What’s particularly alarming about the data is that
psychotherapy isn’t prescribed even in situations — such as
mild to moderate depression or sleep disorders — where we
know that psychotherapy and medication are equally effective
or effective if done in combination, says Katherine C. Nordal,
PhD, executive director of APA’s Practice Directorate. “We have
a society that wants a quick fix,” she says.
Psychiatry’s loss is psychology’s gain
Psychologists aren’t the only ones concerned
about the decline in psychotherapy’s use. In
a front-page story in The New York Times in
March (see www.nytimes.com/2011/03/06/
health/policy/ 06doctors.html), psychiatrists
revealed frustration about the decline in
psychotherapy within their own profession.
As the headline noted, “Talk doesn’t pay, so
psychiatry turns instead to drug therapy.”
That’s a travesty, APA Chief Executive
Officer Norman B. Anderson, PhD, said in a
response published in the Times (see www.
response.aspx). “There is something
inherently wrong with a health-care system
that allows a practitioner to earn more for
three 15-minute prescription-writing sessions
than for a 45-minute therapy session that
teaches patients lifelong coping skills and has
no adverse physical side effects,” he wrote.
The good news? Patients who need
psychotherapy will have to turn to
psychologists. In fact, Anderson notes, one
of the psychiatrists interviewed in the Times
article urges his patients to seek help from a
psychologist when they need therapy.
That’s even better news for patients, since
psychologists can get to patients’ root problems
instead of just relieving their symptoms, says
Katherine C. Nordal, PhD, executive director of
APA’s Practice Directorate.
“If you’re a medical doctor, and I come to
you with a pain in my gut, you want to solve
the pain in my gut,” she says. “If I come to you
with sleep disturbance, and there’s a pill you
can give me to make me sleep better, that’s
what you’re going to do. Psychiatrists tend to
be much more focused on symptom relief and
not so much on how to better equip patients to
handle their problems now and in the future.”
To help counter that trend, APA is developing a series of
treatment guidelines for the first time. Those guidelines aren’t
just for use by psychologists, Nordal emphasizes.
“The guidelines will allow us to present the evidence to
policymakers, insurance companies and other payers who make
decisions about what kind of treatment they’re going to pay
for,” she says. “It will allow us to say, ‘You know what? There’s
a huge evidence base for psychological interventions.’” The
guidelines will also help to inform consumers about the kinds
of treatments that work best for their problems, she adds.
In addition, the new guidelines will help correct the bias
in existing guidelines, such as those created by the American
Psychiatric Association, says Steven D. Hollon, PhD, who
chairs the Advisory Steering Committee that will oversee APA’s
Take the current treatment guideline for depression, for in-
stance. It’s not a bad guideline, says Hollon, but it’s a guideline de-
signed for practicing psychiatrists and so emphasizes medication.
“It’s like one of those maps of the United States done by New
Yorkers: New York dominates three-quarters of the page, and
the rest of the states are kind of off on the edge,” he says. “The
guideline has lots of coverage of pharmacological interventions,
which are generally quite effective and quite safe. It has much
briefer descriptions of psychotherapeutic approaches, which are
generally comparably effective, are even safer and often have
long-term enduring effects.”
While the topics to be covered in the treatment guidelines
are still undecided, Hollon predicts APA will produce one
guideline per year.
Another effort that may soon bear fruit is a resolution
highlighting psychotherapy’s effectiveness that APA President
Melba J. T. Vasquez, PhD, introduced at APA’s Council of
Representatives meeting in February 2010.
The resolution, which Vasquez and others are revising based
on feedback from colleagues, summarizes studies and meta-analyses of psychotherapy with various groups, treatment types
and other factors. (See sidebar for examples of studies that
may be included in the resolution.) Vasquez hopes the council
will approve it in 2012. APA staff and individual psychologists
can then use the document to educate insurance companies,
managed-care organizations and anyone else who makes policy
decisions about psychotherapy, she says.
Meanwhile, APA’s Mind/Body Health initiative continues
to work to educate the public and promote the value of
psychotherapy. Local and national outreach activities include
APA’s online Help Center, its annual Stress in America survey
and a partnership with the YMCA of the USA. APA’s Div. 29
is also busy advocating for psychotherapy, says Past President
Jeffrey J. Magnavita, PhD. To help build the evidence base and
draw attention to the area, the division’s new Norine Johnson
Psychotherapy Research Grant, for example, will award $20,000
to a psychologist conducting research on psychotherapy
effectiveness. The first grant will be awarded this year.