduced lengths of stay or staffs consisting mainly of counselors with less in the way of medical care).  And if a person needs a sobriety-oriented residence as a next stage of recovery, there is also a 2-tiered world – very comfortable accommodations for those who can afford to spend well over $1000 a week, or relatively rough [but sometimes life-saving] halfway house environments (with long waiting lists) for those without wealth.  (More to come at a later date.)

Jeff Fortgang, PhD, LADC-I

Feb 01

Many years ago when I was first trained as a clinical psychologist, patients’ interest in self-help books was often viewed as a cheap substitute for psychotherapy, and their requests for book recommendations was sometimes deemed a form of resistance to therapy.  In my own memory it was the world of alcoholism treatment, and then the 1980s explosion of interest in adult children of alcoholics, that opened the door to what is sometimes called “biblio-therapy”.

Things have certainly changed, and now, according to a study by psychologists at the University of Scranton, 85% of psychologists polled found that their patients/clients reported benefitting from self-help books, and 57% said the same of autobiographies.  Reviewing these results recently in The Register Report, a periodical for psychologists, the researchers had provided a list of the top 50 self-help books and top 50 autobiographies for issues including grief, depression, bipolar disorder, substance abuse, and more.  [Unfortunately they have taken down these pages since this blog was originally composed, but if you need ideas feel free to call Dr. Fortgang at LCL.]

Jeff Fortgang, PhD

Jan 14

As a clinician at LCL, I recurrently have the opportunity to meet lawyers who present with exceptional academic backgrounds, who have excelled in their careers, and who have shown impressive vision and determination in their professional lives.  Even so, the matters bringing them to me are reminders that depression, addiction, attention deficit, anxiety, and the like are equal-opportunity problems, and that these individuals are no more immune from them than those whose backgrounds are less extraordinary.

One reason for that is the fact that different parts of our brains are, in some respects, at war with one another.  Rationality, decision-making, goal-directedness, etc. are functions that seem to go on mainly in the prefrontal cortex, a part of the cerebrum that is uniquely evolved in humans, and we’d like to think that we employ our cognitive capacities to control our lives.  But the fact is that much of our behavior is affected strongly by the limbic system, where we find the influence of emotion and reward.

Lawyers seek to live professionally in the prefrontal cortex, which is essential in the practice of law.  But they are human beings as well, and subject to the powerful behavioral impact of feelings (whether or not these are acknowledged) and reward states (such as those that can be unnaturally elevated by alcohol and other drugs of abuse).   Thus, we find highly intelligent, accomplished individuals, who have tried to apply their reasoning skills to problems of emotion or addictive behavior only to see these difficulties worsen.

We all have to recognize that there is much of life over which we have little or no control, and that when it comes to those parts of our experience we will probably benefit most from (a) acceptance of our human limitations and (b) willingness to make honest connections to others as sources of help.

Jeff Fortgang, PhD

Jan 04

… Little did I suspect that I would be faced with a significantly larger number of uninsured lawyers after the advent of “universal” coverage here in the Bay State – and virtually nowhere to send them (since the free care pool subsequently diminished or disappeared)….. [To read entire blog, originally posted 1/4/10, click here.]

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