PSYCHOTHERAPY’S BOTTOMLINE

When we buy a drug, we ask IF AND HOW SOON it relieves the symptoms and cures the ailment. We might even ask how much it will cost us and compare the brand name medicine with generics (if you don’t have drug coverage insurance). So we are doing is practicing bottom line analysis. We do the same for buying a pair of shoes or a car, we compare prices. We evaluate the ‘deal’s worthiness in terms of the product’s comfort and longevity. And relate it to the cost

But when it comes to buying psychotherapies or services to treat cognitive problems, we often don’t use bottom line to evaluate its worthiness. In fact, bottom line worthiness is inversely correlated to how ‘psychological’ or ‘mental’ the problem is deemed and treated, that is, we tend to give a lot more allowance for treatment ineffectiveness if we think the problem is deep-seeded in the psychological realm.

So if Johnny gets D’s and F’s from school, or fluctuating grades from A’s to D’s, the parent might have the following options of services, in ascending order of ‘mental/psychological/psychiatric‘ orientation:
1. Get a tutor
2. Get a school counselor
3. Get a behavioral psychologist
4. Get a behavioral life coach
5. Get an educational psychologist
6. Get special education services from school
7. Get a motivational coach
8. Get a clinical psychologist
9. Get a child psychiatrist
10. Get a psychotherapist
11. Get a psychoanalyst.

The list is not exhaustive, as there are myriads of variation of therapies, training, services, etc. available. In general, as you go down the list, the same original problem gets to be treated with increasing complexity and vagueness, and the expectation for improvement diminishes.

Thus, if the parent thinks Johnny’s grade problem stems from deficient academic skills or inadequate curriculum, then a tutor might be called and the bottom line here is easily measured by grade improvement. But if s/he thinks the problem is caused by ADHD, the child could get evaluated and be diagnosed (almost always) as such and receive special ed services or be seen by a psychologist or psychiatrist or be put on medication, or a combination of these. The relationship between improvement of school grades (the original concern) and the effects of therapy(ies) becomes much less direct. The idea is that we are treating the ‘whole’ child - his mental well being, his hyperactivity, his impulsivity, etc. - rather than just improving school grades.

I am often amazed that parents who are very successful in their own rights (CEO’s, psychologists, lawyers, famous actors, etc.) don’t use bottom line to evaluate choice of therapy or program. A teenager who has attended private school wanted to go to a structured boarding school to be with his friends, then threatened to commit suicide seven months later; He was taken back home and be home-schooled, and was happy to be tutored only twice a week and be able to resume the late sleeping schedule and weekend partying. The nationally famous father told me his son was "under too much pressure" and the suicide gesture was a sign of "crying for help.". The same issue if viewed in a more behavioral, less psychodynamic way might become "taking the easy way out" rather than "crying for help". It would not be surprising to see that his son would want to 'cry for help' whenever the issue of going back to school full-time comes up.

Buying an ineffective therapy or service does not only waste money and time, but may actually have 'negative side effects'. So I say: BUY THERAPY BY ALL MEANS - BUT CHECK THE BOTTOMLINE
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