Photo credit: Jty33

What has gone wrong in the field of mental health care? In recent decades there has been a decline in the quality and availability of psychotherapy in America that has gone unnoticed—even though rates of anxiety, depression, and suicide are on the rise. Many people struggle to find an available and affordable practitioner in their area, and if they do, they’re limited to restrictive short-term treatment options, sporadic appointment schedules, and prescriptions for medications they don’t want or need. On top of that, psychotropic drugs, if no longer thought of as a magical cure, are still over-prescribed. How do we bring back the days of patients sitting comfortably across from their therapists, talking through their thoughts, struggles, and desires?

In Saving Talk Therapy: How Health Insurers, Big Pharma, and Slanted Science are Ruining Good Mental Health, leading clinical psychologist Dr. Enrico Gnaulati presents powerful case studies from his practice to remind patients and therapists alike how and why traditional talk therapy works. Using cutting-edge research findings, he also unpacks the problematic incentives in our health-care system and in academic psychology that explain its decline. The following list of facts about the current state of psychotherapy and mental health from Saving Talk Therapy highlight why Dr. Gnaulati makes his case that doctors and patients need to come together to create a more balanced and nuanced approach to therapy.

Talk Therapy and General Mental Health Care

• In the late 1950s, about 14% of Americans had visited a psychotherapist at some point in their lives. The number rose to 26% in the 1970s and to 50% in 2010
• For most Americans who enter therapy for help with moderate anxiety and depression, one to two years of weekly therapy appears to be indicated for meaningful and lasting change to occur
• 90% of people claim they would rather meet with a therapist to talk about their problems than take medications
• Only about 3% of Americans ever enter psychotherapy, even though roughly half the population meet lifetime criteria for a serious emotional problem
• In one study of consumer preferences in service delivery, choice of therapist ranked second in importance, leading the investigators to assert that selection of a compatible psychotherapist may be one of the most crucial decisions a prospective client can make given the well-established importance of the therapeutic relationship

Medication Use

• Of the approximately 49,000 psychiatrists in the United States, the overwhelming majority exclusively prescribe medications. Fewer than 11% now provide talk therapy to their patients
• 58% of emotionally troubled people take medications only, with no psychotherapy. About 10% of such people attend psychotherapy only and opt out of medication usage
• In 2010, approximately 40% of Americans seeking mental health treatment received psychotherapy, down from 71% before the advent of Prozac
• Studies show that (SSRIs) selective serotonin reuptake inhibitors are no more effective in treating depression than the older, cheaper antidepressants; they dampen sexual functioning, they are linked to a risk for suicidality and violence. More large-scale studies have revealed that SSRI antidepressants are no more effective than sugar pills in the treatment of depression
• The use of antipsychotics to treat ADHD and explosive or disruptive behavior in young children and teenagers accounts for about 38% of all sales

Psych Industry and Pharmaceutical Industry

• 50% of research articles in the field of psychiatry are ghostwritten in some shape or form, penned by outsiders and published under the names of prominent academics, all whom draw paychecks from pharmaceutical companies
• The United States shells out about $113 billion a year on mental health treatment; approximately half of that covers the cost of psychiatric drugs. Expenditures on mental health care account for only 5.6% of the total health-care budget
• In the past 10 years, psychotherapy referrals by physicians have fallen by nearly 50% even though figures confirm that mental health problems are on the rise
• According to the 2014 article “Expanding the Lens of Evidenced-Based Practice in Psychotherapy: A Common Factors Perspective, ” therapist empathy is about 9x more effective than any other technique is in helping clients
• In a 2004 Therapy in America poll, patients were asked what led to success in their treatment. The two top-ranked factors were “therapist’s listening skills” and “therapist’s personality,” endorsed by 63% and 52% of participants, respectively

About Enrico Gnaulati 

Enrico Gnaulati PhD is a clinical psychologist based in Pasadena, California. His work has been featured on Al Jazeera America, KPCC Los Angeles, KPFA Berkeley, and online at the Atlantic and Salon. He is a nationally-recognized critic of mental health practice and policy and the author of Back to Normal: Why Ordinary Childhood Behavior is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder. Visit his website.