Will psychotherapy die?

[Psychology 76]

This thought has been bothering me ever since I first aspired to be a clinical psychologist. Its also why I'm unsure if I want go strait clinical psych or go neuropsych. I've read a great deal about this issue and so far its still pretty much up in the air. Some people believe that psychotherapy will always be needed because people need to connect with another to help the ect. Others think the advancements of psychoactive drugs will make psychotherapy obsolete. Especially when taking a pill is much cheaper. I think psychotherapy is very important and effective. But ultimately medicine might take it over in the future. So my fear now would be to go through a gruelling 5 years of clinical grad school and once I'm certified I would trouble finding a job. I'd like to hear other opinions.

http://forums.studentdoctor.net/showthread.php?t=322345

That post discusses neuroscience and psychotherapy which interests me a lot which is what I hope personally will happen. Neuroscience will allow for psychotherapy to be proven that it works somehow and people wont need to rely on pills. But that is to be determined

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[Sassafrass]

This thought has been bothering me ever since I first aspired to be a clinical psychologist. Its also why I'm unsure if I want go strait clinical psych or go neuropsych. I've read a great deal about this issue and so far its still pretty much up in the air. Some people believe that psychotherapy will always be needed because people need to connect with another to help the ect. Others think the advancements of psychoactive drugs will make psychotherapy obsolete. Especially when taking a pill is much cheaper. I think psychotherapy is very important and effective. But ultimately medicine might take it over in the future. So my fear now would be to go through a gruelling 5 years of clinical grad school and once I'm certified I would trouble finding a job. I'd like to hear other opinions.

http://forums.studentdoctor.net/showthread.php?t=322345

That post discusses neuroscience and psychotherapy which interests me a lot which is what I hope personally will happen. Neuroscience will allow for psychotherapy to be proven that it works somehow and people wont need to rely on pills. But that is to be determined

I don't foresee psychotherapy becoming obsolete in our lifetime. We are many years off from having "absolutes" within psychology (as many can attest you need to take into account numerous varibles during treatment, making each person relatively unique). Honestly, I think that as the stigma of seeing a therapist lessens in our culture (which it is doing SLOWLY) the need for them increases; however, with that said, insurance companies are more likely to be the major concern (as is close ties with Pharma, governemtal agencies like FDA, etc).

One of my old graduate professors discussed the idea with me at length some time ago - something she was actively lobbying against in conjunction with some medical non-profits. Having worked closely with the pharmaceutical companies AND insurance companies in a former job, I can attest that her theory is more probable. From an insurance company perspective, if you need psychotherapy it is typically "cheaper" to have someone with a masters (or a degree less costly by their standards then a PhD in Clinical Psych) facilitate treatment. If you need the medication, then the insurance companies would send you directly to a psychiatrist (or other MD based practicioner), thus again bypassing the PhDs. Again, this is not necessarily reflecting a lack of demand for clinical psychologists, but instead highlighting issues in our medical system.

I am not expert on this (heck, I'm trying to get INTO a PhD program now!) but its an interesting notion.

 

[apumic]

I dunno... EVEN on pills, the clients I am working with now (troubled children in rez tx, most with diagnoses such as conduct disorder, ODD, bipolar I & II, major depressive disorder, etc.) need very individualized programs for even a minimal level of functioning. Even on meds, I would estimate their GAF scores as typically between 40 and 50. That's not really ready to be let out into the world, so at least when it comes to children, I would expect evidence-based treatments to remain a mainstay. The behaviorally-based therapies that actually show progress with clients are necessary; however, I honestly hope the stereotypical forms of "talk therapy" that have an extreme emphasis on such concepts as an unconscious that we really know nothing about (and attempting to treat this unconscious when we really don't even know whether it actually exists) and a focus more on one's past than on presenting symptoms (unless there is research evidence showing a connection between a specific precursor or event and the presenting mental illness) goes the way of the dinosaur sooner than later. I personally think it would do a lot of good for the field to do away with the concepts that have basically made us a laughing-stock of healthcare. (I mean, honestly, what other field, besides religions and cults, has theories involving mystical forces that battle it out to overcome one another and take control of the target?) -- I do, however, like cognitive therapy and think there are probably some good uses for psychodynamic concepts. I do wonder, however, if most of the effect with some of these therapies is nothing more than a de facto placebo; in which case, why not simply give them a sugar pill and tell them it'll solve all their problems? It'd be a lot cheaper and you could then bill the way psychiatrists do! j/k....

 

[Ollie123]

I'm quite certain therapy is going to be replaced with drugs in the future. In our lifetime though? Probably not. Several hundred years down the line maybe.

We've come a long ways, but drug treatments are not a panacea. Some disorders don't have any effective drug treatments, others have drug treatments that are still not as effective as therapy (e.g. anxiety), even in depression, which is probably the domain where drugs have taken over the most, therapy has been shown to help when added to the drugs, and evidence points towards better long-term efficacy for therapy.

As for the neuroscience of therapy...I'd love to move in that direction myself, and I think the field as a whole already is.

 

[KillerDiller]

I dunno... EVEN on pills, the clients I am working with now (troubled children in rez tx, most with diagnoses such as conduct disorder, ODD, bipolar I & II, major depressive disorder, etc.) need very individualized programs for even a minimal level of functioning. Even on meds, I would estimate their GAF scores as typically between 40 and 50. That's not really ready to be let out into the world, so at least when it comes to children, I would expect evidence-based treatments to remain a mainstay.

I see the same thing at my practicum site, only I work with adults. In practicing with clinical populations the choice is seldom medication or therapy. Both are important and insurance companies reimburse for both.

 

[Therapist4Chnge]

Your first blog entry mentioned wanting to read other psych/neuro blogs. Below I listed a few I frequent:

http://scienceblogs.com/cognitivedaily/
http://scienceblogs.com/neurophilosophy/
http://www.mindhacks.com/
http://blogs.psychologytoday.com/topics/neuroscience
http://bps-research-digest.blogspot.com/

They are a mix of entertaining and academic.

 

[PsyDr]

oh hell no.


even when they come up with a pill that is 100% effective for every DSM diagnosis, there will still be a need. mostly because therapy somehow makes the non-patients feel safer.

there are TONS of things that are incredibly horrible that others believe require psychotherapy even when treated with drugs.

sex offenders is one thing that comes to mind. people want these individuals to be "in treatment". it makes the public feel safer to know someone is in therapy. therapy does that for a wide range of terrible terrible things.

imagine if you caught your child having sex with a dog. you think there is a pill for that? even if there were, would you be cool never talking about it? what if you walked in on your spouse masturbating in an elephant costume. i bet you would have some interest in him/her having a wee chat with a professional.

martial therapy will always be needed.

other non-diagnoses will continue to have a need. what about individuals who "just don't know what i want to do with my life"? there is no pill for that. nor will one be possible. as will be the patients who wants therapy to learn more about themselves. they seem to want therapy. i don't see a pill for that forthcoming.


but i do think the more formal DSM diagnoses will fade from the psychotherapy field. depression, schizophrenia, bipolar d/o, etc will all be seen less and less. the YAVIS patient will fade, preferring to take a pill because the idea that their neurotransmitters are out of whack is preferable to the idea that their thoughts are maladaptive. but some problems that are beyond diagnosis will still have a desire for therapy.

than again, that is just my opinion.

 

[Psychology 76]

Again, thank you for your input.

This topic is something that always crosses my mind when thinking about the future and graduate school. I really hope psychotherapy stays strong, I think its a great tool to use to help people. Being a clinical psychologist was my first dream once I got into psychology. Perhaps I'll go back to it. Hopefully I'll get an internship this summer that will give me some experience in clinical psych or neuropsych so I'll really know for sure what to do.

 

[Eruca]

oh hell no.

other non-diagnoses will continue to have a need. what about individuals who "just don't know what i want to do with my life"? there is no pill for that. nor will one be possible. as will be the patients who wants therapy to learn more about themselves. they seem to want therapy. i don't see a pill for that forthcoming.

Couldn't agree more. Do cholesterol or blood pressure meds replace needed behavioral changes? Nope. Does gastric bypass replace the necessity to change your diet? Nope. (in fact the opposite)

I think it's far too simplistic to assume that meds will be a replacement for psychotherapy.. particularly anytime in the near future. We have too little an understanding of mental illness, and the drugs we currently have still need a LOT of refinement. Don't forget that psychotherapy is not just about treating symptoms or syndromes -- it's also about quality of life, general well-being, and interpersonal effectiveness. These are not easily solved by the medical model.

On a separate note, you don't have to choose fields! My program offers its clinical students a Neuroscience certificate (basically a non-official dual phd). Check out schools that offer the same...

 

[shiva1008]

Another factor is that not everyone wants to take pharmaceuticals to cure their mental ailments/disabilities. I have been depressed for most of my life, but nowadays I would rather try to mitigate it with exercise, social interaction, and achievement of goals instead of taking a pill (not to imply that it's an either/or situation). I used to take Effexor, but I stopped taking it because I felt that it put a screen between myself and the world, and decreased the intensity of emotions. Plus after going through the withdrawals, I was sure that I never wanted to be on it again. No matter how effective the drugs are that they develop, there are always (in my opinion) going to be people who would rather go the cognitive-behavioral route than take allopathic medicine. Please excuse me if it's impertinent to reference personal experience... I am probably out of my depth here.

 

[Eruca]

Another factor is that not everyone wants to take pharmaceuticals to cure their mental ailments/disabilities. Please excuse me if it's impertinent to reference personal experience... I am probably out of my depth here.

I think you brought up a really great point! If people have noticed, even medicine has increasingly become more behavioral, holistic, and centered around well-being. (slow going, but definitely increasing)

On that note, most of the clinical internships I applied to have awesome rotations for cancer, pain, and other health-related areas. Psychology is getting incorporated into the medical more often, rather than less...

 

[TMS@1987]

I think you brought up a really great point! If people have noticed, even medicine has increasingly become more behavioral, holistic, and centered around well-being. (slow going, but definitely increasing)

On that note, most of the clinical internships I applied to have awesome rotations for cancer, pain, and other health-related areas. Psychology is getting incorporated into the medical more often, rather than less...

I actually think that medication will never overtake psychotherapy and make it obsolete. Just the sheer economics of having to go to a psychiatrist for the rest of your life and taking pills until you die, I think, bars medication from ever being a widely accepted viable long-term solution to mental illness. Barring some pharmaceutical company developing vaccines for depression, anxiety, OCD, BPD, etc. that effectively immunize patients from from these illnesses for life, I think that many people will always want the long term results that psychotherapy can offer.

 

[positivepsych]

Medication is not the threat to psychotherapy in the immediate future. It's going to be the advent of computerized therapy, guided by non or para-professionals.

Now that there's manualized treatments, the idea that they can be administered easily is being combined with technology. If you've been paying attention to what's been going on in the research literature lately, there is a growing push to investigate "computerized" therapy, whether via software or websites (particularly CBT).

Managed care is all about efficiency and cheapness. Now that they've figured out that master's level practitioners are cheaper than PhDs, they figure they can replace mental health practitioners altogether with computerized programs, sometimes guided by the assistance of a medical assistant or nurse (in case the patient has any questions).

There's a lot of research coming out, some of it comparing traditional CBT vs. computerized CBT, showing similar effects for certain disorders. With a couple of studies like this in their belts, insurance is going to to jump on the bandwagon because they'll argue that it's just as good, it's cheap, and can be distributed on a mass-scale (the wet dream of an insurance company).

Envision the future of places like Kaiser: Patient presents with MDD or Anxiety Disorder. In 15 minutes, their GP doc gives them a prescription for generic SSRI (according to PDA software that uses their medical history and presenting psych. symptoms to recommend a medication) + an access code to a 12-session online CBT website. No need to refer to a psychiatrist or a psychologist, except in complex cases.

There will always be a place for face-to-face psychotherapy amongst the self-pay or seriously-ill populations who don't want or cannot do computerized therapy. But I think the YAVIS patient--particularly those that grew up with YouTube and text messaging, will gladly be pushed into (and perhaps embrace) computerized therapy.

Obviously, this makes me concerned that we're trading quality for quantity. But these days, I wouldn't be surprised considering how much psychologists are being squeezed out of the therapy market already... (and I predict neuropsych batteries will all be computerized soon enough). Any thoughts?

 

[Psychology 76]

Medication is not the threat to psychotherapy in the immediate future. It's going to be the advent of computerized therapy, guided by non or para-professionals.

Now that there's manualized treatments, the idea that they can be administered easily is being combined with technology. If you've been paying attention to what's been going on in the research literature lately, there is a growing push to investigate "computerized" therapy, whether via software or websites (particularly CBT).

Managed care is all about efficiency and cheapness. Now that they've figured out that master's level practitioners are cheaper than PhDs, they figure they can replace mental health practitioners altogether with computerized programs, sometimes guided by the assistance of a medical assistant or nurse (in case the patient has any questions).

There's a lot of research coming out, some of it comparing traditional CBT vs. computerized CBT, showing similar effects for certain disorders. With a couple of studies like this in their belts, insurance is going to to jump on the bandwagon because they'll argue that it's just as good, it's cheap, and can be distributed on a mass-scale (the wet dream of an insurance company).

Envision the future of places like Kaiser: Patient presents with MDD or Anxiety Disorder. In 15 minutes, their GP doc gives them a prescription for generic SSRI (according to PDA software that uses their medical history and presenting psych. symptoms to recommend a medication) + an access code to a 12-session online CBT website. No need to refer to a psychiatrist or a psychologist, except in complex cases.

There will always be a place for face-to-face psychotherapy amongst the self-pay or seriously-ill populations who don't want or cannot do computerized therapy. But I think the YAVIS patient--particularly those that grew up with YouTube and text messaging, will gladly be pushed into (and perhaps embrace) computerized therapy.

Obviously, this makes me concerned that we're trading quality for quantity. But these days, I wouldn't be surprised considering how much psychologists are being squeezed out of the therapy market already... (and I predict neuropsych batteries will all be computerized soon enough). Any thoughts?

I respect your opinion positivepsych but I'm going to have to strongly disagree that psychotherapy will be replaced by computerized psychotherapy anytime soon if ever. Even if a computer does pass the Turing Test, the client would still have to be engage in psychotherapy with a machine. I grew up with text messaging and Youtube but those are really people that I'm communicating with, not a machine. I don't see it ever happening, at least not before robots are created in a way that they are accepted as citizens.

 

[Psychology 76]

I respect your opinion positivepsych but I'm going to have to strongly disagree that psychotherapy will be replaced by computerized psychotherapy anytime soon if ever. Even if a computer does pass the Turing Test, the client would still have to be engage in psychotherapy with a machine. I grew up with text messaging and Youtube but those are really people that I'm communicating with, not a machine. I don't see it ever happening, at least not before robots are created in a way that they are accepted as citizens.

As for neuropsych look at question 5

http://forums.studentdoctor.net/archive/index.php/t-127454.html