Well Being

Psychologists Make It Hard For Patients To Embrace Talk Therapy

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Psychologists are having trouble drumming up business not because psychology has a “branding problem” but because they refuse to let go of outdated talk therapy models and embrace evidence-based mental health treatments, writes Maia Szalavitz at Time. As someone with a little experience in the mental health care system, I couldn't agree more.

The very very very important point that Szalavitz makes is that it's really had for patients today to find therapists willing to give them the treatment they need. She's writing in response to an article in the Sunday New York Times from psychotherapist Lori Gottlieb — yes, that would be the same Lori Gottlieb who wants you to just settle already — who hired a branding consultant when she was having trouble drumming up patients for her therapy practice.

Gottlieb and many psychologists see therapy “in a more ‘Woody Allen' mode, like the endless sessions of psychoanalysis practiced in the 1950s and 1960s,” writes Szalavitz.

“She wants to explore ‘unconscious feelings' about other people transferred to the ‘blank slate' of the therapist and to provide the ‘opportunity' for a patient to ‘truly understand himself and, ultimately, change.'


But psychological research on effective treatment for disorders like depression, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder and the like has moved far beyond this view.  Indeed, the most effective treatments for these conditions do not prioritize digging into the unconscious.  As Yale psychologist Alan Kazdin put it when we discussed a 2011 article he wrote on the problems with individual talk therapy, “If you want to get over an anxiety disorder, do graduated exposure. But sit down and relate to me or love me like your mom and dad? There’s no evidence for that.”

Szalavitz concludes that “Psychotherapy doesn’t have an “image problem”: it has an evidence problem.”

The lack of embrace for these evidence-based methods — graduated exposure for anxiety disorders,  dialectical behavior therapy for borderline personality disorder, cognitive behavioral therapy (CBT) for everything from mood and anxiety disorders to eating disorders, personality disorders and psychosis — is evident if you've ever searched for a therapist. I've been seeing mental health professionals about depression since 2008, during which time I've moved all over the place and switched health insurance plans a few times. I've had to look for a quite a lot of psychiatric doctors as a result, and one thing I've noticed is that you're given very little to go on when choosing between them.

In writing about health for a living, dealing with my own mental health issues and reading the psychiatric memoirs that are, like, one of my favorite literary genres, I've learned quite a bit about what in vogue in terms of treatment. So I've actually tried to look up psychologists in various cities based on different therapy methods, with very little success.

While the insurance company booklet might tell you a doctor specializes in “mood disorders,” you have no idea if they're going to want to try CBT, talk about your last relationship or hear about your dreams. And the doctors' or health groups' websites themselves are often no better. Unless someone super-specializes in one type of therapy, you're unlikely to see anything about their treatment methods or beliefs at all. I've given up and just gone with a psychiatrist and a Wellbutrin prescription several times because at least I know what I'm getting into that way.

Maybe that is a branding issue — this isn't the 1960s, and people don't want to just blindly go into therapy. Psychologists and counselors should get better about communicating with potential patients what kind of treatment philosophies they prescribe to and what the patient can expect.

But it seems like it's also an issue of too few doctors being willing to let go of the therapeutic profession as they imagined it and embrace new ideas about psychology and therapy. Szavalitz points to a comment on Gottlieb's original piece that illustrates the problem well:

I have serious OCD. I spent more than a month on a fruitless search for a new therapist who practices ERP (exposure and [response prevention]). It is the only treatment recommended by the Obsessive Compulsive Foundation and other organizations, and it is the treatment with which I have had the most success. And yet, here I am, in a city with perhaps the highest number of therapists per capita, and I am unable to find an ERP therapist who takes insurance. Instead, I’ve encountered therapists who claim to treat OCD with everything from traditional talk therapy and hypnotism.