Talk therapy by U.S. psychiatrists declined by half since 1996, study reveals

NEW YORK — Talk therapy rates among American psychiatrists have declined considerably over the past few decades, according to researchers from Columbia University. For a long time, psychiatrists would routinely employ a combination of both medication and psychotherapy (talk therapy) to help their patients, but these numbers indicate a clear shift in treatment philosophy.

Study authors analyzed data from a period between 1996 and 2016 for this report. The analysis revealed that the percentage of psychiatrist visits involving psychotherapy was cut in half during that time. By 2016, only 21.6 percent of U.S. psychiatrist-patient visits involved talk therapy, compared to over 44 percent in 1996. Researchers note that by the mid-2010s, over half of all U.S. psychiatrists did not practice any psychotherapy at all. They add that figure has probably increased since then.

Who is receiving less access to talk therapy?

Importantly, this trend did not affect all patient groups equally. Older, white patients living in the Northeast and the West paying out-of-pocket for treatment weren’t all that inconvenienced by these changes. These groups retained access to a small contingent of psychiatrists who were more likely to provide talk therapy, focused on a small number of patients, and typically saw their patients often.

Meanwhile, younger people in general, those living in rural areas, Black or Hispanic patients, and people using public insurance to pay for therapy all received far less talk therapy over the past 20 years or so.

“We knew psychiatrists were providing less therapy than before, but we were surprised by the magnitude of the drop and its persistence. Almost all patient groups were impacted, though some much more than others,” says lead study author Daniel Tadmon, a PhD candidate in the Department of Sociology at Columbia, in a university release.

Certain patients seemed to see bigger declines than others. For example, in the mid-1990s, people diagnosed with a personality disorder would undergo some talk therapy during 68 percent of psychiatrist visits. By 2010, that number dropped to a mere 17 percent.

So, what caused all this?

Study authors say many factors may revolve around economics. Simply put, it’s cheaper for the average American to get their talk therapy from a counselor, social worker, or other type of mental health professional. Focusing on medication over talk therapy makes financial sense for psychiatrists as well. A talk therapy session is going to take at least 40 minutes. Within that same time frame, a psychiatrist can have multiple, shorter, medication management visits.

“For many psychiatrists, this helps pay their soaring medical school debt,” Tadmon explains.

Researchers note that the U.S. is also experiencing a nationwide shortage of psychiatrists, which has likely contributed to this trend. COVID-19, which increased demand for mental health services dramatically, certainly hasn’t helped either.

According to the American Psychiatric Association, psychiatrists treat “both the mental and physical aspects of psychological problems,” via an expert blending of both psychological and pharmacological treatment approaches. Senior study author Mark Olfson, a professor of psychiatry and medicine at Columbia University Vagelos College of Physicians and Surgeons, however, believes this research makes a compelling case that the field of psychiatry is undeniably leaving psychotherapy behind.

“In response to powerful economic incentives, U.S. psychiatrists have become increasingly focused on medication management,” Prof. Olfson concludes. “This transformation risks leaving unaddressed difficulties that their patients have in their personal relationships, families, and work roles.”

The findings appear in the American Journal of Psychiatry.

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