Psychotherapy for All

Spring 2010
Final Research Essays

Article 7 of 12

With his heart racing as if it were keeping up with the beat of a steady African drum, Trevor walked into the waiting room for his first therapy session. After getting into an fight with another student and accidentally hitting the principal in the crossfire, he was forced to see a psychotherapist. Resentment was the only emotion his seven-year-old body could feel. He trudged into the room, head hanging low, mouth scrunched up in anger, and eyes glued to the floor. He was not excited for the treatment, but ready to get it over with. For “one miserable year” as he describes it, he went in and out of that dreaded office. Although even to this day resentment and hatred for psychotherapy still run through his veins every time he hears the word, he cannot deny the benefits and the fact that he became a different person by the time the therapy ended.

Just like Trevor, outsiders, patients, and health insurance companies have been continuously skeptical about the effectiveness of psychotherapy. Although certain types of counseling, such as psychotherapy, are typically covered under health insurance plans, this may not be the case in the near future. Big name companies are constantly looking for ways to cut corners and save money. Arguments against the effectiveness of psychotherapy have already caused debate on whether or not it should be covered in healthcare. Now that President Obama, as well as the Democratic and Republican parties, are proposing new healthcare plans, psychotherapy may be even further scrutinized. In order to save Americans money on these expensive alternatives to the healthcare system already in place, it is a possibility that some practices that are not used as often, or seen as expendable, will be eliminated from the coverage of the health insurance companies. Psychotherapy should not be one of the practices considered disposable, nonessential, or useless. Psychotherapy is clearly effective, and can work for most, if not all, with the correct patient-therapist dynamics, treatment duration, and little to no limitations due to health insurance coverage, and therefore should continue to be covered in the new healthcare plan.

Psychotherapy, defined as “the psychological treatment of psychiatric and behavioral disorders that is enacted through the establishment of a professional relationship with a patient for the purpose of alleviating existing symptoms and preventing the recurrence of maladaptive patterns of behavior”, has been the target of criticisms and debates (Segal 298). Some critics take the same position as Christian radio hosts Dave Hunt and T. A McMahon, who feel that psychotherapy is the same concept as conversation, and therefore conversation will yield the same benefits. However, what they fail to take into account is the experimental data and the personal anecdotes from those who have experienced counseling first hand that verify psychotherapy is indeed effective. According to Dr. Greg Mulhauser, online counselor and leader in the development of CounselingResource.com, the effectiveness of psychotherapy is “relatively unambiguous: counseling does work” (1). Although numerous factors determine the success of this treatment, it is well known that it indeed works and is not a useless practice. In fact, in one experiment, the average recipient saw more improvement than 80% of people on a waiting list to get treatment (Eysenck 5). 

However, the factors that play a role in the success of the treatment are hard to judge. Some may ask if it is at all possible to measure the effectives of psychotherapy treatments. Although it is not impossible, it is difficult. Because so many factors such as the patient-therapist dynamic, the patients personality, and the patient’s willingness to participate, all play a significant role in the success of therapy, measuring its effectiveness becomes quite a task. As the University of Wisconsin’s Ann Margaret put it, in order to see whether or not therapy has been successful, we have to look at the patient first (65). Martin Seligman, American psychologist and author of many self-help books, gives one solution: surveys. Because surveys record the patient’s opinion directly from him or her, they are one of the most reliable sources of information. Such surveys generally ask about mental health professionals, emotional state at the beginning of treatment, limitations due to insurance coverage, and so on (Seligman). In the surveys Seligman distributed during one of his experiments, 87% of patients who said they felt “very poor” before therapy, responded that they felt very good or at least “so-so” after their therapy sessions were complete. That percentage is too large to ignore. Therefore, according to the 87% of people who saw improvements in this study, psychotherapy is effective.

Psychotherapy will or will not be successful depending on the person receiving the treatment. If the client is willing to change, then his or her therapy will become a success. Ultimately, the internal motivation to change leads to the success of therapy (Snyder 280). Nevertheless, the patient is not the only person who plays a major role in the success of therapy. The dynamics between the patient and the therapist can determine how effective the treatment will be as well. After all, “client perceptions of the therapists and of the therapeutic process were the most important determinants of their staying in and progressing in psychotherapy” (Bent 149). Basically, if the client feels that his her therapist is genuinely interested in his or her well being, the client will continue the therapy treatments, and eventually get better.

Although it has been said that both the client and the therapist have motives for wanting the psychotherapy treatments to be a success, and therefore will report it as such, this accusation can be considered a hasty generalization (“Pyschotherapy”). In experiments such as the one run by Russell J. Bent, clients were willing to express their disappointment with their treatments, which were mostly due to their relationship with their therapists (149). Also, patients, such as Trevor from the beginning narrative, who are mandated to go through counseling have no personal reasons for wanting therapy to be a success. In fact, they will most likely exhibit resistance at first, as if daring therapy not to work. Therefore the idea that motives will cause patients and therapists to report therapy treatments as effective is not always true.

Although psychotherapy’s success does greatly depend on the dynamics between the patient and his or her therapist, it does not always stop the treatment from being effective. For example, although Trevor was forced to attend his treatments, and hated every minute of it, he could not deny the change he saw in his behaviors and attitude for the better once it was over. Plenty of other examples like Trevor are seen in an experiment studied by scholar Christine Snyder, who is affiliated with the University of Connecticut.  Her studies indicate that both voluntary and mandated clients benefitted from therapy (281). Most therapists agree that in order for therapy for to be a success, there must be “a strong therapeutic alliance with the client” (Snyder 281).  Therefore, therapy must be reestablished as a voluntary process for these clients. This further supports the claim that it is best for therapists and patients to form some type of positive bond in order for the therapy to be effective and successful.

The duration of treatment can also alter the effectiveness of the psychotherapy. Those limited in their choice of duration of treatment due to financials, often saw minimal to no results. Dr. Allan Abbass, Dalhousie's Director of Education, conducted a study to initially confirm intensive short-term treatment was cost efficient and effective. However, he ignores a couple of important issues. First, patients did not return to for their follow up session (Abbass 228). It is impossible to have conclusive data that states the effectiveness of a treatment if patients were not analyzed or surveyed to judge whether or not they have truly gotten better. Secondly, those patients who did complete a post-therapy analysis only completed one follow up a short time after the therapy was completed (Abbass 228).  Therefore, if the treatment was only effective immediately, the patient could have relapsed shortly after the follow up. If this was the case, the intensive short-term treatment is not more cost efficient because the patient will most likely end up receiving more treatments from another therapist. This is not to say that short-term psychotherapy treatments are never effective, but instead that cost efficient methods are not always the best methods for those needing the special care.

Long-term treatments not only work best for specific problems, but they also help for coping with everyday life and personal growth (Seligman). Patients were the most satisfied with long-term treatments, and had fewer follow up appointments for relapses. Being the best and most effective, long-term therapy treatments should become the standard. Although that would mean insurance companies investing more money in this practice, in the end it may end up being cheaper. Patients would not have to continuously go back to the therapist for relapses, causing the insurance companies to spend more money on the more “cost efficient” therapy treatments. Therefore, it would actually be a smart investment and business move to spend more money on long-term therapy. Paying more money for the more effective therapies now will eventually save the insurance companies money in the end.

Because the patient-therapist relationship and treatment duration are two of the most important factors in the success of psychotherapy, it is important that limitations are not put on people seeking treatment. Seligman’s study showed “the outcome [of the therapy] was worse when insurance coverage limited their choice of therapist or the length of time they were in treatment.” Many insurance companies offer little to no treatment at all due to their skepticism, damaging the effectiveness of the treatment for millions. This is one reason why therapy should not be removed under the new healthcare plan. If the effects of psychotherapy can be damaged by limitations with insurance, imagine all of the people who will have nowhere to go to seek help for their problems if psychotherapy were not covered at all. This lack of coverage will only cause people with disturbing and maladaptive behaviors to remain the same or get worse. This can have a major effect on the person’s health and well-being. Sometimes the most cost efficient options are not the best options.

Although American psychologist and scientist-practitioner Joseph D. Matarazzo, and others, would say that the most inexpensive psychotherapist would be a good friend, I have to disagree (231). No matter how good of a friend someone may be, he or she will not have the professional training that can aid in offering the suggestions and techniques that will help a person change his or her maladaptive behaviors.  Also, friends may bring their biases into consideration when offering advice.  For example, if person A is offering person B advice about to handle the issues they are having with person C, and person A is also friends with person C, person A will take person C’s perspective of the situation into consideration when offering his or her advice to person B.  Do not get me wrong. My point is not that good friends cannot be good resources, give wonderful advice and help those in need. My point is, good friends are not always professional psychotherapists, and cannot be completely trusted to give the right advice for certain situations as well as handle the maladaptive behaviors that psychotherapists are trained to manage.

In conclusion, psychotherapy should continue to be covered by health insurance companies, even under the new healthcare plan. In fact, because studies show that long-term therapies treatments are the most effective, health insurance companies should invest more money into this type of therapy treatment duration and provide even more coverage. Therapy is a beneficial practice, despite the scrutiny it faces by the health insurance companies, outsiders, and even its patients. Therapy can be effective for most, if not all, with the right client-therapist dynamics, duration of treatment, and minimal limits on health insurance coverage. Therapy helped Trevor work out his anger management issues, and therapy can help millions of other Americans with issues they are experiencing as well. Although it may not save Americans money, it is possible it will save the patient’s mental health, and maybe even his or her life. So we have to ask ourselves as Americans, what is more important to us; saving a little money, or preserving the lives of other Americans?

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