Whither psychotherapy?

So I worry about psychotherapy—about how it may be deformed by economic pressures and impoverished by radically abbreviated training programs. Nonetheless, I am confident that, in the future, a cohort of therapists coming from a variety of educational disciplines (psychology, counseling, social work, pastoral counseling, clinical philosophy) will continue to pursue rigorous postgraduate training and, even in the crush of HMO reality, will find patients desiring extensive growth and change willing to make an open-ended commitment to therapy.

Yalom, Irvin. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients . HarperCollins. Kindle Edition. 

Social Workers make up the largest percentage of mental health professionals in the United States at about 60% while psychiatrists make up 10%, clinical psychologists 23%, and psychiatric nurse practitioners about 5%. There also are other groups of licensed mental health professionals in some states such as licensed mental health counselors, and licensed marriage and family therapists.

Increasingly, health insurance reimbursement for psychotherapy has been restricted and made difficult to access. As a married male with nine children I was forced out of private practice because with reimbursement rates from insurance companies for a unit of service so low, and there are only so many hours in the day, revenue did not cover my practice expenses and cost of living. At this point of my life, at age 77, I still practice 3 days per week seeing about 20 clients per week and I am what I call a “gentleman psychotherapist” like a “gentleman farmer” in yesteryear. 

Dr. Yalom is very optimistic about psychotherapy continuing as a profession. In our current climate of telehealth it has devolved into case management and psychoeducational coaching for symptom relief.

To continue, psychotherapy will have to be rebranded as an activity other than a medical service. Psychotherapy is more akin to education and the facilitation of growth and development. Mental health services sold its soul to the devil when it sought health insurance reimbursement as a commodified service targeted to symptom reduction rather than personal growth.

There are other paths to consider such as considering mental health as a public health concern as was the case during the days of the Community Mental Health Model following deinstitutionalization of State Hospitals. This will require a return to deficit financing of agencies such as community mental health centers.