The work of psychotherapy.
Article Type: Report
Subject: Psychotherapy (Economic aspects)
Psychotherapy (Reports)
Psychiatric personnel (Practice)
Psychiatric personnel (Compensation and benefits)
Prospective payment systems (Medical care) (Reports)
Author: Rosenberg-Javors, Irene
Pub Date: 12/22/2008
Publication: Name: Annals of the American Psychotherapy Association Publisher: American Psychotherapy Association Audience: Academic; Professional Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2008 American Psychotherapy Association ISSN: 1535-4075
Issue: Date: Winter, 2008 Source Volume: 11 Source Issue: 4
Topic: Event Code: 200 Management dynamics; 280 Personnel administration
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 192800783

Over this past summer, I read an article, "Medication Increasingly Replaces Psychotherapy, Study Finds," wherein the author, Denise Gellene (2008), reported that a study drawn from data gathered by the National Ambulatory Medical Care Survey had shown that, "the percentage of patients who received psychotherapy fell to 28.9% in 2004-2005 from 44.4% in 1996-1997."

According to the research, "financial incentives were weighted against psychotherapy ... reimbursement for a 45- to 50-minute outpatient psychotherapy session was 40.9% lower than reimbursement for three 15 minute medication management visits." An author of the study, Dr. Mark Olfson of the Columbia University Medical Center, said, "Patient attitudes might also be hastening the shift ... taking a pill may look a lot easier to patients than psychotherapy, which is more time consuming and may involve the regular participation of more than one family member."

The data dealt exclusively with psychiatrists. It is not known if other mental health professionals are being affected by the trend. Olfson pointed out that the study "couldn't determine whether patients who needed psychotherapy were receiving it from other mental health providers or going without treatment." Interim Chairman of the Department of Psychiatry at Yale University, Dr. William H. Sledge, said that "the report was worrisome ... although training in psychotherapy is a standard part of psychiatric training ... that know-how is in danger of becoming lost."

What are the implications of this report for those of us who practice psychotherapy? Has the "talking cure" become obsolete, a waste of time and money, impractical, and too slow for our nanosecond universe? Over this past year, I had an experience with a new client that very much reflected the trend toward "fast food therapy." Client "X" came to the session and asked me, "Just how long does this business of therapy take?" She told me that she had no time to sit around and go on endlessly about her parents and that she wanted "fast results." I told her that we needed to talk about the meaning of therapy. She looked at me and replied, "Talk? I don't want to talk. I want to get rid of this pain and forget about it." Needless to say, this was our first and last session. She asked for the name of a psychopharmacologist, and that was the last time I saw her. Often, I hear people ask, "Why not just take a pill--who needs all this psychotherapy stuff?"

Hyped-up advertisements on television about the wonders of medication and the increasing emphasis on the biology of mental disorders, combined with the pressure of managed care, have altered how the public sees psychotherapy. Are these trends something to be concerned about? The Chairman of the Department of Psychiatry at the Stanford University School of Medicine, who is also the President-Elect of the American Psychiatric Association, has said that, "the trend was not necessarily bad ... it could be seen as a natural evolution, similar to what is seen in other fields of medicine." He further observed, "Years ago, if someone had a herniated disc, they had a very complicated surgical procedure and were in traction for weeks ... fields change."

However, he strongly has emphasized that "what we don't want to do is decide treatment based on reimbursement." And there's the rub, so to speak. Psychotherapy is costly. Indeed, according to this study, "researchers found that patients who paid out-of-pocket, generally the wealthiest patient group, were more likely to receive psychotherapy." So we are back to the money issue and insurance reimbursement.

We know that for some people a combination of talk therapy and medication has proven the best treatment plan. Unfortunately, insurance companies are not convinced. Medication rather than psychotherapy is the preferred choice because the bottom line is cutting costs.

As mental health professionals, the issue of how to make psychotherapy affordable, while at the same time not diminishing our capacity to earn a living, is quite a challenge. Many of my colleagues are no longer willing to take insurance. They are strictly fee-for-service. They have come to this place after years of putting up with managed care's relentless concern over the bottom line. As a result, the financial demographic of their clients is now predominantly middle to upper-middle class, whereas before, when they took insurance, their client base also included those from lower income groups.

For many, there is no doubt that medication has helped dramatically. But, if the trend toward medication to the exclusion of psychotherapy continues as a result of insurance companies not wanting to pay for psychotherapy, then our clients are not being served well. Medication relieves symptoms; it does not necessarily remove the source of the disorder. That is the work of psychotherapy.

All of us in the mental health field need to become advocates for affordable mental health care that includes psychotherapy, medication, and whatever else will help those in need.


Gellene, D. (2008, August 5). Medication increasingly replaces psychotherapy, study finds. LosAngeles Times. Retrieved from, 0,7966688.story?track=rss

By Irene Rosenberg-Javors, MEd, LMHC, DAPA

Irene Rosenberg-Javors, MEd, Diplomate of the American Psychotherapy Association, Licensed Mental Heahh Counselor, is a psychotherapist in NYC. She is also Adjunct Associate Professor of Mental Health Counseling, Mental Health Counseling Program, Ferkauf Graduate School of Psychology, Yeshiva University. She can be reached at
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