Freudian Falloff

Share this article

Are Freudian analyses of the human mind becoming a thing of the past? A new study released this month finds that psychiatric practices are increasingly opting for medical therapies over the traditional “couch talks” that once symbolized this mental health profession.

Those consumers continuing to seek counseling are increasingly moving away from the psychiatry for counseling, preferring more non-medical approaches—partially because “managed care” such as HMO’s reimburse psychiatrists more for a 15 minute prescription session than for 45 minutes of psychotherapy.

Two researchers from Columbia University and Beth Israel Medical Center found the percentage of psychiatric visits involving “psychotherapy” declined from 44.4% to 28.9% between 1996 and 2005.

Those practices providing psychotherapy for all of their patients halved in the last ten years, from 19.1% in 1996-1997 to a mere 10.8% for the 2004-2005 period, the researchers point out in their study which appeared in the Archives of General Psychiatry.

Psychotherapy in this case was defined by using the National Ambulatory Medical Care Survey (NAMCS) definition, as “treatments involving the intentional use of verbal techniques to explore or alter the patient’s emotional life in order to effect symptom reduction or behavior change.” Sessions were only considered psychotherapeutic if they were explicitly designated as such by the psychiatrist and lasted 30 minutes or more.

The professors attributed changes in psychiatry to several trends within healthcare:

• ongoing managed care (HMO) incentives for medications rather than psychotherapy;
• demand “fostered by aggressive pharmaceutical campaigns;”
• “increased public awareness of common mental disorders;”
• the “availability of new medications with fewer address effects;” and
• “greater public receptivity toward mental health treatments.”

The move away from traditional psychotherapy (counseling) sessions and toward pharmacotherapy (medicating) may also be the product of philosophical changes within academic circles, argue Doctors Ramin Mojtabai and Mark Olfson. Dr. Ramin Mojtabai is now an associate professor at Johns Hopkins University. They write,

“In some [residency training] programs, influential role models in academic psychiatry have turned away from providing psychotherapy, partly because of financial disincentives built into contemporary academic practice pay plans. Furthermore, many psychotherapeutically-oriented psychiatrists serve as volunteer rather than core faculty members…If these trends continue in the coming years, the ranks of psychotherapeutically oriented psychiatrists will continue to diminish and office-based psychiatry will become increasingly dominated by psychiatrists who specialized in pharmacotherapy.”

In such a culture shift, new psychiatrists would be predisposed towards doling out psychotropic medication rather than talking with their patients, encouraging them to adopt new habits, mental processes, and lifestyles.

Despite the authors’ dire predictions for the “diminishing” influence of psychotherapy and the substitution of psychotherapy, psychiatrists may actually be moving to an integrated model of therapy rather than an all-or-nothing pill-intensive service. As the authors point out near the end of their article, “National Trends in Psychotherapy by Office-Based Psychiatrists,” their definition of psychotherapy may actually be too restrictive.

“Some visits likely involved use of psychotherapeutic techniques but were not classified as psychotherapy in the current analysis,” write the authors. They continue,

“Psychotherapeutic techniques can be effectively taught and used in brief medication management visits by psychiatrists and other health care providers. Future research might examine the extent to which brief visits by psychiatrists include such well-defined elements of psychotherapy.”

Overall, the authors only make modest claims about their research, calling the study a “broad picture of nation trends.”

Bethany Stotts is a staff writer at Accuracy in Academia.