The Road Online to Empowered Clients and Providers
This chapter focuses on how the provider’s changing role, combined with psychoeducational Web sites, online support groups, and emerging modalities like e-therapy, can open the door to providing clients with a higher-quality level of care, reduce cost, and improve access to services. The Internet allows professionals to reach out and offer a wider range of affordable services to more consumers than ever before. The therapist is not only a direct provider of services in this new paradigm of the empowered client, but also the coach and consultant to the patient. This new role allows the professional to help the client be a more educated consumer of the growing set of resources available to them online.
How it Was
Historically, psychotherapists and psychiatrists have acted as the gatekeepers to mental health services. While this role changes marginally from decade to decade, most therapists act as the expert to change in guiding the client to a successful resolution to their problems. No matter the specific psychological orientation of the therapist, whether she be a Freudian or a cognitive-behavioral therapist, the professional nearly always takes the lead in guiding therapy, dispensing information about the specific disorder, and acting as a conduit for additional support services in the community.
Therapist as Expert
These roles are defined by specific boundaries, which are often explicitly elucidated early on in the therapeutic relationship. “Here is how I work. These are my expectations of you as the client, and these are the expectations you can have of me as your therapist. Here is what you do in case of an emergency.” The therapist makes it clear that while she is not a friend or advice-giver to the client, she is acting in the role as an expert in human behavior and experience. This role often translates simplistically to the client, “Doctor knows best.” If the professional says that a psychiatric consultation is necessary in order to evaluate the client for medications, the client goes along with it. If the professional says that he works using cognitive-behavioral techniques in order to help effect change in the client’s life, the client goes along with it. If the therapist suggests that couples counseling is in order, the client goes along with it. Very rarely do clients verbalize disagreement with choices made about their treatment, and for the clients that do, they are sometimes labeled as “resistant” or using some similar psychotherapeutic mumbo-jumbo.
At this point, many professionals will object to this characterization of the traditional psychotherapeutic relationship, claiming, “Oh no, I don’t act like that. I’m a partner with the client in helping them change.” While that may be philosophically many therapists’ orientation, their practice is often reduced to making specific recommendations for behavioral or thought changes in order to effect emotional change. Clients who do not follow the recommendations often spend a great deal of time in therapy, and the therapist is left scratching her head as to why.
Dissemination of Information
Nearly all the information the client wanted to know about their disorder or diagnosis was delivered to them by their mental health professional. “What is depression?” would be answered in session by the “expert” therapist or doctor. Ten years ago, this was the client’s primary, and often only, source of such information. Many therapists refused (and still refuse) to share even the client’s own diagnosis with them, often with the claim, “Well, they wouldn’t understand what that means.” The thought of explaining the assorted complexities of the diagnosis, and the entire diagnostic system used within mental health, was un-thought of.
If the client was prescribed a psychotropic medication by a psychiatrist or their primary care doctor, the client was often left with very little information about the possible side effects or even the insert accompanying the medication. “What should I expect while taking this medication,” was often met with a short reply, and no place for the client to get additional information. For those few clients who felt brave enough to actually ask the question. Most clients are often intimidated by their doctors and defer questions altogether, preferring to take a “wait and see” attitude – “If it doesn’t hurt me, I won’t bother the doctor with all of these silly questions.”