Therapy Meltdown

So is the quality of our nation’s mental health therapy a problem? 

Mental health therapists are trying, many moonlighting, many in their 20s just out of school, some talking to kids just 5 years younger who are in the midst of a crisis complicated by what they see, what they hear and what they know. 59% of the 374 therapists in our poll this week say they more often than not feel unable to treat, their readiness to solve the storm of pressures kids and young adults are facing today “is getting complicated.” Teen therapist Kelley, 29, said she had the supervision hours but “it wasn’t what I thought it would be, my supervisor wasn’t always present – they had a full panel,” she said. “I see a lot of teenagers who identify as LGBTQIA+, bullied on Instagram, struggling to find their footing at home and school. I’m doing my best, but this is hard – I’m having a hard time,” she admits. Kathie, a 46-year-old family therapist, says she left her corporate job to help people but admits it’s hard getting to the root of the issue for the 16- to 20-year-olds she works with who are struggling with transitions and self-worth. “I think the complexity of their experience is sometimes beyond the scope of my training and my experience.” Some say the issue is we box the patient into a set of diagnoses but fail to train the therapists on figuring out how to identify and treat childhood trauma, how to adjust what we ask and what we say.

Others acknowledge that there are so many patients that it's difficult to match the specialist to the patient’s diagnosis – like the therapist trained around addiction is not necessarily the right fit for the 17-year-old with compulsion. Maybe the problem isn’t really the quality or training of the therapist but the lack of consistent physical movement and exercise as we come of age and go through transitions. In some ways, this isn’t surprising given the meaningful growth in coverage of mental healthcare and the rising demand in the wake of two epidemics, COVID and the opioid crisis, and the constant struggle of youth today to manage life on social media. These issues are exacerbated when therapists and psychologists stop taking insurance as is happening in some states or leave their jobs to join better paying work for a division 1 college sports team. If we are to improve quality and outcomes, we probably need to think about all of this and not just how we pay for therapy but how we pay for quality and help therapists learn how to “measure” progress. Maybe we should take a cue from Ronnie, 34, who completed training to be an LCSW last year. None of Ronnie’s sessions are over zoom and none are in the office – "I do 45 minutes around a lake, jogging, some walking, some talking….and a lot of listening….”