Behavior: Nader’s Guide to Shrinks

The only thing worse than feeling mentally ill these days may be deciding what to do about it. The would-be patient, not exactly on top of things anyway, is confronted with a bewildering and contradictory assortment of therapies, from classical Freudian to behavior modification. Choosing a therapist can get just as complicated. Should it be a psychiatrist, or a social worker? And once that is decided, which one? With all these questions, the path to the couch seems like an obstacle course.

But now onto the scene charges Ralph Nader’s Health Research Group with a consumer’s guide to therapy, Through the Mental Health Maze ($4). This step-by-step handbook is designed not to judge therapies but to explain them. Among the guide’s offerings are handy capsule descriptions of the kinds of treatment available (e.g., “reality therapy”: an approach emphasizing how to cope with a hostile environment), drugs (from Valium, a mild sedative, to antidepressants) and the therapists themselves.

The author: Sallie Adams, 28, who came to the project with no professional experience other than what she calls a “miserable year” of physical illness spent in “a botched encounter with the health-care system.” The guide counsels consumers about the side effects of drugs and advises them to be wary of long-range therapy. It also provides rules of thumb, such as that three sessions are usually enough for a diagnosis of a patient’s problem. Although criticism is muted, the guide considers the mental-health profession just another big ($14.5 billion yearly) business that lacks “public accountability.”

One novel idea is a sample seven-page questionnaire, to be filled out by the therapist. Its aim: to turn the tables and allow the patient to do some probing. Forty-one detailed questions explore the therapist’s credentials, favored forms of treatment and prices. For Washington, D.C., consumers, 86 pages of information are included on 348 local therapists (out of a total of some 2,000) who responded to a blanket mailing of the questionnaire. Sample nugget: Psychologist Ernest Kamm is “particularly interested” in treating “musicians or music lovers.”

A second “idea whose time has come,” according to the guide, is its model “consumer-therapist” contract. Among other things, the agreement sets forth number of sessions for treatment, the fees, and a statement of joint patient-therapist goals (Example: “explaining why I always lose my temper when I visit my parents”). The contract also stipulates that the patient be allowed to cancel further sessions (without paying) if therapy does not satisfy him.

Contract Dismissed. Neither the questionnaire nor the contract has rated rave notices from most therapists. Of the 1,474 therapists (76%) who refused to reply, some 600 were psychiatrists; they had been warned by Dr. Alex Kelly, president-elect of the Washington Psychiatric Society, that the guide might be slanted. Kelly also dismissed the contract as absurd and pointed to “defects” in the questions—an argument used against Who Runs Congress?, an earlier, highly criticized report.

Dr. Sidney Wolfe, a public-interest physician who heads the Health Research Group and oversaw the project, counters that the guide was devised with the help of five therapists and hopes the idea of a contract and of local directories will spread. Meanwhile, the proposals have picked up some professional backing. Washington Psychiatrist John Lofft thinks the contract will protect doctor as well as patient. Often, he says, patients drop out of therapy, giving therapists headaches. Says he happily: “I’d write in all kinds of obligations.”