Have American Psychiatrists Given Up on Psychotherapy?

Psychiatric Times recently featured two responses to a 5 March 2011 piece in The New York Times that outlined what it called “the switch from talk therapy to medications” among practicing psychiatrists in the United States.  The New York Times article cites a 2005 government purportedly finding “that just 11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since. Psychiatric hospitals that once offered patients months of talk therapy now discharge them within days with only pills.”

Two psychiatrists and contributing writers to Psychiatric Times, however, expand upon and take issue with at least some of the portrait painted by the news story.   Ronald Pies (editor in chief emeritus of Psychiatric Times and professor in the psychiatry departments of SUNY Upstate Medical University and Tufts University School of Medicine) agrees that “the declining use of psychotherapy in psychiatric practice is unquestionably worrisome,” noting that the shift away from psychotherapy between 1996 and 2005 has coincided with changes in reimbursement, managed care, and medication prescriptions.  What The New York Times article neglected to mention, he argues, however, was that evidence shows that most psychiatrists provide psychotherapy to at least some of their patients.  Moreover, the 2005 study defined “psychotherapy” in such a narrow fashion as to leave out forms of “very brief psychotherapy” (J. Gustafson) as well as other forms of patient contact.

James Knoll IV (editor-in-chief of Psychiatric Times, and director of forensic psychiatry at SUNY Upstate Medical University), in his response, rejects what he refers to as “the implications that psychiatrists must now ‘play the game,’ and resign themselves to a bleak future of harried pill dispensing.” Instead, he encourages colleagues and students to consider taking up the historical mission of caring for those in institutional settings, albeit under the changed circumstances of today:

Many of our patients have been relocated. Jails now house more persons with serious mental illness than do psychiatric hospitals. Perhaps we might consider a return to the original ideals of our path–the care and well being of persons suffering with serious mental illness, and especially the many who are now in our ‘new asylums.’ The fact is that such jobs are plentiful, lucrative and rewarding. One can practice without any false partitions. Medical concerns, medications, psychotherapy-– all may be attended to by the psychiatrist. The patients are grateful for competent care, and time constraints are far less of an issue. Here is a noble calling and return to psychiatry’s roots. There is great honor in following this path that was originally traveled by names such as Rush, Ray, Pinel, and Menninger, among many others.

Keep in mind, you must register to read articles in Psychiatric Times, but registration is free.

One thought on “Have American Psychiatrists Given Up on Psychotherapy?

  1. clarespark says:

    Please see http://clarespark.com/2010/02/10/a-brooding-meditation-on-intimacy-and-distance/, especially the introductory remarks on Roy Grinker’s aim for “stability” rather than cure. The material above does not adequately deal with the long-term objectives of psychiatric treatment and the rhyming with other institutional objectives that similarly aim for “stability.”
    For and index to my other blogs on military psychiatry as a model for non-military methods, see http://clarespark.com/2010/04/22/links-to-blogs-on-military-psychiatry/.

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