This page contains brief articles for people exploring the
possibility of psychotherapy. You can choose from the list
below or simply scroll down.
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 dru
g 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 p
sychotherapy 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
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
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.