One morning early this year, I opened my e-mail inbox and immediately heard the crashing sound of our profession’s bar being lowered.
On that day as on most weekdays, I surveyed the 10 or so different Groupon mimics that arrive in my inbox each day. For those who have yet to come across Groupon, it’s a popular Internet coupon program that purports to offer great savings for goods and services if enough people sign up and pay for that day’s deal. Reading through the usual offerings—a half-hour Swedish massage for only $40, a pedicure and manicure with free facial for $30—I was surprised to find an offer for a completely different type of service: the psychotherapy Groupon.
“The e-mail earnings . . . the enduring, rewarding relationships you’ve always wanted . . . a higher sense of purpose and life satisfaction . . . less stress . . . overall happiness.” All this in just 2 convenient 50-minute sessions!
Although I strive to provide my patients—and myself—with all the benefits described in the e-mail, I can’t help but fret over its message. As 1 of the 2 pillars of modern psychiatry, psychotherapy is a powerful instrument. In the hands of a skilled professional, it can bring tremendous healing and relief from suffering. In the hands of the reckless practitioner, there are few limits to the harm it can induce. The practice of psychotherapy holds within it no easy cures. One could argue that in no other of the healing arts is so much demand-ed of the patient to assist in achieving his or her own wellness. While patients are never asked to remove their own inflamed appendix, in our profession we often guide our patients on a journey of close consideration and careful dissection of their most intimate life experiences.
Although I have several com-plaints with the advertisement, my greatest concern is the ease of success being promised. In less than the time that it would take to see a feature film, I am being told I will experience what for most is a lifetime’s ongoing work. The advertisement brings psychotherapy down to the level of so many “get rich quick” and “lose weight while eating anything you want and not exercising” offers that populate late night television. The person who takes advantage of this “deal” will probably not experience all, or likely any, of the benefits promised and may come to view psychotherapy as unhelpful and “not for them.” If, as I suspect, the therapist is simply trying to enroll people for a longer course of therapy at a higher price (she values the $99 offer at over $200, suggesting a normal rate for her services of over double the offer price), the unsophisticated patient may view all psychotherapists as hucksters and con artists.
Also of concern is the fact that the therapist is advertising her services in a manner that is generally reserved for purchases made on a whim. Rather than seeing psychotherapy as a serious undertaking that should be entered into after careful deliberation and/or on the advice of a qualified health care professional, the therapist in the ad encourages people to choose therapy the same way they choose a nail salon or a place to enjoy Sunday brunch.
If there is one lesson that has been impressed on me during my residency thus far, it has been the importance of outlining realistic costs and benefits at the initiation of treatment. With medications, I can offer my patients the very likely remission of their psy-chiatric illnesses, but it may involve lifestyle modification, weight gain, GI distress, a less satisfying sex life, and/or a combination of these costs. With therapy, I may be able to offer my patients great relief from suffering, but it will likely involve a thoroughfare of unpleasant work.
It behooves me to let every new patient know that improvement is often difficult and that the success or failure of treatment will depend on the work that he or she does, not only in the office but also in daily living. I have found that the patients who commit to the hard work of examining their minds without hope of a quick fix often discover with time that they have made the greatest deal of all.