Private Practice Made Simple

4 02 2012

My review of “Private Practice Made Simple” by Randy J. Paterson, PhD:

Private Practice Made Simple front cover

There are plenty of books and websites out there offering advice to mental health professionals who want to know how to establish their own private practice. With this new release Randy J. Paterson, PhD offers his own comprehensive take on this popular topic, promising to provide “everything you need to know to set up and manage a successful mental health practice,” from “getting client referrals and creating a positive and comfortable office atmosphere to building a strong and thriving therapy practice that can serve both you and your clients.”

As the 2008 recipient of the Canadian Psychological Association’s Distinguished Practitioner Award, and the owner of a private multiple-provider outpatient practice in Vancouver, Paterson certainly seems to write with a wealth of personal experience in this area. Indeed, what differentiates this book from so many of the others available on the market is that personal touch, as Paterson shares his own journey into private practice, and the lessons learned along the way, explaining that:

No one really teaches you how to manage a mental health or counseling practice. As clinicians we stumble through our careers, gradually picking up shortcuts and strategies that make our lives (or those of our clients) a lot easier. Many of these useful ideas aren’t rocket science and could have been taught to us in an afternoon if anyone had thought about it. That’s what this book is for: it’s nothing more than a collection of useful basic tips … The emphasis of the book is on quick and easy strategies that can save a lot of headaches.

This light, conversational style typifies Paterson’s everyman approach to the topic, ensuring that the book is easy to read and full of accessible ideas for anyone contemplating the possibility of working in private practice.

While some other books might launch straight into the practical side of running a private practice, Paterson predicates this by starting his book with a chapter focusing on the importance of weighing up the pros and cons of running this kind of business in the first place. Paterson lists his ten most frequently-heard arguments both for and against private practice, and I can guarantee that any mental health professional will be able to relate to at least some of this debate.

The arguments in favor are listed as:

1. No Big-Organization Hassles
2. Getting Away from the Medical Model of Distress
3. Increased Accessibility for Clients
4. You Get to See Whom You Want
5. More Money
6. Supplement Your Salaried Income
7. Flexible Hours and Holidays
8. Work Fewer Hours
9. No Commute!
10. A Service Based on Your Own Vision

Whilst the arguments against are:

1. You’ll Never Get Clients
2. You’re No Good at Networking or Marketing
3. Uncertainty About Income from Month to Month
4. You Hate All the Clerical and Business Demands
5. You Don’t Know Enough to Practice Independently
6. Dealing with Fees will be a Huge Hassle
7. You’ll be Helpless in the Face of Insurers or Funders
8. No Retirement Plan or Benefits
9. You’ll Burn Out and Won’t Have a Safety Net
10. You Won’t have a Sense of Meaning in Your Work

Paterson follows this up with a considered appraisal of what is truly involved in the day-to-day running of a successful private practice, and then allows you to make up your own mind as to whether you’re really suited to this type of business. Assuming that you are, this book then serves as a comprehensive guide to everything involved in setting up and maintaining your practice, from such subtle nuances as the ‘olfactory environment’ and placement of clocks, to website design and finance tips.

As Paterson says, many of the ideas in this book aren’t rocket science, and might initially just seem like common sense, but don’t let this be a deterrent. As you make your way through the book you’ll realize there are also countless suggestions here which will leave you wondering “Why didn’t I ever think of that before?” and feeling enlightened. One such example is the section on ‘The Client’s View,’where Paterson explains the importance of the contents of the therapist’s bookcase:

Look at your own bookshelf from the client’s position. Notice where your eye naturally falls. These are the most salient shelves. Banish books that imply you are having significant problems yourself (Avoiding Burnout, The Wounded Healer), your introductory psychology textbooks, the trashy novels you secretly read at lunch, the books on handling problem clients, the self-help books you wouldn’t recommend to your worst enemy, and all the books on managing the finances of your private practice (including this book). Shift those books upward or downward, and replace them with scholarly books on your specialty areas of practice, books on diversity, a book or two on sexuality (this subtly gives clients to put such issues on the table), the self-help books you most frequently recommend, high-level books on practice and therapy, and other books that communicate your expertise, interests, and breadth of knowledge.

Once you’ve thought about it this seems so obvious, but I have seen plenty of counseling rooms where this advice had clearly been sorely missed, and where business may have suffered as a result.

It is these kinds of subtle tips which can make a huge amount of difference to the way a private practice is run, and which might distinguish an outstanding business from a mediocre one. Having all of these ideas listed in one simple book is truly invaluable, and will surely offer numerous benefits to anyone in the mental health profession. I couldn’t think of anything which Paterson had missed from this book, and he even includes a link to free downloads of practice worksheets and sample forms to help you on your way. If you’ve ever considered setting up a private practice, or you’re running one already, then this book’s for you.

3 out of 5 stars.





How To Change Your Drinking: A Harm Reduction Guide to Alcohol

16 12 2011

My review of “How To Change Your Drinking: A Harm Reduction Guide to Alcohol” by Kenneth Anderson:

How to change your drinking front cover

Substance misuse is one of the most common and widely discussed topics within the mental health community, as both clients and professionals debate the most effective ways to deal with addictions and their causes.

In the past, treatment might typically have involved a focus on abstinence as the ultimate goal, through zero-tolerance groups such as Alcoholics Anonymous, or a 12-step program, where clients would be rewarded only for complete sobriety and nothing less.

This has slowly changed over the past decade, though, through the realization that complete abstinence simply wasn’t a realistic or achievable goal for some, and that such a harsh insistence on withdrawal simply wasn’t working. In fact, it is estimated that 60 to 95 percent of clients who enter 12-step programs either drop out or otherwise fail to maintain abstinence from alcohol, and the NIAAA’s statistics suggest that only 7 percent of people who suffer from an alcohol use disorder will typically seek treatment within any given year.

As a result the treatment focus has shifted from simple cold turkey toward an overall emphasis on healthier and safer habits, and lowering risks. This has seen an emerging popularity for modalities such as motivational interviewing, where both the pros and cons of sustaining the negative behaviors are acknowledged. The client is then free to decide how, and at what pace, to proceed.

The HAMS group takes a similar “baby steps” approach. HAMS — the acronym stands for Harm reduction, Alcohol abstinence, and Moderation Support — describes itself as “a free of charge, lay-led support and informational group for people who want to change their drinking for the better.” Founder and CEO Kenneth Anderson is himself a former problem drinker.

In this book, How To Change Your Drinking: A Harm Reduction Guide To Alcohol, Anderson presents a comprehensive summary of the harm reduction approach to drug and alcohol problems, suggesting it could “either be used as a self-help manual for people working on their own or by people who are participating in a harm reduction support group.”

The book begins by introducing the underlying theories of harm reduction, and is written in a nonjudgmental tone that will be reassuring to most readers:

Some folks today want to say that everything fun is an addiction and that everyone had better spend their lives in 12 step meetings talking about their ‘Higher Power’ and holding hands and saying the Lord’s Prayer instead of ever doing anything fun. We beg to differ with these people. Prohibition does not work because there is nothing essentially evil, sinful, or diseased about having fun. There is nothing evil, sinful or diseased about drinking alcohol moderately, and for that matter there is nothing sinful, evil or diseased about engaging in recreational intoxication either.

There is not some specific magical quantity which we can say is too much alcohol – free individuals have the right to make up their own minds about how much they believe is too much for them personally. Occasional intoxication is not a symptom of a disease; it is a choice.

It is this focus on individual choice and empowerment which personifies this book and differentiates it from much of the rest of the substance misuse canon. Instead of focusing on problematic labels or clinical diagnosis as a means of demanding perfect abstinence, the author leads the reader on a step-by-step journey toward deciding what their own goals should be, and offers advice and support on the healthiest ways to achieve and maintain them. There is even a short section titled “Ken’s Story,” where Anderson talks about his own previous drinking problems and near-death experiences in AA. Those led to his resolution to “find a better way” and start the HAMS network.

The opening chapters might seem familiar to many mental health professionals, as Anderson suggests that each reader completes a Cost Benefit Analysis exercise, similar to those used in motivational interviewing techniques:

Miller and Rollnick (2002) say, ‘Often individuals considering changing a problem behavior will concentrate on all the negative aspects of the behavior. ‘I know how bad my drinking is for me,’ they say. In fact, they can often produce a litany of reasons why what they are doing is bad for them. Clinician and client are often baffled by the fact that even with all these negatives, change does not occur. The reality is that if the behavior were not in some way beneficial to the client, he or she would not be doing it. Until the client acknowledges the ‘good things’ about the behavior, they cannot prepare to combat temptation once they make an attempt to change. The decisional balance helps facilitate this process.

It is clear that Anderson has done his research in this field, and even though much of the book features personal stories and experiences, these are all presented within a scientifically supported framework, using clinically proven techniques and offering further resources where appropriate. Later in the book, Anderson explains Prochaska’s “stages of change” model, leading the reader through each stage and explaining the range of thoughts and behaviors that might accompany this process. He offers readers a large quantity of materials to help them along this journey, too, ranging from goal-setting and risk-ranking worksheets, to consumption charts and graphs, to the chemical breakdown of different alcoholic beverages and how they are processed within the body.

The book also addresses the addict’s friends and family. Anderson features chapters on specific topics such as spousal goals, alcoholism’s effects on children, and a study of drinking patterns as affected by ethnic identity and religious affiliation.

There is a wealth of knowledge in this book, but the clear, concise and easy-to-read style ensures that it never becomes overwhelming or difficult to follow. Anderson describes things in layman’s terms and it is doubtless this open, reassuring style which attracts so many of the HAMSters to the harm reduction approach.

As a comprehensive manual to changing drinking behaviors, readers will be hard-pressed to find a better book than this. If you’re looking for support, advice, scientific facts, or recovery tools, you’ll find them all here, clearly laid out for both mental health professionals and clients alike.

4 out of 5 stars.

It is worth noting that alcohol misuse has been a major issue in the British media since I wrote this review; with suggestions of major changes in government policy and the introduction of ‘drunk tanks’ and ‘booze buses’. I have a lot more to say on this topic, and it is one that is close to my heart as I do a lot of work for a substance misuse agency within the NHS in North London; but that’ll have to wait for another time.





Stop Suffering Needlessly: How to Quickly Recover from Depression

18 07 2011

Another book review: “Stop Suffering Needlessly: How to Quickly Recover from Depression”, by Kathy Reagan.

Stop Suffering Needlessly cover

Almost everyone reading this review – particularly those in the mental health field – will have had first-hand experience of dealing with depression at one time or another, whether the sufferer was a client, a relative, a friend, or themselves. The World Health Organization predicts that by 2020, depression will be the second largest cause of suffering in the world, second only to heart disease. Depression affects over 15 million Americans alone, and is one of the most prevalent and debilitating mental illnesses in the world today, often going undiagnosed and untreated. So there is no doubt that this is a topic which deserves to be written about, and which requires serious attention.

With her new book ‘Stop Suffering Needlessly’, Kathy Reagan joins the host of other self-help authors who all proclaim to be able to offer their readers the secret cure to depression. The back cover of Reagan’s book suggests that “If you’re one of the majority of people who aren’t receiving any treatment for your depression, this book will teach you everything that you need to know to recover quickly.” The cover also promises that “Stop Suffering Needlessly will benefit you, whatever your age, gender, ethnicity, geography, socioeconomic status, sexual orientation, or religious beliefs.” Bold statements indeed.

Unfortunately, on just the second page of the book, these promises begin to come undone, when Reagan says:

Whether we suffer as a result of things we can or cannot control, I believe that there is value in suffering. I believe that God gives all of us at least one opportunity, if not many opportunities (especially for those of us who don’t get it the first time), to fall to our knees, acknowledge our weaknesses, and ask for help. Maybe that’s the lesson to be learned when we suffer. Maybe learning to finally ‘let go and let God,’ and rely on a Power greater than ourselves, is the true value of suffering.

Reagan goes on to explain that:

I believe that there is a Divine plan, which calls each of us to heal from whatever suffering we may experience, to learn and choose to be happy, to pay it forward, and to grow toward our Maker. This is why I wrote Stop Suffering Needlessly.

It quickly becomes clear that this is not a book which would appeal to the general populace. In fact, Reagan seems to be writing exclusively for a very specific audience here: those who share only her own religious beliefs. One of Reagan’s concluding remarks tells us to “Learn to give up control, rely on God or your Higher Power,” and to say the Serenity Prayer daily. The book will also be of most relevance to American readers, as Reagan quotes only from American television shows throughout, and all of her statistics are taken from the American Psychological Association (APA).

This is a disappointing approach to the topic, as it will immediately alienate a huge part of Reagan’s potential audience from her book and limit it to a niche market; rendering many of her suggestions invalid and not applicable to other people. It is also a surprising one, as one would not expect to find such a polarizing opinion in the field of mental health advice or self-help, especially coming from someone who has worked as a professional therapist for almost 20 years. Far from the unbiased, open-minded and nonjudgmental approach we might expect, Reagan makes no hesitation in stating her own beliefs, and repeats them again and again throughout her book, seemingly imposing them on her readers:

I believe that guilt and shame are gifts to help us become better human beings. Following the Ten Commandments for example, is a wonderful guide for our conscience and behavior, and feeling and experiencing some guilt for breaking a commandment can help us do better.

At best this makes Reagan’s book come across as one which should only be read by a select readership, but at worst it comes across as patronizing, insulting, or downright irresponsible. I can only hope that Reagan has adopted this tone for her writing alone, and does not voice her personal beliefs so openly in session, with her clients.

Sadly, the problems with this book do not end at Reagan’s insistence on expressing her beliefs, but continue to emerge as she gives her advice on the topic of depression and its cures. Reagan’s suggestions are purely anecdotal; drawn from her own memories and personal experiences, rather than from any kind of professional research or actual facts. She scatters the phrases “in my experience” and “in my opinion” frequently throughout her book, but fails to back up her theories with any proof or further evidence, instead supplying the reader with occasional quotes from TV shows:

Rejection is God’s protection is a line from a recent episode of ‘Law and Order.’ If you’ve experienced rejection (who hasn’t at one time or another?), consider the possibility that this statement is true. If you’re suffering from the loss of a relationship, is it possible that God is protecting you from some future danger or sorrow that you can’t see? Or that God has something better planned for you in the future?

As if this wasn’t bad enough, Reagan consistently makes sweeping statements, offering vague generalizations and clichés:

It’s common for people who experience depression, and women in particular, to lose a sense of themselves, especially if they have been trained to be care-givers for their partners, children, or others. Do you know who you are and what you need? Do you even have a clue what you need? Many women do not.

As seen here, Reagan has a tendency to pepper her prose with incessant questions, one after the other, presumably aimed at her imaginary readers. Unfortunately these have the effect of making it seem like the author herself is not sure of the answers, and at times make the book completely unreadable, as the text dissolves into entire paragraphs of theoretical questioning and rhetoric.

I do not wish to be overly critical here, as there are a few snippets of worthwhile information hidden among the text. Some of Reagan’s stories do contain interesting suggestions and techniques, and she supplies a useful collection of links and resources in her Appendix. Her nine steps toward taking control of depression may also be of use to some readers:

1. Recognize and acknowledge your depression.
2. Ask for help. Expect to recover.
3. Take medication if you need it.
4. Take care of your body.
5. Seek therapy.
6. Practice Cognitive Behavioral Therapy (CBT).
7. Learn other important skills.
8. Increase your social support.
9. Develop a relapse prevention plan: Take responsibility for your depression and your recovery.

However, whenever Reagan seems to latch on to something of interest, or to present a promising theme, she just as quickly goes on to contradict herself, or undo her sentiments entirely. In an early chapter Reagan writes:

Have you ever heard the phrase’ Just pull yourself up by your bootstraps?’ Or ‘Just think positively!’ These old simplistic and cavalier responses to people with depression now sound ridiculous, knowing that depression is a medical illness. As if depressed people could do just that and recover easily… Effective treatment for the medical illness of depression involves more than trite solutions.

Then, just a few pages later she says:

Even if you currently don’t have health insurance, that doesn’t mean that you cannot receive recommended treatment if you want it. You are likely still eligible for some kind of assistance or program, so if you want help, ask for it.

And again, in another chapter, Reagan repeats this sentiment:

Do what you need to do to obtain care. Some health care providers also provide pro bono (free) care. Some retail and drug stores offer free walk-in services too. If you need treatment, you can find it.

These simplistic and cavalier suggestions do indeed come across as ridiculous, particularly as Reagan herself dismissed them earlier, and they seem to lack the sensitivity or understanding one would expect from an author in this field. One can only wonder how a seriously depressed reader might feel, if they turned to this book during a time of utter desperation and exhaustion, only to find such unsympathetic, matter-of-fact advice. Even the book’s title, Stop Suffering Needlessly, seems accusatory and blunt when taken in this context.

Even though I operate from a strengths-based perspective and believe in carrying this approach across to all aspects of my life — including book reviews — it is hard to find many positives in this self-published text. It may conceivably be helpful to the few readers who happen to share Reagan’s exact outlook on life and her religious beliefs, but otherwise it would be best avoided. There are numerous other books on offer which cover this same topic, and do so far better, without any sense of discrimination or prejudice against their readers, and with a grounding in reputable clinical experience and scientific fact, all of which are lacking here.

Reagan is right about one thing: the effective treatment of depression definitely does involve more than trite solutions. Unfortunately, those are all you’ll find in this book.

1 out of 5 stars.





Saying No To Naked Women

28 05 2011

I thought I would share some of my book reviews on this blog, as they do contain some interesting themes.

I’ll start with my review of “Saying No To Naked Women” by David R. Yale:

Saying No To Naked Women

In the summer of 1974, Jack Derritt leaves the city and all of his material possessions behind and heads out to the Arkansas countryside, to live in a shack and take stock of his life. Tired of meaningless flings and constant feelings of misery and self-doubt, Jack wants to figure out why he’s never been able to find a stable, loving relationship, and why he never feels good enough for anyone. He asks himself: “Why is there a throbbing hurt inside me that never leaves?”

This is the opening to David R. Yale’s “Saying No To Naked Women; the story of one man’s struggle to free himself from porn values and sexual addiction”. With Jack’s story as an example, Yale’s novel shows us how our childhood fears can continue to haunt us as adults, manifesting themselves as self-doubt or insecurity, and preventing us from living fulfilling lives or maintaining loving relationships.

As Jack attempts to settle in his new home, he comes to realize that there is no escape from his inner monologue, which is often delivered in his father’s voice, constantly reminding him what a failure and a disappointment he is.

“I’ll never produce anything worthwhile. No woman will ever want me – once she sees my terrible faults. I’ve managed to fool people, but they’ll see: I don’t know what I’m doing. My father is right. I’m a parasite.”

We learn that Jack’s parents were Orthodox Jews and Marxists, and that Jack was raised in a climate of fear and secrecy, and taught to hide his identity. His parents never told him they loved him; instead they made him feel inadequate, and different from the rest of the world. The legacy of the Rosenbergs hung over his head, as a reminder of what might happen to his family if their religious and political beliefs were discovered. It’s these feelings of fear which continue to haunt Jack as an adult, as he remains convinced that he’ll never meet anyone who could possibly understand or value him for the man he is, and that he must always conceal his true self if he wants to be accepted.

Jack seems trapped in a spiral of loneliness, depression and paranoia, and at times this can be frustrating to read. Yale’s story takes a while to get going, and his pace is slow to start with. He focuses closely on setting the scene and building up the characters, but it is not always clear where this is leading, or to what end. Readers who find themselves struggling through the first half of this book should be encouraged to persevere, as the second half rewards us with plenty of valuable lessons and the denouement contains a powerful and important message. Yale’s prose is engaging and easy to read, and I found myself deeply involved in the story, once I had decided to stick with it, past the uncertain beginning. After around 200 pages, the story finally takes an interesting twist, as the solution to Jack’s torment begins to unfold.

One day, divine intervention strikes: he gets stung by a bee in the woods, and the resulting adrenaline shot sends him into a feverish dream world. In this dream world, Jack is visited by a mystical mentor, in the form of a Chassid, who begins to lead Jack through a number of conversations and sessions of immersion therapy which transform his way of thinking about himself and others.

This exposition is somewhat reminiscent of “A Christmas Carol” by Charles Dickens; just as Scrooge meets the Ghosts of Christmas Past, Present, and Yet To Come, so too must Jack accompany the Chassid on a journey through his childhood, a summary of his present life, and an enactment of what the future might be like if he continues along his current path. Yale’s novel is a Dickensian fairytale for the modern age, demonstrating the ways in which childhood fears and insecurities can leave many men struggling with the porn values and sexual addictions that are so prevalent in society today.

Jack comes to realize that he views sex as a form of validation. He tells the Chassid, “I feel like there’s something wrong with me if I’m not having sex on a regular basis.” The Chassid then helps him see how this is connected to his childhood, and he how can end this cycle:

“Some of your anger was at your Dad for not teaching you how to be a man?”
“Yes.”
“And you turned that anger against women – the more frustrated you got the angrier your fantasies got?”
“Damn! What do I do now?”
“Learn how to communicate your feelings to women.”

The Chassid requests that Jack repeat a mantra: “I define myself. I do not let others define me. I do not let my parents define me.” Through this mantra, Jack begins to understand that his parents do not control him any more, and that he is able to live his own life. He begins to let go of the fear and secrecy he learned as a little boy, and to set himself free of the doubt and anger that have controlled him for so long.

“You must affirm yourself… Every time you think a negative thought about yourself, you have to confront it, and contradict it… You can’t deal with yourself the way your parents treated you. I forbid you! When you find you’re making harsh, critical judgments about yourself, stop! And then affirm yourself.”

Through these teachings, Jack is finally able to forgive his parents for their shortcomings, and to uncover the happiness and confidence he has always longed for. He begins to feel accepted by others, and understands what it takes to have a healthy and fulfilling relationship; knowing that the sexual fantasies and flings of his past were just a repeat of the anger and confusion he felt as a child. Finally, by the time he awakes from the dream world of the fever, Jack has learned to integrate the Chassid’s teachings into himself, as an alternative to the voice of his father, which once ruled his thoughts:

“I’m sure not used to thinking strategically like this. It’s a new experience.”
“Do you like it?”
“It makes me finally feel like I have power over my own life.”
“Even without the Chassid?”
“Yes. But maybe the Chassid has become part of me.”

Yale’s novel teaches us that we must understand, forgive, and honor both ourselves and other people in order to find happiness, and that, instead of holding on to our anger, living well is often the best revenge of all. Jack’s story is one that many men will be able to relate to, and the teachings of the Chassid will no doubt resonate with them, too.

One criticism I have, though, is that the book seems unsure of its audience. As a fictional novel about a man setting off into the wilderness to reflect on his life, the book might initially seem to fit alongside classics such as Thoreau’s “Walden”, Kerouac’s “Lonesome Traveler”, Pirsig’s “Zen and the Art Of Motorcycle Maintenance”, and Krakauer’s “Into The Wild”. However, what separates this book from those (including its misleading title) is the suggestion that it is some kind of self-help manual. The back cover suggests that this book “unlocks invisible behavior patterns you must understand to solve personal troubles and identify problem people”, and this certainly seems a little far-fetched.

As a systemic marriage and family therapist, I enjoyed reading about the Chassid’s immersion therapy techniques, and recognized the narrative therapy methods employed to help Jack re-write his own story and take control of his life. I’m sure many readers will benefit from Yale’s suggestions of how to find happiness and overcome the demons of the past. But, while these techniques may work well for some, suggesting that this book could serve as a universal guide to love and happiness seems a little extreme. Those who are simply looking for an engaging fairytale about a man in the wild, on a journey to self-fulfillment, will find that this is a story worth reading. It won’t appeal to everyone, but this is a worthy book, and one that should be recommended to anyone struggling to find love as a consequence of painful childhood experiences.

3 out of 5 stars.

In addition to my review, I’d like to add that I agree with Dr Thaddeus Birchard, an expert in sexual compulsivity and addiction, who states that “sexual addiction, like any addictive substance or process, is a response to the pain and distress of narcissistic damage. All addictions have a common underlying psychobiological process. I think of narcissistic damage as the outcome of a disturbance in attachment. The function of an addiction is therefore to anaesthetize the subjective distress created by the narcissistic damage.”

In other words, sexual addiction often forms as a means by which to avoid dealing with the pain that is caused by attachment injuries from the past. And it is only by identifying and resolving these injuries -through successful therapy sessions – that the addiction can be truly cured.

If you currently suffer from sexual addiction – or are in a relationship with someone who you suspect may be a sex addict – I can help you with these issues. Don’t wait for that change – make it happen now!