Psychotherapy In a Tailspin | Who Slashed the Tank? And Should You Be Concerned?

What to Do About Depression

If you’re wondering what to do about depression or what to do about anxiety, psychotherapy may have come to mind. It’s a natural, right? So why is its use in a tailspin? And should you be concerned?

Before we dig-in, I want to emphasize I’m a practicing psychotherapist. That either means I’m making a huge mistake by writing about my bread and butter spiraling downward, or I believe the facts need to be analyzed and vulnerabilities addressed. Given I have my client’s and reader’s best interests at heart, I’m opting for the latter.

Alrighty, then – let’s take a peek and see what’s going on here…

What to Do About Depression? | What to Do About Anxiety? | Psychotherapy Treatment In a Tailspin

In a special issue of Clinical Psychology Review, Brown University professors of psychiatry and human behavior Brandon Gaudiano, PhD and Ivan Miller, PhD sliced-and-diced this fact: the use of psychotherapy has “tailspinned” in the United States – in spite of strong evidence it works.

So what’s the deal here, anyway?

According to Gaudiano and Miller, issues exist within and outside the profession. They submit the psychotherapy community hasn’t defined, embraced, and spread the word regarding exactly what it does. Nor has it made its case pertaining to adherence to evidence-based practice. And that leads us to the “outside” problem. Pharmaceutical companies (Big Pharma) – and their co-conspirators – have.

Let’s chat evidence-based practice for a moment. The skinny: As it applies here, be it a medical or psych issue, all practical treatment decisions should be grounded in research studies, and these studies need to be selected and interpreted according to specific norms. In a perfect world, this would prohibit the theoretical. But since when do we live in a perfect world?

Our current system of medicine and health insurance gives more credence to the biological, rewarding evidence-based practice. And since it’s perceived psychotherapy has no “evidence-base,” it’s lost credibility among physicians, insurers, and policymakers. (All of whom, by the way, would lose big-bucks if they assigned even a smidge of credibility to psychotherapy.)

From Gaudiano and Miller…

One might think that this deep and expanding evidence base would have promoted a similar increase in the use of psychosocial interventions that at least would have paralleled the one witnessed over the recent years by psychotropics, but it decidedly has not. Thus a time that should have been a relative boon for psychotherapy based on scientific standards has become more of a bust.


How in the heck did that happen? Well, Gaudiano and Miller believe the psychotherapy tailspin occurred because clinicians haven’t held themselves to an evidence-based practice standard. Oh, for the record, there are evidence-based psychotherapies. Among them, cognitive behavioral therapy, acceptance and commitment therapy, and dialectical behavior therapy.

Gaudiano and Miller state there are studies that show a significant number of psychotherapists place personal experience and intuition ahead of the evidence-based. So, yes, there are therapists out and about who on occasion use, shall we say, a “creative, unsupported” therapy. And according to Gaudiano and Miller, said therapists refuse to support strict standards because they fear they may be forced to change how they treat their clients. I happen to be one of those therapists, and supporting strict standards and being forced to change my clinical approach don’t frighten me in the least.

Now, while all this evidence-based adherence volleyball was being played on the psychotherapy court, a variety of factors outside the field marched onward, placing greater emphasis upon strictly medical and biological approaches to emotional/mental health disorders.

Those factors? Less than effective campaigns to “destigmatize” emotional/mental illness as a “legitimate” physical disease, and lopsided reimbursement for meds vs. psychotherapy grounded in issues of evidence-base. Ever wonder why psychiatrists abandoned therapy, opting for meds-exclusive practices? There you have it. But you can be sure many of these psychiatrists have psychotherapists on staff. Can’t leave any money on the table.

Very sadly, what we’ve discussed has hurt the field of psychotherapy – and those enduring emotional/mental health disorders – in far-reaching ways. For example, federal and private funding for emotional/mental health research, which has traditionally supported the development of effective psychosocial treatments – building an evidence-base – is drying-up. That’s right, the bucks are being thrown at purely medical and biological research.

Well, in spite of Gaudiano’s and Miller’s revelations, all is not lost for psychotherapists. They cite mobile technology as providing a new platform for efficient therapy delivery, as well as the Affordable Care Act (“Obamacare”) offering new avenues for psychotherapists to become part of collaborative health care teams.

Still, Gaudiano and Miller submit psychotherapists must “rally” around evidenced-based practice to secure their future.

Final Thoughts

So now to you, the user (or potential) of psychotherapy services. What to do about depression? What to do about anxiety? Should you be concerned? How ’bout this? Do not – I repeat – do not abandon psychotherapy as an option. Sure, I’m a provider; however, I’d say the same to a family member or close friend.

Listen, I fully support the use of evidence-based practice. However, in our imperfect world things aren’t always so neatly cut-and-dried. Psychotherapists have no choice but to occasionally lean upon the theoretical – relying upon, say, experience and intuition. Think about it! Until there are lab and radiological tests that can for-sure diagnose emotional/mental illnesses – and medical/pharmacological treatments that can for-sure provide healing – what choice have we? This is not an exact science.

Ah, but you can be sure while the kinks are being ironed-out, Big Pharma and their billions will continue to hold those with emotional/mental health disorders hostage. And insurance companies, with their bottom-line driven “quick-fix” M.O., will continue to co-conspire.

No doubt about it, the psychotherapy tailspin is being forced, selfish and cash-drunk opportunists slashing the tank.

More Chipur articles addressing vital mood and anxiety disorder information are yours for the reading. Take the time, learn, and heal.

  • Patricia Miller August 27, 2013, 11:42 am

    I’ve seen many of the same things happen in education due to the requirement for a control group to be compared to the experimental group in order to prove efficacy. So many times a great practioner will KNOW that a new intervention will work with a particular student or set of students, and it does. However because that opportunity was not denied via the scientific method to another group, it is viewed as an anomaly based on the practioner’s skill and/or relationship with the individual(s). I can see the same thing being true in psychotherapy. A truly skilled clinician will be aware of the client and see that a change of strategy could be effective, and the more tools in the toolbelt the greater the chances of success. One size does not fit all, and in therapy it would certainly make sense that needs could, and should, change as healing progresses along the way. To expect a psychotherapist to limit him/herself to one modality for the “proof’s sake” would ultimately be more limiting to client mental health success. Too much of dealing with people is based on the interaction and relationship rather than the tools alone.

    • chipur August 27, 2013, 1:38 pm

      “A truly skilled clinician will be aware of the client and see that a change of strategy could be effective, and the more tools in the toolbelt the greater the chances of success.” Well said, Patricia. Again, I have no problem with an evidence-based standard; however, there needs to be some wiggle-room – especially when one is working with emotional/mental health disorders. What aggravates me the most here is Big Pharma seizing upon opportunity. Oh, there may be studies supporting the efficacy of meds; however, they’re still such a crap-shoot. And let’s not forget who’s funding many of these studies – Big Pharma! Thank you for your visit and contribution. It’s always a pleasure hearing from you…

  • Leslie Ferris August 27, 2013, 2:47 pm

    Thanks Bill for another great article looking at the bigger wider picture. I am amazed about what big companies can do and what influence (good and bad) they can have on so many. I will definitely share this!

    • chipur August 27, 2013, 5:46 pm

      Hey, you’re welcome, Leslie. Big Pharma has stunning influence. Were it that their offerings in the emotional/mental health arena were consistently effective. Such is not the case. At any rate, always good to look at the “bigger wider picture.” And always good that you visit and contribute. Thank you…

  • chipur August 27, 2013, 10:05 pm

    As long as I’m into my Big Pharma rant, check-out this Chipur piece re psychiatrists on the take from some 3.5 years ago:

  • Dr. Herby Bell September 2, 2013, 5:09 pm

    Rant on, Bill White! You speak the unadulterated truth and as the proverbial bubble of Truth gets held under the surface at increasingly greater depths, it will surely emerge with more pop and vigor than ever as professionals like you stay the good course.

    I’m reminded of that little pesky quantum science LAW that informs us that even observation affects outcome so not even science is evidence based science anymore except to the economically expedient lock steppers who oughta be ashamed.

    In a world moving from closets and compartments to the whole fam damly and Enchilada, here’s to your unapologetic, True work of art here, Bill.

    Damn, you’re good.

    • chipur September 2, 2013, 6:27 pm

      We’re givin’ ’em hell, aren’t we, Herby!? And why not? It’s a worthy – necessary – cause. I always appreciate your visits and participation – and your way with thoughts/words. You’re one bright and creative hombre…