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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by jane d on January 29, 2003, at 11:02:30
http://www.nytimes.com/2003/01/26/magazine/26WWLN.html
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Lauren Slater wrote in last weekend's NY Times Maggazine suggesting that we have a system where all therapists work is reviewed by their peers. They should show tapes or files. She argues that it would help eliminate major abuses in the relationship - she mentions the recent accusation that a psychiatrist tried to hire a patient to kill someone (definate dual relationship problem there). Presumably it would also lead to higher standards of compentence.
She says that patient privacy would be preserved but I don't see how it could be. I can see choosing to confide personal things to one person that I chose to trust (I am not in therapy so this is hypothetical). I cannot see confiding anything to the profession in general. I guess I want to retain control over who hears what I say. It seems to me that she is providing more protection for patients at the risk or reducing the amount of control they have in the relationship and that this can't be a good thing.
I'd really like to hear what people who actually are in therapy think about her suggestions.
Jane
Posted by Dinah on January 29, 2003, at 11:07:15
In reply to Article: Peer review for all therapy, posted by jane d on January 29, 2003, at 11:02:30
That would be the end of my therapy. My therapist had a tape recorder in his office once and I made him unplug it and show me that there was no tape in it, and even then it put me off.
It seems like a dreadful idea. Although I do understand the profession's frustration at being unable to uphold standards. I guess they do it all the time with therapists in training and in certain types of therapy. I wouldn't be involved in that situation, though. Just me.
Hire a patient as a hit man?! Unbelievable.
Posted by noa on January 29, 2003, at 19:53:41
In reply to Re: Article: Peer review for all therapy, posted by Dinah on January 29, 2003, at 11:07:15
I recently heard of a therapist who lost his licence because he was taking taking stock tips/buying stocks through a patient. I don't know any more details than that--it could have been more complicated.
Posted by mair on January 30, 2003, at 7:31:08
In reply to Article: Peer review for all therapy, posted by jane d on January 29, 2003, at 11:02:30
Jane I had read this article too and I thought it addressed these issues on a very superficial basis. She talks about the benefits, the principal one of which is that patients won't be so easily abused although her statistics indicate that the number of abusing shrinks is quite low. She really gives pretty short shrift to the privacy issue. Her contention is that the patient will feel better for knowing that someone else is reviewing his or her treatment and since it is peer review, confidentiality will not breached.
On the other hand, in her schema, it's not clear whether the patient knows who will be doing the peer reveiw. I live in a pretty self-contained area and know alot of therapists on a social basis. I'd be horrified to find out that one of them was reviewing my case. Even if my therapist didn't reveal the identity of her patient, there may be enough material in her notes to indicate who I was. (Although she did not start out this way, my therapist now takes pretty copious notes throughout our sessions)
Also, what happens when there's a disagreement among the peers? Who's really driving the course of my therapy? My therapist or peer reviewers? If a peer reviewer really questions what's going on, what is his or her recourse. Does he go directly to the patient? Does he go to the licensing board? Is a peer reviewer only going to see what the treating therapist wants him to see?
My conclusion is that what would happen is that a peer reviewer would only want to intervene in the most egregious of cases and that alot of privacy will be sacrificed to successfully flush out very few therapists.
Mair
PS: My guess is that many of the best therapists already seek a measure of peer review. I know my therapist is a part of a group which meets periodically to review one another's more difficult cases. I think this is different from the kind of "open door" the writer was considering, where a reviewer would have access to a patient's file.
Posted by jane d on February 3, 2003, at 21:01:17
In reply to Re: Article: Peer review for all therapy » jane d, posted by mair on January 30, 2003, at 7:31:08
> Jane I had read this article too and I thought it addressed these issues on a very superficial basis. She talks about the benefits, the principal one of which is that patients won't be so easily abused although her statistics indicate that the number of abusing shrinks is quite low. She really gives pretty short shrift to the privacy issue. Her contention is that the patient will feel better for knowing that someone else is reviewing his or her treatment and since it is peer review, confidentiality will not breached.
>
> On the other hand, in her schema, it's not clear whether the patient knows who will be doing the peer reveiw. I live in a pretty self-contained area and know alot of therapists on a social basis. I'd be horrified to find out that one of them was reviewing my case. Even if my therapist didn't reveal the identity of her patient, there may be enough material in her notes to indicate who I was. (Although she did not start out this way, my therapist now takes pretty copious notes throughout our sessions)
>
> Also, what happens when there's a disagreement among the peers? Who's really driving the course of my therapy? My therapist or peer reviewers? If a peer reviewer really questions what's going on, what is his or her recourse. Does he go directly to the patient? Does he go to the licensing board? Is a peer reviewer only going to see what the treating therapist wants him to see?
>
> My conclusion is that what would happen is that a peer reviewer would only want to intervene in the most egregious of cases and that alot of privacy will be sacrificed to successfully flush out very few therapists.
>
> Mair
>
> PS: My guess is that many of the best therapists already seek a measure of peer review. I know my therapist is a part of a group which meets periodically to review one another's more difficult cases. I think this is different from the kind of "open door" the writer was considering, where a reviewer would have access to a patient's file.
Mair,I agree. It doesn't seem like abuse is common enough to justify the loss of privacy or the time involved in monitoring. I would never agree to it unless I knew the person monitoring as well. I did wonder whether this would help with the problem of incompetent therapists which I think is also a result of everything being done behind closed doors and is far more frequent than abuse. In what other field are you sent out on your own with no one looking over your shoulder? From what I understand supervision in training consists of the therapists reporting his view of what happened in a session. And if he's wrong? Or if he says the right things but in the wrong way? Or if he's got his license already? How can he ever learn to do it better if he can never see other therapists at work? I know that in business I've been learning new things for years because I find myself working with someone who is very good at handling some type of problem or person and I look at them and go "Wow. I should do it that way."
This would still leave the problem of who is "driving" that you raised. I can't see how this arrangement wouldn't take power away from you. Suddenly you are not dealing with one person, your therapist, with biases you can learn to take into account but with a committee whose proceedings are closed to you. I guess that does mean I think any peer reviewer would talk to your therapist before talking to you.
I think I had an experience similar to this dealing with a student therapist in a clinic. I would get different answers to my questions from week to week. I thought he was completely unstable and evasive and I never could form any kind of a relationship with him. In retrospect I think that was because sometimes it was him in the room with me and sometime it was his body possessed by the spirit of one or more of his supervisors. I think that when I said something that confused him (which was probably often since I had no experience in how to be a good therapy patient) he wouldn't ask me about it. Instead he'd tell his supervisor what he thought I'd said, get the supervisors interpretation, and then come back to me with a completely new attitude then the one he'd left with. Since I wasn't a party to half the discussion I couldn't correct any misunderstandings - in fact I couldn't even understand why they were happening. I just saw the end result which was disasterous.
Jane
Posted by Dinah on February 3, 2003, at 21:54:27
In reply to Re: Article: Peer review for all therapy » mair, posted by jane d on February 3, 2003, at 21:01:17
That sounds crazy-making Jane. It must be frustrating for both patient and therapist to have the therapist playing to two crowds, as it were. That would make for bad therapy. The guy probably was just looking for a chance to use his latest lesson instead of listening to what you said.
I'm not sure it would reduce incompetence either. It might just add an additional layer of incompetence.
This is the end of the thread.
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