Is Psychotherapy Research The Answer?
Posted by Dr. Vollmer on July 22, 2015
“The brain is notoriously hard to study and won’t give up its secrets easily.”
Eleanor, a blog reader, pointed me to this article, reminding me that I am not alone in my fight against the reductionistic approach to mental illness, either by promising a magic bullet, in the form of a pill, or a procedure, such as Transcranial Magnetic Stimulation, or by the form of a short-term, cookbook type of psychotherapy. In this New York Times, opinion piece, Dr. Richard A. Friedman argues that more federal dollars should be directed towards psychotherapy research. He reminds us that Dr. Markowitz published a study on PTSD where the helpful treatment was Interpersonal Psychotherapy, as opposed to exposure therapy. In other words, people with trauma need to re-build their relationships, and not just desensitize themselves to their triggers. My issue here is that psychotherapy research, although potentially promising, does not account for the individual differences between psychotherapists, along with the individual differences in the length of treatment required. We share this issue with physical therapists, who also do not have good evidence for how many sessions are needed for a back or knee injury. The numbers become arbitrary and so the payments are helpful to some, but not to all with physical complaints. Likewise, if insurance pays for 12 psychotherapy sessions, then this will help some people, but for many people this will not suffice. Is some psychotherapy better than none? I think so, but for training purposes, the therapists need to learn long-term psychotherapy in order to use those skills in a shorter-term setting. Dr. Friedman only highlights our identity crisis further, which by that I mean, that promoting psychotherapy research could also send us down the rabbit’s hole. How do we justify our work, if we assume that people have deeply unconscious reasons for symptom formation, and as such, the length of treatment is not knowable, and the measure of success is also not knowable. Patients often sit with ideas that we have generated in my office for months and years before the concepts penetrate, allowing them to release themselves from their self-imposed shackles. Healing is slow and not steady. Dr. Friedman and I agree on this, I am sure. Where we part ways is how the government, or insurance companies should support our treatment. Funding neuroscience is only partly the answer. On this, we concur. Funding psychotherapy research is questionable in my mind, and hence our ideas diverge. My suggestion: Introduce patients in psychological pain to psychotherapy, paid for by insurance, with a limit of 20 sessions per year, so that the patient and the therapist can try to find a way to fund the other 30 sessions, knowing up front, that those 20 sessions may help with symptom relief, or it may not, and as such, the journey begins, but the endpoint is not known and it is not knowable.