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.

Here’s the heart of the story:

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....


To read the rest, please, log onto my blog, Sacred Disorder.



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Comment by Julie Messer on March 7, 2011 at 11:37am

Mitch and Cliff,

I cannot think of a time when this will not be an issue for us. Based on societies focus on treating symptoms and not their causes who knows if we will ever be valued in the same manner as a psychiatrist let alone get paid at the same rate. After pursuing my passion in Ecology and being laid off and unable to find work I feel like I have again chosen a field I am passionate about and yet remain deeply worried about paying off my student loans and making ends meat! I find myself torn between wanting to help the community and work in the non-profit sector but needing to go into private practice where I will hopefully get paid a little bit more. At least we love what we do which makes it al worth it!!!

Comment by Cliff Bostock on March 7, 2011 at 11:21am

Hey, Mitchell. Yeah, I laughed out loud when I came to the phrase "worried wealthy." I couldn't decide if the writer was being intentionally snarky or suffers the tunnel vision of privileged Manhattan residents.

I believe we swapped mail some time ago and I think it's a good thing you're working toward licensure, despite the insurance company problem. I graduated from my clinical master's program just as the state radically revised the licensure law, so that hundreds of us did not qualify for practice. I went to court twice over my right to practice and both times the state dropped the case, simply disappearing.

I found the work I was doing outside the paradigm of most psychotherapy much more effective with my clientele of mainly creative types. In retrospect, it would have been better for me to pursue a clinical PhD at Pacifica, since the economy has leveled a lot of "alternative" care.


Comment by Mitchell Foy on March 7, 2011 at 7:24am

Cliff, this is a timely subject as I watch my traineeship site struggle financially, bending over backwards to please insurance companies so they can be reimbursed for services rendered to people who cannot afford to pay out of pocket. As I approach my graduation I am concerned about finding work that will nurture my interests and abilities while paying the bills and of course provide me with hours for liscensure. I'm thinking there are no well worn paths into the woods that I will want to walk on.


BTW, the Time's use of "worried wealthy" feels like a bias that sticks in my craw. We are all potentially in need of assistance regardless of our financial status. The overcharging psychiatrist and the extremely wealthy do make uncomfortably strange dance partners though.

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