According to the New York Times, many psychiatrists who know perfectly well that talk therapy is a better option for their patients are under the financial gun because insurance companies won’t pay for them to develop a relationship with the people they’re supposed to heal. The result is psychiatrists who treat hundreds of patients in 15 minute intervals, adjusting doses for people they don’t really know at all.
The story follows Dr. Donald Levin, a psychiatrist who has been in private practice for nearly 40 years, as he deals with the personal and professional struggle to provide care for his patients. He and his colleagues confront a number of issues:
The over reliance on pharmaceuticals
The need for therapists, psychiatrists, and psychologists to be affordable to people of all incomes
The relationship between therapists, psychiatrists and psychologists and the insurance industry
All three of these issues have brought Dr. Levin and other psychiatrists to a place of having to choose between a long held tradition of talk therapy and the all mighty dollar. Generally they choose to follow the insurance companies’ lead.
Why has this become an issue? Insurance company reimbursement rates are cited as the primary reasons. Psychiatrists generally get $150 for a 15 minute medication visits and $90 for a 45 minute session. That math is pretty simple here.
With the growing evidence that antidepressants are no more effective than placebos, we are left to wonder why the insurance company places a higher monetary value on prescribing meds than providing therapy.
Certainly what most people who go to mental health professionals are really seeking is a therapeutic change that leads to positive and healthy changes in person. Carl Rogers, one of the great clinicians of the modern era, stated that for this change to occur the six elements must be present,
relationship between the client and therapy,
the clients’ vulnerability to anxiety
the therapists’ genuineness
the clients’ perception of the therapists’ genuineness
the therapist’s unconditional positive regard for the client
It would be difficult to provide this in a 15 minute session. Even in the scope of the better known behavioral therapies, the presence of the therapist with the client is important to help move them through their emotional pain.
Relationships between the doctor and the client have been shown to ease the mental and physical suffering of many. Even in this article Dr. Levin reflects on how many of his clients are grateful for even his short physical presence with them.
The article takes a jab at the insurance industry that is a source of the problem. The financial motivations of the industry have pushed some psychiatrists away from the foundation of their practice. It’s not really a death to talk therapy, but more like a threat.
Psychologists, MFT’s, social workers, licensed counselors are still able to provide a variety of therapies including talk therapies. Psychiatrists are still in a position to make the choice to be fully engaged with their clients and to manage their financial sustainability as well.
There are a few things that may be at stake here. One is the role of the psychiatrist. There may be a need to do some soul searching on what it means to be a psychiatrist and how that can help people live better lives. Another is the role of therapy in helping people recover. Therapy can still help many people recover their lives.
As Rollo May put it, “…the purpose of psychotherapy is to set people free.”
Hopefully this will never be forgotten in the pursuit of mental health.
— Makenna Berry