Why is talk therapy going out of favor?

Despite the evidence, a decline Between 1998 and 2007 the percentage of patients in outpatient mental health facilities receiving psychotherapy alone fell from 15.9 percent to 10.5 percent, while the percentage of patients receiving medication alone increased from 44.1 percent to 57.4 percent. Credit: Olfson & Marcus, 2010

Despite the evidence, a decline
Between 1998 and 2007 the percentage of patients in outpatient mental health facilities receiving psychotherapy alone fell from 15.9 percent to 10.5 percent, while the percentage of patients receiving medication alone increased from 44.1 percent to 57.4 percent. Credit: Olfson & Marcus, 2010

A special issue of Clinical Psychology Review examines the decline of talk therapies:

Psychotherapy has issues. Evidence shows that some psychosocial treatments work well for common mental health problems such as anxiety and depression and that consumers often prefer them to medication. Yet the use of psychotherapy is on a clear decline in the United States. In a set of research review papers in the November issue of the journal Clinical Psychology Review, psychologists put psychotherapy on the proverbial couch to examine why it’s foundering.

Their diagnosis? Much as in many human patients, psychotherapy has a combination of problems. Some of them are of its own making while some come from outside the field itself. Fundamentally, argue Brandon Gaudiano and Ivan Miller, Brown University professors of psychiatry and human behavior whose review paper introduces the section they edited, the psychotherapy community hasn’t defined, embraced, and articulated the ample evidence base clarifying their practice, while drug makers and prescribers have done so for medications. In a system of medicine and health insurance

that rewards evidence-based practice and looks upon biology as a more rigorous science, psychotherapy has lost ground among physicians, insurers and policymakers.

Starting in the 1950s Carl Rogers brought Pers...

Starting in the 1950s Carl Rogers brought Person-centered psychotherapy into mainstream focus. (Photo credit: Wikipedia)

“One might think that this deep and expanding evidence base would have promoted a similar increase in the use of psychosocial interventions that at least would have paralleled the one witnessed over the recent years by psychotropics, but it decidedly has not,” Gaudiano and Miller wrote. “Thus a time that should have been a relative boon for psychotherapy based on scientific standards has become more of a bust.”

Specifically, between 1998 and 2007 the proportion of patients in outpatient mental health facilities receiving psychotherapy alone fell from 15.9 percent to 10.5 percent, while the number of patients receiving medication alone increased from 44.1 percent to 57.4 percent, according to a 2010 study in the American Journal of Psychiatry. Depressed patients receiving both psychotherapy and medication fell from 40 percent to 32.1 percent. Psychotherapy was once in the picture for more than half such patients but is not now.

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