Up Front: Good Counsel
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I really wanted to respond to this post BUT
*I cant quote from it!
Islander, who disagrees with the idea that counselling isnt routinely offered - as opposed SSRIs- having unfortunately large family experience in these matters-
Emma Hart, in reply to
who disagrees with the idea that counselling isnt routinely offered
None of the three times I've been put on SSRIs was counselling even mentioned.
Three to six cents a day seems very attractive when compared to the hundred-plus dollars it costs for each counselling session.
Yes, it does. But not compared to the cost of not finding the right combination of treatments for the particular person who is right there in front of you.
Judith Fursdon, in reply to
And how I wish that they would factor that in to their calculators
The comment in the original article which pisses me off the most is this:
The country's biggest income protection insurer, Sovereign, says claims for depression have reached a crippling 40 per cent and the cost of counsellors it sends clients to "out of the goodness of our hearts" can't be sustained.
"Out of the goodness of [your] hearts"? It's your fucking JOB. You ask people about their history of depression when you accept their policies. Why does it seem such a surprise to insurers that their job includes paying out?
Hi all. When I was originally approached for comment for this story, the whole story was hung on a quote the reporter had managed to get from Sovereign that "How do we even know that talk therapy works anyway". Sadly in the editing process this quote disappeared, presumably because Sovereign advertise with APN, justified in terms of "balance".
The real story here is unethical incompetence by the Chief Medical Officer at Sovereign. But sadly, Judith Collins has made more or less the same argument about the removal of relationship counselling from the Family Court processes.
It stuns me we're still having this conversation. Therapy is AT LEAST as effective as counselling in most cases, and in some MORE. Further effect size (how much it works) is bigger and the relapse rate is lower.
Thanks for this post, and for keeping the conversation going.
Islander, in reply to
Kia ora Emma – 3 of my sisters, and my beloved mother, have been on SSRIs for the
past 7 to 10 years (except for the sister who died of pancreatic cancer in 2007, they live well & work when they need to.) My mother is on Venlafaxine (started on citalopam, that was a disaster): I am unsure what my 2 remaining sisters take – they’re both nurses, and take what they have researched & find personally effective.
ALL FOUR were offered talk therapy/counselling as soon as their depressions were diagnosed…and they were all in the Canterbury area at the time (except for Mary E. who was in Oz at first diagnosis.) As my mother cheerfully will tell people who come to her (because she is not only well – she thrives!) “If only I had those the unjudgmental informed listeners when I lost babies…!"**
Venlafaxine costs the taxpayer approximately $690 A MONTH PER RECIPIENT-
my brother & myself have emergency plans to sell stuff if it should ever become chargeable-
my mother found counselling – interesting. It brought up a lot of past history (she had 9 pregnancies & 6 live children, and lost 2 husbands – I know, careless, careless-)and with skilled listening, and low-key suggestions – like, like – OK, you had 4 kids under 5, and then your beloved Dad died- do you think there was any relation between this? That possibly your Maori Dad thought you’d re-established his line? **
I dunno. I’ve never been severely depressed. I know it is a severe, acutely painful, life-threatening disease. All I know is – my family members who have been so afflicted, have been routinely offered the counselling as well as the SSRIs…
I dont want to bring this up, but feel I must.
With the exception of my mother & self, and one brother – all my sibs & their partners are involved with medicine…
**Neither of my Mother’s brothers bred (and it was very clear, early on, that they never would.)
Judith Fursdon, in reply to
It gives me a little bit of hope that at least somewhere in the country, people are being offered that option. My experience, and the experience of several people I know, has not been so positive. I wish it had been, and I wish therapy was more widely available. As you point out, it makes a difference for people.
Judith Fursdon, in reply to
“How do we even know that talk therapy works anyway”
How did they manage to miss the piles of research that is behind the recommendations of groups like the NHS? Mild to moderate depression = talk therapy. It's the standard of treatment, and antidepressants aren't supposed to be initiated unless the depression does not resolve or it is severe. How do they not know this?
Kyle MacDonald, in reply to
At best ignorance, at worst malfeasance.
The world of insurance is a largely heartless, bottom line driven industry. What they can get way with, largely they will.
Lilith __, in reply to
Thanks for writing this, Judith.
I owe my sanity to counselling, which was funded both by the Family Court and by WINZ.
The relationship counselling I had through Family Court did not officially result in “reconciliation”, but it resulted in mutual understanding after a huge amount of distress and misunderstanding. Difficult breakups can destroy people, and getting out in one piece is a successful outcome.
WINZ funded me to have ongoing counselling for issues arising from my chronic illness, and that counselling changed my life. I went from intense self-hatred to acceptance, and gained a range of tools for dealing with other people and their reactions.
I would never have got any of that from drugs.
SSRIs have their place, and I am on one to help me with quake-related anxiety: it’s been a big help.
Help must be available depending on individual needs, not on cost. The policy of not funding counselling will cost lives, and it will also cost society the unrealised potential of so many people, whose problems could have been worked out.
I too was disappointed by the article. It was good that they raised the issue, however the failure to question the statements of the medical officer was a woeful omission. The evidence for SSRI's (once the pharma companies were forced to release all the data) shows that for the vast majority they are no better than placebo. In those experiencing the most severe depression there is some efficacy. These drugs are not without serious side effects as well. This is well documented and based on the evidence - published in the Journal of the American Medical Association (JAMA) back in 2010 among many other places. Robert Whitaker is one journalist who has covered this well.
The Chief medical officer of Sovereign sounds like he is quoting from the PR material rather than the scientific literature. Either that or he is 10-15 years out of date!
Regarding WINZ Disability Allowance for counselling, it has been cancelled at least once in the past (in the late 90s, IIRC) and then quietly reinstated, because there is a need for it .
Islander, in reply to
for counselling, it has been cancelled at least once in the past (in the late 90s, IIRC) and then quietly reinstated, because there is a need for it .
Yo Lilith - I think there must be a difference btwn. WINZ *disability*allowance and
and assistance allowance.
Angus Maxwell: I go by family experience. I've seen what works. And, I've sure as shit seen what doesnt work. Maybe - research a leetle more?
In those who are severely depressed - the drugs work. And -that!- frankly is all I care about. Because - until the drugs start working - the talk therapy/counselling
sure as shit doesnt even begin to connect (talking as somone who, you know, held her mother while she was bloody close to dying-)
thank you so very much for sharing your story.
this whole thing just destroys my brain a little. I can truly say without both medication and therapy i wouldn't be able to even leave the house., or even attempt to do the teeny tiny amounts of work i do. And i'm the lucky one because i share a house with my mum and when i feel i need to check in with my therapist, she pays for it
Islander, in reply to
(talking as somone who, you know, held her mother while she was bloody close to dying-)
That was when she was on citalopram...she developed hyponaetremia due to a change in dose...
good people all -I think we are all agreed that whatever helps is what we need, and there is no one answer for that need. I would support - totally- a move for
talk-therapy/psychotherapy/counselling *for those it works for.* Otherwise - go for the drugs!
Incidentally: I am a dysthymic- a 'permanant Blue Monday' person. There isnt anything you can do about this condition except
* rejoice in being the only 8-letter/1 vowel word in the English language!
*laugh-occaisionally-for the entire stupidity of our kind of intelligence AND!
*really enjoy drinking alcohol!
I thank you for this, Judith. I have only felt that grey fog for one day in my life - yes, honestly - and it was only lifted by some talky therapy. And just recently, I went through a bit of a break down - more a lack of coping than anything else - and once again, talky therapy helped ease the load. And I know many people who, I think I can safely say, may not be here without the counselling that they have sought, or have been offered. That gladdens my heart, that they are still here and in my life. The slashing of funding or withdrawal of any service that genuinely helps people in need makes me fearful. We are increasingly becoming a very petty, judgemental, cruel society and this is just the tip of the iceberg.
Thank you Judith.
And everyone else for sharing what must be very personal and difficult stories to tell.
The article doesn't mention it, but would this include counseling for someone diagnosed with a terminal illness, or their family? That would seem to be a huge area where talk therapy is crucial.
I despair of the cynicism these policies and profit driven motives represent. As if we are trying to systematically remove compassion and empathy from society.
Not on my watch.
Excellent words, thank you Judith.
Pegasus Health in Chchch offers an excellent Mental Health GP Liaison service, offering 5 sessions of free psych support over a 12 month period with a GP referral.
Perhaps someone should tell Sovereign that this health provider says:
In any one year around 20 percent of the community will have a mental health problem. Not all will seek help, nor do they probably need to. However, in the event that they do seek help, most people will do so from their general practice team because mental health and physical health are inextricably linked.
And to my way of thinking, it is a wetware/software issue - talking is the main way to access mental programming - talk is code...
I'm sure the medication may help case by case, but better yet in tandem with some information, instruction or insight...
To indulge in a little metaphor play:
Better to discover and use the clutch than be constantly pouring lubricant into the gearbox...
or for the less mechanical:
You don't untangle knots by pouring chemicals on them...
In the beginning was the word...
and we are still resonant beings.
Thanks for your post Judith. I am one of those who has found talk therapy vital in dealing with grief stuff including family deaths. But you have to find the right person.
My daughter is a counsellor who works for an NGO which specialises in supporting children and families, particularly those suffering grief and loss. She seems to spend a lot of time trying to get funding especially for counselling for children. If I won Lotto this is a cause I would donate to. Many families under stress just cannot afford counselling and there have been cut backs to funding through PHOs, CYFs and similar routes. As a society we do not value children, and pay lip service to their resilience but are not prepared to resource it or put the needs of children central to government policy. The new Family Court rules are an example.
I also found out what high professional standards are required to join the NZ Assoc of Counsellors (so people can trust counsellors who are members of NZAC), and how little she is paid compared to her previous nursing carer.
Thank you so much for this post Judith.
When I was seen for panic attacks by my GP I was offered the choice of medication or free talk therapy sessions (through the liaison service that Ian refers to). I took the talk therapy and, when I did not improve, was referred to a private provider. The panic attacks were dealt with through introceptive exposure, but I was later diagnosed with depression. I can not understate how much talk therapy has helped me. It is like being given a new set of eyes to see the world through. It has been the best thing I have done for my own self. Having said that, without the addition of medication (fluoxetine)*, the task faced would have been immeasurably harder. The medication helped to take the edge off the brutal low, and gave my brain some space to process the therapy. However, it is the therapy, not the medication, that has allowed me to stay more well.
I have always been offered the choice of medication and/or therapy by my GP, and I would have expected this experience to be universal given the evidence that exists around the efficacy of both options.
*I do appreciate that I am very fortunate that I have not had to play medication roulette. That is a special kind of hell.
Thank you for stepping up to the plate and posting on this.
When a combination of my father's death, issues at work and mid-life threw me into depression I was lucky enough to have good medical insurance and a good GP. We talked about it, he offered either talking therapy or drugs or both. I went with talking therapy because I wasn't sure I wanted to alter my brain chemistry. I was lucky that my GP knew me well and recommended a therapist who was right for me and I got through depression.
I know the signs - I know the things I have to work on in myself and with the people around me. I know I need my friends, especialy those who are able and willing to listen. I learned to focus on the people and things that are actually important to me. I learned those things and many more from my therapist over four years and it really took that long.
But I was very lucky in that I had enough money to pay for that myself. Very very lucky.
I've seen people for whom drugs have worked brilliantly. But I've also read some of the literature and had close experience with someone for whom the drugs were a disaster. The combination of an incompetant GP, a not so good therapist and the bad luck to have the wrong biology came close to being very bad. SSRIs are crude tools for altering brain chemistry, that they work for some people is bloody amazing given how little we know about them and the brain. And for some people they can be life threatening.
No, counseling doesn't work for everyone. And yes drugs do work for some. But to argue that taking away an effective therapy just because it ruins the bottom line for an insurance company??? What the f*ck are the premiums for anyway? Do they really think "harden up" works?
Sacha, in reply to
taking away an effective therapy just because it ruins the bottom line for an insurance company
And for government agencies, let's not forget. Judith Collins has some explaining to do.
If the government gets away with behaving like a corporate insurer, other public agencies are bound to follow suit under ongoing budget pressures and poor governance.
Recent welfare changes aimed at sickness beneficiaries (many with depression) will only incentivise similar scrimping by outsourced services seeking placement bonuses at least cost.
Personally I've found counselling invariably helpful at various stages of my adult life. I have no doubts whatsoever about the cost-benefit ratio for myself and those around me, and for what it has helped me contribute to our society and economy. I'd like to believe it has made me a better person, and hate seeing similar opportunities for others stealthily removed without decent evidence.
Sacha, in reply to
If I won Lotto this is a cause I would donate to
yes, and lobby future governments to invest properly in this.
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