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Psychotherapy use on the wane; Psychiatrists increasingly turning to antidepressants and other prescription medications
Once the major tool in treating depression and other psychiatric illnesses, the use of psychotherapy fell from 44% to 29% over the 10-year period from 1996 to 2005. Meanwhile the use of antidepressants and other drugs became more widely used during the same period. These were the conclusions of a report on psychotherapy published in Archives of General Psychiatry and reported in the Los Angeles Times.
Researchers attributed the shift to insurance reimbursement policies that favor short medication visits compared with longer psychotherapy sessions, and to the introduction of a new generation of psychotropic medications with fewer side effects. ...Reimbursement for a 45- to 50-minute outpatient psychotherapy session was 40.9% lower than reimbursement for three 15-minute medication management visits.
Although not a surprise to many psychiatrists, the findings were expected to intensify a debate over the increased medicalization of psychiatric care, which in part reflects an emphasis on the biology of mental illness, as opposed to the processes of the mind. Psychotherapy is an interpersonal intervention that may involve such things as behavior modification and group discussion. It is recommended -- with or without medication -- for major depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.
In addition to medical reimbursement policies, the authors of the study noted that patients may also be a reason for the increase. In today's society, taking a pill looks quicker and easier than the time-consuming process of psychotherapy.
It should be noted that the study only looked at psychiatrists and not at other types of professionals who provide treatment for depression and other similar illnesses.
Expect this debate to continue. If you are contemplating treatment do your best to not have your insurance company's reimbursement policies dictate what is the best form of treatment for your condition though that is not always possible.
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Anti-depressants vs. Psychotherapy
I am a psychiatrist with an outpatient practice in the Washington, DC area, and sadly, I no longer provide traditional psychotherapeutic services. As a practicioner who recognizes the superior response of psychotherapy combined with antidepressants for treatment of depression, I believe this incentivizing and molding of psychiatrists' practice behavior has had a palpable negative impact on the quality of patient care. This mandated separation of psyche from soma does nothing but create fragmented, less than optimal psychiatric care in my opinion. And as a point of information, the "allowable" reimbursement rates for ALL psychiatric services has decreased substantially over the past 3-5 years, not just psychotherapy, forcing our hand to either see more patients to maintain the same income, or refuse to deal with insurance companies all together. If the momentum of what I believe to be destructive trends are to be reversed at all, it will be the collective outcry of disgruntled patients that will make the difference.
In order to counterbalance my work in this "sick care" system of treating pathologies, I have chosen to focus most of my professional energy on promoting mental health and wellness of individuals and families in whatever ways I can. Much more can be done to bolster and empower families to be emotionally healthy and resilient, thereby minimizing to the degree possible the expression of dysfunctional behavior and mental illness.
In the spirit of continued evolution and growth through mid-life and beyond, I encourage all to stand against the oncoming tide against optimal emotional health and to RIGOROUSLY PURSUE IT ANYWAY - and find healthcare providers who will support you in your efforts!
Cynthia Turner-Graham, M.D. www.ForSoundMind.com
Psychotherapy Use on the Wane
Hi Wesley: As a trained counsellor (with a Master's degree), & now a writer, life coach & group facilitator, this article brings up so many issues! Yes, HMO structure is responsible for much of what's going on I'm sure. In my EAP work there was a limited number of sessions, that was different from the way I was used to working in a large agency with problem gamblers.
But I really think people want a 'quick fix', as was mentioned later in the article. They live in the fast lane & have bought into the idea that change happens in the blink of an eye. We're all works in progress & will be until we die!
Thanks for all the good stuff you're putting up.
Ellen Besso www.ellenbesso.com/midlifemaze
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