Specialist Q&A: What Can a Psychologist Do for You?

Blair: I started my clinic almost a decade ago, so I've been doing clinical work outside of Stanford for a decade. I went to Stanford for graduate school. I've been seeing patients since 2007. During my first year of graduate school, I kind of happenstanced on a workshop on sexual health. I was astonished to learn 1 in 2 women and 1 in 3 men have some form of sexual dysfunction. I was even more astonished to learn how effective treatment was. And so, that first year of graduate school, I was training as a clinical psychologist but I decided in that light-bulb moment that this is what I am going to dedicate my life to.

In my third year of grad school, I was kind of forced to do a rotation at a sleep clinic, because while you're training, you don't really have a choice in terms of what your subject matter is. So I did a rotation in the sleep clinic and got addicted. We were doing nonpharmacological interventions, so behavioral medicine, and [patients] would come in just ill, looking green from not being able to sleep. In just a few weeks of treatment, they were pink and plushy and doing much, much better.

I ended up getting boarded [certified] in sexual health and sleep medicine. Those are my two specialties. When people come to see me, usually it's a couple that has some kind of erotic disconnection or a couple that wants to get pregnant but they can't have intercourse because of sexual dysfunction. Or [it's] a couple that's been partnered for a long time and they've just lost their way with one another and libido has gone down over time. Those are the kind of people who seek out my treatment.

Same with sleep; people who have insomnia, maybe they've tried medication, maybe they don't want to be on medication anymore and maybe they want a nonmedication solution for sleep. This is something a lot of people don't know about psychologists. There are subspecialists who subspecialize in not just doing therapy for depression, anxiety or stress. We certainly do a lot of that, but we also specialize in behavioral medicine. So people who don't want to be taking medications can seek out alternative therapies for that.

People who seek a behavioral medicine specialist are usually people who have some problem at the intersection of the psychological and the physiological. Those two things can't be separated because our bodies affect our minds and our minds affect our bodies. That's why someone would see a behavior medicine specialist.

A lot of people will see a general psychologist because they want to work on some type of mental health challenge, which could be something as simple as stress, depression or anxiety, OCD [obsessive-compulsive disorder] or bipolar disorder. It's a wide range. All of us could benefit from being in therapy, all the way to people who have a severe mental illness. They either want to get treated without medication or they want therapy in addition to medication.

Change doesn't happen overnight. Change is not necessarily going to happen in the room while you're chatting with your therapist. A lot of change can happen there, but it really requires motivation to improve your life or steer your life more in line with your values. In therapy, you can process things and you can get the tools you need to change your life, and then it's outside the therapy you really…go to work. The most important thing is that it's very, very effective. There's less stigma now; therapy is extremely beneficial for people.

They could ask where they did their training. That would be important. A really good question is, "How many patients do you see a week?" If you have a psychologist who's seeing 30, 40 patients a week, that's probably someone who's on the edge of burnout and is probably not clinically effective. The data suggests anything over 20 patients a week and your efficacy starts to go down, because the work we do is incredibly emotionally loaded. It's a lot of energy we're giving our patients.

You can ask about modality. Do they give you practical skills? Or do they just allow you to come to a solution on your own? That can give you a sense of whether it's a good fit. It's often about goodness of the fit, not so much about the approach of the therapist or how they practice. Is this a good fit for you? Will that be workable for you?

I think to prepare for the first session, my advice would be to start where you are. What are you coming in for? What is the presenting problem? And then be willing to be open and vulnerable. Be open to exploring the problem with the clinician.

Through a clinical interview, they'll ask a bunch of questions about symptoms, they'll ask about the history of the presenting problem and if there's a family history of the problem. They'll ask about how it's affecting you and your daily life. They'll gather a ton of information and that's how they come to a diagnosis. We have a manual called the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]. Basically, the manual lays out many health concerns and what criteria need to be met in order to have that diagnosis.

There are survey measures, like the GAD-7 [General Anxiety Disorder-7] and the PHQ9 [Patient Health Questionnaire-9], which is a measure for depression. Most of the time, psychologists will work from a clinical interview, asking questions and getting a sense of what's going on.

Usually, the sessions are anywhere from 50 minutes to 75 minutes. Oftentimes, couples sessions will be 75 minutes. Frequency depends on the patient and their clinician. Most common would be once a week, but some people go once every other week. Some people go three times a week.

There are folks who specialize in chronic pain, substance abuse or smoking cessation. There are people who specialize in mood disorders. Basically, anything you can think of, there's somebody that specializes in that. The field is moving more and more toward specialization. I can't treat someone for sleep or sexual health but also be an expert in depression and anxiety and substance abuse. The human experience is so broad.

For the entire medical and mental health establishment to recognize individuals as holistic beings. We cannot separate the biological, psychological or social. All of the evidence suggests there is a strong bidirectional relationship between these facets of the self. So what is good for the mind is good for the body and vice versa. If healthcare could be less siloed and more open-minded and collaborative, I think we could be healing and curing and not just treating symptoms.