Click. The picture on the television screen shows a conservatively dressed woman sitting on a cranberry-colored sofa in a relaxed setting resembling a living room.
"What," an off-screen interviewer asks her, "do you enjoy most about being a psychotherapist?"
"I like helping people understand how they act and react," says Jane Myers Drew, a Mission Viejo licensed clinical social worker. "I don't know if I can express the pleasure that I get when I see somebody who came into my office in tears and then, through therapy, has that kind of smile that just radiates that they feel good about who they are. I really enjoy being an integral part of somebody changing."
Click. Same couch, same interviewer, different therapist.
"What would it be like," the interviewer asks, "for a person to first walk into Dr. Hayter's office and meet with you?"
"Well, hopefully, comfort," says Dr. George M. Hayter, an Orange psychiatrist. "I'm going to try to do what I can to put you at ease. My office is comfortable, and I try to make it that way. In spite of this coat and tie, I'm usually a kind of a relaxed person, and I think therapy should go that way . . . ."
Click. Another therapist . . . .
At first glance these videotaped interviews look like outtakes from a television talk show, but there's more to them than psychotherapy shop talk.
These mental health professionals are part of a 29-member panel of Orange County psychiatrists, clinical psychologists, licensed clinical social workers and marriage, family and child counselors who make up Therapy Selection Services--the latest twist to the video revolution of the '80s and a high-tech alternative to the traditional name and phone number method of referral.
In operation in Santa Ana since January, Therapy Selection Services (TSS) was designed to match people seeking professional help for mental health problems with the right kind of therapist and the appropriate kind of treatment.
And a major part of the process is having clients view three- to five-minute videotapes of several potential therapists whose training, experience and expertise are most suited to the client's needs.
"The advantage of the videotape is that the person can get a valid first impression of the therapist as a person and how the therapist works," said Dr. David Davis, executive director. "A name and a phone number doesn't tell you anything."
Davis, a psychiatrist in private practice in Santa Ana, maintains that "there is really no way anybody can do better than they themselves in selecting a therapist that they'll feel rapport with."
Having good client-therapist rapport, he said, "is extremely important. Research shows that if there's not good rapport, therapy doesn't go well. I think a first-rate therapist can create an environment where that happens, but what goes on in watching the tapes is there's really a feeling that 'There's something about that person I'm drawn to.' It's an intuitive sense."
Watching the videotapes, however, is only part of the process that begins with an initial consultation with TSS administrator Dean Wilson, a licensed marriage, family and child counselor.
During the 50-minute session, which costs $67, Wilson identifies the nature of the client's problem and determines what kind of therapist and treatment methods could most appropriately meet the client's needs.
"Dean's job," Davis explained, "is to make the person feel comfortable, answer questions about therapy and then help them decide on the best kinds of treatment. I think a lot of people really don't have a clear idea of what therapy is all about. They really don't know what therapy can and can't do or the different types of therapy.
"TSS is essentially an educational process for the persons. They become educated and informed about therapy and are able to make a selection about the type of therapeutic approach that best suits them. Most people don't bother to do that on their own."
Davis believes that Therapy Selection Services also helps alleviate fear of therapy.
"When somebody comes through here, they're not afraid to seek therapy anymore," he said. "It gives them a positive outlook on therapy and what it can do and what they can expect."
In three months of operation, about 40 people have gone through the service, which has attracted an unusually large percentage of men. Wilson, who said men traditionally are less inclined than women to seek therapy on their own, is not sure why the men-to-women client ratio is three to one, except that "the whole procedure just seems to be appealing to men."
"I thought it was a rather ingenious idea," said John, a 35-year-old technical writer from La Mirada. "I'm a video-oriented person so it seemed natural for me."
John, who said he has been depressed over his inability to "come up with a decent job, " was considering going to a therapist when he heard about Therapy Selection Services.
"It seemed like an easy way to find one," he said. "I don't know anyone in this area seeing a psychologist or psychiatrist, so it would have been strictly the phone book."
Going With Instinct
In viewing videotapes of potential therapists, he said, "First of all, you almost find yourself judging them on whether you instinctively like the person. I chose (his therapist) because he's in Santa Ana, which is not too far away; his price was more in line with what I needed, and after that I guess you'd have to say instinct: He just seemed like a sympathetic, down-to-earth type."
When he went in for his first visit with the therapist, John recalled, "It was like I knew him already. You don't really know him that well, but at least you've seen him before and heard him talk. I've heard stories of people maybe going to three or four therapists before they found one they liked."
"As it turned out," he said, "I'm very happy with my choice."
"I thought it sounded like a good idea; I'm new in this area and didn't know where to go," said Rhonda, a 31-year-old administrative assistant for a health care company, who sought a therapist because of her depression: "I was just feeling not at ease with myself, like I wasn't getting everything out of life that I should."
In viewing the videotapes, she said, "It was kind of like watching a television interview. I definitely had a response to the person I thought I could work best with. She talked about the type of work she does, and she just seemed like she'd like me and be easy to talk to."
Rhonda said she had been in counseling before, "usually at clinic-type places," which she found in the phone book. Previously "it's taken four or five visits just to get down and work on whatever's going on."
But with the therapist she chose from the tape, Rhonda said, she was able to start discussing her problem during the first visit. "When I talked to her, I felt like I already had met her. It has definitely been a lot easier for me to work with her."
Saying she would recommend the service, Rhonda observed that "it'll save you a lot of time and money going to different people. It's not cheap--$67--but that's at least what you're going to pay the first time you see somebody."
The idea for Therapy Selection Services grew, in part, out of Davis' personal experience over years of having patients referred by family physicians, clergymen, professional associations and word of mouth. But, he said, if he was too busy to take on a new client, or if he felt that a person's particular problem could best be helped by someone else, he would recommend two or three therapists.
He discovered, however, that only one out of five people would actually follow up on his referral.
'Slip Through the Cracks'
"I feel they took it as a rejection by me or they felt they didn't want to open up to another person again," he said. "I saw a lot of people slip through the cracks or wind up with people not as well trained as the people I was recommending, or maybe they were good but not at that particular problem."
Although Davis acknowledges that the traditional referral system "is very valid," he maintains that it functions more for the people doing the referring than the consumer.
And, he added, "What's missing in the traditional method is the ability to really get the patients with perhaps the person they would have liked the best." By using Therapy Selection Services, he said, "the person with the problem can choose on their own. I think it allows for a better fit."
He emphasized, however, that the service is not designed to replace the traditional methods of referral.
"We're not an emergency service," he said. "I feel we're really designed for a motivated person who's aware they can use some therapy . . . and who wants to make the decision rather than rely on someone else's opinion."
In assembling his panel, Davis said he sought mental health professionals with whom he had worked or whom he had used as referrals in the past.
"I think we have a panel of very good people, and that's the thing I'm most proud of," he said. "These are people who are very well qualified. They've been in the community a long time, and they've had success with people."
He said that the advantage to the therapists, who pay $900 a year to participate on the panel, is that "the people coming to them have the types of problems they seem to get the best results with and their treatment can be done in a way they feel the most comfortable."
Davis acknowledged that not every therapist approached to join the panel agreed to do so.
"Some people had reservations," Davis said. "They were very busy and didn't see it was worth their while to participate, or they were uncomfortable making a video or were uncomfortable with the idea of marketing for health services, which is a new idea. Some people feel awkward because it's just over the last five or six years that it's become more commonplace."
Others, like panel member Jane Myers Drew, had no reservations.
'It Intrigued Me'
"I thought it was a good idea," she said. "It just seemed fascinating, and it intrigued me. My impression was that this is the first high-tech approach that really links therapists and clients."
So far, Drew has received three clients through Therapy Selection Services.
"What I particularly like about this is that the clients who do come to see me already have a feeling about who I am and they seem to come into my office ready to start the work of therapy, more so than other referrals," Drew said. "On the tape I've talked about who I am, how I go about therapy, the kind of people I work with, and I think there's already a sense of connection."
Panel member Dr. George Hayter has received only one referral through Therapy Selection Services. "I haven't had any time and haven't had a chance to use them," he said, noting, however, that "it was a very appropriate referral."
"The advantage to seeing your potential therapist on tape is that you should be able to sense how well you could work with that person," Hayter said. "But a therapeutic alliance is a complex process and long-term compatibility with a therapist is difficult to assess in a short, taped interview."
Nevertheless, he said, "I think there's potentially a place for a professional selection referral. In other words, a resource place where someone can do a preliminary diagnosis of your problem and make an appropriate referral. I think if it's handled right, a professional selection service could provide a definite advantage to some patients in selecting a therapist."
Panel member Tom Cavalli Ph.D., a clinical psychologist at Santa Ana Psychiatric Hospital, agrees with Hayter that "on a five- to six-minute tape you're not going to know who I am. There's no substitute for being in therapy."
Cavalli, who is using Therapy Selection Services for his private practice, added, however, that the service "saves prospective patients a lot of time and ensures quality service that is otherwise hit or miss. They know the kind of patient I can best provide service for--it's not blind dating."
"What's neat about this," he added, "is that people know what they're getting. If this can save people time and money, I think that is clinically efficacious."
Margaret H. White Ph.D., a member of the Orange County Psychological Assn. ethics committee, said that her "greatest concern is that potential patients have a way to find good health care providers to work with."
In the past, she said, "the traditional way of asking another respected health care provider such as your doctor or another psychologist or asking the referral services run by professional organizations such as the Orange County Psychological Assn. have worked well a great deal of the time.
"Occasionally, there are mismatches--more on the basis of personality conflicts than problems with the health care provider not being qualified. And Therapy Selection Services, if they do pick well-qualified psychologists as they say they do, may be of help, especially to the person who does not have an ongoing relationship to a physician, a minister or friend who might be in the position to provide a name or names in the traditional way. Of course, this person still would have access to the professional referral services in the area by phone at no charge to them."
White, a Fullerton psychologist, added that "I think it remains to be seen whether or not this system (TSS) actually does match up people better than the two traditional systems I mentioned. My concern would be that they have picked well-qualified professionals to be a part of their service and that the person doing the initial interview of the potential client is able to make an accurate diagnosis on the basis of a 50-minute interview."