Referrals

If you are a healthcare provider, please consider referring those you serve for psychotherapy or life skills training with Dr. Yoman. He was trained in the leading form of evidence-based psychology practice, called cognitive-behavioral therapy. He maintains a general practice serving adults of all ages, but has extensive specialized training and experience in helping those with:

  • Bipolar Disordercontemplation_manmeditate
  • Family Stress Related to Serious Mental Illnesses
  • Insomnia
  • Major Depression
  • Schizophrenia
  • Social Skills Deficits
  • Substance Abuse

Referral FAQ

Why refer my patient or client to cognitive-behavioral therapy?
Unlike many other psychotherapies based on anecdotal evidence, theory, or unsubstantiated claims, cognitive-behavioral psychotherapy is based on research. Efficacy studies of these therapies have met scientific standards like those required for approval of medications and surgical procedures. Thus referral to these therapies enhances the quality of care for your patients or clients with mental illnesses.

Isn’t medication sufficient to treat most mental disorders… and aren’t they really biological in origin?
Influential inherited risk factors (or biological vulnerability) for major mental disorders indeed exist. However, genetics are not destiny. For example, if one’s identical twin has schizophrenia (a mental illness with a strong genetic predisposition), one’s chances of developing that illness range between only 25% and 45%. Thus, most researchers view a vulnerability-stress-coping model as the best explanation for the development of major mental disorders. Effective psychotherapies help clients manage stress and strengthen coping skills to improve the course of their illness.

Even when medications are the treatment of choice, prescription adherence is often a problem. Psychotherapy in general has been shown to improve prescription adherence. Moreover, there are psychosocial interventions which can directly target medication self-management.

In peer-reviewed scientific studies, cognitive and behavioral psychotherapies rival medications in their effectiveness with major depression, and appear to add a measure of relapse prevention above and beyond what medication can achieve. Thus they have been listed as “well-established treatments” in a report by members of the Task Force on Psychological Interventions of the American Psychological Association’s Division of Clinical Psychology. Both the American Psychiatric Association Practice Guideline for Major Depressive Disorder in Adults and the Agency for Health Care Policy and Research Depression in Primary Care clinical practice guidelines suggest medication and psychotherapy as the standard of care for major depression.

In schizophrenia, cognitive and behavioral interventions can improve residual symptoms and functional deficits after medication stabilization. Family therapy (addressing specific types of communication and problem solving) has been demonstrated in nine controlled trials to reduce the ill family member’s symptom relapse rates an average of 35% over customary outpatient care.  This article from the American Psychological Association’s Monitor describes the challenge of improving access to such therapies.

All that science sounds rather cold and impersonal. Is that what cognitive-behavioral therapy is like?
If it were it wouldn’t work. It is next to impossible to help a client make lasting changes without first developing a warm, personal, collaborative relationship. Such therapeutic relationships are an important part of cognitive-behavioral therapy.

What role should psychotherapy play in the treatment of depression? 
Current treatment guidelines for clinical depression are out of step with the latest research. Below, I provide links to abstracts describing some recent studies. While the effectiveness of antidepressant medications and electroconvulsive therapy are well documented, several forms of cognitive behavioral therapy (CBT) have very comparable outcomes to these biological treatments (click here for a study abstract). Contrary to treatment guidelines, these results also do appear to hold for severe depression, especially if the therapist is experienced(click here for a study abstract). Moreover, several studies suggest that the enduring relapse prevention effects of CBT after termination of treatment appear to be at least as good as the effects of keeping a patient on medication during that period (click here for a study abstract). Indeed, PET scan studies of CBT suggest the brain-behavior relationship works in both directions: CBT responders who took no medication, but made changes in their thinking and behavior, showed metabolic changes in their brains (click here for a study abstract).

Should antidepressants and psychotherapy be combined?
Any given treatment for depression, biological or psychosocial, works in about 50% of cases. Therefore, having treatment options, and in refractory cases combining treatments, makes good clinical sense. Patients who complain of lack of energy or motivation may participate more effectively in therapy with a course of antidepressant. Conversely, involvement in psychotherapy has been shown to enhance prescription adherence. There is also evidence that adding CBT to pharmacotherapy reduces recurrence of depression. Moreover, regular visits with a psychotherapist present opportunities for careful assessment and monitoring of suicide risk, which may fluctuate during various phases of pharmacotherapy.

I know that long term use of sedative-hypnotics is contraindicated. What is the alternative for chronic insomnia?
Cognitive-behavioral therapy for insomnia has emerged in medical journals as the front line treatment for chronic insomnia [click here (Article 1), (Article 2), (Article 3) for brief articles]. The therapy can be completed in as few as four visits and has a high success rate, with longer-acting effects than medication.

How do I find a CBT therapist for my patients?
The Association for Behavioral and Cognitive Therapies (ABCT), the leading organization for professionals trained in CBT, maintains an on-line therapist directory. Members of this organization are regularly offered continuing education by CBT experts who encourage use of empirically validated therapy manuals and validated assessment instruments to track patient progress. Such practices are essential to therapists faithfully implementing the techniques and principles that have made CBT effective. Professional education at a recognized CBT academic program also provides a foundation for competent CBT practice. The American Board of Professional Psychology certifies psychologists as specialists in cognitive and behavioral therapies.  The Academy of Cognitive Therapy certifies cognitive therapists.