Psychotherapy’s Image Problem

“I just wanted to talk to someone and they gave me pills.”

This lament, which we have heard repeatedly from those who have spent time in foster care, is becoming increasingly common in all factions of the population. Brandon Gaudiano, professor of psychiatry at Brown University, in a recent New York Times Op Ed, suggested that among the reasons for the decline in psychotherapy as a treatment of choice for emotional distress is that psychotherapy has an “image problem.”

Psychotherapy is often perceived by consumers and medical professionals alike as being costly, time-consuming and ineffectual, while psychotropic medications are perceived as inexpensive, fast-acting, and effective. As in so many cases, the truth is not so simple

Psychoactive medications help some people some of the time, as does psychotherapy. Answering the question of which is the better choice for any individual at any given time is not nearly as easy as advertisements for anti-depressants and anti-anxiety medications would have us believe.

And, as Gaudiano points out, pharmaceutical companies have enormous budgets to create and promote the positive image of their products, while advocates for psychotherapy lack those financial resources and the will to develop practice guidelines that would aid mental health professionals and consumers alike.

Image courtesy of Curtis Perry.

There is abundant evidence that relationships are a powerful agent of therapeutic change, yet too often we deprive those in emotional distress of the chance to develop a relationship with a skilled and experienced mental health professional. Psychotherapy can help relieve suffering without risking the physical and psychological side-effects of medications.

When we medicate too quickly we also deprive people of the chance to enjoy the longer lasting effects of psychotherapy. It takes more time to build a therapeutic relationship than it does to take a pill, but the benefits last longer. People who are medicated passively ingest the thing that promises to cure them, while those who undertake psychotherapy must actively engage in the process of building or reestablishing their mental health.

Through the clinical process they have the opportunity to internalize the knowledge and experience the therapist offers. Unlike a prescription, it will not have to be refilled endlessly to remain effective.

When people turn to us for help we need to remember that there is no medication that can cure the sense of abandonment when a child is removed from her parents and no pill that can create trust in the face of repeated losses and disappointments. Those who have suffered the trauma of chronic loss, the mind-numbing effects of poverty, or the brutality of discrimination need us to lend a hand before handing out drugs.

Toni Heineman is a clinical social worker and psychologist, and is the founder and executive director of A Home Within.

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