In honor of National Psychotherapy Day, I must beat the drum for one of the best known forms of treatment for virtually any mental illness or mental health concern — psychotherapy.
It’s a drum I’ve happily been beating since I went to grad school in the early 1990s. There I learned about the decades’ worth of research into the effectiveness of psychotherapy for virtually any disorder. Since then, I’ve been telling anyone who will listen — psychotherapy works!
And now with the implementation of the mental health parity act and the Affordable Care Act, psychotherapy will become even more affordable to anyone who wants to give it a try. So why not try it?
Psychotherapy is suffering a decline in usage in the past decade. Yet the research tells us psychotherapy is often more effective than medications in helping patients relieve the symptoms of common mental disorders, like depression, anxiety and bipolar disorder.
As Horvath (2013) wrote earlier this year, there is no question whether psychotherapy is effective or not: “The impact of the first meta-analysis, and those that followed, was multidirectional and far-reaching. To a large extent, the question whether psychotherapy — as such — is effective is no longer debated.” Put simply — it works.
Too often today, people first turn to a medication, and then to psychotherapy. What I argued back in 2008 is still true today — psychotherapy goes along with medication. Always. For virtually every disorder, and every individual, psychotherapy will enhance and speed up the process of recovery and healing from mental illness.
Forgo psychotherapy, and you’re getting half the treatment effectiveness, which will more often than not take twice as long. I’m not just make this up… Glick (2004) cites multiple studies that clearly demonstrate psychotherapy’s value in conjunction with medication: “The Barlow et al. study on panic disorder [for instance] showed that following drug alone, about 85 percent of patients relapsed, but only 15 relapsed when they had psychotherapy plus drug.”
Psychotherapy works as a first-line treatment for many common mental disorders, including most forms of depression. Psychotherapy is effective and time-limited when wielded by an experienced therapist.
But it’s important to find the right therapist — one you can form a good, professional working relationship with. In the field, they call this forming a strong therapeutic alliance. And in such relationships, you’ll find good patient outcomes according to Horvath (2013): “One of the most important research finding is that alliance, measured as early as between the third and fifth session, is a reliable prognosticator of therapy outcome.”
Just like you may not find the right contractor when you go to build a deck on the back of your house, or the right hair stylist when you go to get a haircut, you may not find the right therapist on your first try. It’s important to recognize that the therapist works for you — so it is in your best interests to find one you feel comfortable with and helps you bring about changes in your life and thinking.
In short, psychotherapy works. So why not try it?
This post is written in honor of National Psychotherapy Day, “a day when clinicians, clients, and therapy advocates will unite to promote the profession, fight stigma, educate the public, and draw attention to the needs of community mental health.” I hope you’ll join us!
References
Horvath, AO. (2013). You can’t step into the same river twice, but you can stub your toes on the same rock: Psychotherapy outcome from a 50-year perspective. Psychotherapy, 50, 25-32.
Glick, ID. (2004). Adding Psychotherapy to Pharmacotherapy: Data, Benefits, and Guidelines for Integration. American Journal of Psychotherapy, 58, 186-208.
8 comments
Well said, John! What a helpful breakdown of current research. Keep beating that drum!
People still need this encouragement! Thank you for saying it.
It’s got a bad rep, doc’s are reluctant to use it and you’ve often have to goto more than one therapist before you get anywhere.
If you’re disclosing personal information people don’t want a process of trial and error, because just one negative partnership and the client won’t try again. Especially if it’s taken that person a particularly long time (Years/Decades) in building up the fragile confidence to even start with therapy.
Great post, though I wonder how mental health parity and ACA is actually going to make a difference. All the good therapists in my area have opted out of insurance panels, leaving only the average and below average ones who are “on panel.” I don’t blame them.
As for forming a therapeutic alliance, I think the best thing that could be done in that regard is for the APA, NASW, etc. to mandate a special rate for member first sessions that is a third (33%) of what the therapist would normally charge. That way, clients can investigate multiple therapists before making a choice. Right now, a potential client has to invest upwards of $800 to check out four or five therapists . When a scrip for Celexa is 20% of that at most, who is going to do that without trying the Celexa first?
Diagnosis is the key. The idea that psychotherapy could be used to talk my brother out of the hallucinations and delusions he suffered due to a brain illness known as schizophrenia – is ridiculous!
Yes, once the positive symptoms are under control, and if the person has insight into their illness – understands s/he is sick – then psychotherapy can help the person cope with their illness…but first comes the meds to control the positive symptoms…
and then there is CET – Cognitive enhancement Therapy to help restore cognitive functioning – since Schizophrenia is first and foremost, a Cognitive Brain Disorder – not a “Behavioral Health Issue” – CET has been proven to help restore brain functioning…memory…insight…cognitive reasoning…
AND since it is done in teams, CET helps build social interaction skills…also a negative deficit for people with schizophrenia….
So, it really is a matter of the diagnosis…
Let’s have one minute of honesty and candor, Dr Grohol, when has bureaucracy truly benefited health care in general, mental health care specifically?
Why don’t you consider asking in a separate post why providers are NOT taking insurance and certainly not interested to participate in PPACA? Maybe you would read from colleagues like myself, while I am personally not currently in a private practice, we do not like the incredibly intrusive micromanagement that is escalating, like with medication authorizations as a start. Nor do we like the idea that at the end of the day there will still be a double standard and this alleged parity will not be experienced by mental health care providers or patients.
Frankly, this naivete and terminal idealism reflected by some providers that government will help the public, yet with the DOZENS of mandates this legislation includes, it is making health care punitive, and that is just starting out with costs/expenses. Wait ’til the fine print of health care access comes out, the parts Nancy Pelosi et al haven’t read to themselves or us yet to reveal what the IPAB will really do once in place.
Piece of advice to readers who might not be aware of this little observation: politicians don’t like mental health for at least two reasons, first patients as a whole more likely don’t vote, so they are constituents that don’t matter to the politicians, and two, politicians don’t want any scrutiny that responsibly observant and concerned mental health care providers, and patients who are politically involved, would shine on such officials.
Let’s be frank, the narcissism and antisocial traits that are more pervasive these days aren’t receptive to boundaries and accountability.
TRUE?!
Kaiser Permanente steadfastly refuses to offer weekly psychotherapy, maintaining instead that group therapy is just as good. They have a gazillion groups but if you have issues with doing group therapy over individual you are out of luck. Protest and you are pathologized. I challenged it up to the state level where the company that handles their investigations sided with Kaiser–though I am labeled severely depressed with a history of attempts. I am holding a fundraiser for sessions outside Kaiser. Individual therapy has always helped me before and I trust that it will again. I am a chronic pain patient and I need that support much more now.
Until quality psychotherapy is as widely available as psychiatric services, and as widely covered by insurance plans, psychotherapy will always be an afterthought. Basically, I cannot afford therapy, although my psychiatry is covered by public health insurance. It’s a purely political issue.