G'day Hugh
The CBT is organised as a series of 6 - 12 appointments, each of 40
minutes duration but allowing 45 minutes - this allows time for
writing notes or bringing a session to a close with any tasks I may
have for the patient for the intervening week. I charge the "Focussed
Psychological Strategies" extended attendance fee (Item 2725) plus a
gap fee of $45. The gap fee is payable at the time of booking, is not
refundable, and reduces the no-shows which were sometimes a problem
before switching to this strategy.
I see all the patients in normal consultation prior to commencing the
CBT to explain the process and to gain an initial understanding of
their problems and what they hope to gain from the process. I also
perform a medical review at this consultation. Sometimes these
patients require further medical work-up plus/minus medication before
proceeding to CBT. Currently the only referral base I have is from
within the general practice in which I work but my CBT sessions - 2
per week each of 3 or four patients - are booked weeks ahead so there
is no ethical concern or difficulty in eliminating any medical issues
which may be influencing the patient's presentation. I discuss any
suggested medication options with the doctor who is the primary carer
of the patient in the practice before proceeding.
Generally patients book in blocks of three appointments, each a week
apart.
So in answer to your specific questions:
1) The $300 (average) is on top of the Medicare Rebate
2) I perform the CBT
3) I know of a number of psychologists in my area and there are also
many non-psychologist "counsellors" but I do not know who performs
CBT and I do not have knowledge of which of them obtain good outcomes
for their patients. I have little need to refer for psychologist
services and those of my general practice patients who have used
other psychological services have generally asked for specific
referral or been referred from other practitioners. I am in regular
telephone contact with a couple of local psychiatrists who have been
generous with their time and advice when needed.
4) I have not done formal training in CBT. My most significant
learning came from a lay counsellor called Christopher Greene whom I
met when working in far north Queensland about fifteen years ago. My
stimulus was the frustration I felt at not being of any use to the
depressed patients who were presenting to my general practice at the
time. Christopher was widely read and used techniques derived from
neurolinguistic programming (NLP) and cognitive behaviour therapy
(CBT). He had had spectacular success with a number of patients with
the so-called "allergy to the twentieth century" using these techniques.
After his chance but extraordinarily successful encounter with one of
my patients, a desperate young woman whose baby had died, I invited
Christopher to take a room in the practice and referred patients to
him. As we were close friends at the time I often discussed his
strategy with particular patients. I was impressed with the results
he achieved with these patients. Since that time I have read widely
and attended a number of short courses at different times in the
intervening years. In the ten years that I have been in my present
location, I have maintained a case load of 2-3 patients per week and
gradually honed my skills. I did the Sphere course in 2004 which I
found very useful. I am planning to take the Diploma in Mental Health
Sciences at Monash, probably starting in 2008 - I have studies in
skin cancer medicine on the go at the moment.
I use a proactive style which I think works quite well in the brief
encounter model available in general practice. One of the basic
tenets of CBT is to challenge previously fixed perceptions which
patients hold about themselves and about events, especially those
which they find traumatic. One thing it is not is "rentafriend". It
is often confronting. Nevertheless it can be liberating for patients
to discover that the negative long-held view they have had about
themselves is a myth they can give away and that they can take
control of their lives in ways they didn't think possible.
5) I have a number of texts on NLP and CBT but not one which stands
out particularly. I have found it worthwhile to read a range of
different authors, incorporating just those ideas which I could make
use of with my patients. The key factor has been practice - regularly
taking on patients and working their issues through with them. Some
of the best moments of my medical career have come from seeing
patients recover their lives through psychological medicine.
Alex
Dr Alexander G Bennett
Pomona Qld 4568
Australia
[EMAIL PROTECTED]
On 12/05/2006, at 8:25 AM, Dr Hugh Nelson wrote:
Alex
please tell us more about how to organise the CBT.
Is the $300 on top of medicare rebates.
Do you do the CBT or use a psychologist.
How do you ensure the psychologist is one who gets effective outcomes.
What do you do if the psychologist just operates as "rentafriend"
and there is no effective outcome for the patients.
Did you do some specific training in CBT yourself.
Do you recommend any good books.
Hugh.
Alexander Bennett wrote:
Depends who you talk to and what kind of patients you see. Agree
with KL doc if all he sees are psychotic patients; sounds like he
is too busy making his millions to be fussed with patient
outcomes. What kind of psychiatry do you deliver to 30-40 patients
per day? Definitely not true for patients who do not have a
thinking disorder and who come to CBT. I can point you at any
number of patients whose lives have improved immeasurably with
CBT. In my practice the cost is $300 over 6 weeks - hardly a
fortune and much cheaper than divorce or decompensation.
Alex
Dr Alexander G Bennett
Pomona Qld 4568
Australia
[EMAIL PROTECTED]
On 28/04/2006, at 3:42 PM, David de Bhál wrote:
But that is all psychiatry talk. Does not exist in ICD-9 and have
not
checked ICD-10.
Fasciniating to meet a pure private practitioner psychiatrist in
KL and sees
lots of high profile patients. He sees 30 to 40 patients per day.
Very few
GP referrals.Totally chemically focused but quite proprietary
about his
'cures'. Says that psychotherapy is pure bunkum. I don’t think
there are any
talking cures unless you have heaps of money and then that is
probably the
problem in itself.
He also does his own EHRs but it is on a local server with no
security.
Interesting.
David de Bhál
www.v-practice.com
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:gpcg_talk-
[EMAIL PROTECTED]
On Behalf Of Ian Cheong
Sent: Friday, April 28, 2006 6:19 AM
To: General Practice Computing Group Talk
Subject: Bordeline personality disorder was Re: [GPCG_TALK]
Clinicalsoftware
recommendations
At 5:24 pm +1000 27/4/06, ash wrote:
Oliver wrote:
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] Behalf Of David de Bhál
Sent: Thursday, 27 April 2006 4:34 PM
And WTF is "borderline personality disorder"?
Is it akin to borderline pregnancy or
borderline senility or borderline?
I think that it may have been invented since
you and I graduated. I wonder what the label
used to be for people who behaved in these ways.
sociopath i believe (or psychopath was the less demure expression)
Label first introduced officially in 1980 DSMIII.
Definitely not sociopath. Perhaps "suicidal",
"non-coper", "pain in the ...". I recall when I
was a student they had the label of "too hard to
deal with" from psych registrars.
If you want to help these people, you could read:
Marsha Linehan on "dialectic behaviour therapy"
(a newish term not on the cover!)
http://tinyurl.com/l6kle
Russel Meares on "self psychology"
http://tinyurl.com/jj9cn
And remember that a large number of "borderline"
patients have suffered significant childhood
trauma (sexual/physical/emotional).
Also search for "borderline" on this page, which
is a fabulous site for complete exploration of
trauma, including full text of all major research
papers:
http://www.trauma-pages.com/pg4.htm
Major issues include:
* boundaries
* trust
* control
So attaching a label and not telling them about
it is a serious problem, which helps perpetuate
their aberrant behaviour.
"Borderline" patients are a long-term project
that can be helped towards cure. I have a couple
of them who have eventually been relabelled
correctly as "dissociative" rather than
"borderline" and are moving towards cure after a
long trail of different psychiatrists over
decades who didn't manage to help them. It seems
they often fall over at "...that was a long time
ago...get over it...."
Ian.
--Dr Ian R Cheong, BMedSc, FRACGP, GradDipCompSc, MBA(Exec)
Health Informatics Consultant, Brisbane, Australia
Internet: [EMAIL PROTECTED]
(for urgent matters, please send a copy to my
practice email as well:
[EMAIL PROTECTED])
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