By Frank Schwoeri PhD
An opinion piece in Sunday’s New York Times by a professor of clinical psychiatry at Weill- Cornell Medical College (Richard A. Friedman, “Psychiatry’s Identity Crisis”, July 19, 2015) extols the value of psychotherapy, and deplores psychiatry’s leaders “turning their backs on psychotherapy and psychotherapy research”. Psychiatry as a profession has gone in a decidedly biological and drug-oriented direction in the past couple of decades; it’s hard to find a psychiatrist trained in the last 15 or 20 years who still does much talk therapy. So even though he describes himself as “ a psychiatrist and psychopharmacologist who loves neuroscience”, Dr. Friedman nonetheless points out that “psychotherapy has been shown in scores of well-controlled clinical trials to be as effective as psychotropic medications” for many common psychological problems. I would add here that in studies comparing psychotherapy outcomes to antidepressants, psychotherapy effects held up much better at follow-up, with much lower relapse rates. In addition, some kinds of real-world psychological problems outside of the research laboratory just don’t respond well at all to drug therapies; Dr. Friedman notes that for many patients with histories of trauma, sexual abuse, PTSD, or the stress of poverty or deprivation, “there is no biological quick fix for these complex problems”.
As an example of psychotherapy’s power, and the value of continued comparative research on psychotherapy outcomes, Dr. Friedman cites a recent study comparing three types of treatment for PTSD- Prolonged Exposure Therapy (PET), relaxation therapy, and Interpersonal Therapy (IPT) (Markowitz, J.C., JAMA Psychiatry, May 2015). Many patients with PTSD find Prolonged Exposure Therapy intolerable and don’t respond well to it (see my previous blog post/book review on PTSD treatment). Interpersonal Therapy is a research-friendly (because it is “manualized”, hence has very specified rules for therapist interventions) version of what many therapists in clinical practice mostly do. IPT focuses on a patient’s relationships and their emotional response to them, which does not involve exposure to traumatic memories. The study found that the positive response rate to IPT was 63%, while the rate of positive response for exposure therapy was 47%. This kind of research finding can help guide treatment planning decisions.
Some time ago (in the 1990’s) U. Penn psychology professor Martin Seligman did a survey-based study for a popular consumer products review magazine which found that most people who had psychotherapy, for a wide variety of issues, felt they were significantly helped by it. And a large body of research finds a clear “dose-response relationship” for psychotherapy; that is, longer therapy (larger “dose”) gets better results, as one might intuitively expect would be the case for any effective treatment. Psychotherapy works.