Don't Legislate Rules for Psychotherapy

Article excerpt

The Missouri House of Representatives may soon consider a bill (HB 669) to restrict psychotherapy practice through a series of crippling requirements. Failure to adhere to these rules would lead to suspension of a license to practice. This legislation would require psychotherapists to: (1) provide an excessively detailed informed consent before third-party payment could be made and (2) provide scientific rationale for the proposed treatment plan.

Scientific studies have repeatedly demonstrated the general effectiveness of psychotherapy, especially for the treatment of depression and anxiety disorders, which affect more than 25 percent of the U.S. population. Psychotherapy can also help to reduce the medical costs of chronic illnesses by helping people cope better with the inevitable losses associated with chronic disability. Several studies have clearly demonstrated that psychotherapy is generally more effective in treating its target symptoms than drugs for arthritis, anticoagulants and aspirin used to prevent heart attacks.

So what is the problem?

Politicians and the public lack clear ideas about the practice of psychotherapy. Hollywood has tended to portray the process of treatment as single dramatic instances of talking cure - the patient suddenly realizes something critical about the past, emotionally relives the experience and is cured. On the other hand, the print media tend to suggest that psychotherapy goes on for many years, several times a week, slowly peeling the onion of the unconscious mind.

The reality of psychotherapy practice lies somewhere between these extremes. Most people seeking therapy come for fewer than four sessions. They usually develop a good relationship with the therapist while discussing their immediate concerns like depression, panic attacks, excessive self-doubt, binge eating or drinking, and problematic relationships. They often improve dramatically; a few remain for more than five to 20 more sessions if their finances and needs are strong enough. Many return for a few sessions many months or years later. Some patients do not improve; very few become worse.

Unfortunately, a minority of therapists use poor judgment with some technical approaches or do not accommodate their methods to the needs of their patients. …