On the Decline of Psychotherapy

In the July 3 issue, Psychiatric News published yet another article lamenting the decline of psychotherapy in the practice of psychiatry (“Psychiatrists Lament Decline of Key Treatment Modality”). It seems this “tragedy” has been gradually occurring in the field over a number of years. In multiple articles and lectures, it's referred to as“ losing the mind.” Supposedly, psychiatry is in danger of becoming less of what it is, and the rest of medicine will be worse off because of it. Psychoanalytic/psychodynamic psychiatric practitioners regard themselves as the last bastion against the creep of a non-feeling, coldhearted, high-tech medical world. To these psychiatrists, they are the guardians of humanity in medicine; only a psychiatrist trained in psychodynamic psychotherapy knows how to talk and empathize with patients.

All of this is not only false, but insulting to many nonpsychiatric physicians, who provide respectful listening to their patients.

The diminishing role of psychotherapy in the psychiatrist's tool bag isn't a loss to be mourned and resisted, but progress to be praised and encouraged. It reflects a move toward the medical identity of psychiatry. The psychotherapy-oriented psychiatrists would like to blame their demise on HMOs, but the truth of the matter is, the decline of psychotherapy by psychiatrists parallels the growth of psychopharmacology. It is also representative of the free-choice and preference of our patients. The value of psychotherapy and how much to pay for it are determined by the mutual agreement of physician and patient. Let's be honest: a person can receive quality psychotherapy from a nonphysician. If psychiatrists want to provide traditional psychotherapy, they either have to charge a competitive fee or convince the patient that the extra expense is worth it. If our leaders were smart, they would recognize the absurdity of emphasizing a skill that a social worker can provide adequately at a much lower fee. In general terms, there have always been two types of physicians: those who are innovative and open to new modalities of care, and those who resist change and stick to roles that are neither economically sound nor therapeutically advantageous.

In truth, the only damage done with the decline of psychodynamic psychotherapy by psychiatrists is to the pocketbooks of the practitioners, not to the patients themselves.


ETHAN KASS, D.O., M.B.A.
 Coral Springs, Fla.