Do you see therapy as EBM/"best practice"?

[biogirl215]

Just curious: How do psychiatrists tend to view therapy as a treatment? Antiquated and largely inferior to medication? As a valuable adjunct to meds? As a nice but ultimately unnecessarily adjunct to meds? As a potential curative treatment for some disorders? Something else? Is therapy truly EBM in modern times? Will therapy even be around in 20-50 years?

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[erg923]

I'm not a psychiatrist (clinical psych grad student), so I can't speak for them. But in general, I think it is looked upon very positively (as an adjunct depending on severity of the disorder). Not too many are into actually providing the "therapeutic hour" themselves though for obvious financial reasons, which I can totally understand. You might also want to check out the "NYT: "Have you ever been in psychotherapy, doctor?"

Good discussion of psychotherapy there as well. And lots of posts by me

 

[cleareyedguy]

EBM clearly indicates that the combination works best for most patients who have the major axis I disorders. Further, there is plenty of evidence that lobbing meds at every axis II symptom is common but often-misguided.

 

[biogirl215]

So, is therapy usually "prescribed" to most axis I patients, then? In practice (i.e., excluding residence training), is it usually done by psychs or referred out to psychologists and other clinicians?

 

[Thewonderer]

Therapy should ALWAYS be prescribed (except maybe for schizophrenia. I am really underwhelmed by the efficacy of CBT for psychosis in real world situation).

The trouble is, "pts can't afford weekly psychotherapy!" Theray is not cheap by any stretch of imagination. Taking an hour a week (and another extra 1-2 hours stuck in traffic) to do therapy is becoming a luxury that most people can't afford. Say, you get paid $30 an hour at your own job. If you take 2 hours off per week to go to therapy (stuck in traffic and all) and, in the best scenario, your therapist takes insurance and your co-pay is $20 per session. That's still ($30 x 2 + $20) x 4 = $320 per month including opportunity cost and $3840 per year. That compares to your co-pay of $15 per month for Prozac, Celexa or Zoloft (all three have generics now).

That's the reality in real world.