Saving Psychotherapy From the Medication Takeover

One of the best experiences of my career occurred in the 1980s when I was a member of the group that decided which psychotherapy studies would be funded by the National Institute of Mental Health.

It was hard work. Every three months, we would review about twenty-five studies, knowing that only three or four would be funded. Psychotherapy research was relatively new in those days and it was often difficult to decide which approaches and which people were most likely to make contributions that would count. But our efforts were rewarded. The studies we supported helped establish the effectiveness of Cognitive Behavior Therapy, Dialectic Behavior Therapy, Interpersonal Therapy, and other forms of brief therapy.

Psychotherapy research is inherently more difficult to do than drug research. The treatments are harder to standardize, there is no real equivalent to pill placebo, the time horizon is longer, outcome measures less clear, and the patients are more heterogeneous. Many interesting studies were never done because they had fatal flaws in one or more of these areas.

But we did learn a lot. Psychotherapy is as effective as medication for mild to moderate presentations of many different mental disorders. It takes longer to work, but its benefits last longer and there many fewer side effects and complications. Comparisons between different psychotherapies usually end in tie scores — suggesting that the quality of the therapeutic relationship and other common factors may be more important than the specifics of technique.

NIMH funding for psychotherapy took a nosedive starting with its “Decade of the Brain” in 1990. NIMH has become almost exclusively a brain research institute. Its once well-rounded biopsychosocial approach has been replaced by a narrow bio-reductionism.

The neuroscience research has been fascinating, but so far has had zero impact on clinical practice and has not improved —> Read More