Rebooting Psychotherapy

Psychotherapy has come a long way since the days of Freudian psychoanalysis – today, rigorous scientific studies are providing evidence for the kinds of psychotherapies that effectively treat various psychiatric disorders. But Alan Kazdin, the John M. Musser Professor of Psychology at Yale University, believes that we must acknowledge a basic truth – all of our progress and development in evidence-based psychotherapy has failed to solve the rather serious problem of mental illness in the United States. In an article published in the January 2011 issue of Perspectives on Psychological Science, Kazdin and his co-author, Stacey Blase, also at Yale University, urge psychological scientists to rethink the current mental health system in order to make adequate treatment available and accessible to all who need it.

Now, in the latest issue of Perspectives on Psychological Science, several eminent scientists have come forth in response to Kazdin and Blase’s article, highlighting important points that will need to be addressed before the mental health care system can be overhauled, including:

• Understanding what works and for whom: Psychological scientists Varda Shoham, of the University of Arizona-Tucson and Thomas R. Insel, Director of the National Institute of Mental Health, contend that knowing which treatments work won’t matter unless we know how to target the interventions to the people who will benefit most. “In the absence of such knowledge,” they argue, “we risk treatment decisions guided by accessibility to resources rather than patient needs – the very problem Kazdin and Blase aim to solve.”

• Integrating several levels of care: Marc S. Atkins and Stacy L. Frazier at the University of Illinois at Chicago argue that “only a comprehensive and integrated public health model can adequately address the pervasive societal problems that underlie our country’s mental health needs.” Adopting such a public health approach will require that we pay attention to all levels of mental health care, distributing resources equally from the prevention to intervention stage of the treatment process.

• Identifying optimal methods of delivery: According to Brian Yates of American University, we have to find more effective ways to deliver treatment – “methods that use less therapist time, less client time, minimize client transportation costs as well as brick-and-mortar space, and use less of other increasingly scarce and costly resources.”

While the notion of rethinking the current approach to mental health care seems like an incredibly daunting endeavor, there is some hope. As the authors of one commentary point out, the United States Department of Veterans Affairs has already developed and implemented new and innovative programs to address the mental health of its veterans.

Together, these commentaries offer frank insights into the challenges we face in trying to address the mental health burden in the United States.

Alan Kazdin discusses this pressing issue at the 2010 APS Annual Convention: