How Psychotherapy Has Evolved

Ira Halper, MD, a psychiatrist at Rush University Medical Center in Chicago, Illinois.By Ira S. Halper, MD

I was saddened to read a recent article in the New York Times featuring a psychiatrist who used to like doing psychotherapy. He now restricts his practice to writing prescriptions. He no longer talks to his patients about their emotional problems; he refers them to nonmedical therapists.

Many people are familiar with the dramatic developments in the field of psychopharmacology beginning in the 1950s. Less well known are the equally exciting developments in the field of psychotherapy during these years, particularly cognitive therapy and other cognitive-behavioral therapies.

Cognitive therapy and other cognitive-behavioral therapies are active and structured forms of psychotherapy based on the idea that the way an individual views the world has a major influence on emotions and behavior.  A variety of cognitive and behavioral strategies are employed to reduce unpleasant feelings and change maladaptive behavior.

These treatments are more efficient and often more effective than traditional psychotherapy in the treatment of depression, anxiety disorders and other psychiatric illnesses. Cognitive therapy and other cognitive-behavioral therapies can be used alone or with medication, and treatment often takes months rather than years. These treatments are based on scientific research.

Not every psychiatrist is interested in doing psychotherapy, and not every psychiatrist is trained in the newer psychotherapeutic techniques. Splitting the treatment can work well. Nevertheless, there is an advantage to patients receiving both medication and psychotherapy from the same clinician, particularly in complicated cases. Receiving treatment from a single clinician who integrates both the biological and the psychological elements of the treatment can lead to better results in a shorter period of time.

Ira S. Halper, MD, is director of the Cognitive TherapyCenter in the Department of Psychiatry at Rush University Medical Center.

2 thoughts on “How Psychotherapy Has Evolved

  1. Good article and it’s sad to read about that psychiatrist who “used” to do talk therapy.

    I think one reason psychiatrists prefer to just write prescriptions is the amount of time it takes. You can have a client come in, quickly diagnose their main issue and write a script for them – all in 15 minutes. As opposed to talk therapy, which can take upwards of 1 1/2 hours for the initial intake and subsequent 60 minute sessions.

    From just a business perspective, it makes sense to forgo the latter in favor of seeing more clients in the same amount of time. Unfortunately, in my experience, this seems all too often the case.

    This really reinforces the notion of getting help from multiple sources and I completely agree with the premise of your article.


  2. I agree with all of the above – in part I think it is fueled by a lack of training and economics. Good or bad, many more states are allowing psychologists to prescribe (who would do both) and there are there are others cutting into the market share (e.g., NP, PA). If psychiatrists fail to evolve, where will they be in 10 years?

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