¶ … Psychotherapy's Claims, Skeptics Demand Proof By BENEDICT CAREY (NYT).
Published: August 10, 2004
Insurance companies are pushing psychotherapists to prove that what they do produces results. Insurance companies pay for therapies selectively, with the result that people who receive psychotherapy, an estimated 20 million, often have to pay for it themselves. Insurance companies and some others argue that the therapists should be able to show scientific studies demonstrating what patients benefit from what they do. Others say that it's not possible to quantify talk therapy to the point that research can prove its effectiveness. Some think the future of talk therapy may depend on the outcome of this disagreement. Some experts claim the process is too intuitive to be measurable by quantified methods.
There are some disorders for which clear methods exist, with research showing their effectiveness. They include cognitive therapy and exposure therapy to deal with fears and phobias. Managed care has responded to this data and expects therapists to use only approaches with data backing them. Other limit the number of sessions they will pay for according to diagnosis. Now, many insurance companies require either the therapist, or the patient, or both, to demonstrate that the therapy is helping the patient, in an attempt to make the therapist accountable. Some therapists object because they do not feel talk therapy can be quantified. Others object saying it's a breach of patient confidentiality.
Some experts acknowledge that we have little solid knowledge about which approach will be best for any given patient. The article cites one patient who has found that therapy helped him significantly. He can state why he thinks it works: he had difficulty expressing anger, and the therapist deliberately angered him, and "I just woke up; it was like the Big Bang for me."
Experts acknowledge that they need more information but question whether the best approach is to try to quantify such a spontaneous, interpersonal interaction, especially one taking place over a period of months. The debate is heated and not settled yet.
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