PSYCHOTHEREAPY

September 29, 2013

I just read this today and it could be of interest to those of you who have been posting regarding psychotherapy. It helps explain why some are reluctant to try it, but that it can be very helpful.

I watched an interview with a psychiatrist on Public Television yesterday and she said people should not feel any different about going to a psychiatrist than they do about going to a dentist or the family doctor. In fact, she says, it's a good idea to first talk to your family doctor about any emotional problem and he/she may be of help or, if they think it advisable, they might recommend
a specialist.

Psychotherapy’s Image Problem

By BRANDON A. GAUDIANO

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?
The answer is that psychotherapy has an image problem. Primary care physicians, insurers, policy makers, the public and even many therapists are largely unaware of the high level of research support that psychotherapy has. The situation is exacerbated by an assumption of greater scientific rigor in the biologically based practices of the pharmaceutical industries — industries that, not incidentally, also have the money to aggressively market and lobby for those practices.

For the sake of patients and the health care system itself, psychotherapy needs to overhaul its image, more aggressively embracing, formalizing and promoting its empirically supported methods.

My colleague Ivan W. Miller and I recently surveyed the empirical literature on psychotherapy in a series of papers we edited for the November edition of the journal Clinical Psychology Review. It is clear that a variety of therapies have strong evidentiary support, including cognitive-behavioral, mindfulness, interpersonal, family and even brief psychodynamic therapies (e.g., 20 sessions).

In the short term, these therapies are about as effective as medications in reducing symptoms of clinical depression or anxiety disorders. They can also produce better long-term results for patients and their family members, in that they often improve functioning in social and work contexts and prevent relapse better than medications.

Given the chronic nature of many psychiatric conditions, the more lasting benefits of psychotherapy could help reduce our health care costs and climbing disability rates, which haven’t been significantly affected by the large increases in psychotropic medication prescribing in recent decades.

Psychotherapy faces an uphill battle in making this case to the public. There is no Big Therapy to counteract Big Pharma, with its billions of dollars spent on lobbying, advertising and research and development efforts. Most psychotherapies come from humble beginnings, born from an initial insight in the consulting office or a research finding that is quietly tested and refined in larger studies.

The fact that medications have a clearer, better marketed evidence base leads to more reliable insurance coverage than psychotherapy has. It also means more prescriptions and fewer referrals to psychotherapy.

But psychotherapy’s problems come as much from within as from without. Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which — like some old-fashioned Freudian therapies — should be abandoned.

There is a lot of organizational catching up to do. Groups like the American Psychiatric Association, which typically promote medications as treatments of first choice, have been publishing practice guidelines for more than two decades, providing recommendations for which treatments to use under what circumstances. The American Psychological Association, which promotes psychotherapeutic approaches, only recently formed a committee to begin developing treatment guidelines.

Professional psychotherapy organizations also must devote more of their membership dues and resources to lobbying efforts as well as to marketing campaigns targeting consumers, primary care providers and insurers.

If psychotherapeutic services and expenditures are not based on the best available research, the profession will be further squeezed out by a health care system that increasingly — and rightly — favors evidence-based medicine. Many of psychotherapy’s practices already meet such standards. For the good of its patients, the profession must fight for the parity it deserves.

Brandon A. Gaudiano is a clinical psychologist and assistant professor of psychiatry and human behavior at the Alpert Medical School at Brown University.

 

Pills may work, but as far as I can tell there is no evidence to suggest that we don't become dependent on them. In other words, it may help at the start, but, after a year or so, you may find that you are dependent on a drug that isn't helping you any more. It is changing your brain chemistry without any benefit, because your brain has adapted, just like it might to nicotine or caffeine. Good psychotherapy, on the other hand, can help you for a lifetime.

That being said, I'm not convinced that therapy is right for all TMSers, even ones with very slow recoveries. Take Steve Ozanich, for example. He had a slow recovery, but didn't need psychotherapy at all. Sometimes just accepting the diagnosis, resuming activity, not letting the pain get you down, and an awful lot of time is what you really need.

 

Myg, I agree that therapy isn't always necessary or right for some TMSers. It's not the right approach for some people, period. But even if it's not necessary, couldn't therapy be helpful in "just accepting the diagnosis" and "not letting the pain get you down" as you say?

I think there's a difference between not needing therapy and not responding to therapy. Someone may not need therapy to recover, but a couple sessions (or more) might help them. On the other hand someone who doesn't respond to therapy not only doesn't need therapy to recover, but would probably find therapy useless, perhaps even counterproductive. I think it's an important distinction to make.

Of course, just because therapy might help doesn't mean it's always the right course of action. If that was true I'm pretty sure 98% of the world's population would be seeking therapists (or rather, those who could afford it -- let's face it, it can get expensive, especially when insurance doesn't cover sessions!). I think it's about figuring out whether the benefit of going to therapy is the best route, versus finding support, information, resources, etc in communities like this one. Sometimes, it's enough to go through the Structured Educational Program, or read and re-read Sarno's books, or post on this forum, etc. Sometimes, it isn't. Making that decision to see a therapist to help overcome TMS is a very personal choice. I think something to keep in mind, at least for TMS healing, is that the best therapists are the ones who get fired: they've done their job so well, you may not need them any more!

 

Right you are Myg, and I remember Alan saying that at the end of one of his webinars: "I'm in the only profession that strives to get fired."

 

I am not surprised. First of all it is very expensive and not all insurances cover it. I have seen a couple of them and soon I realized that they going into circles. This is a very delicate profession and there is a lot of mediocrity. Psychiatrists are the worst, they mostly believe only in pills and if you tell them it does not work they want to try another one. I had once a bipolar roommate and she told me that she was numbed for seven years by a psychiatrist until another saved her. Unfortunately the one that I would love to see are the ones writing books and they too busy or too expensive. We are better off helping each other. I do believe that they can help if they are competent.

Leonor

 

(I added the bold in the quote)

It was a psychiatrist that finally diagnosed me and gave me the off-label meds that have helped me so much in simply sleeping. He told me that psychiatrists are brain chemists. It is their job to diagnosis and find the 'right' chemicals to correct the brain. If you go to one, expect pills. It is what they do. He told me that there are two different types of brain disorders: Behavioral and Chronic Pain. Behavioral being anything that you act out, like depression or schizophrenia, etc; Pain being self-explanatory.

Yesterday, I arrived at my scheduled appointment with a counselor. This was my second attempt. It is an hour drive to get there. The first time was cancelled but I had already left home when they called and didn't know until I was standing at the front desk. A few days later they called and rescheduled. So yesterday morning, there I stood, as I was told that someone should have called me on the 29th, as the counselor was out for this week. The roads are icy, and there was a great deal of fog, making the drive very stressful. I never would have left the house except for this appointment.

It would seem to me that Fate is steering me away from this course of action. I invested a great deal of emotional commitment in seeing a therapist. It made me feel quite ill to have it once again be a failed endeavor.

This is why I added a bold to the statement "We are better off helping each other."

with grace and gratitude,
^_^

 

Maybe the Lord has set you a message. Save time and money and stay off icy roads ad
spend the time instead going back into old TMSWiki posts. There really is a treasure trove
of free information there. Who needs pills and professional listeners. We an talk to each other
at the TMSWiki forums.

And Lily Rose, you are an inspiration in yourself.