This page contains brief articles for people
exploring the possibility of psychotherapy.
You can choose from the list below or simply
Psychotherapy: No Side Effects
The Freedom to Choose Your Doctor
Psychotherapy: No Side Effects
I don't watch much television, but now and then I notice one of those
commercials for psychiatric medication promising relief from anxiety,
depression, and other distressing conditions. The ads always end with a
long list of possible side effects, including some rather frightening ones.
These are glossed over in a soft-spoken, rapid-fire delivery that contrasts
sharply with the hopeful portrayals and enthusiastic endorsements
presented a few seconds earlier.
Despite the guise of offering help, it is easy to appreciate the profit
motive of the drug companies sponsoring these ads. They are attempting
to sell happiness, more or less in the same way that manufacturers of
luxury cars or stain-resistant carpeting do: we have a product that will
change your life—for the better!
And, despite the threat of side effects, these ads are quite successful,
with more than $40 billion in psychiatric drug sales in 2008. This, too, is
understandable. Both legal and illegal drugs appeal to those who would
like a quick, convenient solution to their unhappiness and who presume
that addiction and other complications happen only to other people. A
prescription can often be obtained from a familiar and trusted primary
care physician, so one doesn't need to see a psychiatrist and think of
oneself as a "mental case." Nor need one consult a psychologist to
investigate the causes of distress or explore better ways to cope.
Although medication has an important role to play in mental health, that
role should not be determined by the sales goals of marketing
departments manipulating the demand for their product. A wise use of
medication presupposes a careful history and assessment, a thoughtful
weighing of risks and benefits, and regular monitoring of results. Wiser
still would be to appreciate the role psychotherapy can play, both instead
of and as a complement to medication.
The huge success of the drug company advertising campaigns has left
most people with the impression that medication is the up-to-date remedy
for emotional distress. They have been sold on the idea that their troubles
stem from a "chemical imbalance," the solution to which, of course,
involves rebalancing their chemicals, just like diabetics taking insulin. As
plausible as this clichéd description sounds, it has no scientific support.
Despite intense research efforts, no biological cause for even the most
serious mental illnesses has been demonstrated.
Scientific journals and professional books increasingly document the
superiority of psychotherapy over medication for many people, but their
audience is small. Occasionally, the general media report on this issue,
as The New York Times did last year when Elissa Ely described how
experienced psychiatrists having their own life crises apparently still
prefer the wisdom and insight of experts in psychotherapy over the
marvels in the medicine cabinet. Surprised that doctors hesitate to rely
on pills? I'm not. The talking cure remains the most complete and
desirable route to recovery for the vast majority of emotional problems.
For every person who read that article, or others like it, there are probably
a hundred exposed to pharmaceutical marketing. Sadly, there is no
competition to the drug ads on television permitting the public to hear an
alternative point of view. There are no equivalents to Big Pharma buying
time to talk about how weak the evidence is for the effectiveness of
psychiatric medication (especially in the long term), how devastating the
side effects can be, and how much solid research supports the
effectiveness of psychotherapy. And, of course, there is no quiet voice at
the end to point out that the talking cure has no side effects.
The Freedom to Choose Your Doctor
Beginning in 2010, the new federal parity law mandates the end of
discrimination by insurance companies against people seeking mental
health services. In prior years, it was legal to put arbitrary limits on the
number of visits allowed, and to reimburse you at a lower rate (as well as
make you pay a separate deductible) for mental health office visits.
These obstacles made people reluctant to use the out-of-network
coverage their insurance provided. It was much cheaper to stay in-
network, make a co-payment for each visit, and not have to meet a
deductible. But the trade-off was significant: you couldn't see any doctor
you wanted (he or she had to participate with your plan), and oftentimes, if
your insurance changed, you faced a dilemma: pay out of pocket to the
doctor who knows and understands you, or start over with someone else
in your new insurance plan.
A little-publicized fact is that, because of the parity law, your out of pocket
cost may now be about the same whether you remain in-network or not.
That's because the law requires insurance companies to reimburse you at
the same rate for both physical and mental health. Policies vary
enormously, and HMOs permit no out-of-network care, but a common
feature of many policies is to reimburse 80% of out-of-network costs.
Here's a hypothetical example to illustrate what to expect under parity.
Let's say your in-network co-payment is $25 for mental health treatment. If
you are reimbursed at 80%, you could afford to see an out-of-network
doctor who charged up to $125 per visit—and still pay the same $25
(20% of $125).
Why is that important? Because now you have a choice. You can see the
person your relative or friend recommended without having to worry if he
or she is on your insurance company's panel. Picking a name out of a
"Directory of Participating Providers" is like picking a name out of the
Yellow Pages—most people are more comfortable choosing on the basis
of a recommendation or researching the qualifications and experience of
the doctor they decide on.
My advice: Don't choose a psychotherapist with less care than you would
a financial advisor or an attorney. Check with your insurance company
about your out-of-network coverage under the mental health parity law
(some exceptions apply), and then look for the best qualified person you
can find. When it comes to psychotherapy, psychologists are the most
highly trained mental health professionals.