Psychotherapy's Image Problem

[beginner2011]

---

Members don't see this ad.

I'm in my first year of a clinical PhD program, and this is a topic of discussion in several of my courses/readings. It's great to see that the issue is getting some attention in the Times, but it would be great to hear some thoughts from you all as well.

From the article:

"Psychotherapy is in decline. In the United States, from 1998 to 2007, the number of patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent, while the number receiving medication alone increased by 23 percent. "


http://www.nytimes.com/2013/09/30/opinion/psychotherapys-image-problem.html?_r=2&

 

[KillerDiller]

Just wanted to point out that the article then goes on to list statistics showing that the demand for psychotherapy has actually not gone down over that period (just the numbers of people receiving it). The issue isn't so much that people don't want therapy, it's that insurance isn't pushing it as a first-line treatment.

 

[xXIDaShizIXx]

Just wanted to point out that the article then goes on to list statistics showing that the demand for psychotherapy has actually not gone down over that period (just the numbers of people receiving it). The issue isn't so much that people don't want therapy, it's that insurance isn't pushing it as a first-line treatment.

This unfortunately. Good article nonetheless.

 

[LivingOffLoans]

The issue isn't so much that people don't want therapy, it's that insurance isn't pushing it as a first-line treatment.

My thoughts too after I read this, which left me with the impression that the article's title was somewhat misleading. He might have chosen the title because of his ill feelings for fad therapies, like Thought Field Therapy ('tapping') and EMDR (which some of his earlier research is devoted to invalidating, if you look up his prior work).

I do wonder just how effective his argument looks in practice. No matter how much of an evidence-base we develop for the effectiveness of psychotherapy, my impression is that there are more incentives in place for insurance companies to promote the evidence behind pharmaceutical interventions. Like KillerDiller said, insurance isn't pushing therapy as a first-line treatment, and I don't see that changing anytime soon regardless of the evidence we produce, sadly. We are a 'soft science'.

So, why does the author suggest that therapists need to adhere closer to evidence-based therapies to manage an image problem? In my experience, the majority of therapists (at least in my area) are practicing from the evidence-based frameworks he mentioned (CBT, mindfulness, psychodynamic, interpersonal, family). I think his argument for the effectiveness of psychotherapy makes sense, but I'm unsure about his concluding argument, let alone his definition of the "problem".

 

[Neuropsych2be]

Actually the evidence for the efficacy of antidepressants is rather poor. If you examine the effect sizes for psychotherapy versus medication management, psychotherapy can ahve greater efficacy.

 

[AcronymAllergy]

Actually the evidence for the efficacy of antidepressants is rather poor. If you examine the effect sizes for psychotherapy versus medication management, psychotherapy can ahve greater efficacy.

Medication is (or at least seems to be) easier, appeals more to the "sciency" side of folks' conceptualizations of mental illness (e.g., it's a "chemical imbalance"), and has better marketing.

 

[futureapppsy2]

Medication is (or at least seems to be) easier, appeals more to the "sciency" side of folks' conceptualizations of mental illness (e.g., it's a "chemical imbalance"), and has better marketing.

Yep. I wish the research linking CBT to neurological changes on MRIs and CT scans was better known for this reason.

 

[KillerDiller]

Yep. I wish the research linking CBT to neurological changes on MRIs and CT scans was better known for this reason.

Yeah, I think the marketing of research is the biggest factor. There is no Big Therapy like there is Big Pharma. You're not going to see ads on tv for CBT or ERP the same way you see ads for Zoloft and Abilify. (Personally, I'd rather resolve this inequality by not having ads for treatments in general.)

 

[erg923]

Well, how does that help, in your opnion?

I think many of us feel it the lack of promotion and our strange aversion to mainstreaming and promoting ourselves that is responsible for our obscurity and lack power. I mean, AACN just now launched a Facebook?! That was 4 years of promotion of neuropsychology to the public that was wasted...no?

 

[KillerDiller]

I mean, AACN just now launched a Facebook?! That was 4 years of promotion of neuropsychology to the public that was wasted...no?

Well, we're talking about psychologists here, so those 4 years were probably spent in meetings discussing the possibility of opening a facebook account 😀

In all seriousness, though, our profession does need to be better about advocating for ourselves and speaking about ESTs with confidence. I think this is important on the individual level. I'm tired of seeing psychologists defer to physicians in treatment team meetings, as if physicians are the experts on mental health and psychologists are not. As for how taking down medication ads helps, it just makes medications seem a little less like the go-to treatment for psychological problems. I'd rather have this happen then have ads for therapy because I don't think that having the general public half-informed about potential treatments (how much info can really be conveyed in a 30 second spot?) helps with the delivery of services. However, if this is the way we need to go to advocate for our profession, I won't throw a fit over it. It's better than doing nothing. Personally, I think the reality tv shows that actually portray ESTs are awesome platforms for psychology.

 

[Sanman]

If you want to talk about a public image fail, I saw a segment on the today show about a new breakthrough in scent that can reduce anxiety. The physician guest hosting the segment stated that it would be really nice to have an option to give pts to reduce their anxiety without medication?!? Really!!!' Hmm, let me see if I can think of an alternative treatment to medication that could effectively treat anxiety.

We don't need marketing spots. What we should have is a requirement for anyone on certain psych meds I see a therapist to reduce or eliminate medication in the long term and decrease cost. You would think we could lobby for that in the new ACA standards.

 

[erg923]

If you want to talk about a public image fail, I saw a segment on the today show about a new breakthrough in scent that can reduce anxiety. The physician guest hosting the segment stated that it would be really nice to have an option to give pts to reduce their anxiety without medication?!? Really!!!' Hmm, let me see if I can think of an alternative treatment to medication that could effectively treat anxiety.

We don't need marketing spots. What we should have is a requirement for anyone on certain psych meds I see a therapist to reduce or eliminate medication in the long term and decrease cost. You would think we could lobby for that in the new ACA standards.

Wow! On the one hand that is terrible and laughable. On the other, I suppose Joe and Jane Shmo wouldn't know any better,,,and why should they?! What information and evidence have we given them?!

 

[LivingOffLoans]

Medication is (or at least seems to be) easier, appeals more to the "sciency" side of folks' conceptualizations of mental illness (e.g., it's a "chemical imbalance"), and has better marketing.

And the consumer doesn't have to change their behavior, thoughts, feelings, or personality. The "quick fix".
(Side note before I get attacked - I know some meds are life savers, but I am referring here more generally to folks who could benefit at least as well from seeing a therapist but don't even consider it, and instead go for pills, usually through their PCP!)

 

[cara susanna]

Yeah, I think the marketing of research is the biggest factor. There is no Big Therapy like there is Big Pharma. You're not going to see ads on tv for CBT or ERP the same way you see ads for Zoloft and Abilify. (Personally, I'd rather resolve this inequality by not having ads for treatments in general.)

I am not a fan of direct-to-consumer medication marketing. I know physicians who feel the same way.

 

[PsyDNaut]

a

 

[quickpsych]

Thanks everyone, helpful information to know.

4chnge - I did get the sense that personality testing was pretty rare these days.

erg - It's great to hear you're close to 6 figures that soon out of school and that you enjoy your work. It's interesting you say you do mostly "assessment." A professor of mine who is a neuropsych always reiterates the fact that "really anyone could administer a test, your job is to interpret the results and make an assessment based on that." I've found in doing intakes currently that not only is the pay somewhat higher than straight therapy, it's a combination of basic assessing and information gathering.

lisa - I wasn't even aware schools housed these extensive testing and assessment offices. It does sound like it's more outside of the realm of psychological testing but still sounds interesting. Was your Masters in some type of quantitative research oriented area?

 

[erg923]

Well, I work in an ICF/MR facilty, so my "assessment" is often adaptive measures and functional behavior assessment tools (QABF, etc.). Johnny Matson's scales (from LSU) are used alot as well for attemting to assess mood and the like. There is alot of observation, some time sampling data recording, and alot of staff interviews. Maybe token test once in while for the relatively higher functioning folks. Full WAISs and the like are impossible with my population...

 

[erg923]

I dont really agree with your professors comments either. Observation is important part of the assessment (although its inclusion in the report should be minimal) and that takes clincial training, savy, and judgment.

And frankly, some tests are damn hard to administer and take a butt load of EF on part of the examiner. That new WMS-IV subest (forgot the name), Wisconsin Card Sort, Tower of London/Hanoi, Ruff-Light trail learning test, etc.

 

[Lisa44201]

lisa - I wasn't even aware schools housed these extensive testing and assessment offices. It does sound like it's more outside of the realm of psychological testing but still sounds interesting. Was your Masters in some type of quantitative research oriented area?

Alternative academic positions are slowly becoming more well-known; given there are only so many faculty positions available, it's an opportunity for folks who want to go into academia but don't land the faculty job.

You can browse through the Assessment, Accredidation, & Compliance tab at this website - http://www.higheredjobs.com/admin/ - to get an idea of some of the positions available in this field.

The office at this University doesn't do psych testing, but that varies by University. I have a Masters in Psychology. I had a RA position as a Statistical Analyst while I was working on the Masters, but nothing that could really be considered extensive stats training during that time, except for that Bayesian class; the rest of it was fairly standard. The RA position provided me with experience running a multitude of analyses on data from all over the University. I was fortunate enough when I moved here to look at the HR website and see a listing for a Statistical Analyst.

To paraphrase Erg, there's a difference between administering a test and assessment.