Dr. John A. Riolo (The Insider) hosts the Your Advocate Online website. This website has several distinct but related and interconnected parts.  Dr. Riolo hosts The Insider Internet Radio Show and The Insider’s Guide to Laws and Ethics in Mental Health. He is also the Vice-President of Psychjourney.

Dr. Riolo has recently been honored by having a character "Psychinsider" created in his image on the WANTED:HERO comic book series.

Dr. Riolo is available for consultation or speaking engagements. You may contact him directly at johnr@psychjourney.com or 401-263-1730 if you wish to discuss a particular situation. Please to not put confidential or sensitive information in a non-encrypted email.

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Interview Questions

What are the qualities of a user or consumer friendly therapist?
Are there major differences in the credentials of a psychotherapist?
If so what are the significant differences?
How confidential is a mental health record anyway?
Can I get see or obtain copies of my mental health records?
Should I?
What are “psychotherapy notes” and how are they different from the rest of my record?
What should I do if I have a business dispute with my therapist?
How can I lodge a complaint against a therapist who did not treat me adequately or properly?

Story Angles

What is an Insider?

The Insider idea is based on the character in the movie with Russell Crowe and Al Pacino. An Insider is someone who works in an industry and decides to reveal to the public professional “trade secrets”. The insider is not a clandestine spy who works in secret. To be effective, he or she presents credible evidence and is willing to endure criticism and the inevitable backlash. An Insider is passionately committed to giving the mental health consumer the information he or she needs to make informed decisions.

Some of Dr. Riolo’s colleagues and even friends are very disturbed that he advocates that the practices of therapists should be “an open book.” What are they worried about?
Some therapists believe that the therapeutic relationship is unique, with almost magical or mystical qualities. Consequently, they object to comparisons with other professional relationships. Dr. Riolo believes that while there are special qualities to a therapeutic relationship, the rules that govern all relationships still apply. Honesty and candor are critical. The major difference between a professional relationship and personal relationship is that the client’ or consumers interests should have precedence over those of the mental health professional.

Dr. Riolo cautions consumers to stay away from some therapists “with a ten foot pole.” How can a consumer spot an incompetent or untrustworthy therapist?
There is no easy formula. Some therapists may be fine for some people and disasters for others. However, there are some red flags. Among them are a therapist that is too wedded to his or her own theories and a therapist who will claim to use deception to help you. Anyone who will claim to lie for you could just as easily deceive you if they see fit.Dr. Riolo has strong opinions on the qualities of a therapist he wouldn’t hesitate to refer a loved one to for treatment. How can a consumer recognize a trustworthy therapist?

It can be summed up with “disciplined flexibility”. A therapist must be flexible in their theories and approaches. They must be open to criticism from their patients. They should be flexible in their schedules. However, they also need to be disciplined in evaluating their own work and have a sense of when to quit or refer to others when necessary. 

Many therapists hate managed care companies. Why?
There are many reasons, some rational some not. Managed care has changed the way most of us work. It has had a major impact on our income. But most of all, managed care wants to have a say in what we do. Some therapist can’t abide outside interference. They have a hard time differentiating the reasonable demands of managed care from the unreasonable.

Are there any business practices the managed care companies wish consumers to stay in the dark about?
Often times managed care companies tell consumers one thing in their advertising about limitations of coverage and tell the therapist something else. At one time, they had “gag clauses” in our contracts that restricted what we could share with consumers. This can create many difficulties. 

How can a mental health consumer determine who is reading his or her “confidential” mental health record? How do consumers protect their private information from falling into the wrong hands?
In the age of technology, it is extremely difficult. Some say the battle to protect privacy in the computer age is all but lost. However, the first step is for consumers to know what is in their record. Then they can begin to make informed decisions.

What do all those initials after a therapists name mean? Should consumers care?
Yes and no. For many people seeking therapy one credential may be as good as another. None are a sure guarantee that the consumer will find a therapist that is right for their unique situation. Some letters represent specific educational training, some the type of license and some are just a bunch of letters. In general, having a therapist with a license to practice independently at least gives the patient some recourse if they are mistreated. 

There are many horror stories of consumers being abused by managed care companies. How can mental health patients protect themselves?
Consumers should carefully read their managed care contract. In addition, they should make sure their therapist has read their contract and their provider contract. Your therapist can help their patients avoid being one of the horror stories only if they understand the system and combine consumer advocacy with personal integrity and honesty.

Dr. Riolo describes some mental health professional’s theories and treatment methods as “wacky.” What is he talking about?
For some,” wacky” is as good a word as any. Some treatment methods have no empirical foundation at all. They fall in the category of junk science. Now some therapists claim to be artists not scientists. There is as much art as science in doing therapy. But all good artists are disciplined. They study and think out their masterpieces. If an artist makes a mistake, all that is lost is the canvas or marble for a painting or sculpture. In therapy the consumer is the canvas or marble. A therapist cannot afford to make too many mistakes for the patient pays the price.

Some therapists believe it is perfectly justifiable to turn their clients over to a collection agency for one missed payment. Dr. Riolo strongly disagrees. Why?
It may be legal. It may not even violate the therapist code of ethics. Regardless, except under the most extreme and extraordinary of circumstances it is hardly justifiable and surely not helpful. If a patient becomes the target of a collection agency, it will adversely affect their credit rating. This could have very profound impact. There are better ways to resolve a business dispute between therapists and patients.

Dr. Riolo receives many letters and emails from mental health consumers who believe they have been victimized by their mental health professional. What kind of recourse is available to patients who have been abused by a therapist or the mental health system?
Just as a therapist should not use a collection agency frivolously, patients should not peruse formal grievances either through licensing board complaints or courts lightly. If all reasonable efforts to rectify problems or resolve a dispute fail and the consumer believe he or she was were harmed, there are steps they can take to “make themselves whole.”

Are there too many mental health professionals trying to survive in a saturated field? What effect is this having on the profession?
The sad reality for therapists is that they are too many of us. Despite pockets of scarcity, the supply of mental health professionals far exceeds the market demand. Certain locations are worse than others, but we are all competing for a limited pool of patients. Competition is good. It keeps us on our toes. However, there will always be some who want to compete unfairly by giving misleading information. Let the buyer beware.

The Insider Internet Radio Show

 

I invite you to listen to my Internet Radio Show The Insider where I and my guests examine mental health treatment from the viewpoint of both the health seeker and professional.

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I welcome your feedback, praise and criticism. Please feel free to contact me at johnr@psychjourney.com with suggestions for future articles, and questions.