Jung At Heart

...Ramblings About Psychotherapy and Whatever Else Comes to Mind...

Whither Psychotherapy?

One of the search terms I have set for Google News is "psychotherapy". It's interesting to me that I almost never see any articles about the battle that is being fought over the very existence of psychotherapy.

A friend of mine is recently interviewed for psychiatry positions and at most of the ones she has visited, she is greeted with a proud declaration that they are all medical model and she is told of a wide array of support services for her and very little about what, if any, psychotherapeutic services are offered.

On the level of community mental health, this is the direction that things are going. Such centers depend on health insurance reimbursements and health insurance companies are less and less interested in paying for therapy, even when it is as effective as medication and more effective in combination with medication than is medication alone. So it is very cost effective to pay the high salary -- relative to what other mental health professionals earn -- for psychiatrists and have them see many patients a day in medication clinics. Far more cost effective than paying other professionals to see 6-8 patients a day in psychotherapy.

Psychotherapy is losing its place in community mental health. Because it does not fit well within the medical model. But even more than that, it is because psychotherapy has long been riven with turf battles of its own -- which theory is correct? who should be licensed? different training standards for each of the several disciplines involved. So instead of a single field, psychotherapy, we have the field Balkanized into social work, family systems, clinical psychology, counseling, nursing, psychoanalysis, cognitive behavioral therapy and on and on. There is no single voice, no single umbrella organization speaking up for psychotherapy.

I wonder what would happen if someone presented at a conference suggesting that psychotherapy should not be in the medical model at all? That maybe psychotherapy belongs in a wholly different category, somewhere in the neighborhood of education, spiritual development, and personal growth? What if we stopped trying to prove scientifically that the relationship in therapy is healing? What if we gave credence to self-report by patients that therapy had helped them? What if we stopped considering problems in living, which is what most people coming for therapy are struggling with, as illnesses? What if we considered treatment of depression and other problems responsive to psychotropic medications as belonging to one field and psychotherapy to another one altogether, that the former is about brain problems while we address mind problems? What if?

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