Stages of Care
The average client comes into treatment only after having lived with their problem for a period of time. It may have been a few weeks, a few months, or a few years. They often have tried resolving the problem on their own, talked to family members or friends about it, and maybe even went to a bookstore or library to see if there are any books on subject.
Once in the mental health system, whether they see a psychiatrist or therapist first, the professional does an intake and makes a diagnosis. Then a course of treatment is defined, often with a specific treatment plan written out on a form. Sometimes the client is a part of defining their treatment, sometimes not. Even if the client does collaborate with the therapist on their treatment plan, how they actually obtain the goals defined therein is left to the therapist’s training, experience, and knowledge.
Treatment ends when the client’s self-report of symptoms have decreased enough to the therapist’s or client’s satisfaction, when the client’s insurance coverage is exhausted, or the client is frustrated with the lack of progress in therapy. More recently, the onset of managed care in many health care systems around the world means trying to better define outcomes and measure progress in therapy. This can be done with a variety of measures, including treatment plans, symptom checklists, or other measures of the client’s well-being.
The Internet’s Potential
The Internet is turning the traditional psychotherapeutic relationship on end. No longer are clients content to sit back and be told how to change. Instead, they are taking a more proactive role. Clients are learning more about their disorder and diagnoses ahead of time. Many quality Web sites provide comprehensive lists of diagnostic symptoms for various disorders, as well as the usual and standard treatments prescribed.
Some clients are even helping to narrow down possible differential diagnoses by taking interactive, self-help quizzes online. Clients are finding others online with a similar diagnosis and joining self-help support groups that make living with the disorder easier and more understandable. For some people, the convenience and lower cost of the emerging e-therapy modality makes sense to try.
Since 1995, a wide variety of Web sites are providing a virtual encyclopedia of knowledge about mental health disorders that before that time, was simply not readily available to the lay public. These sites were first begun by a handful of professionals who understood the Internet as an inexpensive transmission medium for disseminating information. By learning a simple language called HyperText Markup Language (HTML), anyone could publish a Web site on any topic they chose.
Given the paucity of consumer-focused information on mental health issues, these Web sites quickly gained a hungry following of mental health consumers. Government-funded institutes, such as the National Institute of Mental Health, worked hard to bring their sites online and provide the wealth of consumer information they had developed over the years in paper brochure format. Before the Internet, even getting a simple list of what constitutes a diagnosis of “major depression,” for instance, was extremely difficult if a person didn’t know a cooperative mental health professional. These Web sites provided valuable resources on mental disorder symptoms, diagnoses, and treatment to a much larger audience than ever before1.
This reluctance on the profession’s behalf to share this knowledge is less surprising when considered in context of the evolution of our modern mental disorder diagnostic system. This system, codified within the Diagnostic and Statistical Manual of Mental Disorders (2), really only gained widespread acceptance a decade earlier, and was still making slow inroads in many established therapeutic practices. Before this more-scientific model of diagnosis was adopted, most professionals handed out diagnoses in a very personalized, experience-based manner that had little empirical support or reliability between professionals. Given the diagnostic system’s overall young age, the lack of information supplied about diagnoses derived from it (and subsequent empirical diagnostic systems) is perhaps more understandable.
In addition to basic information about how mental disorder diagnoses are made, Web sites offered increasingly detailed information about theoretical orientations practiced in psychotherapy and the techniques that accompany them. Not surprisingly, many consumers’ impressions of psychotherapy are still rooted in the traditional Psychology 101 teachings of Jung and Freud, of clients lying on couches discussing their dreams with a distant, unattached therapist. The Web put to rest many of these inaccurate characterizations and brought full light to bear on the wide range of orientations practiced in psychotherapy today. Clients learned that therapy doesn’t have to last for years and cost a significant amount of money. Instead, therapy can be short-term, goal-oriented, and valuable from time to time as life gives a person something unexpected to handle.