Therapy’s Image Problem

I’ve read several articles recently about the decline in psychotherapy as a modality to address such common issues as depression and anxiety. The articles cite the rise of medication prescriptions as a reason for the decline despite “mental health parity” regulations. (1,2) These regulations require group health plans and health insurance issuers to ensure that financial requirements are no more restrictive than the predominant requirements or limitations applied to all medical/surgical benefits. (3)

One source cited that at the start of the 1990s, psychotherapy was the treatment of choice for depression, with 71.1 percent of depressed people saying they had been treated with psychotherapy. When the numbers were looked again in 2007, that percentage had dropped to an all-time low — to only 43.1 percent.  And that with the increasing research demonstrating the efficacy of cognitive behavioral therapies.

I’ve been mulling about what I could write about this image problem when an experience over the holidays galvanized my thinking on this.

A friend’s daughter is in her late twenties and is in graduate school. Her undergraduate degree is from a prestigious college. While visiting at the holidays, she worked on a research paper and described how she had repeatedly sought out her professor during the semester for reassurance that she was getting it “right.” And she enlisted family and friends around her at this holiday time to suggest a title for the paper.

It suddenly hit me! Children who grow up with the idea that getting good grades is the goal and making sure to get the “right” answer is the way to that goal are not prepared to introspect and examine their feelings and inner life.

Raised on a diet of hearing how smart they are leaves no room for them to admit that problems in their lives might be due to faulty thinking or actions on their part and leaves them unprepared to look inside to make changes. It’s simply out of their thinking or too threatening to admit that they are less than perfect, and so they go for the “quick fix.” I thought back how in recent times, I had stopped taking undergraduate referrals from the local university student health because it seemed there was a trend: they were unwilling or unable to engage in therapy and came seeking medication, which I do not prescribe.

So, does psychotherapy have an image problem or is it becoming outmoded as a treatment option? Do we need to think up other ways of engaging people who are unhappy but do not have the skills necessary to look inside themselves? Or should psychotherapists join the growing wave of researchers looking into the destructive patterns of child rearing that leave large numbers of young people unequipped to deal with the vicissitudes of life?

References 

1. Gaudiano, B. Psychotherapy’s Image Problem, The New York Times, Sep. 29, 2013.

2. Grohol, J. https://psychcentral.com/blog/archives/2010/12/08/psychotherapy-continues-decline-as-depression-treatment/

3. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), US Department of Labor

Leslie Durr, PhD, RN, PMHCNS-BC is an advanced practice psychiatric-mental health nurse with a private psychotherapy practice in Charlottesville, Virginia.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.