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A few weeks ago, the New York Times ran a feature on Dr. Donald Levin, a psychiatrist in New York City. Dr. Levin was trained as a "talk therapist," but now, because of the way that insurance reimbursements work, he provides 15-minute medication consults to patients. Patients leave his office with a prescription and, sometimes, a referral to someone who can serve as a talk therapist.
I'd encourage anyone who works in mental health, (and) or who struggles with personal mental health, to read the piece on Dr. Levin. I wouldn't say that it's the definitive piece on this issue. But, the article does open up a side of the field of mental health treatment that has been whispered about for at least the past few years.
The financial incentives and disincentives created by insurance companies, the information provided to the public through television advertising about medications, and the general commoditization of therapy have affected how the therapist is perceived and how therapy is received.
If emotional health can be treated by a physician who can prescribe medication for an inexpensive co-pay, is there a reason to seek out a therapist?
A psychiatrist friend, who provides both medication consults (30 minute sessions at Boston prices) and talk therapy (50 minute sessions, even bigger Boston price tag) recently told me that her practice is getting smaller - patients who previously prioritized therapy are no longer able to afford it, so are either coming less or not at all. She does not accept insurance, so patients must be able to pay upfront out of pocket and then submit bills to their insurance companies for reimbursement. She doesn't think that people are cutting back on the things that provide more of a quick fix and that are cheaper in the short run - like the regular trip to Starbucks - but therapy, with relatively high costs upfront, is easy to think about eliminating.
For the "worried well," I'm not so worried. I think everyone can use therapy, but I don't see therapy as essential for someone who's not in psychological crisis when it's financially out of reach. But, for people in crisis, who end up in psychiatrists' offices because they are in serious psychological distress, I'm very worried.
I'm worried because we know that 15-minute appointments for physical illness don't do much more than put a Band-Aid on the problem. I'm worried because there is no magic pill for emotional health. Though we don't know exactly how it works, we do know that talk therapy does help people feel better. Therapy works as a function of the effort that's put into it. It's not meant to be a quick fix.
I'm very curious what you think about this issue. I realize there are a lot of aspects to it, and welcome comments on any of these sides.
Copyright 2011 Elana Premack Sandler, All Rights Reserved
