… In the United States, from 1998 to 2007, the number of patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent, while the number receiving medication alone increased by 23 percent. This is not necessarily for a lack of interest. A recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medications.
Yet psychotherapy for the most common conditions is considered the best treatment “of first choice”. What is going on? The benefits of psychotherapy seem fuzzy to many potential patients, but pharmacological treatment enjoys “clearer, better marketed evidence” of its efficacy. Some of this comes from the failure of psychotherapists to take a scientific approach to patient treatment.
But psychotherapy’s problems come as much from within as from without. Many therapists are contributing to the problem by failing to recognize and use evidence-based psychotherapies (and by sometimes proffering patently outlandish ideas). There has been a disappointing reluctance among psychotherapists to make the hard choices about which therapies are effective and which — like some old-fashioned Freudian therapies — should be abandoned.
Psychologists need better, well-defined treatment guidelines.
There is a lot of organizational catching up to do. Groups like the American Psychiatric Association, which typically promote medications as treatments of first choice, have been publishing practice guidelines for more than two decades, providing recommendations for which treatments to use under what circumstances. The American Psychological Association, which promotes psychotherapeutic approaches, only recently formed a committee to begin developing treatment guidelines.
Lack of clarity is also a problem in diagnosis. Gary Greenberg, a practicing psychotherapist and author of of The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatry, argues that another problem is the method used to diagnose mental disorders, which “is not scientific, but political and bureaucratic”.
Psychiatry and psychology just seems fuzzy all around, more art than science.