Second Session: Psychiatry, Talk and Drug Therapy
To the Editor:
As “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” (“Doctors Inc.” series, front page, March 6) noted, decades of research have shown that psychotherapy, now eschewed for financial reasons by many practicing psychiatrists, is often as effective as psychotropic drugs — if not more so, as in the treatment for depression.
There is something inherently wrong with a health care system that allows a practitioner to earn more for three 15-minute prescription-writing sessions than for a 45-minute therapy session that teaches patients lifelong coping skills and has no adverse physical side effects.
What is of great concern with the current treatment situation, driven in large measure by the pharmaceutical and health insurance industries, is the diminished quality of care provided to patients. While many of the new psychotropic drugs have proved effective, taking a pill is not always the answer to a mental health problem.
I was heartened to read that Dr. Donald Levin recommends that his patients see a psychologist for psychotherapy, in addition to receiving medications from him. But I must take issue with the article’s statement that psychologists “can often afford to charge less” than psychiatrists because they did not go to medical school.
To earn a doctorate in health service psychology, one must complete five to seven years of graduate academic and clinical work, including a yearlong supervised internship — a rigorous regimen on a par with medical school.
More important, psychotherapy is often the treatment of choice, and it is a travesty that the current health care system promotes medication over psychotherapy regardless of what is in the best interest of the patient.
Norman B. Anderson
Chief Executive
American Psychological Association
Washington, March 7, 2011
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To the Editor:
Kudos for telling like it is. Patients who consult psychiatrists often receive little more than a diagnostic label and a prescription, not because it is optimal care but because economic pressures are turning psychiatry practices into assembly lines. At least Dr. Donald Levin knows this and encourages his patients to get psychotherapy from someone else.
What the article does not say is that the same economic pressures are also transforming psychology practices into assembly lines. Once, psychologists worked to understand their patients deeply and to help them better understand themselves. This kind of therapy — known as psychodynamic therapy — offers meaningful and lasting help.
Nevertheless, fewer and fewer psychologists are trained to provide this kind of in-depth therapy or even understand how or why it is helpful. Instead, they are being trained to provide the brief, one-size-fits-all treatments that health insurers want to pay for.
Jonathan Shedler
Denver, March 6, 2011
The writer is an associate professor of psychiatry at the University of Colorado School of Medicine.
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To the Editor:
Your article points to horrible developments in psychiatry. But readers need to know that many psychiatrists and mental health professionals do not give in to insurance companies. We provide the best care available despite economic pressures because for many people exploring their situation in depth is essential.
Psychoanalysts are highly trained talk therapists. We charge appropriate fees, but most of us see some patients at lower rates when necessary. Most analytic institutes operate reduced-fee clinics staffed by advanced trainees.
The insurance companies’ fight against optimal care, in the mistaken belief that pushing pills saves money, must be addressed. In the meantime, patients need to know that there are able mental health professionals, many trained as psychoanalysts, available to provide the care they need.
Robert M. Galatzer-Levy
Chicago, March 6, 2011
The writer is the secretary of the American Psychoanalytic Association and a lecturer in psychiatry at the University of Chicago.
As “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy” (“Doctors Inc.” series, front page, March 6) noted, decades of research have shown that psychotherapy, now eschewed for financial reasons by many practicing psychiatrists, is often as effective as psychotropic drugs — if not more so, as in the treatment for depression.
There is something inherently wrong with a health care system that allows a practitioner to earn more for three 15-minute prescription-writing sessions than for a 45-minute therapy session that teaches patients lifelong coping skills and has no adverse physical side effects.
What is of great concern with the current treatment situation, driven in large measure by the pharmaceutical and health insurance industries, is the diminished quality of care provided to patients. While many of the new psychotropic drugs have proved effective, taking a pill is not always the answer to a mental health problem.
I was heartened to read that Dr. Donald Levin recommends that his patients see a psychologist for psychotherapy, in addition to receiving medications from him. But I must take issue with the article’s statement that psychologists “can often afford to charge less” than psychiatrists because they did not go to medical school.
To earn a doctorate in health service psychology, one must complete five to seven years of graduate academic and clinical work, including a yearlong supervised internship — a rigorous regimen on a par with medical school.
More important, psychotherapy is often the treatment of choice, and it is a travesty that the current health care system promotes medication over psychotherapy regardless of what is in the best interest of the patient.
Norman B. Anderson
Chief Executive
American Psychological Association
Washington, March 7, 2011
•
To the Editor:
Kudos for telling like it is. Patients who consult psychiatrists often receive little more than a diagnostic label and a prescription, not because it is optimal care but because economic pressures are turning psychiatry practices into assembly lines. At least Dr. Donald Levin knows this and encourages his patients to get psychotherapy from someone else.
What the article does not say is that the same economic pressures are also transforming psychology practices into assembly lines. Once, psychologists worked to understand their patients deeply and to help them better understand themselves. This kind of therapy — known as psychodynamic therapy — offers meaningful and lasting help.
Nevertheless, fewer and fewer psychologists are trained to provide this kind of in-depth therapy or even understand how or why it is helpful. Instead, they are being trained to provide the brief, one-size-fits-all treatments that health insurers want to pay for.
Jonathan Shedler
Denver, March 6, 2011
The writer is an associate professor of psychiatry at the University of Colorado School of Medicine.
•
To the Editor:
Your article points to horrible developments in psychiatry. But readers need to know that many psychiatrists and mental health professionals do not give in to insurance companies. We provide the best care available despite economic pressures because for many people exploring their situation in depth is essential.
Psychoanalysts are highly trained talk therapists. We charge appropriate fees, but most of us see some patients at lower rates when necessary. Most analytic institutes operate reduced-fee clinics staffed by advanced trainees.
The insurance companies’ fight against optimal care, in the mistaken belief that pushing pills saves money, must be addressed. In the meantime, patients need to know that there are able mental health professionals, many trained as psychoanalysts, available to provide the care they need.
Robert M. Galatzer-Levy
Chicago, March 6, 2011
The writer is the secretary of the American Psychoanalytic Association and a lecturer in psychiatry at the University of Chicago.
