New Caucus to Promote Value of Psychotherapy Treatment

The APA Board of Trustees last December approved establishment of the Psychotherapy Caucus, providing a place within the organizational structure of APA for psychiatrists interested in psychotherapy.

The inaugural meeting of the Psychotherapy Caucus will occur at APA’s 2014 annual meeting on Monday, May 5, from 2 p.m. to 4 p.m. in Conference Room E, Lower Lobby, Sheraton New York Times Square Hotel.

APA Assembly member Eric Plakun, M.D., who has taken a lead in gathering support for the caucus, said it is the result of a grassroots movement among members to create a body within the governance structure of the Association where the voice of psychiatrists interested in psychotherapy could be heard. A Committee on Psychotherapy by Psychiatrists was one of many committees that were sunsetted in 2009 in an effort to streamline APA’s component structure. In the roughly dozen years of its existence, the committee promulgated evidence about the efficacy of psychotherapy and its association with brain change, organized psychotherapy-related programs for APA’s annual meeting and Institute on Psychiatric Services, and developed the “Y-model” for teaching psychotherapy across schools in an integrated, evidence-based way.

In 2012, an Assembly action paper led to the creation of the Task Force on Psychotherapy, which was chaired by Plakun. Last year, task force members gathered letters urging the re-creation of a more formal group to represent psychotherapy and submitted them to APA-President-elect Paul Summergrad, M.D., who took the request to the APA Board of Trustees. The caucus was approved in December 2013.

Plakun said the caucus is a step in the direction of reversing what he believes is the biologically reductionistic stance of the field. “It seems particularly auspicious that a Psychotherapy Caucus exists at this moment in time when, ironically, even as the evidence for the efficacy for psychotherapy grows, there is evidence that the provision of psychotherapy by psychiatrists is declining,” he told Psychiatric News.

He noted that a 2010 survey by members of the former Committee on Psychotherapy by Psychiatrists and the American Psychiatric Institute for Research and Education found that from 2002 to 2010 there was a 20 percent decline in the provision of psychotherapy to patients by psychiatrists, from 68 percent to 48 percent of office visits reported by 394 psychiatrists. Those providing therapy to their patients tended to be over age 65, white, and U.S. medical school graduates, and half of their patients were self-pay or privately insured. Obstacles to provision of psychotherapy cited by psychiatrists included significant debt burden, lower compensation for psychotherapy compared with other services, and intrusive and time-consuming utilization review burdens.

Plakun said more than 60 APA members have expressed an interest in the caucus, and he said there is a sense of excitement about the inaugural meeting in New York. (He noted that cost of the meeting is being subsidized by the Austen Riggs Center, Sheppard Pratt Hospital and Health System, and the Menninger Clinic; however, he stressed that there will be no marketing.)

He said possible activities of the caucus include networking, sharing new research on psychotherapy, putting together programs for the annual meeting and Institute on Psychiatric Services, developing joint research projects, and providing mentors to young psychiatrists interested in pursuing psychotherapy. Plakun said he also hopes the caucus will be able to review other APA products—such as proposed treatment guidelines—and offer consultation on issues relevant to the practice of psychotherapy by psychiatrists.

Former APA President John Oldham, M.D., called the caucus a “good idea” and said it can help to keep the Association—and training programs around the country—stay focused on the value of psychotherapy in the skill set of psychiatrists.

Oldham said in the burgeoning movement toward integrated care, psychiatrists who bring together the skills of psychotherapy and knowledge about the effects of medicine and about general medical care can have a powerful role in a reformed health care system.

“Many patients with medical problems—diabetes, heart disease, and other conditions—have significant co-occurring mental disorders,” Oldham said. “Psychiatrists who do psychotherapy and can also speak the language of general medical care with primary care colleagues will bring a valuable talent to integrated care networks.” ■