Saul Rosenthal, PhD

HEALTH PSYCHOLOGIST

Health Psychology

What is a health psychologist?

Health psychologists are experts in the ways that thoughts, feelings and behavior affect health and wellness. Whether working with an anxious client to reduce physical reactivity, a diabetic to maintain a healthy diet or an individual to reduce migraines, health psychologists focus on strengthening the mind-body connection.

Most, if not all medical issues are at least affected by psychosocial factors. In fact, modern health care utilizes a biopsychosocial understanding of health and illness. Even for conditions that have a clear biological cause, psychosocial intervention can help improve quality of life.

For that reason, you will find health psychologists playing a growing role in medical care. Health psychologists might help clients change habits like smoking or overeating, teach them to manage chronic diabetes, hypertension or other conditions, prepare individuals for surgery or help them manage pain or the significant stressors of serious illness. Psychologists are also involved in training physicians and other healthcare providers and helping to improve health policies.

Health psychologists like myself can serve as an integral member of your health care team. We work alongside medical providers, bringing a holistic approach to wellness. We are experts at bringing together non-biological and medical care, improving treatment outcomes, quality of life and overall health.

I have a medical condition. Why should I work with a psychologist?

Non-biological factors affect health and illness. Enhancing psychosocial strengths can improve the effectiveness of traditional medical treatment. For example, many people find that stress management and lifestyle changes help reduce or resolve conditions like hypertension and diabetes.

Health psychologists are particularly well prepared to work with clients who have medical conditions. Because we train in medical settings, we understand how the medical system works and can collaborate with physicians, nurses and other members of your medical team. In fact, many of my referral sources are medical providers, asking me to work with individuals who need more than the traditional medical treatment. In addition, I work in a behavioral health service embedded within a Veteran’s primary care clinic. We work alongside the medical staff, often seeing patients together to consider best approaches to health conditions.

Why would I choose a health psychologist for anxiety, depression or other non-medical condition?

Whether a condition is considered physical or mental, the best treatments are those that take into consideration physical, psychological and social factors. Health psychologists are trained to understand health from a holistic perspective. We do not limit ourselves to a ‘mental’ or ‘physical’ perspective. Whatever condition you are experiencing, a health psychologist approaches it comprehensively.

For example, anxiety is a physiologic over-reaction to what a person believes is a threat. A health psychologist will attend to all aspects of the issue – the fearful emotion, the thoughts that misinterpret a situation as dangerous and the physical reaction of anxiety (rapid heart rate, difficulties breathing, etc.). Health psychologists, trained to integrate psychological and biological aspects of wellness, are best prepared to work comprehensively with you.


About the Practice

Why aren’t you on any insurance panels? Are there any advantages to me for not using insurance?

We all know that health care in this country is very expensive. While I respect the decision of many of my colleagues to accept insurance, I have chosen not to, for a number of reasons. My primary concern about insurance companies it their growing influence in the realm of clinical practice as well as finance. Your insurance company can demand to review your records at any time, including from years ago. They can refuse to reimburse for treatments you have already received (and can ‘claw back’ payments they already made). Insurance companies can also influence your treatment team and approach by labeling some approaches ‘medically necessary’ or not, sometimes regardless of actual research-based evidence.

Is there any way that I can use my insurance?

If you have out-of-network benefits, your insurance company might reimburse a portion of my fees, typically after a deductible and possibly with a co-insurance cost.

In some situations, your insurance company will agree to a single case agreement. That is, they will reimburse for my services even if you do not have out-of-network benefits. They do this because they cannot provide you with a clinician who has my skills and experience. For example, there are very few clinicians trained to work with children or adolescents experiencing chronic pain. Because insurance companies by law have to provide appropriate clinicians, they will sometimes contract with me for specific cases.

Feel free to discuss either possibility with me. Ultimately, you will have to check with your insurance company.

What can I do if my insurance company refuses to pay for your services, even if they cannot provide a clinician with the appropriate skills or experience?

By law, an insurance company must pay for appropriate care. More and more companies are ending the practice of single-case agreements, where they contract with a specialist for a particular case. However, if necessary, you can build a case to convince the insurance company to reimburse for the appropriate care. I am happy to discuss your options.

If you find that your insurance company refuses to pay for appropriate care, you can file an appeal with the State of Massachusetts. Visit http://www.mass.gov/ago/bureaus/hcfc/the-health-care-division/.


Choosing Treatment

How long does treatment last?

While it is impossible to predict the length of treatment, my approach typically follows a time-limited model. Every person is different, but I know you want improvement as quickly as possible. So do I. Oftentimes, change begins immediately or within a few sessions. While there is no guarantee, I believe that most people begin to show positive change within four to six sessions. I continually assess the effectiveness of treatment with my clients in order to determine if we are taking the best approach.

As I often tell my clients, my job is to get fired because you no longer need me.

LMHC, MD, LICSW, MFT, PSY.D, Ph.D, XYZ? Help, I don’t understand what all these initials mean!

These days, people with all sorts of backgrounds call themselves ‘therapists’ or even ‘psychotherapists.’ However, they might have very little training, experience or supervision. Many of these titles can be used without any qualifications or proof of training.

It is important to recognize that the best clinicians have completed significant amounts of training and maintain a current license to practice. In Massachusetts, the term ‘Licensed Psychologist’ is legally protected for individuals who complete an approved doctoral-level course in clinical psychology and keep up with the requirements for licensure (including passing a comprehensive exam, completing continuing education courses and maintaining the ethical standards of practice). Typically, these are individuals with a doctorate of philosophy (PhD), psychology (PsyD) or education (EdD).

Other licensed clinicians who provide psychotherapy might include psychiatrists (physicians who complete a residency focused on behavioral health), social workers who typically complete a Master’s degree (LICSW or MSW), nurses who have completed specialized training in psychiatric treatment and Licensed Mental Health Counselors (LMHC).

Others might also call themselves ‘psychotherapists’ but are not licensed to provide behavioral health service. It is important that you investigate the background of a potential therapist. What is their background, training and experience? The best treatment is with the best-trained clinician.

How to choose a clinician

Choosing a good clinician for psychotherapy is an extremely important and difficult decision. You are committing time, money and effort to a professional who you have to trust will help you through significant challenges. Unfortunately there is no easy way to make the choice.

The best predictors of effective therapy are how experienced the clinician is and how well the therapist and client ‘fit.’ While assessing good fit requires experience working together, there are some ways to help narrow down your choices even before your first visit.

First, consider the referral source. Your physician or a friend might both have suggestions, but they know you in very different ways. What can you find out about the clinician even before you meet them? Second, investigate effective approaches to your particular problem. Where possible, focus on research evidence supporting treatment. Third, find clinicians who utilize those effective treatments. You can do this by looking at online professional organizations like the Association for Behavioral and Cognitive Therapies (www.abct.org), the Biofeedback Certification International Alliance (www.bcia.or) or Psychology Today (www.psychologytoday.com). These and other organizations list clinicians in your area who deal with the issues you want to work on. Finally, when you identify some specific clinicians, investigate them. You can check a license (in Massachusetts, go to http://www.mass.gov/ocabr/government/oca-agencies/dpl-lp/). Additionally, many clinicians have websites that explain their experience and treatment approach. Contact clinicians you find interesting and ask them some questions:

  1. Does the clinician have experience in your particular problem? If you have a stomachache, you would not go see a podiatrist. While psychology is not as specialized as medicine, clinicians often focus on a few issues. When you first speak with potential clinicians, ask about how they would work with you and their success with your issue.
  2. What experience and ongoing training is the clinician involved with? New approaches are continually under development. Is the clinician aware of the most effective approaches? Do they continue to receive supervision and consultation (even the most senior clinicians benefit from ongoing examination of their work)?
  3. What is the clinician’s approach and does it resonate with you? While some approaches have stronger evidence than others, you should feel confident with the approach of your clinician. Some people prefer the time-limited, proactive approach of cognitive behavioral therapy while others prefer the more introspective, open-ended approach of psychodynamic therapy.

I do not recommend simply making an appointment with the first clinician you hear about or find on a Google search. While that can work out (and I confess some of my clients find their ways to me that way), it really is worth taking time to find the right clinician. You will save time, effort and money in the long run.


I have another question!

Feel free to contact me for any questions or further information.

 

Disclaimer: The information posted here was accurate to the best of my knowledge at the time of publication. I cannot be held responsible for inaccuracies or consequences of those inaccuracies.