Inpatient Treatment For SD Mayor Filner Amid Allegations Of Sexual Harassment
July 29, 2013 1:20 p.m.
Jeff Daly, Psy.D., Clinical Psychologist
Anne M. Fletcher, author Inside Rehab:The Surprising Truth About Addiction Treatment-and How to Get Help That Works
CAVANAUGH: Coming up, what goes on inside a behavioral therapy clinic. We will hear from the author of inside rehab. It is 12:19 you are listening to KPBS Midday Edition. After accusations of sexual harassment and sexual misconduct by seven women Mayor Bob Filner announced Friday he is seeking treatment for his behavior by entering a behavior counseling clinic. We contacted the mayor's office and were told that Mayor Filner is not available for interviews. So many questions remain unanswered. What type of treatment might the mayor be seeking and will it work? I'd like to welcome two guests who can help shed some light on behavior treatment and treatment facilities. Anne Fletcher is a nationally known health and medical writer. She's the author of the book Inside Rehab and Anne, welcome to the program.
FLETCHER: Hi, good to be with you.
CAVANAUGH: And Dr. Jeff Daly is a clinical psychologist in private practice here in San Diego and Jeff, welcome to the program.
DALY: So good to be here. Thank you very much.
CAVANAUGH: Anne, in your book you wrote about all sorts of therapeutic settings for addictions and behavior problems. Where does the counseling clinic described by the mayor fall in to the rehab scenario?
FLETCHER: It's really hard to know because it's there's not a definition as one expert said in my book there is no FDA for addiction treatment or behavior treatment. So what is a behavior counseling clinic one does not know what that means is that residential where you go stay overnight. Is it an outpatient program which would be the ideal setting for somebody I would think with this kind of problem. So, we really don't know where the mayor is going for treatment, or what kind of treatment it is. Have they given any details about the program?
CAVANAUGH: No, intensive is the only adjective that's been used.
FLETCHER: Yeah that could be outpatient it could be residential. I studied addiction treatment programs all across the United States both residential and outpatient and many of them today are now also treating what they call sex addiction and treatment and sometimes they could occur which means they exist together, however I will say that the new diagnostic standard manual called the DSM, which just came out in May in an updated version which is what psychiatrist and psychologist used to diagnose mental health disorders doesn't even recognize sex addiction. So, it is not a recognized disorder in an addiction category and it should not be treated the same way as addiction, but it often is treated the same way in some of these sex rehabs or these addiction rehabs.
CAVANAUGH: Does a person need to be diagnosed before he's put into any kind of therapy, Jeff?
DALY: Now, ideally you would know before you went into a facility what's going on but sometimes we don't know. So we are talking about a few things here, what we are talking about two weeks of treatment, anything above and beyond once a week that the typical therapy you go once a week anything above and beyond that is intensive. So will he live at the hospital, will he go a few days a week. These are all things that are somewhat confusing and confounding and we are not sure what intensive really means the other thing is two weeks where does this number come from? What is two weeks I run an addiction hospital in Oceanside are not aware of anything that can be cured in two weeks. In fact, what's common is six months to 12 months. If you go and stay at hospital what that tells me is that you are unstable. If you have to live in a hospital or you have to go to intensive treatment that tells me your life is unstable, that you cannot manage on your own, that you need constant surveillance you need to be isolated and another problem I'm having with this is that he wants to take care of their business in the morning and evening that's going to eat into his treatment.
CAVANAUGH: How would a psychologist, Jeff, go about making a diagnosis, how long does that take?
DALY: Depends on the diagnosis. Takes time to get outpatient you have to sit down and the other thing is when a patient comes in we have to figure out are they even motivated, are they going to feed us the only information they want to feed us, are they therefore applicable reason once again passed all that once we get a history once they figure out all the complicated factors childhood stuff, then we can land on a diagnosis or diagnoses, there may be more than one thing going on once we get that taken care of we can look at a treatment plan.
CAVANAUGH: Yeah, Anne?
FLETCHER: One of the things I found is there is no evidence of addiction and we don't know exactly what the problem is here. Is there some kind of, The term of the experts that I used interview for what most of us call sex addiction is hypersexual disorder. We don't know about that what the mayor's problem is, is it some sort of power issue, some sort of other problem that he has? We don't know what is driving this behavior, so we cannot define that without some experts sitting down and really evaluating him as the doctor has said. So we really don't know what is driving all of this but most psychological disorders are not treated in a residential setting. I happen to be on the advisory board for practical recovery which is right there in San Diego. And they have both residential and outpatient programs. They would treat a problem like this in an outpatient setting, person like this would not be hospitalized for disorder like this unless the person had a severe drug or alcohol problem to go along with it. And I don't see any sign for anything I've read or heard that the mayor has that problem. It would be treated in an outpatient way, not someplace where you go away overnight.
CAVANAUGH: Let me ask you, Jeff I think a lot of people who are not therapists are really stumped the competing ideas of addiction, compulsion, disorder, what's the difference?
DALY: So that's why people are stumped. Because it's all intertwined. So a really good valid point, the one is that I agree, what we are looking at with Mayor Filner is not an inpatient issue. Whether it's a sexual addiction, whether it's a more traditional values and he's got poor moral compasses, and inability to kind of see someone at par with him and on the same level. If you have a true addiction in my personal opinion I've been doing this for a while it is a biological disease. It's something you're born with there's other factors at psychological, coping it sounds like a perfect storm of variables. That's a true addiction and needs to be addressed in a more may be impatient, or more intensive kind of treatment. That may not be what we are dealing with. We may have someone that has more of a narcissistic sociopathic tendency. I'm not saying he is, I'm just saying these are the traits. What are the traits of someone that has this kind of diagnosis? They dehumanize people. They lack empathy and understanding and remorse and guilt so they can act out on other people as a way to gratify themselves.
CAVANAUGH: So during an intensive therapeutic setting for a number of weeks I would actually go on? Would this be a talk with a psychologist, would this be group therapy? What would be the typical thing that someone undergoing that kind of therapy for some sort of behavioral problem would be?
DALY: It's incredibly structured from the time you get up from the time you go to bed it is a completely structured and you're going to have different types of therapy. You may have therapy with a psychologist me you may have therapy with an art therapist you may have group therapy with your peers. You may have tennis. You may get a massage. You may swim in the pool. But what you are doing is you are not dealing with outside stuff, work, family. You are dealing with you, your personal issues. The whole things is regimented. That's a typical day at an inpatient level. So again one of the concerns I have if he is in treatment is he's working on outside stuff. That's one of the concerns because you are taking away from your treatment.
CAVANAUGH: What about if it's a personality disorder, just can it be treated?
DALY: According to insurance companies it cannot. Here's the deal. Personalities are formed relatively early;the brain stops growing in his 20s. If someone's in their 70s you have a really solidified personality. My biggest thing is anyone can change if they want to change. Now there are certain things that doesn't tend to get better according to research, pedophilia, things like that. But in terms of do you want to be a better person, and you want to treat people with respect, and you want to put someone at the same level of you, do you really want it? Okay then you may respond well to treatment. There are other variables two, as you get older your personality is more solidified you get more rigid in your thinking but again how much intrinsic or internal motivation he has can make or break how well he gets.
CAVANAUGH: Our KPBS reporter David Wagner spoke with UC San Diego's Elizabeth Becker. She designs educational programs for doctors who have done inappropriate things like sexual harassment. Here's what she had to say about Mayor Filner's behavior
BECKER (RECORDED): He may be a guy who just doesn't get it and it is an abuse of his authority and it is an abuse of his power. But that does not mean it is psychopathology. It means that he can just be a jerk.
CAVANAUGH: Now, Anne, I would like to get your reaction to that.
FLETCHER: I agree with that, and actually the experts I interviewed for my book clinical people like Dr. (Larry Horvat), who runs recovery, Dr. Reid was probably the foremost expert who studies this at the expert academic level at UCLA Department of psychology and bio-behavioral sciences, he studies hypersexual behavior. He says, sadly many residential integration programs for sex addiction charges exorbitant amounts of money for group treatment and he said to my knowledge not one of them has invested in or published research to show the efficacy of their interventions. And he says he also does work clinically and he says every approach I've used for people who come to me with problems that are of this kind of hypersexual nature and again, it could be that the mayor is just a jerk as this woman said, it does not have a sub hypersexual problem but when we are talking about something that is of that nature, it is treated in a highly individual way. More like a one-on-one approach where when you go to a psychologist for depression it is not treated in, again in a residential orientation structure type of program.
CAVANAUGH: I'm wondering, Jeff, when intensive counseling is over and as you say you have not actually heard of a two-week period of time. But the patient returns to his normal life. Are there triggers that can lead to certain behaviors?
DALY: Yes certainly there's behaviors and part of dealing with the triggers is ongoing treatment at a different level. If you're going two weeks of intensive treatment you need to trickle down to titrate your treatment. Maybe go and see the doctor twice a week instead of five times a week and maybe that once a week for follow-up consultation of ongoing treatment will help address the relapse triggers which will be unfortunately him being in power, him being around certain types of women potentially and also there is and I don't know if he's in a 12 step program, but part of addiction in my opinion is getting involved in the 12 steps. That's a little controversial. Not everyone with addiction is involved in 12 steps but if that's part of the program, he will have ongoing groups and meetings and because again, there is no two-week tour, this is a good point, is he just being a jerk, or is a pathological. One of the features is how much does it impact his quality of life? Is it a significant impairment? If it's not, it's probably not psychopathological. If it does significantly impact the quality of his life, his work and family, that can be psychopathological.
CAVANAUGH: And you say motivation is going to be a great determiner as to whether or not a patient succeeds in overcoming this kind of behavioral problem
DALY: The determinant. So if someone goes into treatment and they don't want, it's fine if you want to go into treatment and you don't want to be here that's okay my philosophy is just go we will work with whatever we have but once you get in there you have to surrender to treatment if you don't surrender it didn't want to be there you just nod your head up and down and then you go and say everything they want to hear you are not going to get anything out of treatment.
FLETCHER: Whatever the issue is a think it comes back to does he want to change and so often we find that celebrities will go to rehab whether it's for addiction or drugs and non-celebrities because they're trying to get out of trouble. And you know, whether his problem is some kind of addiction are hypersexual behavior or not, obviously it is causing problems. And the question is, does he want to change his behavior to change the problems that are going on in the work situation? And if he does, great. But if he's just doing it to save face, then there's a bigger problem there.
CAVANAUGH: Okay let me ended there than I've been speaking with Anne Fletcher, she's a nationally known health and medical writer and the author of the book inside rehab and Dr. Jeff Daly is a clinical psychologist in private practice right here in San Diego thank you both very much.
BOTH: Thank you, take care.