Bishop, Jerry E. "Psychotherapy's Value Becomes a Key Issue as More and More People Use
It," Wall Street Journal, 22 October 1986, pp. 1, 27.
This is the second in a series appearing in this newspaper concerning mental illness. This article
deals with effectiveness of therapy and, as the title suggests, the rationalizers of the system for
reimbursing providers - the insurance companies and Medicare - want to know that they're
getting effective treatment for their dollars. The problems cited here are old but these are
relatively new people asking the old question: how can one evaluate therapy? Perhaps these new
investigators will come up with answers which will satisfy them, but therapeutics in psychiatry
will never be satisfactorily evaluated.
The first point noted is that Freudian therapy is never ending. Freud mused on the same point in
Therapy, Interminable or Terminable? After all, one can endlessly mull over some childhood
event or dwell on some dream. When does the talking cure end? Is it when the patient
subjectively reports that he feels better?
Hard data on effectiveness of therapy is very difficult to come by. There is reference here to Hans
Eysenck's 1952 report in which he says that time is just as effective as therapy. But with that as a
base line, more recent studies are discussed and the clear implication here (what else could it
be?) is that therapy does work but is difficult to evaluate. Think of the variables and the
tremendous variation in the situations of therapy: the problems of human beings display that
variation. Then, think of the tremendous number of therapies and therapists. Then, imagine the
mix of patients and their problems, therapists and their therapies, and you get an idea of the
complexities. For example, a particular therapist may do well with schizophrenia in children, but
be worthless with depressed adult males. It is all too easy to report on data which makes therapy
look good or bad, depending on one's assumptions. One could make a career out of daming or
defending psychotherapy, and I think there are researchers who do just that.
There is the suggestion here that psychotherapy is more effective than drug therapy. The next
study to come down the pike will undoubtedly report the opposite.