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Sean Hoel
Lindenwood University




The number of patients in outpatient mental
health facilities receiving psychotherapy has
dropped by 34% while the number receiving
medication has increased by 23% (Gaudiano,
2013).
The estimated number of Americans
receiving outpatient mental health treatment
increased from approximately 16.1 million in
1998 to 23.3 million in 2007. (Olfson &
Marcus, 2010)




There were significant declines in the
percentages of mental health outpatients
who were treated with psychotherapy alone
and of those treated with a combination of
psychotherapy and psychotropic medication.
Across all mental health outpatients, there
was a significant increase in the percentage
who received psychotropic medication
without psychotherapy. (Olfson & Marcus,
2010)
The average effect size for psychotherapy was
0.85, indicating that treated patients were
better off than 80% of untreated control
subjects.” (Joyce et al., 2006)
 The high response (70%) and remission rates
(49%) and the low relapse rates (13% in a 12month period) may reflect the high intensity of
the multicomponent treatment program
(Schramm, Dietrich, Dykierek, Lieb, & al, e.,
2007)

More people are seeking mental help than ever
More people are receiving antidepressant drugs
than ever
 Medication is NOT the most effective treatment
for psychopathology
 Medication in combination with psychotherapy
IS the most effective treatment
 Why is this not the most prevalent type of
treatment then?







The problem resides in the failure to
recognize and use evidence-based methods
Failure to abandon older Freudian techniques
Lack of exposure that psychotherapy has to
the public
There is not “Big Therapy” to counteract the
“Big Pharm”




Medications have better marketed evidence,
meaning their empirical findings are much
more easily available to the general public
than psychotherapeutic results
Transfers directly to more reliable insurance
coverage, which in turn translates into more
prescriptions and less psychotherapy
referrals




Many therapists do not use the empirically
supported methods of psychotherapy; use
outlandish old-fashioned Freudian methods
that should be abandoned in this era
No equivalence between American
Psychiatric Association and American
Psychological Association









Consistent practice amongst peers in the field
Financial support and marketing
Organization equivalence between APAs
Make information easily accessible to public
Financial incentives (insurance coverage)
Powerful endorsement like FDA
Continue to empirically prove that it is an
effective method








Guadiano, Brandon. (2013). Psychotherapy’s image problem. New York
Times. Retrieved from
http://www.nytimes.com/2013/09/30/opinion/psychotherapys-imageproblem.html?src=me&ref=general&_r=0
Joyce, A. S., Wolfaardt, U., Sribney, C., & Aylwin, A. S. (2006).
Psychotherapy research at the start of the 21st century: The persistence
of the art versus science controversy. Canadian Journal of Psychiatry,
51(13), 797-809. Retrieved from
http://search.proquest.com/docview/222797971?accountid=12104
Olfson, Mark,M.D., M.P.H., & Marcus, S. C., PhD. (2010). National trends
in outpatient psychotherapy.The American Journal of Psychiatry, 167(12),
1456-63. Retrieved from
http://search.proquest.com/docview/816090016?accountid=12104
Schramm, E., Dietrich, v. C., Dykierek, P., Lieb, K., & al, e. (2007). An
intensive treatment program of interpersonal psychotherapy plus
pharmacotherapy for depressed inpatients: Acute and long-term results.
The American Journal of Psychiatry, 164(5), 768-77. Retrieved from
http://search.proquest.com/docview/220475472?accountid=12104

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Psychotherapy and its modern image problem presentation, sean hoel

  • 2.   The number of patients in outpatient mental health facilities receiving psychotherapy has dropped by 34% while the number receiving medication has increased by 23% (Gaudiano, 2013). The estimated number of Americans receiving outpatient mental health treatment increased from approximately 16.1 million in 1998 to 23.3 million in 2007. (Olfson & Marcus, 2010)
  • 3.   There were significant declines in the percentages of mental health outpatients who were treated with psychotherapy alone and of those treated with a combination of psychotherapy and psychotropic medication. Across all mental health outpatients, there was a significant increase in the percentage who received psychotropic medication without psychotherapy. (Olfson & Marcus, 2010)
  • 4. The average effect size for psychotherapy was 0.85, indicating that treated patients were better off than 80% of untreated control subjects.” (Joyce et al., 2006)  The high response (70%) and remission rates (49%) and the low relapse rates (13% in a 12month period) may reflect the high intensity of the multicomponent treatment program (Schramm, Dietrich, Dykierek, Lieb, & al, e., 2007) 
  • 5. More people are seeking mental help than ever More people are receiving antidepressant drugs than ever  Medication is NOT the most effective treatment for psychopathology  Medication in combination with psychotherapy IS the most effective treatment  Why is this not the most prevalent type of treatment then?  
  • 6.     The problem resides in the failure to recognize and use evidence-based methods Failure to abandon older Freudian techniques Lack of exposure that psychotherapy has to the public There is not “Big Therapy” to counteract the “Big Pharm”
  • 7.   Medications have better marketed evidence, meaning their empirical findings are much more easily available to the general public than psychotherapeutic results Transfers directly to more reliable insurance coverage, which in turn translates into more prescriptions and less psychotherapy referrals
  • 8.   Many therapists do not use the empirically supported methods of psychotherapy; use outlandish old-fashioned Freudian methods that should be abandoned in this era No equivalence between American Psychiatric Association and American Psychological Association
  • 9.        Consistent practice amongst peers in the field Financial support and marketing Organization equivalence between APAs Make information easily accessible to public Financial incentives (insurance coverage) Powerful endorsement like FDA Continue to empirically prove that it is an effective method
  • 10.     Guadiano, Brandon. (2013). Psychotherapy’s image problem. New York Times. Retrieved from http://www.nytimes.com/2013/09/30/opinion/psychotherapys-imageproblem.html?src=me&ref=general&_r=0 Joyce, A. S., Wolfaardt, U., Sribney, C., & Aylwin, A. S. (2006). Psychotherapy research at the start of the 21st century: The persistence of the art versus science controversy. Canadian Journal of Psychiatry, 51(13), 797-809. Retrieved from http://search.proquest.com/docview/222797971?accountid=12104 Olfson, Mark,M.D., M.P.H., & Marcus, S. C., PhD. (2010). National trends in outpatient psychotherapy.The American Journal of Psychiatry, 167(12), 1456-63. Retrieved from http://search.proquest.com/docview/816090016?accountid=12104 Schramm, E., Dietrich, v. C., Dykierek, P., Lieb, K., & al, e. (2007). An intensive treatment program of interpersonal psychotherapy plus pharmacotherapy for depressed inpatients: Acute and long-term results. The American Journal of Psychiatry, 164(5), 768-77. Retrieved from http://search.proquest.com/docview/220475472?accountid=12104