In this morning’s New York Times magazine, former journalist Lori Gottlieb wrote a feature titled The Branding Cure, My so-called career as a therapist, about the dying practice of psychotherapy. As a newly minted psychotherapist, she sat in her empty office awaiting patients to flock to her door for her help. They neither flocked nor walked. They stayed away in droves.

No more traditional psychotherapy?

In an effort to find out why, Gottlieb discovered that according to Dr. Katherine C. Nordal in a 2010 American Psychological Association paper titled “Where Has all the Psychotherapy Gone? that psychotherapy as we know it – or at least I know it as 50 to 60 minute face-to-face sessions with a caring and knowledgeable psychiatrist or psychologist – is quickly becoming archaic.

Meanwhile, as “managed care” has declined dramatically, “pharmaceutical companies spent $4.2 billion on direct to consumer advertising and $7.2 billion on promotion to physicians, nearly twice what they spent on research and development,” Gottlieb reported from Nordal’s paper. Increasingly more and more patients are receiving medication only – 57.8% in 2007 or 30% more than 10 years before.

I find that shocking and sad, but I know it’s true.

Having lost my only kidney (yes, I was born with one) to carelessly monitored Lithium Carbonate back in the 1970s and 1980s – iatrogenic acute endstage kidney failure – I know that unmonitored medication can be perilous.

Nordal admits at the outset that “while medication is an appropriate part of a treatment plan for many mental health disorders, psychotherapy has been documented as the preferred treatment for many common psychological disorders.” I have learned that medication PLUS psychotherapy is the best route, but that is my experience. My psychiatric experience started in the 1960s, its dark ages with precious few pharmaceutical choices.

11 Comments to
Branding Psychotherapy: A New Quick Fix

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  1. Cognitive Behavioural Therapy has become huge here as in HUUUUGE, capital letters can’t be emphasised enough. It’s become an industry. Whatever the issue, cbt is what you get, ten sessions. It’s cheaper for the hospitals but the actual long-term benefits has yet to be reviewed. Sure, might be great for some issues. Phobias, changing negative thinking. For me, not so much. I had alot I needed to talk about. Much of my background needed far more than changing my thinking about it. I outgrew my first therapist after a while. She could no longer see what I needed, and was trying to steer me in a direction that I felt was totally wrong for me.
    I don’t know what theories the therapist used. I just needed to talk, I needed feed-back, I needed someone that could help me move on. It worked. Took 5 years but it worked.

    • Hi Jessika,

      So good to hear from you. You sound very well and I’m happy to hear it.

      CBT is very popular here, too. And Dialectical Behavioural Therapy. At least these are therapies that involve face-to-face communication in person. My psychiatrist is eclectic in his approach, but it took a very long time and we’re still working on it. There are all kinds of therapeutic approaches and I’m sure today’s well-qualified clinical psychologists take different approaches with their patients. Mine did, when I was being treated for my eating disorder starting with CBT and using DBT, too. Plus other techniques.

      There is no one-size fits all psychotherapy and there is no quick fix. I suspect that these branded psychotherapists are trying to find a way to attract patients to work with, and a specific niche, at least in California and perhaps other parts of the U.S. where it seems to be the latest “new” thing.

      A good psychotherapist is still the best psychotherapist for the patient and chemistry, approach and personality has a lot to do with it. Techniques can vary greatly. Good therapists meet the specific needs of their patients.

      I’m glad you got the help you needed and I’m not surprised that it took five years. It takes time, lots of time. You worked at it and it worked for you.

      I’m so happy for you.

      Hugs,
      sln

    • Hi again, Jessika,

      I was just thinking about the fact that you said you “outgrew” your first therapist.

      That happens. Therapy promotes remarkable emotional growth and self-awareness, but the pace varies. Some therapists have only so much to give and then the growth process slows or stops. I think the patient should drive the direction, not the therapist, so when that happens, it’s time to move on, as you wisely recognized. I certainly outgrew several of my therapists in the past, but thus far, with Dr. Bob, we’re still working well together. I suspect he will be my last therapist.

      But, you never know.

      Again, thank you for commenting, Jessika. You are always a joy to read and your insights carry the conversation into intriguing places. I am so grateful to know you’re there and thriving.

      Take care and be well.
      xox
      s

  2. Really nice article! Just a note of important distinction: This Gottlieb is NOT a psychologist. One must have a Doctorate in psychology and a license to practice in order to use such a title. She has a Master’s degree and is under supervision, meaning she does not have her master’s level license yet. Important distinction.

    • Hi Dr. Deibler,

      Thank you for your correction. I’ve changed the copy and profoundly appreciate your taking the time to make this distinction.

      Take care and be well.

      Cheers,
      sln

  3. The most important part you’re ignoring is the cost. I’d love to do therapy but there are very few spots in Ontario covered by OHIP, and most of those are psychiatric nurses or social workers. Forget trying to get a psychiatrist for more than a consult. I read your posts with envy that you can see someone on a regular basis.

    I’ve done therapy privately. My last therapist charged $90 for 50 minutes. That was the low end of their sliding scale and my insurance didn’t cover it. My insurance only covers one thousand dollars towards therapy, which doesn’t go far at all.

    In Ontario, the access you have to mental health services is based on luck, location and your ability to self-advocate. It has nothing to do with how badly you need the services. Sometimes having a good GP or pdoc can open doors to other services. Some wait on waiting list for 1hr consult.

    • Hi,

      I know that it’s almost impossible to find OHIP-covered psychotherapy with a psychiatrist. And you’re right. Insurance coverage for psychological therapy doesn’t seem to go nearly far enough. I wish I had an answer for you, but I don’t. Except this… community health care centres offer a variety of services including peer support groups. At first blush, it may seem that this approach pales compared to one-on-one psychiatric support, but you may be surprised.

      A few years ago, I researched and wrote a story on a program called Pathways to Recovery offered at a community health centre in Richmond Hill. Other centres offer this and WRAP programs, too. Here’s a link to my story which was published by The Walrus. Community Health Centres offer free programs.

      Wellness Recovery Action Plan programs are offered in Toronto. Other programs, as well, but you have to work hard to find them. Most medical doctors don’t know much about non-medical models of recovery. Peer Support is very helpful. Perhaps contacting the Ontario Peer Development Initiative might be helpful.

      I wish I could help you more, but you’re right about having a good GP to talk to and to help you find affordable psychological therapy.

      Take care and be well.

      sln

  4. Hi, My experience in therapy was for the most part satisfying, until I met my last therapist, who in the beginning was very accomdating and seemed interested, she convinced me that “Psychoanalysis ” was the best treatment for me.Little did I know I was her case study. She then became this Antagonistic, Provoking, Verbally Abusive person I did not know how to get out… I felt as if I were in an “Abusive Relationship” I never knew who or what I was walking into. Then she Physically Assaulted Me and I’m out of there… however any complaints I’ve made against her have not been enough, including 3 police complaints. That is my experience, if it doesn’t feel right… don’t do it…. even though they have the degree.

    • Hi Rose,

      I am terribly sorry to hear about your experience with a psychoanalyst, especially one whom you describe as being so unethical and abusive. There are all kinds of people in this world and all kinds of psychotherapists. You’re right to trust your gut, but you can also always do some homework and see if you can find someone to refer you to a therapist. My rule of thumb is to go through referrals. It’s not an ironclad rule and it doesn’t always work one hundred percent, but it’s better than going blind. Also, psychoanalysis is a very specific approach to therapy. I am sorry you had such a dreadful experience and I hope you are recovering.

      Best,
      sln

  5. Yes “Psychoanalysis” is a very deep intense therapy…It does not give the “Analyst” the right to treat a client the way she mistreated me… and she’s still allowed to practice! Maybe in her country… but as long as I have a say the law will change… no one deserves to be “Dehumanized and “Physically Assaulted” I willgo to “Supreme Court” I do not give up… if she knew anything about she should know that!I can’t even begin to try and heal… who will I trust?

    • No one has the right to treat you or ANYONE as you were treated. Here, in Canada, you can write a formal letter of complaint to the Royal College of Physicians and Surgeons, if the psychoanalyst is also a medical doctor and a psychiatrist. That complaint will be taken seriously. However, if the police were unwilling to take your consider your complaints, perhaps there is a professional psychoanalytic association you can address with these complaints. Still, one bad therapist doesn’t mean that all therapists are bad. Perhaps you can find another therapist to help you recover from this experience. Have you spoken to your family doctor? That might be a good place to start.

      Good luck,
      sln

  6. I go to a very caring, honest and helpful psychotherapist who admits to me that he is or what he practices is akin to the dinosaurs. We have 50 minutes of “talk therapy” and he also carefully administers the medicine I NEED to help with my mental illness. He says that practitioners such as himself are disappearing due to the insurance companies who are refusing to pay for his type of practice. This man has helped me immeasurably. I can’t imagine managing my illness with him. Before I found him, I was subject to several psychiatrists who wanted to know nothing about ME or how I felt. They wanted a list of my symptoms, how my latest drugs were doing, handed me scripts or prescribed “shock treatments” and I was out the door in 20 minutes! They said if I needed to talk, I should find a “therapist” to talk with but there was never any communication between those two. It was completely frustrating and I think, harmful. I did that kind of garbage for 23 years interspersed with CB classes that only made me feel worse. How nice it was to go back to CB from day to day and find out who in your class had committed suicide since the last time class met. That happened 3 times. Very healthy and helpful indeed!

    • Hi Judith,

      I, too, go to a therapist/dinosaur like yours. We are very lucky to be in their care. Mine is in semi-retirement, but after 22+ years with me, who can blame him? No, honestly. We’re both in semi-retirement. Much of our work is done and I have a wonderful psychologist who pinch hits from time to time.

      Lucky, indeed. Here in Canada a psychiatrist’s care is covered by OHIP but far too few psychiatrists believe in the empowerment of talking therapy and the quickly dying 50 or 60 minute hour.

      This is a tragedy, but I believe that time will prove that 15-minutes and prescription doesn’t work either. As for CBT, it has it’s place. A good therapist is an eclectic therapist who uses many different approaches. My psychiatrist does as does my psychologist.

      My heart breaks for those who cannot find a good ear. The right ear. The ear with eyes and heart.

      Thank you for sharing, Judith.

      Best,
      sln

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