Breaking The Clouds

http://www.psych.org/share/parents-med-guide.aspx

Published by American Psychiatric Association, the two free online guides provide parents with credible, scientific information about the safety and indications of medications commonly prescribed to treat ADHD and depression in children and adolescents.

C. Huntsinger from Northern Illinois University and P. Jose from Victoria University of Wellington also published their study “Relations Among Parental Acceptance and Control and Children’s Social Adjustment in Chinese American and European American Families” in the issue of Journal of Family Psychology 2009, Vol. 23, No. 3. The authors studied parental acceptance, control, and “Chiao Shun” (or, Jiao-Xun, the Chinese word for training) in 35 immigrant Chinese American families as well as 38 European American families (parents were mostly born in the States). Data were collected from children from preschool to 4^th grade.

They found that within the couples, fathers and mothers in Chinese American family group rated similar levels of acceptance and control; but they did not in European American family group. Parental acceptance and control showed to influence children’s social development. Parents who are warm and accepting has been associated with positive adjustment, while parents who are overly controlling and punitive as well as those who show affection but low levels of controlling are related to maladjustment among children and adolescents in the USA.

Findings from this study concluded that for Chinese American fathers and mothers as well as European American mothers, higher acceptance and greater control were linked to their children’s more positive psychosocial adjustment, while for European fathers, acceptance and control did not predict children’s outcome four years later. Among the limitations to this study are relatively small sample size and over-representation of well-educated individuals in both Chinese American immigrants and European American study groups.

In the issue of Jan/Feb 2002 of journal Child Development, researchers (A.J. Fuligni, et al) from Center for Culture and Health, UCLA published article, “The Impact of Family Obligation on the Daily Activities and Psychological Well-Being of Chinese American Adolescents.” The authors studied 140 adolescents (ave. age 14.6 years old, 74 girls and 64 boys) of Chinese immigrant families in the U.S. using a daily diary method that includes an initial measure of attitude towards daily family obligation and several checklists of their daily activities and psychological well-being for a period of two weeks. The authors found that subjects show a greater inclination to balance family obligations with their academic demands than their social life with peers on a daily basis. The extent of involvement in family obligations was not associated with psychological distress. Not surprisingly, girls were asked to sacrifice more for family obligations than boys; however, analysis of gender differences in psychological well-being is not shown in the article. The authors did report that oldest and only children tend to show more distress than their younger siblings.

Also in the issue of Journal of Family Psychology 2009, Vol. 23, Number 3, R. Chao et al from University of California published research article, “Interpretations of Parental Control by Asian Immigrant and European American Youth”. The authors studied adolescents’ affective interpretations of parents’ control, that is, feelings of anger toward control, and how their interpretations moderate the relationship between control and adolescents’ behavioral adjustment. A total of 1085 immigrant youth of Chinese, Korean, and Filipino descent, and also European American youth from high school in the greater Los Angeles area were included in the study. Parental behavioral control was measured with the Firm Control/Lax Control scale of the Children’s Report on Parent Behavior Inventory. Parental psychological control was measured with Barber’s revised scale of psychological control from the Child-Rearing Practices Behavioral Inventory. Affective interpretations of anger toward parental control were measured by asking adolescents how angry they would feel toward parental control. Adolescents’ behavioral adjustment was measured using the internalizing and externalizing scales from the Youth Self-Report of the Child Behavioral Checklist.

Not surprisingly, there were differences between European American and Asian immigrant youth in the effects of both behavioral control and psychological control. The immigrant youth from Chinese and Korean families demonstrated less anger toward parental control (both behavioral and psychological control) than European American youth. The authors attribute such differences to cultural differences and Confucian influences on Chinese and Koreans. The authors also report that among European Americans, as adolescents’ feelings of anger increased, the beneficial consequences of behavioral control decreased, whereas the negative effects of psychological control on behavior problems decreased. These were not observed in Asian immigrants.

In the issue of Journal of Family Psychology 2009, Vol. 23, No. 3, S.Y. Kim et al from University of Texas at Austin published article, “Parent-Child Acculturation, Parenting, and Adolescent Depressive Symptoms in Chinese Immigrant Families.” Adolescent either US born or foreign born in households with at least foreign-born one parent were recruited from seven middle schools in Northern California. In a pool of 444 Chinese American families, the authors used a sample of 388 father-adolescent dyads with foreign-born fathers, and 399 mother-adolescent dyads with foreign-born mothers. Most of the participants originally came from Hong Kong or southern provinces of China. Fewer than 10 families came from Taiwan. Each parent and the child received a packet of bilingual questionnaires (in English and Chinese) measuring acculturation, parenting quality, and adolescent depressive symptoms. The authors found that a high discrepancy in father-adolescent acculturation levels relates significantly to more adolescent depressive symptoms. Furthermore, a high level of discrepancy in American orientation / adaptation between fathers and adolescents is associated with unsupportive parenting practices that is in turn linked to more adolescent depressive symptoms. These findings are reportedly sustained after controlling of the influence of parents’ socioeconomic status.

The Chinese have a long history in the United States. Earlier Chinese immigrants mostly contributed to building railroads of this country and making delicious Dim Sum. Over the years, more and more Chinese immigrants have made significant contributions to the intellectual and other aspects of the society. Since hundreds and thousands of those highly educated mainland students and scholars immigrated after late 1970s and 1980s, with their hard work and achievements, not only the population of Chinese has been greatly increased but the overall socioeconomic level of Chinese has been significantly elevated as well. Still, awareness of mental health in the community is yet to improve. Despite enormous research on mental health in generally, both biologically and psychologically, specific works on Chinese/Asian population here are only just a few. Here I provide some summaries of research related to Chinese/Asian American mental health. For more detailed information, please read the original journal papers. (Two students in the community, E. Tsai and W. Hsu, have provided substantial help and I appreciate their dedication to this important community work.)

Mom, Dad, Computer

(Transference Reactions to Computers)

Think of your husband or wife, or your romantic relationship, or a close friend. Think about some important characteristic of that individual’s personality - a characteristic or trait in that person to which you have a strong emotional reaction, positive OR negative…. Now think about one of your parents, or perhaps a sibling. Do they have that very same characteristic, and are the reactions you have to that aspect of them similar to those concerning your current close relationship?

The phenomenon of “transference” is one of the cornerstones of psychoanalytic theory. Rows of bookshelves could be filled with what has been written about it. The basic premise is that we tend to recreate in our current relationships the patterns of thinking, feeling, and behaving that were formed early in our life, most importantly in the relationships with our parents and siblings when we were children.

Critics challenge this idea. They accuse psychoanalytic theory of dwelling too much on the effects of childhood and family dynamics on the evolution of one’s personality. Surely, one’s personality does develop and change throughout the course of one’s life as a result of our friends, lovers, and new life experiences. It is not solely determined by how our parents raised us as children.

I think this is a perfectly valid criticism. We are not SIMPLY the products of our families. Nevertheless, our parents (or other parental figures) and siblings did indeed spend a great deal of time with us during those formative years, when our minds were young, impressionable, and eager to learn about how we humans relate to each other. Based on our relationships with them, we created models or templates in our mind about what constitutes the expected ways in which people will behave in relationships. We formed basic impressions about the kinds of needs, wishes, fears, and hopes that shape relationships and our image of ourselves in those relationships. Often we don’t realize these are OUR OWN models. They may be very different than the models taking shape in the heads of other people. Think of a time when, as a young person, you went to a friend’s house and were totally surprised, maybe even shocked, at how differently that family behaved as compared to your own family.

As we grow up we take these models with us. Often operating at an unconscious level, they affect the choices we make in the kinds of people we get involved with as well as how we experience those people. For example, think of your first boyfriend or girlfriend, and how similar that person might have been to one of your parents (usually your opposite sex parent). How often have young men said to their girlfriends “You’re just like my mother!”… or vice versa.

These models also shape how people select and experience things in their lives that are NOT human, but so closely touch our needs and emotions that we want to imbue them with human characteristics. We humans can’t help but anthropomorphize the elements in the world around us. It’s in our blood. We use our internal models to humanize and shape our experience of cars, houses, pets, careers, the weather…. and COMPUTERS.

Yes, computers can be a prime target for transference because they may be perceived as human-like. They are complex machines that almost seem to “think” like humans think. In fact, some people say they WILL someday be able to “think” like us. Unlike TV, movies, or books, they are highly interactive. We ask them to do something and they do it - at least, they usually do (like humans they sometimes disobey and surprise us). With the new generation of highly visual, auditory, and customizable operating systems and software applications, we also have a machine that can be tailored to reflect what we expect in a companion. The science fiction fascination with robots and androids is the culmination of this perception of machines as being almost like one of us.

What makes computers especially enticing targets for transference is that they are VAGUELY human and PROGRAMMABLE to be whatever we make them out to be. Psychoanalysts discovered that if they remain relatively ambiguous and neutral in how they behaved with their clients, the clients would begin to shape their perceptions of the analyst according to their internal models from childhood. When faced with an indistinct, seemingly malleable “other”, we instinctively fall back on our familiar mental theories about relationships and use those theories to shape how we think, feel, and react to this new, somewhat unclear relationship. This whole process often is unconscious. We are so used to these old templates that they automatically start to mold our perceptions and actions without our really thinking about it.

So now we go back to the exercise at the beginning of this article. Only now we substitute in “computer” for husband, wife, lover, or friend. Do we unconsciously experience the computer as being like our mother or father, or sibling? At first glance the question may seem silly. Keep in mind, though, that I am not saying that we think the computer IS our parent or sibling, but rather that we recreate in our relationship with the computer some ASPECT of how we related to our family members. Still, even if you apply the exercise to an important person in your life or to your computer, you may insist that they are nothing like your mother or father! Here’s where we need to examine the process of transference more carefully - for there are curious twists and turns in this phenomenon that make it considerably more complex than what I have described so far. We’ll see that the same pattern of relating to a family member can be played out in various ways in one’s relationship to the computer. In the descriptions that follow, I’ll focus mostly on relationships with parents, though these also could apply to other family members.

You as You, Computer as Parent

This is the most basic, obvious type of transference - the type I’ve already described. You experience the other as being like your parent and yourself as the child you once were.

So let’s say Leonard had a mother who had many rules for how he should behave as a child, but the rules always seemed to be changing. Even though he tried to figure out and obey his mother’s requests, he never quite succeeded and never satisfied her. He could never seem to do anything right. As a result, he felt frustrated, helpless, and defeated whenever he tried his best but ultimately failed in the eyes of his mother. As an adult, Leonard experiences his computer in the same light. He is intimidated by it, is never quite sure how to please it. When he tries to accomplish something, the computer doesn’t seem to like what he does. It won’t respond. He gets error messages. He has failed once again. His computer makes him feel frustrated, helpless, and defeated. Maybe he even tries to avoid it, just like he did with his mother.

Jenny had a father who was frail and not quite competent as a person. She loved him, and so took care of him and was very attentive to his needs. Perhaps she sometimes sacrificed her own needs in order to attend to his. As an adult, she perceives her computer as something that is a bit fragile and vulnerable. She is very careful about how she uses it because she doesn’t want to cause damage. She is very conscientious about running diagnostics and anti-virus programs. The health and well-being of her computer, she feels very earnestly, is in her hands. Some might even say she is bit over-protective of her machine.

Leonard and Jenny are only two examples. This first type of transference can take many different forms. Traditional psychoanalysis (”Freudian” theory) often described it in terms of sexual wishes and fantasies towards the parent. The child hopes to possess the opposite sex parent as someone to satisfy their sensual/emotional desires. Later, after resolving the conflicts associated with these wishes, the child learns to identify with the sexuality of the same sex parent. In his article “The Internet Regression,” Norman Holland focuses on these types of transferences towards computers. The computer is seen as seductive, as a sex object, a satisfier of desire, as a symbol of sexual power and prowess. As an illustration, consider this real conversation from a cyberspace chat room in which the members are discussing how one of their friends “Suzy” on CUseeme (internet video conferencing) was flashed by a exhibitionist.

Daisy: so all she sees is a big penis on her screen! lol!
Hawkeye: lol
Daisy: I can’t figure out why he wanted to see *Suzy’s* penis!
Dragon: next ur gonna say she has a 15 inch monitor, right?
Daisy: 20 inch, Dragon
THR: geez and black and white haha
Mr. Tops: 17 in rotating
Daisy: hahahahhahah
Tweety: bigger is… bigger!
Dragon: wow, no wonder you gals like macs so much
Daisy: doesn’t have to be bigger, just better
Daisy: and rechargeable
Tweety: or plugged in the wall…
Hawkeye: what about bigger AND better?
Mr. Tops: its not the size of the monitor, but the driver behind it
Tweety: with loads of amps
Hawkeye: as one of my friends like to say, “How hard is your big drive?”
Daisy: lol!
Dragon: more importantly, Hawkeye, is it compressed?
Daisy: more importantly, is it unzipped
Hawkeye: and how often do you optimize it?
Lola: or is it backed up?
Dragon: only in san francisco
Daisy: LOL!

Freud would have a field day with this dialogue. It’s not too difficult to detect themes about phallic power, penis envy, castration fears, and a miscellaneous collection of heterosexual and homosexual issues. However, I don’t want to dwell on the idea of computers as powerful (parental) sex objects. This type of transference applies to some people, but not all. I’m not even convinced that it is a prominent type of transference. The language of classical Freudian theory also gets downright sexist and culturally biased.

What I think is most important about this “erotic” transference is not the sexual feelings towards computers, but rather the perception of the computer as POWERFUL, perhaps in ways similar to how parents are perceived as powerful. This perception of power is obvious in the dialogue from the chat room. The computer can think faster than us, often has more knowledge on a subject, can perform tasks that we couldn’t do alone… and now, in the age of the internet, is a link and guide to a vast, wondrous “outside” world. For some people, these qualities may stir up feelings of admiration, awe, fear, competition - not unlike transferential feelings towards any authority figure.

You as Parent, Computer as You

In this type of transference, a person’s mind reverses the roles played by the child and parent. A clearly visible, and pathological, example of this is when the abused child grows up to become a child abuser. This is a process of “turning the passive into the active” where the child’s feelings of helplessness and anxiety in the face of being controlled, manipulated, and used is warded off in adulthood by assuming the role of one who is powerful and in command.

It’s possible that some users might abuse their computers just as they might have been abused, to a greater or lesser extent, within their family of origin. But computers are expensive. For most people, the possibility of damaging them would not be very satisfying in the long run. On a more subtle level, people who once were controlled, dominated, and manipulated within their family - as if they were not really people at all, but just objects to be used - may very well as adults treat their computers in the same manner. Anger and outright rage at the computer, when it doesn’t behave the way YOU want it to, may be a symptom of this kind of transference. This may have been the same emotional reaction of the disappointed, “betrayed” parent.

The computer also can be perceived, almost lovingly, as one’s baby. You attend to it’s needs, nurture it, help it develop and grow (by adding software and hardware). Not unlike Jenny, who assumed a parental role towards her father, you feel protective and responsible for the computer’s well-being. You become invested in it’s strivings and achievements, even taking pride in the new things it can do. With delight and wonder, you take part in the creation of a new individual with it’s own unique abilities and personality. It is a reflection of you, YOUR abilities and personality, but you also realize that much of what you have done is to direct and shape the raw qualities and potentials that already existed inherently in your “baby.” And quite unlike real life babies, this silicone substitute will never become independent and leave you. For some people, that may be a very attractive proposition.

You as You, Computer as Wished-For Parent

Many people wish, consciously or unconsciously, that their parents could have been different in some way. That wish may shape their perception of the computer as possessing those desired characteristics.

Sam’s mother was, to use a less than technical term, “crazy.” Her behavior and emotions were unpredictable. One moment she would be caring and loving, and the next harsh, critical, and punishing. Never being able to tell what was coming his way next, Sam became a hypervigilant, paranoid child. He needed always to be on the lookout for subtle cues indicating how his mother would behave. He tried to anticipate her moves, but often was not successful. Feeling helpless and angry (in some ways similar to Leonard), he experienced life as unpredictable, dangerous, and beyond his control.

As an adult, Sam takes comfort in his computers. They possess the qualities he wished his mother had - predictable, reliable, non-judgmental, and no unexplained emotional outbursts. If he applies his hard-earned skills at analyzing the subtle details of how it behaves, almost all of the time he CAN predict and control how it will behave. There is very little intimacy and “loving” feelings towards his computer. But that’s quite OK by him. Those things only got him entangled in trouble with his mother. In fact, he takes some pleasure in his cold dominance over the submissive machine.

Lorna experiences her computer quite differently. She sees it as a benign presence. It is always there, waiting for her. It pays attention to what she wants and gives immediate feedback. It allows her to express her thoughts, her feelings, her creativity. It takes and accompanies her wherever she wants to go on the internet. She almost sees it as a very responsive, compassionate companion who recognizes her value and individuality as a person. It even HELPS her develop her individuality…. How unlike her parents who were so busy and preoccupied that they often neglected to show an interest in her life.

You as Wished-For Parent, Computer as You

In this last type of transference, a reversal once again occurs - only this time the user acquires the wished-for parental qualities and the computer becomes like the child. Often people strive for the benign qualities that were missing in their parents - which is often a matter of reversing some characteristic of the parent. Sometimes that reversal may go too far. If your parents were too strict, you may become too liberal with your child. If your parents were uninvolved in your life, you may become too intrusive in your child’s life.

Becoming the wished-for parent of one’s computer may follow the same pattern. Users strive to be “good” to their computer in ways that their own parents were not “good” to them. In some cases they carry that effort too far. One user is careful about making sure her computer is safe and healthy. Another becomes so worried about viruses and possible damage to his machine that he refuses to explore the internet, is wary of installing new software, and rarely lets anyone else use it. One user takes interest in what goes on “inside” his computer and so tries to learn about its hardware and software. Another becomes so invested in the technology of her machine that it becomes an obsession that rules her life.

You are Me, I am You, We are All Together

Some type of transferences (called “selfobject” transferences) involve a bolstering and enhancing of one’s sense of self. When the parent admires the child’s painting, acknowledges her thoughts about a TV program, or empathizes with her feelings of anger, sadness, and delight, the child’s identity is fortified through this “mirroring.” When a boy imitates his father mowing the lawn, or a girl plays with Mommy’s briefcase, this identifying with the parent in an “idealizing” relationship augments their self-esteem and sense of self. So too in a “twinship” relationship when siblings play and work with each other. The feeling that “we are doing this together” satisfies their thirst for knowing who they are by what they do with others. In these forms of transference, there is a blending of oneself with the other, so that the other person is not necessarily experienced as a separate person, but as part of oneself.

Users may rely on their computers to clarify and strengthen their sense of identity. The computer is attentive and accommodating to their needs. It mirrors them. As users customize its hardware and software, the computer becomes more and more like a responsive reflection of their needs, feelings, and ambitions. It is part of them, a reflection of who they are, a world created from within themselves. By idealizing it, by participating in all the amazing, powerful things a computer can do, users strengthen their own confidence and feelings of success. By spending time together with their computer, it becomes a reassuring extension of their motivations, personality, and inner psychological life - like a good buddy, a sibling…. a twin.

But there is a danger in relying too heavily on the computer as a support to one’s identity. Placing all your eggs in one basket is never a good idea. The system may crash at exactly the wrong moment. The hard-drive may fail. For any of a wide variety of reasons, your treasured machine may be taken from you. The rug has been pulled out from under your feet. You feel betrayed, abandoned, lost….. resulting in anger and depression.

Perhaps all computer transferences involve a blending of the user’s mind with the “cyberspace” created by the machine. Cyberspace indeed is a psychological space, an extension of the user’s intrapsychic world. Using psychoanalytic terms, we would say that computers create a transitional space - an intermediate zone between self and other - where identifications, partial identifications, internalizations, and introjects interact with each other. In more plain language, we would say that cyberspace is a zone where the big and little bits of our parents and siblings that we’ve taken into our own minds and personalities become free to express themselves, to play, work, fight, and, ideally, make peace with each other.

How Do You Know It’s Transference?

Psychological reactions to one’s computer (and any significant “other”) may be a complex combination of some or all of the types of transference described above. Mother, father, and sibling transferences can interact and change over time. It’s often difficult detecting the interpersonal origin of one’s thoughts or feelings towards the silicone-other. When thinking about transferences in real life, clinicians often ask themselves, “Who is doing what to whom?”

So how do you know when you’re having one of these transference reactions to your computer? …. There are some tell-tale signs. When you want to throw the damn thing against the wall. When it “makes you” feel betrayed and disappointed. When you feel lonely and empty because you have not had enough time to spend with it. When you often want to be at your keyboard more than you want to be with family and friends, or when those people comment on how attached or emotional you get towards it. Any seemingly exaggerated or “inappropriately” strong feelings towards your machine probably means you think of it as more than just a machine.

Transference also may be rearing its head whenever one feels addicted (see “Why is This Thing Eating My Life”). Computer addictions often mean that the user is attempting to use the cyberworld to satisfy some strong internal need, but the strategy never quite works. One never feels fully satisfied or complete because the frustrated need arises from something that was or is missing from one’s relationship to real world people. The computer has become an inadequate substitute target for that unfulfilled need.

Adult and Machine

Growing up into a mature adult is a gradual process of realizing how the mental models from our childhood have shaped our relationships and our lives. Sometimes these models steer us in the right direction - towards the right people and activities - and thereby enrich our lives. Sometimes not. We may need to challenge, develop, or outright abandon some of them. In all cases, the enlightening path is to see these models for what they are - simply models. After all, the computer is not Mom, Dad, Sister, or Brother. It’s just a computer.

Online Others in the Machine

All of the transference reactions described in this article also can explain how the user reacts to other people that he or she encounters in cyberspace. Communicating only by typed text in e-mail, chat rooms, and newsgroups results in a highly ambiguous environment. We can’t see or hear other people. They become a shadowy figure, a screen onto which we may launch any of the variety of transference reactions.

Because we experience online others THROUGH the computer, it’s also possible that the transference reactions to them may interact with the transference reactions to the computer. Transference to the computer may spill over to, amplify, or be contradicted by the perception of the online other. For example, if William perceives the computer as a passive thing to be manipulated (like Dad manipulated him), he might extend that perception to other people he meets online, treating them as weaker people to be controlled. If they happen to say something that sounds passive, or if their personality style is indeed a bit passive, William may greatly amplify in his own mind how passive they seem to be. As a result, his reactions to them may be inappropriate. If others do something that grossly contradicts William’s perception of the computer as passive - if they act assertive or independent - William may react with severe disappointment or anger at the perceived “betrayal.”

Healthy online relationships are those in which we realize that our perceptions are not always accurate. Other people are other people, not extensions of our beliefs or ghosts in our machine. Given the complexities of transference reactions, this isn’t always easy to do. As Otto Kernberg was fond of saying about unraveling transference in psychotherapy, one must continually ask, “Who is doing what to whom?” Once we fully realize that the computer AND online others aren’t our Moms, Dads, Sisters, or Brothers, we become free to enjoy cyberspace in the ways that we wish, without any unconscious strings attached.

10) How is treatment for mental illness covered by health insurances? How much does it usually cost?

A: First, there are several types of treatments for mental illnesses depending on diagnoses and severity of illness. These include commonly used approaches such as psychotropic medications and psychotherapy as well as less commonly used methods such as electroconvulsive therapy (ECT), psychoanalysis, hypnosis, etc. They can be inpatient treatment or outpatient treatment. Different treatment modalities can be applied together or separately. Focusing on the commonly used approaches, medication management and psychotherapy can be practiced together or separately, depending on the therapist’s expertise (see Answers to Question #4, 6. and 7). When they are practiced separately, a medication management session lasts from 15-20 minutes on average and costs almost as much as a psychotherapy session; a formal psychotherapy session usually lasts 45-50 minutes. When they are practiced together, depending on the type of therapy, the session can be 30 to 45 minutes and the cost can be the same as therapy or a little more per session than either type of treatment alone. Keep in mind that the rate can vary by specific practitioner. It may also change over time.

Second, to my knowledge, most health insurance plans cover medication treatment and psychotherapy sessions to some degree. However, many plans limit the number of sessions covered per year and often count medication treatment as part of total mental health sessions allowed for one individual per year. As seeing regular doctors, a per-session copayment is almost the rule. One can discuss with the doctor about the treatment plan and session limits once started. It is quite possible that a patient will need more sessions in a year than covered by the insurance company. In other words, it is not uncommon that a patient needs to pay out of pocket to some degree. Your doctor/therapist can discuss treatment choices with you after evaluation. Psychoanalysis is essentially not covered despite its usefulness for certain patients, which is one of the reasons for its popularity decreased significantly in the US in recent decades. Many of them mostly see patients for psychotherapy.

Third, like medical doctors, there is a difference in coverages for providers who are inside the insurance network vs those outside network — If one wants to pay less out of pocket, it is important to contact your insurance and find out the list of providers. Many doctors and therapists choose not to be a part of an insurance plan due to low payment from insurance companies, unfortunately, including many of the best doctors and therapists. In general, psychologists and social workers charge a lower per-session rate than psychiatrists, but the cost can vary widely depending on other individual factors, such as the experience and popularity of the practitioner, the location, and affiliation (with a hospital or community mental health center vs private practice, for example). Therapists still in training usually charge a much lower rate than fully credited and established ones, but this does not mean their care is necessarily less good, because they always have an experienced professor/mentor who supervises them on each case. In some hospitals, the trainees’ therapy sessions were recorded with the patient’s consent and then supervised by senior faculties. A therapist in training may also be very conscientious with updated knowledge. Seeing a therapist under training at a teaching hospital or clinic can be an economical way to get high-quality treatment. Community mental health centers, some hospitals, and many psychotherapists charge patients on a “sliding scale.” In other words, the rate they charge a patient is pre-arranged according to the patient’s income. Therefore, the cost of mental health care for each person depends on his or her specific needs and financial considerations. Lastly, with doctors and therapists in private practice who have to cover many overhead costs by themselves, don’t be surprised for a small percentage increase of the fee which usually reflects the inflation, but the insurance plans are not necessarily agreeable.

Given all these variables, I can’t give specific numbers here for the costs of treatment. As a rule, it is important to keep good communication with your doctor/therapist about any concerns related to treatment including payment. Unlike other types of medical care, the discussion about the payment of treatment can be a psychological therapeutic issue. Most doctors and therapists will not charge an unreasonable rate both for ethical and practical reasons.

Dr. Cai recommended the following article from New York Times about why it is valuable for psychiatrists to have psychotherapy training, including the experience of personally undergoing psychotherapy:

“Have You Ever Been in Psychotherapy, Doctor?” by Richard Friedman, MD

It should be noted that the psychiatric residency training curriculum requires every future psychiatrist to get training in psychotherapy.  However, fewer and fewer psychiatrists spend less and less time practicing psychotherapy, and high-quality training programs are becoming more scarce in the United States.

Still, clinical studies have shown over and over that the combination of psychotherapy and medication is the most effective and rapid treatment for patients who are seriously ill with depression, anxiety, bipolar disorder, even schizophrenia.

Psychotherapy, especially cognitive behavior therapy (CBT), is “a gift that keeps on giving.”  Studies repeatedly show that patients being treated with CBT not only get better during the study but continue to get better after they leave the study, because they have learned the tools to take care of themselves so that they can keep running farther and getting better on their own.

9) If someone has the tendency to procrastinate, should s/he consider seeking psychological help?

A: Procrastination happens to many people once a while. Very few people can say that they never procrastinated in their lives. However, if one procrastinates frequently, this can cause troubles in life, especially if procrastination causes serious delays in work or health-related issues. There may be numerous reasons to cause procrastination, such as not having enough energy or concentration as a result of physical or mental illnesses, or psychologically resist the pressure or obligation to do certain things. Thus, I would suggest that, if the procrastination is frequent and severe enough to interfere with a person’s daily function, such as getting work done or finish homework at school, or always late to appointments and affect relationships with friends and family, one should seriously consider getting some professional help.