MIDTERM PAPER: ANALYSIS INVOLVING FIRST TWO THREE UNITS
(Title Omitted on Purpose)
Author: Brandon Gaudiamo (10/30/13 NY Times) Brandon A. Gaudiano is a clinical
psychologist and professor of psychiatry and human behavior at the Alpert Medical School at
Brown University.
PSYCHOTHERAPY is in decline. In the United States, from 1998 to 2007, the number of
patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent,
while the number receiving medication alone increased by 23 percent. This is not necessarily for
a lack of interest. A recent analysis of 33 studies found that patients expressed a three-timesgreater preference for psychotherapy over medications.
As well they should: for patients with the most common conditions, like depression and anxiety,
empirically supported psychotherapies — that is, those shown to be safe and effective in
randomized controlled trials — are indeed the best treatments of first choice. Medications,
because of their potential side effects, should in most cases be considered only if therapy either
doesn’t work well or if the patient isn’t willing to try counseling.
So what explains the gap between what people might prefer and benefit from, and what they get?
The answer is that psychotherapy has an image problem. Primary care physicians, insurers, policy
makers, the public and even many therapists are largely unaware of the high level of research
support that psychotherapy has. The situation is exacerbated by an assumption of greater
scientific rigor in the biologically based practices of the pharmaceutical industries — industries
that, not incidentally, also have the money to aggressively market and lobby for those practices.
For the sake of patients and the health care system itself, psychotherapy needs to overhaul its
image, more aggressively embracing, formalizing and promoting its empirically supported
methods.
My colleague Ivan W. Miller and I recently surveyed the empirical literature on psychotherapy in
a series of papers we edited for the November edition of the journal Clinical Psychology Review.
It is clear that a variety of therapies have strong evidentiary support, including cognitivebehavioral, mindfulness, interpersonal, family and even brief psychodynamic therapies (e.g., 20
sessions).
In the short term, these therapies are about as effective as medications in reducing symptoms of
clinical depression or anxiety disorders. They can also produce better long-term results for
patients and their family members, in that they often improve functioning in social and work
contexts and prevent relapse better than medications.
Given the chronic nature of many psychiatric conditions, the more lasting benefits of
psychotherapy could help reduce our health care costs and climbing disability rates, which
haven’t been significantly affected by the large increases in psychotropic medication prescribing
in recent decades.
Psychotherapy faces an uphill battle in making this case to the public. There is no Big Therapy to
counteract Big Pharma, with its billions of dollars spent on lobbying, advertising and research and
development efforts. Most psychotherapies come from humble beginnings, born from an initial
insight in the consulting office or a research finding that is quietly tested and refined in larger
studies.
The fact that medications have a clearer, better-marketed evidence base leads to more reliable
insurance coverage than psychotherapy has. It also means more prescriptions and fewer referrals
to psychotherapy.
But psychotherapy’s problems come as much from within as from without. Many therapists are
contributing to the problem by failing to recognize and use evidence-based psychotherapies (and
by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance
among psychotherapists to make the hard choices about which therapies are effective and which
— like some old-fashioned Freudian therapies — should be abandoned.
There is a lot of organizational catching up to do. Groups like the American Psychiatric
Association, which typically promote medications as treatments of first choice, have been
publishing practice guidelines for more than two decades, providing recommendations for which
treatments to use under what circumstances. The American Psychological Association, which
promotes psychotherapeutic approaches, only recently formed a committee to begin developing
treatment guidelines.
Professional psychotherapy organizations also must devote more of their membership dues and
resources to lobbying efforts as well as to marketing campaigns targeting consumers, primary
care providers and insurers.
If psychotherapeutic services and expenditures are not based on the best available research, the
profession will be further squeezed out by a health care system that increasingly — and rightly —
favors evidence-based medicine. Many of psychotherapy’s practices already meet such standards.
For the good of its patients, the profession must fight for the parity it deserves.
ANSWER THE FOLLOWING QUESTIONS:
1. Is the context of this article valid? (hint: Author? Source? Current?
2. State theme in one short sentence.
3. What does the article propose ?
4. What evidence does it offer?
5. In what way(s) if any is scientific research involved?
6. What is the author’s conclusion
7. Are you convinced, i.e. do you agree with his point of view? Cite evidence
from your readings, class presentation or videos