Making meaning.
Human beings are meaning-making creatures. Faced with confusion, we will attempt to find meaning, even where there is none. Psychotherapy is about uncovering and addressing those meanings. Meanings that may even be obscure to ourselves. A good therapist will gently challenge us to examine inconsistencies in our perceptions and beliefs about ourselves and our interactions with others — and to examine what they might mean. Psychotherapy does not generally come upon “Eureka, that’s it!” sorts of answers, although such insights may suggest further avenues of inquiry. It is a very process focussed endeavor that studies our questions about ourselves in a sustained, methodical, and patient manner.

Recognizing patterns. 
Before we can begin to understand our patterns, we have to become aware of them. Part of what psychotherapy does is help to make people more aware of patterns and behaviors that they themselves might not have noticed. It is a process of teasing out the many possible sources that contribute to those behaviors. Many patients express a sense of relief when they are able to bring new meaning to a past situation they had viewed simply from one perspective.

Of course, there’s much more to it. Look for Part 3.

Also see: Part 1 and the related post, When does therapy end?

Kalea Chapman, Psy.D.

The links to parts 2, 3, and 4 of What is Psychotherapy? can be found on the “psychotherapy?” tab above.

Individual psychotherapy is a conversation between two people — where one person predominantly talks and the other predominantly listens. The goal of the conversation that develops is to foster insight into the nature of the person doing most of the talking, as well as insight into that person’s problems. But insight is not enough. The important work is somehow getting that insight to stick. To incorporate it into that person’s life in meaningful ways that in turn helps that person better adjust to their life.

Even such a simple definition leaves so much that is important out, and there are so many questions it raises, and statements that beg qualification. Look for Part 2.

Kalea Chapman, Psy.D.

This morning’s *Health Leaders* includes an article: “Data Breaches Cost Hospitals $6B Yearly” by Dom Nicastro.

Here are some excerpts:

[begin excerpts]

Hospitals spend $6 billion annually because of data breaches, and Federal regulations enacted under the HITECH Act have not improved the
safety of patient records research from The Ponemon Institute shows.

Among the data security and privacy research firm’s findings:

* Hospitals are not protecting patient data

* Hospitals admit to being vulnerable to a data breach

* Breaches of patient information are occurring frequently and often go unreported, putting patients’ privacy at risk

* A small percentage of healthcare organizations rely on security technologies to prevent and detect data breach incidents

* Federal regulations–HITECH–have not improved the safety of patient records

The Health Information Trust Alliance’s (HITRUST) analyzes of breaches of unsecured protected health information (PHI) of 500 or more affected individuals on the Office for Civil Rights website.

Covered entities and business associates reporting the breaches on the site together could spend nearly $1 billion because of those breaches, the August 2010 report found.

OCR’s breach notification website list has grown since the HITRUST report.

As of Thursday, November 4, 189 entities have reported breaches of 500 or more.

[end excerpts]

The article is online at:

Ken Pope

Here’s the article, as excerpted by Dr. Pope:

Computerworld released an article: “Texas fires two tech chiefs over breach; Data of 3.2M people was inadvertently posted on a publicly
accessible Web site” by Jaikumar Vijayan.

Here are some excerpts:

[begin excerpts]

The Texas State Comptroller’s office has fired its heads of information security and of innovation and technology following an inadvertent data
leak that exposed Social Security numbers and other personal information on over 3.2 million people in the state.

<snip>

The measures come in the wake of a recent disclosure by Combs’ office that Social Security numbers, driver’s license numbers, and names and
addresses of more than 3.2 million Texans were inadvertently posted on a publicly accessible Web site for nearly a year.

<snip>

The exposed data was contained in three files that were transferred to the comptroller’s office from the Teacher Retirement System of Texas
(TRS), the Texas Workforce Commission and the Employees Retirement System of Texas (ERS).

<snip>

However, the data was transferred in an unencrypted manner to the Comptroller.

To compound the mistake, personnel in Combs’ office then put the information onto a server that was accessible to the public and left it
there for an extended period, without purging it as required, the statement said.

<snip>

“Unfortunately, the Attorney General’s Office has learned that Texans affected by the Internet security breach may now be the targets of a new
telephone scam,” Abbott said.

He asked affected victims to be extra vigilant against fraud.

Abbott’s office is currently conducting an investigation into the breach.

The sheer number of records that were exposed by the comptroller’s office makes this the largest breach involving Social Security numbers
and other personal data, this year.

[end excerpts]

This morning’s *Boston Globe* includes an Associated Press article:
“Distracted driving among young is rampant.”

The article notes that the “US Department of Transportation and Consumer Reports magazine have released a poll that….said that 63 percent of people under 30 acknowledged driving while using a handheld phone and 30 percent said they have sent text messages while behind the wheel.  The
Department of Transportation said nearly 5,500 people in the United States were killed in distracted driving accidents in 2009.”

The article is online at
<http://bo.st/KenPopeSurveyOnTextingWhileDriving>

This morning’s *Health Leaders* includes an article: “Data Security
Inadequate at 71% of Hospitals” by Dom Nicastro.

Here are some excerpts:

[begin excerpts]

The HITECH Act has been under recent scrutiny for not improving the
safety of patient records, according to research from The Ponemon Institute.

For 65 hospitals mostly in the 100- to 600-bed range, 71% of respondents
say they have inadequate resources to prevent and quickly detect patient
data loss.

The same percentage of respondents say federal regulations like HITECH
have not improved the safety of patient records, research from the
“Benchmark Study on Patient Privacy and Data Securty” conveys.

Hospitals say that protecting patient data is not a top priority (70%)

Most at risk is patient billing information and medical records, which
is not being protected

Patients are typically first to detect a significant number of breaches
at healthcare organizations (41%)

[end excerpts]

Again, this is of particular concern for healthcare providers as well as patients/clients. Possibly more so with those in psychotherapy, since there remains unfortunate stigma attached with treatment for emotional problems or mental illness.

Ken Pope’s entire post on the matter, here:

*Information Week* includes an article: “Indiana AG Sues Wellpoint Over
Health Data Breach; Consumer health data was at risk for 137 days
through an unsecured Wellpoint website, alleges the suit filed against
the health insurer” by Marianne Kolbasuk McGee.

Here are some excerpts:

[begin excerpts]

Indiana’s attorney general office has filed suit against health insurer
Wellpoint for delaying notification of customers of a data breach
earlier this year.

Indiana law requires businesses to notify individuals potentially
affected by data breaches, as well as the attorney general’s office
“without reasonable delay,” according to a statement by Indiana AG Greg
Zoeller’s office.

However, the AG office alleges that data, including social security
numbers, health records, and financial information for about 32,000
Indiana consumers were potentially available to the general public
through an unsecured Wellpoint website for about 137 days, between
October 2009 and March 2010.

The data was submitted to Wellpoint from applicants seeking insurance
coverage.

The AG office alleges that while Wellpoint was notified on February 22
and March 8 of this year that application records containing personal
information was accessible from its public website, Wellpoint didn’t
begin notifying individuals about the security breach until June 18, 2010.

In a statement from Wellpoint sent to InformationWeek in response to
seeking comment, the company said, “Anthem Blue Cross and Blue Shield is
committed to protecting the privacy and security of our members’ and
applicants’ personal information, in accordance with all applicable laws
and regulations.”

Anthem Blue Cross and Blue Shield is Wellpoint’s operations serving
several states, including Indiana, Colorado, Connecticut and Maine.

[end excerpts]

The sensitivity of private data is one reason many therapists opt out of taking insurance. A diagnosis can follow one around for years, potentially being labeled as a pre-existing condition leading to non-coverage. Private information can become less than private.

Here’s one of his posts, from October 20, 2010:

Today’s *Philadelphia Inquirer* includes an article: “Health insurers
say data on 280,000 Pennsylvania clients may be compromised” by Jane M.
Von Bergen.

Here are some excerpts:

[begin excerpts]

Keystone Mercy Health Plan and AmeriHealth Mercy Health Plan said
Tuesday that a portable computer drive containing the names, addresses,
and health information of 280,000 Medicaid members in Pennsylvania has
been lost.

The affiliated companies together insure 400,000 people on medical
assistance in Pennsylvania.

Also stored on the drive were the last four digits of 801 members’
Social Security numbers, plus complete Social Security numbers for seven
others.

“We deeply regret this unfortunate incident,” said the affiliates’
president, Jay Feldstein, in a statement released by the insurers.

“We take our responsibilities for safeguarding personal health
information very seriously.”

The insurers did not respond to numerous requests for information,
including questions about when and where the incident took place,
whether any complaints have been received, and which regulatory agencies
have been notified.

[end excerpts]

My brother Hal, a psychiatrist at Wake Forest University, used to work as a KOL for GlaxoSmithKline. The event that drove him away from the business came one day when he was giving a lunch lecture at a local primary-care clinic. To his irritation, none of the doctors in attendance paid any attention to the lecture. They were answering pages, talking loudly with one another, helping themselves to the lunch that Glaxo had brought in—anything, it seemed, to avoid listening to him talk. Eventually Hal got so frustrated that he cut the lecture short. As he was packing up his laptop to leave, however, the Glaxo rep asked him a favor. The director of the clinic had been unable to attend the lecture. Would Hal mind sticking around a few more minutes to say hello? Reluctantly, Hal agreed, and the rep took him to a small room adjoining the clinic, where he said they would wait until the director appeared.

Hal calls this his moment of understanding, after which he never gave another industry-funded talk. Up to that point, he had imagined himself as a high-powered academic physician bringing the latest university research to doctors out in the community. Standing next to the drug rep, however, Hal understood how the community of doctors saw him. To them, Hal was a drug-company shill. “I was literally standing in the drug-rep spot begging for a minute of this doctor’s time, like a cocker spaniel begging for a leftover piece of meat from the table,” he says. It was no wonder the doctors saw little difference between Hal and the rep. “It was like I had become a psychiatric call boy,” he says. “I might as well have just said, ‘Hi, I’m Hal. The company sent me to make sure you all have a good time.’”

“There was a line on the floor,” Hal says. He had never seen such a thing before. “The rep told me that we weren’t supposed to step past that line unless a doctor said it was okay.” They stood behind the line, waiting patiently. After a few minutes, the director walked down the hall toward them. “I sort of looked at him hoping to make eye contact and speak, but he wouldn’t even look at us,” Hal says. “This rep just stood there with a big smile on his face, and the doctor stopped in front of the treatment room five feet away from us, and stood there for several minutes reading a chart. Then he walked away into the treatment room like we were not even there.”

And while we’re posting large excerpts, here’s the opener to the article:

In the early 1970s, a group of medical researchers decided to study an unusual question. How would a medical audience respond to a lecture that was completely devoid of content, yet delivered with authority by a convincing phony? To find out, the authors hired a distinguished-looking actor and gave him the name Dr. Myron L. Fox. They fabricated an impressive CV for Dr. Fox and billed him as an expert in mathematics and human behavior. Finally, they provided him with a fake lecture composed largely of impressive-sounding gibberish, and had him deliver the lecture wearing a white coat to three medical audiences under the title “Mathematical Game Theory as Applied to Physician Education.” At the end of the lecture, the audience members filled out a questionnaire.

The responses were overwhelmingly positive. The audience members described Dr. Fox as “extremely articulate” and “captivating.” One said he delivered “a very dramatic presentation.” After one lecture, 90 percent of the audience members said they had found the lecture by Dr. Fox “stimulating.” Over all, almost every member of every audience loved Dr. Fox’s lecture, despite the fact that, as the authors write, it was delivered by an actor “programmed to teach charismatically and nonsubstantively on a topic about which he knew nothing.”