Psychology's overlooked success: the debate we must have

Edited by Jill Wright, 02 October 2013

The op-ed column in the New York Times this week drawing attention to "psychotherapy's image problem" is something that deserves similar attention in this country.

It's not your conventional image problem: as the author, Brandon A. Gaudiano, points out, psychotherapy has proved itself in numerous peer-reviewed studies to be more effective than drugs in relieving the most common mental health problems, like anxiety and depression. In my first post on this blog, back in May, I referred to the fundamental divide between psychologists and some psychiatrists, on the use of drugs in mental health.

Gaudiano reaffirms that unlike drug-based therapy, there are no unwanted side-effects with the techniques used by psychologists, and its beneficial effects are longer-lasting.

Moreover, it is more popular with patients than medication. A recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medication.

Despite that, in the face of all the contrary evidence, GPs continue to prescribe drugs as the treatment of first choice, and many patients, perhaps seduced by the desire for a quick fix, ask for them.

Gaudiano, a clinical psychologist and assistant professor of psychiatry and human behavior at the Alpert Medical School at the Ivy League Brown University in Providence, Rhode Island, puts it down to what can only be described as ignorance: primary care physicians and patients are simply unaware of the evidence supporting psychotherapy against drugs. 

They assume, incorrectly, that biologically-based practices are somehow more scientifically valid.

While one can understand that patients, even in the era of Google searches, might not be in a position to interpret the data, the fact that the people they trust with their care are not properly informed is not particularly comforting. Nor is the fact that legislators continue to allow the public purse to subsidise this pill-pushing.

One reason Gaudiano advances is that Big Pharma can afford to spend more to promote its inferior products and drug companies aggressively market and lobby for their products.

He has issued a call for psychotherapy "to overhaul its image, more aggressively embracing, formalising and promoting its empirically supported methods". 

As he points out, "Given the chronic nature of many psychiatric conditions, the more lasting benefits of psychotherapy could help reduce our health care costs and climbing disability rates, which haven't been significantly affected by the large increases in psychotropic medication prescribing in recent decades."

The question is, what precisely is this "psychotherapy" tasked with effecting these unarguably desirable charges? 

It could be argued that in Australia, psychologists have been rather too focused on internal disputes. For some years now, a good deal of energy has been expended on a debate over whether one small component of the profession - clinical psychologists - should enjoy a higher Medicare rebate for their clients than other specialists, or indeed generalists.

Some clinical psychologists have even suggested that their colleagues aren't adequately trained: a claim which fortunately does not bear close analysis.

Gaudiano points out that there is no "Big Therapy" to counter Big Pharma, but it seems to me that the topic is worth pursuing in the interests of the people psychologists work so hard to serve. 

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• psychologists
• psychology