Tuesday, February 23, 2010
We'll look at the changing nature of psychotherapy and the balancing act between medication and talk therapy to treating mental health issues.
The 2010 Annual Meeting of the American Group Psychotherapy Association runs through Saturday, February 27, at the Sheraton San Diego Hotel and Marina. The public is invited to a special discussion on Wednesday, February 24, at 6:30 p.m. entitled "the Erotic and the Domestic: The Pitfalls of Modern Intimacy."
MAUREEN CAVANAUGH (Host): If you watch TV, you might begin to think there's a pill to cure whatever emotional or psychological problem you're having. There are lots of commercials about medications for conditions like social anxiety or depression. But mental health professionals are quick to remind us that even though prescriptions can be remarkable tools, they do not usually address the root of the problem. For that, new research is telling us, you may still need psychotherapy. I’d like to welcome my guest, Dr. Jeffrey Kleinberg. He’s president-elect of the American Group Psychotherapy Association which has its annual meeting here in San Diego this week. And Dr. Kleinberg, welcome to These Days.
DR. JEFFREY KLEINBERG (Psychotherapist): Thank you. It’s great to be here.
CAVANAUGH: Now, psychotherapy, I think we’re all pretty familiar with the concept but it’s sometimes called talk therapy or the talking cure. Why is that?
DR. KLEINBERG: The major approach to helping people with problems in talk therapy is conversation, conversation that can be about problems or history, conversation that leads to greater insight as to what might be causing problems. So the word ‘therapy’ refers to therapeutic, that there’s a healing value to such conversation.
CAVANAUGH: So is it possible that in a group therapeutic situation that that is – healing is compounded because there are so many people in a certain circle who share a similar problem?
DR. KLEINBERG: Yes, I would call that the multiplier effect.
DR. KLEINBERG: Having 6 to 10 people working with a trained group therapist will reveal common issues, common themes among the patients. One can learn from the other. And, second, one can support the other through compassion and identification. So that elevates the therapeutic value of group.
CAVANAUGH: It’s interesting. So someone will come up with something that another person was thinking or perhaps didn’t want to say or see a new aspect of whatever issue the person is going through.
DR. KLEINBERG: Yes, in fact, the therapist will put together a group based on common issues that individuals are experiencing so, for example, in these very difficult economic times, who doesn’t have concerns about finances? And one person bringing up the conflict that has arisen in the family because of financial problems, everyone will be reminded of what they’re experiencing. Then the group as a whole begins to address problems about financing and how the families are affected in a very cohesive and therapeutic way.
CAVANAUGH: Dr. Kleinberg, I was going to ask you which mental health issues is group therapy good for. I’m surprised you immediately talk about economic problems because that would not be the thing that sprung to mind, you know, right off the bat. So it’s – it must be a wide range of issues.
DR. KLEINBERG: Very much so. After 9/11, for example, through my organization, the American Group Psychotherapy Association, we ran many groups for people who’d been traumatized in New York and in other parts of the country and the value of doing trauma work in groups is tremendous. Other issues that come up are communications problems, communication between husbands and wives, communication on the job. A third issue that comes up frequently is anger management. It seems to be that group provides the forum for people to identify what it is they’re doing that makes anger management, for example, very difficult and others give feedback that therapists alone in a one-to-one counseling session may not be able to give.
CAVANAUGH: Now San Diego has a very large military presence, as you’re aware of, I’m wondering what kind of – is group therapy a technique that’s used for people suffering from post traumatic stress syndrome?
DR. KLEINBERG: Yes, it’s a very effective dynamic for people coming back from the military. In fact, this week we’ve invited clinicians working for the military to attend our conference. There are two issues that I would like to mention. One is the effective work that group can do with returning military people and their families. We work a lot with families. The second one is very, very important, and that is the strain that caregivers experience in working with returning veterans and we have developed a group approach to helping therapists, physicians and other mental health professionals who, themselves, have gotten caught up in the stress of working with those in need.
CAVANAUGH: I’m speaking with Dr. Jeffrey Kleinberg. He’s president-elect of the American Group Psychotherapy Association, which has their annual meeting in San Diego this week. I’m wondering, from what you said, Dr. Kleinberg, that some doctors will choose members of a group in a certain way. What have we learned about group therapy in recent years? Because I think the concept is a rather old one. It’s been going on since I can remember. But is it more focused these days? Are – Have there been changes made?
DR. KLEINBERG: Well, let’s talk about some of the research that has been published recently. I think the research points to the effectiveness of group therapy. We haven’t always had this – these research data. For example, one study shows that the same presenting problem dealt with in individual therapy over a specific number of sessions is equally treated well in group therapy over the same number of sessions. Now that has major implications for cost. It’s usually much cheaper for the individual to go into group than in individual therapy. In many cases, the cost of group therapy is 50% of what the individual therapy session would cost, so this is very significant. Also, we’re learning the importance of theme-centered groups, groups that deal with, for example, parent-child problems, groups that deal with problems of retirement. So I think what we’ve seen over the years is more focus on themes and not just addressing diagnostic problems like depression or anxiety.
CAVANAUGH: I see what you’re saying. Well, speaking of focusing on different symptoms and different particular problems like depression or anxiety, I said in my introduction that there seem to be a lot of medications available to treat mental health problems these days. And I’m wondering, what role does talk therapy, in particular group therapy, play in relation to those medications that are available today?
DR. KLEINBERG: Recent findings question the value of, for example, antidepressants for moderately depressed people, that in a study it seemed that antidepressants were as effective as psychotherapy alone. So this was an important finding. For more disturbed individuals, medication seems to be more effective. The other study that I like to cite is one that suggests that medication for the person who is severely disabled coupled with group or individual therapy is the best package of treatment approaches, that medication may open the individual up to therapy and then the actual group experience or the individual experience really makes a cohesive treatment program. So I would recommend an evaluation by a trained mental health professional and then a treatment plan that might include various aspects of treatment including medication and individual or group therapy.
CAVANAUGH: I wonder, as a mental health professional, do you find more and more people coming to you wanting basically to take a pill and make it all go away?
DR. KLEINBERG: My experience is that people are not that interested in medication alone.
DR. KLEINBERG: Yeah. Unfortunately, in the managed care setting and marketplace that we find ourselves in that many insurance companies promote the use of medication and most therapists would say that is one tool at our disposal but it is not the cure-all for everyone. Many of the medications have a 60% failure rate, which, of course, you don’t see in the advertisements. And all medications have side effects. So today I find that people will use medication if it’s recommended but would like to try talk therapy first.
CAVANAUGH: I’m interested, how do you advise someone who thinks that they might be a candidate for group therapy? How is it that someone begins to find the right therapist, the right group?
DR. KLEINBERG: It’s extremely important that the individual find a trained, highly qualified, licensed mental health professional. Unfortunately, there are groups in this country, some are peer groups, some are formed through the internet, that offer help. Sometimes they’re called life coaches. I’m very worried about this increasing trend because they seem to charge very little money, some charge no money, and people can become involved in these groups and experience quite a lot of harm. So I would recommend that individuals talk to their physicians, their clergy, if it’s a child to the school officials, about qualified mental health professionals who do group or individual counseling. Now the organization that I represent, the American Group Psychotherapy Association, certifies professional mental health people in group therapy based on rigorous standards. And our website is www.agpa.org and there’s a button to click called ‘find a group therapist.’ And you can be assured that those individuals meet some rigorous standards.
CAVANAUGH: And we – I’ve just been informed we do have a link to that at KPBS.org as well if that’s easier for people to remember. I wonder how long would someone have to commit to a group therapeutic situation in order to see benefits?
DR. KLEINBERG: I would say it depends on the presenting problem. It depends on the individual’s motivation. There are groups that are very short term, 10 sessions, and these tend to be about themes, how to deal with conflict, how to deal with anger, how to deal with work problems. But I also recommend that people who would like to take a look at themselves in a new way or review their life situation, look for an open-ended group that can go on for several years. And what the individual will find in that experience is that it’s a safe place to come and to talk about what’s stressing them and there’s no specific agenda but people develop terrific relationships with their peers and the value cannot be measured.
CAVANAUGH: Now to go back to your allusion to what insurance companies will pay for and what they won’t, how much will, let’s say, the average insurance company—I don’t even know if that exists anymore—will pay for someone to enter a group therapy situation?
DR. KLEINBERG: See, here’s the problem, here’s the way that we encounter it in our offices. Most insurance companies will pay for only one session a week.
DR. KLEINBERG: So for many people, what’s needed is one individual session and one group session. So as a result, what we have is that they’ll approve the individual session but not the group. So it’s – that’s one of the efforts that insurance companies make to control costs.
CAVANAUGH: And what do they lose out on? What does a person lose out on if they don’t – if they aren’t able to make that group therapy – enter into that situation?
DR. KLEINBERG: I think they lose out peer support, feedback, safety, identification with others, learning from others who’ve been there before, and a safe place to meet on an ongoing basis once a week in the middle of our very busy lives to feel that people will listen, and that is a very valuable experience.
CAVANAUGH: Dr. Kleinberg, do you think the perception of mental health issues and their treatment have changed over the years? We used to hear about a stigma having to do with going in and getting help for your mental health issues. Does that still apply?
DR. KLEINBERG: I think in some social groups it does apply, people who may experience a lot of shame in admitting that they have psychological problems. But the more education families have, the more education individuals have, the more open they are to psychotherapy and they realize that in the entire country quite a large percentage of people need psychotherapy and benefit from it, and I think the stigma is much less.
CAVANAUGH: Especially when it is – when people such as care workers and people who come back from helping during natural disasters get into group therapy. I would imagine that that would help remove what any – any remaining stigma there might be.
DR. KLEINBERG: Absolutely. And in recent years with school violence and shootings and other – and trauma of hurricanes and traumas related to the financial community, people are looking for group in new ways, looking for relationships. The problem is that it’s often difficult for them to find qualified people in soundly based programs.
CAVANAUGH: I want to thank you so much for speaking with us today. And have a good conference.
DR. KLEINBERG: Thank you for inviting me.
CAVANAUGH: The 2010 annual meeting of the American Group Psychotherapy Association runs through Saturday, February 27th at the Sheraton San Diego Hotel and Marina. The public is invited to a special discussion tomorrow evening at 6:30 entitled "The Erotic and the Domestic: The Pitfalls of Modern Intimacy." You can go to KPBS.org/thesedays for more information. We’ve covered a range of interesting topics today on These Days. You can hear them again at our website, KPBS.org/thesedays. You can also post your comments there as well. Thank you so much for listening and be with us tomorrow, These Days on KPBS.