Thoughts On Therapy

In our busy lives today most other problems that may occur (e.g., the kids, the house, the car, the bills etc.) get quicker and greater attention than do problems with our well-being. We sacrifice and struggle along hoping not to add any burden to those we love. While we do this the problems we are putting on the back burner can slowly grow and become entrenched, draining us of vital energy and enthusiasm to take on all the other challenges we face .

Continuing to drag the difficulties you may be having along can get in the way of each day feeling like a meaningful and welcome invitation to live your life fully. Changes, heartache, lack of confidence, anxiety, depression, relationship problems, important decisions, and other hurdles can show up in anyone's life. When these things take a toll on your contentment, satisfaction or optimal functioning it can be very helpful to have a supportive guide to go with you through a difficult time .

November 18, 2010 - Click this link for recent article on mental health needs.
Need for Mental Health Care May Be More Common Than You Think

December 2010 - Defining Moments brief video link below.
Actor Joe Pantaliano discusses personal experience of depression and treatment

December 19, 2010 - Mental health needs of college students in this link.
Mental health needs growing for college students

September 30, 2013 - The article below discusses medication vs. psychotherapy for treating common psychological problems. It highlights the gap in public awareness of the effectiveness of talk therapy which can be effective without and instead of medication in many cases and can also offer longer term gains as the client's understanding of and tools for coping with their challenges are increased. MPK

Psychotherapy’s Image Problem


Published: September 29, 2013

A version of this op-ed appears in print on September 30, 2013, on page A25 of the New York edition with the headline: Psychotherapy’s Image Problem 
PROVIDENCE, R.I. — PSYCHOTHERAPY is in decline. In the United States, from 1998 to 2007, the number of patients in outpatient This is not necessarily for a lack of interest. A recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medications.

As well they should: for patients with the most common conditions, like depression and anxiety, empirically supported psychotherapies — that is, those shown to be safe and effective in randomized controlled trials — are indeed the best treatments of first choice.
 Medications, because of their potential side effects, should in most cases be considered only if therapy either doesn’t work well or if the patient isn’t willing to try counseling.

So what explains the gap between what people might prefer and benefit from, and what they get?

The answer is that psychotherapy has an image problem. Primary care physicians, insurers, policy makers, the public and even many therapists are largely unaware of the high level of research support that psychotherapy has. The situation is exacerbated by an assumption of greater scientific rigor in the biologically based practices of the pharmaceutical industries — industries that, not incidentally, also have the money to aggressively market and lobby for those practices.

For the sake of patients and the health care system itself, psychotherapy needs to overhaul its image, more aggressively embracing, formalizing and promoting its empirically supported methods.

My colleague Ivan W. Miller and I recently  surveyed the empirical literature on psychotherapy in a series of papers we edited for the November edition of the journal Clinical Psychology Review. It is clear that a variety of therapies have strong evidentiary support, including cognitive-behavioral, mindfulness, interpersonal, family and even brief psychodynamic therapies (e.g., 20 sessions).

In the short term, these therapies are about as effective as medications in reducing symptoms of clinical depression or anxiety disorders. They can also produce better long-term results for patients and their family members, in that they often improve functioning in social and work contexts and prevent relapse better than medications.

Given the chronic nature of many psychiatric conditions, the more lasting benefits of psychotherapy could help reduce our health care costs and climbing disability rates, which haven’t been significantly affected by the large increases in psychotropic medication prescribing in recent decades.

Psychotherapy faces an uphill battle in making this case to the public. There is no Big Therapy to counteract Big Pharma, with its billions of dollars spent on lobbying, advertising and research and development efforts.

The fact that medications have a clearer, better marketed evidence base leads to more reliable insurance coverage than psychotherapy has. It also means more prescriptions and fewer referrals to psychotherapy.

But psychotherapy’s problems come as much from within as from without. Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which — like some old-fashioned Freudian therapies — should be abandoned.

There is a lot of organizational catching up to do. Groups like the American Psychiatric Association, which typically promote medications as treatments of first choice, have been publishing practice guidelines for more than two decades, providing recommendations for which treatments to use under what circumstances. The American Psychological Association, which promotes psychotherapeutic approaches, only recently formed a committee to begin developing treatment guidelines.
Professional psychotherapy organizations also must devote more of their membership dues and resources to lobbying efforts as well as to marketing campaigns targeting consumers, primary care providers and insurers.

If psychotherapeutic services and expenditures are not based on the best available research, the profession will be further squeezed out by a health care system that increasingly — and rightly — favors evidence-based medicine. Many of psychotherapy’s practices already meet such standards. For the good of its patients, the profession must fight for the parity it deserves.

Brandon A. Gaudiano is a clinical psychologist and assistant professor of psychiatry and human behavior at the Alpert Medical School at Brown University.

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