The image of an afflicted patient lying on a couch, detailing problems to a thoughtful psychiatrist, has long been associated with American mental health care.
But, as The New York Times reports, that type of psychiatric treatment is becoming less and less common.
The shift in medicine from individual practices toward health maintenance organizations and other managed health plans has spurred a push toward economies of scale–more patients, less time and less intimacy between doctor and patient, regardless of the malady. For psychiatrists, this has meant that the use of talk therapy, popularized by Sigmund Freud, has diminished.
Instead, brief consultations with patients have become the norm, said Dr. Steven S. Sharfstein, former president of the American Psychiatric Association and currently the chief executive of Sheppard Pratt Health System. “They check up on people; they pull out the prescription pad; they order tests.”
Insurance companies’ reimbursement practices explain much of the shift. Psychiatrists might earn $90 for a single 45-minute talk therapy session, versus $150 for seeing three patients regarding prescriptions during the same amount of time.
Another reason for the change is that other professionals –namely, psychologists and social workers, who do not attend medical school and cannot prescribe drugs– counsel people at lower costs than psychiatrists, and without any demonstrated drop-off in effectiveness.
Yet the changes in the field have meant that as a whole, mental health patients are receiving less psychotherapy, even though some studies show it to be as good or better than prescription drugs. Fewer than half of all depression patients receive talk therapy, while it used to be the overwhelming majority.
Also, according to a government survey from 2005, just 11 percent of psychiatrists treated all of their patients with talk therapy sessions. According to the Times, the proportion likely has fallen even further since.
Psychiatrists complain that the shift toward medication has turned them into little more than dispensers of drugs. “I miss the mystery and intrigue of psychotherapy,” Dr. Donald Levin told the Times. “Now I feel like a good Volkswagen mechanic. I’m good at it, but there’s not a lot to master in medications.”
