Presentation on Social Media for Psychologists

Slide1

 

Reprinted from the Rutgers GSAPP website:  
Dr. Lauren Muhlheim
“Use of Social Media by Professional Psychologists”

 

On Wednesday March 27, 2014, faculty and students at the Graduate School of Applied and Professional Psychology (GSAPP) gathered to hear a colloquium presentation by Lauren Muhlheim, Psy.D, CEDS (Clinical, 1995). Dr. Muhlheim is a prominent GSAPP alumna who has a practice in Los Angeles where she provides psychological treatment specializing in evidence-based cognitive behavioral psychotherapy for adults and adolescents with depression, anxiety, stress, and eating disorders. She presented on the topic of “Use of Social Media by Psychologists in a Safe and Ethical Way.”

After earning a B.A. from Princeton University, Dr. Muhlheim attended the doctoral program in Clinical Psychology at GSAPP. She chose GSAPP because she was “impressed by the quality and depth of the clinical training” and knew that she wanted to work in clinical settings. As a graduate student, Dr. Muhlheim trained in the Rutgers Eating Disorder Clinic. In interview, she shared her favorite memory of GSAPP to be working with Terry Wilson, Ph.D., an internationally renowned eating disorders expert. More recently, Dr. Muhlheim trained in the Maudsley Family-Based Treatment (FBT) for adolescent eating disorders and is certified in FBT by the Training Institute for Child and Adolescent Eating Disorders. She is also certified as an eating disorder specialist (CEDS) by the International Association of Eating Disorders Professionals (IAEDP). Dr. Muhlheim has been providing psychological counseling since 1991. She has also supervised and trained psychology interns and other mental health professionals.

Dr. Muhlheim’s work experience has brought her to multiple settings around the globe. For nearly ten years, she was a staff psychologist at Los Angeles County Jail, followed by three years in Shanghai, China, treating clients of varying national, cultural, religious, and ethnic backgrounds. Dr. Muhlheim spearheaded and served as the first president of the Shanghai International Mental Health Association (SIMHA). She has also worked in an Obesity Research Clinic, inpatient hospitals, outpatient clinics, group homes, and private practice.

Dr. Mulheim’s experiences abroad proved to be a portal for her into the world of social media. In her colloquium presentation, she reflected on her years in Shanghai: “That’s where I first became aware of the power of the internet.” She described how she used search engine optimization to attract international patients to their practice website, as well as commented on the challenges she faced when China blocked Facebook.

In 2012, Dr. Muhlheim joined the social media committee of the Academy for Eating Disorders. She served as a co-chair of AED’s Social Media Committee, AED’s Membership Recruitment and Retention Committee, and AED’s FBT Special Interest Group. In her role as a co-chair of the Social Media Committee for the Academy for Eating Disorders, she helped manage the AED’s Facebook, LinkedIn, and Twitter pages, and helped educate professional AED members about social media. More recently, Dr. Muhlheim has stepped up to the position of Director for Outreach with the board of AED.

Over the course of her talk, Dr. Muhlheim educated the audience about social media from a variety of angles. She presented an overview of current technology, reasons why to be on social media, and recommendations for using social media safely and ethically. Loaded with valuable information and insights, her approach was also light and entertaining. She started out her presentation by differentiating among the various social media formats: “Facebook: I like donuts,” “LinkedIn: My skills include donut eating,” and “Twitter: I’m eating a donut.” Although the list of social media sites was lengthy, Dr. Muhlheim chose to highlight Facebook, LinkedIn, and Twitter in particular.

Citing commentary from the APA Monitor, Dr. Muhlheim presented a general outlook on social networking in the world of professional psychology. A rising number of people are turning to the internet for health information, she noted. As the use of social media is growing, psychological professionals are increasingly using media. Graduate students use social media but often lack guidance, because supervising faulty are less experienced with it. She presented the Social Media Ladder as one way to view online participation, showing how people move from being passively involved to being actively involved, actually becoming content creators.

Why is it important to be on social media? According to Dr. Muhlheim, social media helps us stay informed, make connections, meet patients where they are, build a “brand,” learn new information (e.g., “Tweetchats”), disseminate information, advocate for causes, and market products or services. These concepts came alive as Dr. Muhlheim expounded with personal anecdotes and colorful screenshots. “The more online real estate you control, the better,” she explained, “And one way you control your online real estate is through social media.”

Perhaps the crux of her presentation dealt with the safe and ethical use of social media. APA has not yet published guidelines for psychologists’ use of social media, Dr. Muhlheim pointed out. Subsequently, Dr. Muhlheim shared the social media guidelines published in 2010 by American Medical Association, illustrating how these principles apply to her as a professional.

First, she advised, be sure to separate personal and professional content. Keep a personal facebook page for social connections and create a separate practice page for your practice. Create two email address, and do not allow clients to friend you on Facebook. Second, use privacy settings—and don’t rely on even the most restrictive settings as being absolutely secure. Third, routinely monitor your own internet presence, such as by doing a Google search or checking online rating agencies. Fourth, protect patient confidentiality. Per Dr. Muhlheim’s advice, clarify your social media policy for googling, friending, and following; incorporate it into your informed consent for clients. Fifth, maintain appropriate boundaries. Sixth, remember your career and reputation when using social media. In her words, “Think twice, and tweet once.”

Listeners gleaned a variety of handy tips and bits for using social media to advance professional practice. For instance, use LinkedIn as a virtual rolodex to connect with colleagues. Strive for search engine optimization – increase your visibility on other sites and update your site frequently. Utilize twitter as a great way to share articles and stay current, and as an expedient alternative to blogging.

When asked about the challenges of being involved in social media, Dr. Muhlheim stated, “I think the greatest challenge of social media for psychological practitioners today is the fear/resistance many have to using it.” Her advice for current GSAPP students? “Plan to have an online presence” and “be willing to explore and use social media and other new technologies, such as apps.”

Dr. Mulheim’s presentation generated a wave of questions from the audience on the applications of social media to professional practice. In response to concerns over privacy on Facebook, Dr. Mulheim recommended using the most restrictive privacy and security settings, while noting that privacy settings are imperfect. “Assume anything you publish behind a privacy setting will leak.” Further, she recommended that professionals post only that which they can stand behind with integrity. Finally, Dr. Muhlheim responded to questions about the psychological implications of Facebook use on eating disorders. The discussion was thought-provoking and dynamic, as a room of psychology professionals aired concerns over the ramifications of social media use for children and adolescents.

At the end of her presentation, Dr. Muhlheim shared her social media rendition of a bibliography – a link to her Pinterest page. An exuberant round of applause followed, as GSAPP faculty and students acknowledged Dr. Muhlheim’s cutting-edge contributions to the field of professional psychology.

Dr. Muhlheim can be reached by email at drmuhlheim@gmail.com 
or visited at:

Facebook

Twitter

Pinterest

Tumblir

LinkedIN

By: Chana Crystal, GSAPP

Posted in Psychotherapy, Social Media | Tagged | Comments Off

Highlights from #ICED2014: The FBT Debate

Drs. Le Grange and Strober

Drs. Le Grange and Strober

ICED 2014 in New York provided a wonderful opportunity to connect with colleagues from around the world who share a commitment to providing treatment to those suffering from eating disorders. Among the highlights for me were the well-attended, first-ever tweetUP and my official appointment as Board Director for Outreach of the Academy for Eating Disorders.

Among the workshops, I was very excited to attend A Comprehensive and Measured Critique and Discussion of Maudsley and Family Based Therapy: The Civilizing Influence of Rigorous and Impartial Debate.   In this workshop, UCLA Eating Disorders Program director Dr. Michael Strober, one of the more vocal critics of Maudsley Family Based Therapy (also known as FBT), went head to head with Dr. Daniel LeGrange, director of the University of Chicago’s Eating Disorder Program and one of the developers of FBT. As the only therapist in Los Angeles certified in FBT, I am highly aware of Dr. Strober’s criticisms of the treatment.

Dr. Strober introduced the packed-room debate by saying, “there will be no flowing of blood at the FBT debate.” Dr. LeGrange presented first and cited the empirical evidence for FBT, admitting “it is no panacea” as there are only 7 published controlled trials. He reported the “most compelling” study of FBT showed that 45% of those who received FBT fully remitted, versus only 20% of those who received Adolescent Focused Therapy. He noted that FBT is particularly helpful in rapid weight restoration and in reduction of the need for hospitalization.

Dr. Strober countered by stating, “there is [only] a sprinkling of evidence in support of FBT.” He argued that the evidence for FBT was actually weak, with only 3 published comparative studies. He pointed out there was no statistically significant end of treatment outcome for FBT. Strober concluded that there is a lack of evidence to suggest FBT is the treatment of choice for all patients. He cautioned that the “glossy language” used by FBT’s proponents needs nuance: “The public discussion is the problem; well-trained clinicians have been accused of acting unethically by not recommending FBT.” Strober stated that his questions regarding FBT’s efficacy have led to hostile, finger-pointing treatment from others. “It’s not that ‪FBT lacks value but that [any critique or questioning of it is dismissed as unethical & unfounded]“. He conceded that FBT should not be dismissed: “I recommend it at times when the rationale is sound.” He joked, “I have been asked why I hate families; as far as I can tell the only family I hate is mine; I quite fancy the others.”

In his rebuttal, Le Grange agreed with Dr. Strober, “It concerns me too that FBT is being touted as the be-all-end-all.” However, he noted that it was still the approach that currently has the best evidence supporting its overall efficacy. LeGrange acknowledged “we are clutching at straws” to find effective treatments for eating disorders. “I agree we need to move forward, with much more rigor, to continue to evaluate the efficacy not just ‪ of FBT but also other ED treatments.”

In summary, there was more agreement than disagreement. Both experts acknowledged that while FBT has value, the research is still young. The audience encouraged them to write a paper together on the strengths and limitations of FBT, with the objective of depolarizing the eating disorder community.

For my part, in the outpatient setting in which I work, I will continue to offer FBT to adolescents with eating disorders and their families when the illness duration is under three years, when the adolescent is medically stable and cleared for outpatient treatment, and when the home environment is stable and the parents are committed to FBT. If early weight gain is not achieved, I always recommend a higher level of care.

Posted in Evidence-based treatment, Family based treatment, Family-Based Therapy | Tagged , , , , | Comments Off

On My Recent Zip-Lining Adventure and its Implications for FBT

The author on the zipline

The author on the zipline

On a recent family vacation, I went zip-lining for the second time.  I was terrified.  Although it seems like the experience would have nothing to do with my work, I thought a lot about my FBT families during and after the experience.  When I begin my FBT work with each family for whom I am providing treatment, I educate them about the eating disorder.  One of the things I try to help families understand is that in her/his refusal to eat, their adolescent is not being oppositional – she/he is literally terrified.  Similarly, her/his verbal protesting and arguing or negotiating about meals may often be less a true refusal than an expression of this terror.   Continue reading

Posted in Family based treatment, Family-Based Therapy | Tagged , , , , , , | Comments Off

I’m moving my office

On August 1, my office is moving to

4929 Wilshire Boulevard, Suite 245!

(Only one mile east of my old office)

office moving flyer_Aug2013

Since eating disorders are best addressed by a multidisciplinary approach, I am excited to be able to offer expanded services at this new and larger space.  I am pleased to announce my affiliation with Katherine Grubiak, RD, who will be working in my suite part-time.  Ms. Grubiak brings a wealth of experience with eating disorders in both adolescents and adults, and her approach is consistent with the latest evidence-based treatments.

Katherine Grubiak, RD/Biography

Katherine Grubiak is a Registered Dietitian with a focus on blending Western & Eastern philosophies regarding nutritional healing.  She graduated from the University of Texas at Austin and first pursued a career in public health surrounding herself with different cultures and a mission to honor all those seeking healthcare nutritional support. Continue reading

Posted in Eating Disorders, Evidence-based treatment, Los Angeles | Tagged , , , , , | Comments Off

Lobby Day with the Eating Disorder Coalition

Yesterday I participated in a tweetchat with the Academy for Eating Disorders and Eating Disorder Coalition to learn more about Lobby Day.  Here is a summary of the chat:

What is Lobby Day?

The Eating Disorder Coalition sponsors lobby days at the US Congress twice per year.  The next lobby day is in Washington, DC on April 16 and 17.  The full itinerary is available here:

http://eatingdisorderscoalition.org/LobbyDayApril2013.htm

You do not need to be a member of EDC, but members get a reduced rate to participate.  To get a feel for what lobby day is like, the fall 2010 EDC lobby day hearing is available on youtube here: http://www.youtube.com/playlist?list=PLkWdTgyoj0OZlGp83Sf-49Tb5NyaGzs-C

What issues is the EDC currently addressing?

The EDC is currently working on 2 primary issues:  1) Mental Health Parity (helping make sure people get ED treatment covered at parity) and 2) The FREED Act: http://eatingdisorderscoalition.blogspot.com/2011/07/what-is-freed-act.html.

Previous lobbying by the EDC resulted in Congress directing NIH to release an RFA http://grants.nih.gov/grants/guide/rfa-files/RFA-MH-14-030.html for research studies that use dimensional constructs to integrate biology and behavior in the service of advancing the understanding of biological mechanisms and developmental trajectories of eating disorders.

How can you get involved?

Patients and families can attend lobby day or write letters to their congressman and/or call on Lobby Day to add extra support.

Clinicians can attend lobby day or email mmorris@eatingdisorderscoaliton.

Researchers should apply for the RFA to show NIH that these requests are needed

How does Lobby Day work?

The EDC provides training and then takes you to meetings with your representatives. You get to be a lobbyist for a day!  People get to share their personal stories with members of congress.  There is a team leader from EDC there to help you.  Said one participant, “I confess I was nervous the first time – who was I to lobby? Eek! But all you need is comfy shoes and YOUR story: EDC makes it simple.”

Those who participated in the past described lobby day as empowering and uplifting. “The chance to stand with others and speak our own personal story to people in power is transformative.”  It is also a great chance to stand together and make new contacts and friends.

Hold the Date:

If you can’t make it on April 17 hold the date of September 18 for their fall lobby day

Posted in Family-Based Therapy | Tagged | Comments Off

Who Killed the 50 minute session?

What Consumers Should Know about Changes to Psychotherapy Sessions in 2013

By Lauren Muhlheim, Psy.D., CEDS and Kantor & Kantor, LLP

Unbeknownst to most mental health consumers, a change went into effect in January, 2013 that may have far-reaching ramifications for those receiving outpatient psychotherapy.  For the first time in 15 years, changes were made to the coding system used to describe and bill for mental health treatment.   This change has resulted in chaos for many mental health professionals who bill their patients’ insurance.  Nationwide, many mental health providers have reported problems with filing and receiving timely reimbursement for claims filed under the new coding system.

Why were the Current Procedural Terminology (CPT) codes changed?  The Centers for Medicare and Medicaid Services (CMS) establishes the Current Procedural Terminology (CPT) codes that providers use to communicate with insurance companies.  The CPT codes are periodically reviewed in partnership with the American Medical Association (AMA).  For the last several years, the AMA and the American Psychiatric Association (APA) advocated for changes in the codes that would treat (and reimburse psychiatrists) like other physicians.  Psychiatrists have traditionally been on the low rung of physician pay scales.  The changes allow (and now require) psychiatrists to bill separately for the different services they frequently provide in the course of a single session (medical examination, psychotherapy, and medication management).  The hope was that the new codes, in providing more flexibility in session length, would highlight the complexity and diversity of what psychiatrists do.  There are additional “add on” codes for “complexity” as well as for crisis management.  Since all mental health providers use the same psychotherapy codes, non-psychiatrists have had to adopt these as well.

For the majority of recent psychological treatment history, the standard 50- minute therapy session was billed to insurance under the CPT code “90806”, and was officially described as “individual therapy 45-50 min.” In practice, most therapists have scheduled patients on the hour and allocated one hour per patient, spending approximately 50 minutes face to face.  This often stretches to 55 minutes by the time one handles payments and schedules the next appointment and allows a few minutes between clients for notes, bathroom breaks, and checking messages.  In 2013, the 90806 code was eliminated and replaced with several alternatives:

  • 90832 – psychotherapy 30 minutes
  • 90834 – psychotherapy 45 minutes
  • 90837 – psychotherapy 60 minutes

Practitioners were informed about the change in October 2012, but given little specific information on how to use them.  The American Psychiatric Association provided the following interpretation:

Note: Since the new psychotherapy codes are not for a range of time, like the old ones, but for a specific time, the CPT “time rule” applies. If the time is more than half the time of the code (i.e., for 90832 this would be 16 minutes) then that code can be used. For up to 37 minutes you would use the 30 minute code; for 38 to 52 minutes, you would use the 45-minute code, 90834; and for 53 minutes and beyond, you would use 90837, the 60-minute code.

By “time,” the APA means face-to-face time with the client.

So what’s the hitch?  The 50-minute session suddenly no longer exists, and that creates a problem. Many practitioners assume the 45-minute session is the intended replacement for the 50-minute session.  However, they fear that reducing time spent with patients will both reduce treatment efficacy, as well as be used as justification by insurance companies to reduce reimbursement rates.  Remember, reimbursement rates haven’t been raised in 18 years and are typically only half of what a patient would pay if they didn’t have insurance.  The other option, the 60-minute session, makes it harder for therapists to complete paperwork and take bathroom breaks unless they space clients further apart, complicating schedules for everyone involved.  And it’s not even clear whether insurers will choose to cover the 60-minute session.   It appears that some insurers are not.

For psychiatrists, the new codes are extremely complicated. The 2013 Medicare fee schedule reveals that reimbursement for psychiatric evaluations with medical services – those done by psychiatrists – will be lower than reimbursements for psychiatric evaluations done by social workers and psychologists.  “This makes no sense, and seems to run counter to the premise that creating a comprehensive system of coding services would create an appreciation for the complexity of the medical aspects of treating mental disorders, address parity, and decrease the stigma to seeing a psychiatrist.”[1]

The CPT changes have thus far resulted in confusion and delays in processing mental health claims because insurance companies were not prepared, equipped, or organized for this change.   Insurance companies had not yet set rates for the new codes, nor had they decided which codes they would accept.  As a result, claim processing since the first of the year has been slow, impacting patients, therapists, and insurance companies.   Helen Stojic, a spokeswoman for Blue Cross Blue Shield of Michigan told NBC News, “The amount of changes and the work involved was much bigger than … the folks involved anticipated.”[2]

Around the country, mental health providers have reported problems with insurance reimbursement.  Some are reporting financial difficulty due to the delay in cash flow.  The biggest worry, however, is that this coding chaos will affect care for millions of vulnerable patients.

What does this mean for providers? In simple terms, less pay, delayed payment, and financial hardship.  “We are ethically bound not to leave patients hanging,” Steven Perlow, president of the Georgia Psychological Association and a psychologist in private practice said. “I will personally see people for a sliding scale … there have been situations where I’ve seen people for free.”[3] Additionally, providers may experience disincentives to stay on insurance panels.  Lastly, these factors may affect providers’ ability to deliver quality care.

What does this mean for patients? To start with, session lengths could be reduced by 10%, meaning less treatment.  Furthermore, patients may have increased difficulty finding practitioners who are willing to accept insurance. Therapists may very well be waiting to see what is happening with reimbursement rates before accepting more insurance patients, or may leave panels altogether.

These outright denials of payment and system wide delays have caused chaos among providers and their patients, and could last for months.  This disorder and confusion has the potential to jeopardize access to care for millions of mentally ill Americans, who depend upon the stability of treatment from their mental health providers.

Action Plan

If you feel that the 2013 psychotherapy CPT codes have negatively affected how you are able to deliver or receive patient care, let your voice be heard:

http://www.realpsychpractice.com/2013-cpt-codes/

Lauren Muhlheim, Psy.D., CEDS

Lauren Muhlheim, Psy.D., CEDS is a psychologist and certified eating disorder specialist practicing in Los Angeles.  She specializes in providing evidence-based psychotherapy for adults and adolescents.  www.laurenmuhlheim.com

About Kantor and Kantor                                                                                                                             

Kantor & Kantor is one of the most experienced and highly respected law firms dealing with the prosecution of claims against insurance companies. If your insurance company has unfairly denied payment for benefits, we can help. Call (800) 446-7529 or log on to www.kantorlaw.net.


[2] JoNel Aleccia, NBC News, Glitch in medical code threatens mental health care, therapists warn, http://vitals.nbcnews.com/_news/2013/02/07/16842490-therapists-change-in-medical-coding-threatens-mental-health-care#.URPN_3hBLqc.twitter (February 7, 2013).

3 JoNel Aleccia, NBC News, Glitch in medical code threatens mental health care, therapists warn, http://vitals.nbcnews.com/_news/2013/02/07/16842490-therapists-change-in-medical-coding-threatens-mental-health-care#.URPN_3hBLqc.twitter (February 7, 2013).

 

Posted in Psychotherapy | Tagged , , , | Comments Off

Recovery Record App

Since my first foray into using Recovery Record app several months ago, I was pleased to discover that it is now improved with an interface for clinicians to access their clients’ records which are linked through a  code that patients enter.   Self-monitoring by clients has never been easier.

Self-monitoring of food intake is a helpful eating disorder recovery tool and a central element of treatment in cognitive behavioral therapy.  Research shows that self-monitoring is associated with a positive treatment outcome.  Many of my clients complain about having to carry unwieldy and obtrusive papers to record their intake.  A few have searched for iPhone apps and unfortunately chosen calorie-counter apps that only increase their preoccupation and eating disordered symptoms.  Now there is a better solution, an app called Recovery Record.  Available through the app store, Recovery Record was developed by an Australian student along with Stanford University.  It offers places to record food intake as well as thoughts, feelings, binges, purges, and urges.  There are supportive messages and reminders are sent if a meal is not logged when expected.  There is no affiliated calorie database.

To read more:  visit Recovery Record

 

Posted in Eating Disorders | Tagged , , , | Comments Off

A Family Guide

to the Neurobiology of Eating Disorders

F.E.A.S.T. has produced a great article to help families understand the role of the brain in eating disorders.  This is a must-read.

Puzzling Symptoms:  Eating Disorders and the Brain

Posted in Eating Disorders, Evidence-based treatment, Family based treatment, Family-Based Therapy | Comments Off

ICED 2012

Two weeks ago I attended the International Conference on Eating Disorders, a conference sponsored by the Academy for Eating Disorders.  My attendance at the annual conference allow me to stay up to date on the most recent advances in treatment and provide the best and most recent treatments in my practice.  My involvement in the Academy allows me to connect with clinicians and researchers from all over the world and participate in AED committees and special interest groups.  I also keep up to date through the International Journal of Eating Disorders, the AED listserve, and AED’s social media sites.

Highlights from the International Conference on Eating Disorders 2012

  • Meeting and spending time with some of the major family and patient advocates, other FBT providers, and clinicians and researchers from around the world all coming together to improve treatment for patients suffering from eating disorders.
  • The opportunity to meet and learn from some of the leading researchers in the area of eating disorders.
  • Learning about the most recent and ongoing studies. 

A synopsis of one of my favorite talks below:

Tidbits from Tim Walsh and his group at Columbia:  A New Model for Understanding Anorexia Nervosa and Implications for Treatment

In anorexia, dieting begets weight loss which begets more dieting… why is dieting such a persistent behavior?  Tim Walsh and his group believe that operant conditioning, which is implicated in habit formation, offers an explanation. Continue reading

Posted in Eating Disorders | Tagged , , , , | Comments Off

Empirically Validated Treatments

Empirically Validated Treatments For Eating Disorders

Today’s Los Angeles Times contained an article which highlights Family Based Treatment and Cognitive Behavioral Treatment, two treatments I provide:

Today, doctors and therapists focus on a handful of treatments that have been validated by clinical studies. For teens with anorexia, the first-line treatment is something called family-based therapy, in which parents and siblings work with the patient at home to help restore normal eating habits, said Dr. James Lock, an adolescent psychiatrist at Stanford University who specializes in treating eating disorders. Treating patients at home instead of in a hospital setting is less disruptive to their lives and is thought to promote recovery.

The therapy cures about 40% of patients in three to six months, and another 40% to 50% improve but remain ill, studies have found. The remaining 10% stay the same or get worse.

Researchers are still investigating the best way to treat teens with bulimia. Evidence is mounting in favor of cognitive behavioral therapy, which involves helping individuals change their attitudes and thoughts about food and body image. Studies show that about 40% of people with bulimia will recover after three to six months and another 40% will improve but still struggle with the disease; 20% remain the same or get worse, according to a 2010 review in the journal Minerva Psychiatry.

Full article available here:

Posted in Eating Disorders, Evidence-based treatment, Family-Based Therapy, Los Angeles | Tagged , , , , , | Comments Off