The End of Psychotherapy?

There is a small, yet important, downward trend in the number of office-based psychiatrists providing psychotherapy to their patients, according to a new report published in the Archives of General Psychiatry. Why would the percentage of office visits involving any form of psychotherapy—recommended alone or along with medication, for treating major depression, PTSD, bipolar disorder, and other mental illnesses—decline in psychiatric practice from 44.4% in 1996-1997 to 28.9% in 2004-2005? According to the study authors, the trend can be “attributed to reimbursement policies favoring brief medication management visits rather than psychotherapy and the introduction of newer psychotropic medications with fewer adverse effects.”

The trend was also seen in psychiatrists who provided psychotherapy to all patients, with a decline over the same time from 19.1% to 10.8%. “These trends highlight a gradual but important change in the content of outpatient psychiatric care in the United States and a continued shift toward medicalization of psychiatric practice,” concluded the authors. “A key challenge facing the future generation of psychiatrists will likely involve maintaining their professional role as integrators of the biological and psychosocial perspectives while working within the constraints of the strong market forces of third-party payers and managed care to implement advances in the diagnosis and treatment of mental disorders.”

Do improvements in medications with fewer side effects and an increase in the number of medication options for patients account in your opinion for the declining likelihood that a practitioner will provide psychotherapy to that patient? If not, are there other factors involved? Are changes and decreases in reimbursement diminishing the quality of care psychiatrists, and physicians in general, are able to provide? Does a decrease in psychotherapy necessarily coincide with a decrease in quality of care? Have you been influenced to provide medication therapy to a patient and in lieu of psychotherapy due to reimbursement and cost constraints, or even had to weigh the options because of cost considerations?