Do the Right Thing

Spirit, science, and health

The Transformation of Psychotherapy to Consultation

Could psychotherapy be a relic of the 20th century?

Psychotherapy has changed a lot in the 30 years that I’ve been treating patients..a lot! That makes sense as the field and intervention techniques have evolved with new research and clinical practice approaches unfolding over time. One way that psychotherapy has changed a great deal has been what I refer to as the transformation from a psychotherapy model to a consultative model.

Psychotherapy used to be a longer process where health insurance would pay a sizeable percentage of the costs and treatment could last as long as the therapist and patient desired. It was often more process oriented than results oriented too.  With the revolution of managed health care and the frequent use of psychotropic medications this treatment model changed very quickly. Additionally, people are much less patient about the time investment (and money) involved with ongoing psychotherapy as well as the length of time it often takes to see beneficial results. Thus, psychotherapy has been transformed (in my view) to much more of a consultative model. People come to a psychotherapist with some psychological, behavioral, or relationship problem(s) and expect to get very brief consultative services that offer quick and effective relief. The frequent use of psychotropic medications for pretty much whatever ails you also reinforces this quick fix approach.

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Consultation is similar to how you might talk with an expert about a lot of different aspects of your life. For example, how to plan your vacation or how to invest your money are good examples. At first I had trouble with this change in expectations from patients about psychotherapy. Now I embrace it fully. People come to a psychotherapist, like me, with challenges in living and they don't want to spend weeks, months, or years picking away at their problems.  They want improvement and relief now. They don't want to change their whole personality or lifestyle as a rule but want to cope with their troubles to avoid discomfort. While I don’t have all the answers of course, being a licensed expert in clinical psychology I have expertise in human behavior and relationships. They consult with me in similar ways that they might consult with other experts.

For example, I have a patient who struggles with pornography use. We discuss strategies to deal with the problem and then he returns to me periodically to discuss his progress and challenges with behavior change. We adjust the approach as we go to help him cope more effectively with his impulses. Another patient struggles with loneliness. We discuss strategies to manage his feelings and then he tries the strategies out and reports back about his progress and challenges. We adapt the plan and he tries again.  We meet as needed and not once a week as in the more traditional psychotherapy approach. 

In some respects psychotherapy is a relic of the 20th century while consultation is the new therapy of the 21st century.  Old models of therapy that were so common and popular decades ago no longer seem appropriate for most people today. New approaches focus on consultation and adaptation. While there are plenty of exceptions to the rule for sure (and in fact I have a patient in my clinical practice who I have seen in ongoing regular traditional psychotherapy for over 2 decades) consultation seems to be the new "psychotherapy" reality in the 21st century. There are pros and cons to this transformation but it seems to be the wave of the future. 

So, what do you think?

 

Thomas Plante, PhD, ABPP, is the Augustin Cardinal Bea, SJ University Professor at Santa Clara University and Adjunct Clinical Professor of Psychiatry at Stanford University.

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