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Dr. Susan Rathmell is a licensed clinical psychologist who earned her Ph.D. in clinical psychology from the University of Kansas in 2007. She has been in practice in Alabama for 17 years. She is the owner and managing member of Upward Behavioral Health (www.upwardbehavioralhealth.com), a psychotherapy practice in the Birmingham, Alabama, area that specializes in the evidence-based treatment of insomnia, depression, anxiety, and PTSD.
Through this article, Rathmell emphasizes the importance of evidence-based therapeutic methods, sharing personal experiences that demonstrate the tangible progress and recovery patients have achieved through such treatments. Shaping an Approach to Evidence-Based Psychotherapy The most rewarding experience for a therapist is seeing their client make meaningful progress. Over the years, I have seen firsthand the difference that evidence-based psychotherapy can make. Far more than offering support and perspective to a client, evidence-based psychotherapy helps clients make measurable progress toward recovery. Getting to see this is one of my very favorite parts of my job. One experience that always comes to my mind may seem insignificant at first: I had a client in an evidence-based psychotherapy group who I was treating for PTSD; specifically, my objective for this group was based in Prolonged Exposure Therapy and was intended to help these clients overcome their avoidance of crowded, public places. This discomfort is common among clients with PTSD, even if their trauma did not involve a crowded, public place. We spent the first few weeks of treatment building skills and then I sent each client out into an environment that they were working on not avoiding. This client chose a shopping mall. The first time he tried it was really challenging, but the second time, he was victorious. For the first time since he had become a father, he was able to buy his children’s holiday gifts on his own and he was rightfully so proud of himself. Being able to shop in a mall was a life-changing turning point for him, and although I had already been confident about the usefulness of evidence-based psychotherapy prior to this, it was in this moment that I fell in love with evidence-based psychotherapy. Another experience that has shaped my approach to evidence-based psychotherapy occurred during my training in Cognitive-Behavioral Therapy for Insomnia. Over the course of just 4 weeks, I saw a client who had slept poorly for over a decade progress from having severe insomnia to having no sleep problems at all. He was elated and relieved, and he was very grateful. Although I appreciated his gratitude, I knew that the most important component of the work we had done together was the evidence-based protocol, which was the foundation of our therapy. Experiences like this remind me of the power of science in therapy. Navigating the Stigma of Mental Health Issues I think the best thing I can do is shine a light on facts, such as: Quality, evidence-based psychotherapy can make a significant difference for almost anyone who is struggling with a mental health concern! Focusing on recovery and freedom is so much more productive than spending your energy trying to pretend that you aren’t struggling. The brain is as much an organ as the pancreas, or the heart, or the lungs. We don’t ostracize people who seek treatment for their diabetes, heart murmur, or asthma. It is illogical to stigmatize people seeking treatment for a condition based on their brain. Psychotherapy is simply healthcare for the brain. -almost every family has at least one person who has struggled or is struggling with a mental health concern. Pretending otherwise doesn’t change that fact, but it does add to that person’s and that family’s burden. Maintaining mental Well-Being and Preventing Burnout Research tells us that one of the most powerful ways mental health providers can guard against burnout is to provide quality care that allows them to see results in their clients. If we can see that we are making a difference and that our clients are getting better as a result of the work we do with them, we are much less likely to get burned out. The very best way to accomplish this is to use evidence-based protocols because they work. I also practice what I preach! In my work with clients, I devote a lot of energy to teaching them about coping skills and healthy lifestyle practices that support good mental health. It can be hard to make the time to do these things myself, but I schedule them into my day because, just like my clients, I deserve a life that is peaceful and happy. And I know that when I am peaceful and happy, I can be at my best for my clients. Impact of Changes in Mental Health Policy My biggest hope is that we see major changes in how insurance coverage is applied to mental healthcare. Oftentimes, mental health benefits are only sparingly covered by insurers. Even when mental health treatment is covered, the reimbursement rates to providers are often so low and come with so many complications, such as clawbacks and intrusive demands by insurers (e.g., that providers only offer shorter sessions to clients), that many providers make the choice not to accept insurance. I hope that these practices will change. Other changes that I hope to see include: -continuing to expand access to care through telehealth, as this greatly expands access to mental healthcare for people who live in rural areas without many mental health providers in their community and people who don’t have a lot of sick leave from work or reliable transportation to travel to mental health appointments. -continued integration of primary care and mental health, especially for mental health concerns that really should be first addressed by a mental health provider before placing a client on medication (e.g., insomnia). Engaging and updating clinical staff on the latest therapeutic techniques One of the hallmarks of my business model is rewarding the therapists who work at Upward for helping their clients make meaningful, measurable improvements to their mental health. At Upward, we constantly measure our clients’ symptom severity using reliable, valid assessments—if over the course of treatment, the client is showing improvement, then great! But if not, then we know we need to change direction and find the protocol that does lead to measurable progress for that client. When the course of care with a client ends, if the client has made significant progress, then the provider earns bonus pay from the practice. This motivates our providers to deliver gold-standard care to their clients. At Upward, we also engage in regular case consultation in our weekly meetings—this provides a diverse array of perspectives and areas of expertise and helps us consider treatment possibilities that we might not have conceived of on our own. We also involve ourselves in professional organizations and attend trainings and conferences to hone our skills and keep our knowledge base fresh and current. Emerging therapies and modality for the future I think the public is becoming more and more comfortable with mindfulness training and practice, and that is a very good thing. I think mindfulness has long since been established amongst mental health professionals as a powerful therapeutic tool, and now, more and more people are becoming comfortable talking about it and using it. I would like to think that group therapy will become more prominent in the coming years. It is already a common approach in some areas of the field, like substance abuse, but in my opinion, it is often underutilized for conditions such as depression, anxiety, PTSD, and insomnia. I think that some of this is due to a common misconception that individual therapy is more effective than group therapy, and some is due to the stigmatization mentioned above and some clients’ concern that participating in a group might increase the chances of others finding out that they are receiving mental health treatment. I hope that these misgivings will fade in the coming years since group therapy offers a lot of benefits: it is often less expensive for clients, it opens up more access to and reduces wait times for mental healthcare, and many clients find that they really benefit from working on their mental health concerns with others facing the same struggles. Advice for Aspiring Clinical Psychologists There are lots of ways to use a Ph.D. in clinical psychology. Clinical psychologists can be professors, researchers, staff at medical centers, therapists, and business owners. In some states, they can also be prescribers. My advice would be to spend some time trying on different aspects of the field. Find your niche and build your expertise in that area. For those seeking a career in therapy, I would advise that trying to treat a wide array of conditions may spread you too thin and diminish your ability to really hone your skills. It is much better to know a lot about a few things than a little bit about a lot of things, in my opinion. Developing true expertise in a specialty area takes years of education and experience. Offering expert-level care that yields meaningful, measurable results for your clients will help you build a strong reputation and referral base.
