The subtle art of lying on a therapist's couch is in rapid decline. Psychotherapy, the traditional one-on-one weekly session with a therapist, has been on the downswing for years, as more and more psychiatrists and even primary care doctors prescribe psychotropic medications instead of therapy. As the graphic above illustrates, between 1998 and 2007, psychotherapy use for people being treated for mental health conditions in the U.S. decreased from almost 16 percent to 10.5 percent, and therapy use in conjunction with medication went from 40 percent to 32 percent. By contrast, usage rates of medication alone shot up from 41 percent to a little more than 57 percent.
The decline in popularity of traditional talk therapy isn't because seeing a therapist for depression or anxiety doesn't work. In fact, the evidence points to the fact that it does work, more effectively and for longer stretches of time than psychotropic drugs. Brown University professors Brandon Gaudiano and Ivan Miller, who edited November's Clinical Psychology Review issue devoted to the topic, write in a review that "psychiatric treatment guidelines tend to be biased toward promoting medications and underemphasize the role of psychotherapy as a frontline treatment," even when the research indicates it should be.
As with most things in healthcare, it often comes down to money. The authors explain:
So how will traditional clinical psychology save itself from extinction? Here are a few (semi-serious) ideas to consider:
1. Go Big
We've seen how powerful "Big Pharma" can be. Pharmaceutical companies have immense resources to draw on while lobbying for and advertising their drugs. Psychotherapy has no equivalent. "There is no 'Big Psychotherapy' devoted to developing, testing, and promoting psychological interventions as there is with pharmaceuticals," the authors write.
But maybe there should be. Someone get fundraising. Because with some Big Money, you could:
2. Get Yourself A Cute Commercial
Once psychotherapy advocates have a little bit of a cash cow to play with, they can go on a marketing spree. Big-name depression medications like Zoloft have cute commercials full of sad, adorable anthropomorphic lumps that pop a (brand-name) pill and suddenly start seeing the world in color again. Sitting at home on the couch, we say, "aha, I want that too!" and then rush off to ask our doctors for drugs.
"The pharmaceutical industry spends upwards of $5 billion per year in the United States on [direct-to-consumer advertising]," Gaudiano and Miller write. The U.S. and New Zealand are the only countries that allow this type of medical advertising. "Research suggests that patients' requests for specific medications increase prescriptions received and can lead to unnecessary or inappropriate treatment."
Well, it's time to fight fire with fire. Therapy can look fun on TV, too! The American Psychological Association has started a video campaign touting the benefits of psychotherapy. It's a sassy retort to the quick-fix medication mentality. Psychotherapy needs to get itself a marketing campaign, and here's a start.
3. Drop The Biology Jargon
Over the years, there's been a push to explain mental health problems in biological terms. To reduce the stigma of illnesses like depression and schizophrenia, mental disorders are cast broadly as diseases in the brain caused by chemical imbalances.
While it's important to reduce the stigma associated with mental illness, this approach might not actually work at all. In fact, it could be making things worse, as Guadiano and Miller explain:
Instead, they argue, these campaigns create a perception that mental health disorders can only be treated with intensive treatments like medication. "Talking it out" with a therapist doesn't sound like enough anymore. As another article in this issue of Clinical Psychology Review by psychologist Brett Deacon points out, this mentality has spread even among mental health professionals:
Deacon's advice? Stop searching for a reductionist, purely biological explanation for psychological phenomenon. "It is implausible to expect any one explanation (e.g., neurotransmitter dysregulation, irrational thinking, childhood trauma) to fully account for mental disorders," he writes. "No portion of the biopsychosocial model has a monopoly on the truth."
The real problem with psychotherapy is that psychotherapists are steeped in heavily personally biased situation ethics who are not interested in radical behavior modification which is the only proven way of curing non severe mental illness such as depression. Many depressed humans need a radical change in lifestyle, without drugs, to eradicate the mental symptoms coming from a dysfunctional physical and communications lifestyle. Only healthy living, eating, and thinking will cure most depressive cases and pablum word psychotherapy does not change a habitual dysfunctional lifestyle. You can't change with words only what is a habitual physically and mentally dysfunctional sick lifestyle. Sending people to work on a farm and interact with a farm family for one or two months is an example of radical behavior modification which could cure depression in the short run. Obviously it is not cost effective or realistically possible for most patients.
I've seen lots of psychologists ... I couldn't help any of them.
* seriously though, to me, the real problem is cost.
Who has the money to spend $40.00+ an hour on a shrink?
The people who need a therapist the most are probably the poor people. I'm sure mental health is a social problem which means it affects everyone from the poor to the rich. So psychologists need to get off their high horse and help those who are truly in need and in time it would help everyone.
I guess it would be craZy to suggest to a patient that they start with healthy food, exercise and proper sleep.
actually it is crazy to suggest that.
Poor people especially didnt choose to eat unhealthy.
A shrink cant supply them with quality, healthy food several times a day for the rest of their lives.
You cant tell someone to sleep well if their life wont give the time or place for it - bad home location, work etc.
Shrink cant give a person a job if unemployement is high - and it is a serious cause for depression.
Words alone are not enough. At least meds supress or take away the symptoms without having to get rid of the cause.
And majority of the shrinks need one themselves - they are egoistic, self centered, greedy and often dont give a single fuck about.
Psychology is the softest of sciences. It is just one small baby step above astrology.
That's not to say that people don't need a wise person to talk to, but they can't teach wisdom in school. Of all the psychologists I've seen, all but one resorted to 'tricks' to try to figure out what was going on. "Draw a picture and I'll interpret a spot where the pencil skipped as some significant event in your life." Seriously, how's that any different than palm reading?
People need friends who care about them and are willing to listen, and they need counselors with life experience who are willing to listen and not judge. They don't need arrogant people with a degree to charge them an arm and a leg to say "And how does that make you feel?" all day long.
Not too long ago I read a short history of the founding of the St. Peter( Minnesota) State Hospital. At the time people were literally working themselves 12 to 16 hours a day into physical and mental colapse. The first patient was one such person, and after a few cycles through the hospital he was persuaded to stay on as the porter. I think he probably was doing as much for the patients as the doctor was.
Many of the old hospitals bought whisky by the barrel, which tells me that they were using it to prevent DT's in their alcoholic patients.
Big problem today: Pshrinks ignore the obvious. Case in point: when a child has problems, they do not think to look for the adult who is the cause of the problems. Cure the adult and the child rapidly improves.
Ban the word "ANGER" from psycology. Use the word "FRUSTRATION" and you find that the problems are much easier to treat.
The biological model of mental illness says that the patient is defective- the non biological model says the patient is reacting to the environment. Some say that it is no accident that most psycoactive drugs are sexual sabatours- it is deliberate eugenics based on the idea of the patient as a defective.
I adore a room full of nuts!
Searching for perfection is just not
Let me begin by saying that there is a small portion of the population with severe mental illness for whom drugs and incarceration are the ONLY effective solution for their safety and the safety of others.
For those, however, who are not broken, merely struggling, and need help, rather than protection, drugs are a terrible choice.
The vast majority of psycological medication and treatment is for depression - something easily cured with altruism, hard work/exercise, diet, and sleep (since depression is an inward disorder, anything that gets the person out of their own head is effective).
When working with depressed youths, I found that paintball was wonderfully successful. Competition and shooting others with paint is existentially fun and when your inward desires are about avoiding external pain from being hit, most of those other issues don't have time to fester. Not a permanent fix, but useful (whitewater rafting was also effective - simple outdoors camping was not).
Of course, therapy is expensive, slow, and not always effective. Drugs are cheap, profitable, and show instant results (not always good results, but results).
The danger of the overmedication is easy enough to see. Research how many mass shooters are "off their medication" and crashing harder than their original disorders from withdrawl.
There is nothing wrong with being crazy. We just have to learn to function and get along in life in a postive way.
Now please pass the bowl of nuts please.
When you begin to accept yourself, appreciate yourself and those around you, life starts getting better!
Holly shit "Starz" you are annoying as hell. You comment on every damn article in this website thinking you know everything and always sounding off like an egotistical self centered asshole.
Not everything is simple. Sure accepting and appreciating one's self and others is a good thing, but it does not even scratch the surface! Its not easy for those with mental disabilities and disorders to come to such a conclusion. Hell, even if you shoved that solutiion down their throats it still wouldn't work. There is a reason why psychotherapists, shrinks and medication exist. Great, you learned the secret of a stable life. Good for you. Please lets have a round of aplause. (golf claps)
Please excuse my spelling, English is not even my 3rd language.
Medication is not the solution to any of our illness, being this physical or mental. Medication just place the body in a state that is more likely to recover itself from any illness.
When you break your leg you go to a orthopedist for a cast but after that you still need a kinesiologist (which in my country are not allowed to prescribe medication as they are not physicians) for the daily exercises needed to fully recover muscles, joints or bones, right?
Same happens with mind/mental/psych illness. The medication, mostly put your brain in the state needed to recover as in some cases prevent the re absorption of serotonin for example, used to make the depressed patients feel better, artificially ut not resolving the root cause.
I guess the mistake is that psychotherapy is not just a way to find your inner self or try to get answers from somebody else but another way of finding what's going on. Experiential therapy does that and you don't have to be lying on a couch paying hundreds an hour to tell tour story.
There is a reason why religion, support groups, music concerts, sports events make the people feel better or worse even when there is no medication involved, right?
The big mistake is that psychiatrists don't seek help from psychologists and the other way around, they are complementary.
And for you who think psychologists are just therapist, just analyze that when you go to a skill based job interview or profiling the best suitable candidate based on skills identified in successful employees.
You crack me up, thanks. I so appreciate I pulled you string and wound you up, you yo yo, rofl.
Mental health is a social problem that affects everyone from the rich to the poor. The problem isn't all psychologists being on their high horse though. Getting a doctorate in any profession is very expensive and takes a long time. Paying for that education is often what makes it difficult for psychologists to charge any less, on top of operating costs including continuing education, licensing fees, malpractice insurance, rent, and office staff - just like any doctor. Many psychologists actually enjoy working with populations in need because many got into the business to help people-not make money. If policy makers would realize the importance of psychotherapy and provide better mental health benefits as part of social programs and health insurance it may not be so cost prohibitive.
That said Medication certainly has its place but psychotherapy helps people to make the long lasting changes to stay well. uldissprogis has a very valid point psychotherapists need to work with clients to make significant holistic changes. There are many great therapies out there like Mindfulness Based Stress Reduction that work to change more than just words but the whole person. That is why psychologists go to school for so long and pay to continue their education to learn the most up to date researched techniques to help people.
Maybe a more stringent "culling procedure" would be much more efficient, socially and financially. You're unfit, you have to go.
According to Dr. Peter Breggin, the main thrust of psychology courses taught since the 90's has been toward pharmachology methods. Psychotherapy is almost nowhere to be found or taught. I hope it makes a big comeback, because this is where true help can be found for those who have mental illness.
The new therapy methods are very effective and do get to the root causes a lot faster than psychotherapy, but there are still merits for its use.
With mental illness you're dealing with the subconscious mind, not the thinking mind. Abnormal behavior is not learned by the thinking mind, it is behavior recorded, in the subconscious mind, when the thinking mind is not functioning. As in an auto accident, a fall out of a tree, wounded in a battle, under anethesia on an operating table.
Psychotherapy is a ritual in which someone, equipped with jargon and arbitrary diagnoses, poses as an authority figure to stoke and manipulate a so-called patient's self doubts. Until someone can explain how platitudinous prescriptions like "get in touch with your emotions" "be good to yourself" "don't be afraid to trust" are equivalent to medical remedies, I'll believe that psychotherapy is nothing beyond seat-of-the-pants faith healing. http://disequilibrium1.wordpress.com/