Is talk therapy going silent?
Not entirely, but the Saturday edition of the New York Times featured an article entitled “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy.” This is very old news to anyone in the mental health field — as a patient or practitioner. But it’s good to see that The Times has noticed.
Recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression, but fewer than half of depressed patients now get such therapy compared with the vast majority 20 years ago. Insurance company reimbursement rates and policies that discourage talk therapy are part of the reason. A psychiatrist can earn $150 for three 15-minute medication visits compared with $90 for a 45-minute talk therapy session.
Competition from psychologists and social workers — who unlike psychiatrists do not attend medical school, so they can often afford to charge less — is the reason that talk therapy is priced at a lower rate. There is no evidence that psychiatrists provide higher quality talk therapy than psychologists or social workers.
Of course, there are thousands of psychiatrists who still offer talk therapy to all their patients, but they care mostly for the worried wealthy who pay in cash. In New York City, for instance, a select group of psychiatrists charge $600 or more per hour to treat investment bankers, and top child psychiatrists charge $2,000 and more for initial evaluations.
The truth is that psychotherapy of any type has become unaffordable to the average American without insurance. Of course, this is true of all health care now, but the insurance companies, through “managed care,” have become particularly stingy about psychological services, whether delivered by an MD, an MSW or a PhD....
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