Psychotherapy’s Image Problem

[groovedaddy]

PROVIDENCE, R.I. — PSYCHOTHERAPY is in decline. In the United States, from 1998 to 2007, the number of patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent, while the number receiving medication alone increased by 23 percent.

This is not necessarily for a lack of interest. A recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medications.

As well they should: for patients with the most common conditions, like depression and anxiety, empirically supported psychotherapies — that is, those shown to be safe and effective in randomized controlled trials — are indeed the best treatments of first choice. Medications, because of their potential side effects, should in most cases be considered only if therapy either doesn’t work well or if the patient isn’t willing to try counseling.

So what explains the gap between what people might prefer and benefit from, and what they get?

http://www.nytimes.com/2013/09/30/opinion/psychotherapys-image-problem.html?nl=todaysheadlines&emc=edit_th_20130930

[cbayer]

1. While "image" (or more correctly, stigma) may play a role, money is the real reason, imo.

Insurance companies often don't provide adequate coverage for psychotherapy. Even if they do, they limit visits and co-pays are high.

When a patient can't pay for what an evaluating psychiatrist might recommend, it has to get scratched off the list.

The other issue is that the system is overwhelmed. Seeing four patients in a hour for med checks is much more efficient than seeing one.

And seeing four you get paid for is going to make more sense than one that you don't.

It's much more about the economics, imo.

[Jackpine Radical]

2. Actually, the problem is more fundamental than this article suggests.

Ins. cos. know full well that the average person will be on their plan for about 18 months. While psychotherapy is the most effective way to get a permanent resolution of the problem, they don't care. It's too expensive, so they throw up all kinds of roadblocks to ensure people don't get that sort of help. All they want to do is keep the patient shut up until they get off the plan. They want something that will suppress the symptoms for that long. Medications work for that purpose--and then the patient is off on another plan, and is someone else's problem. Ins. cos. have a lot of tricks, such as forcing the provider to get separate authorizations every few sessions, refusing to pay a reasonable rate, refusing to pay at all even after authorizations, etc.