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CAS psychologist calls for new descriptions, appreciation for therapy
By Jessica Ullian
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David Barlow, director of the Center for Anxiety and Related Disorders, says that insurers need to recognize the proven medical benefits of psychotherapy. “There’s a reluctance to recognize the robust effects of psychotherapy for disorders,” he says. Photo by Vernon Doucette |
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Popular images of psychotherapy — typically involving a leather couch, a solicitous doctor, and the phrase “Tell me about your mother” — are deeply ingrained in the public consciousness. Such impressions are widespread in the health-care system as well, says David Barlow, a CAS professor of psychology and director of the Center for Anxiety and Related Disorders, leaving many medical professionals and insurance providers with misconceptions about the idea of psychological therapy as a medical treatment. The federal Medicaid program, for example, does not require states to include mental health services in their Medicaid plans, and many do not allow psychologists to bill Medicaid for services.
“Our current health-care system tends to mislead people into thinking that all psychotherapy is a long-term, lying-on-the-couch, examining-the-meaning-of-life sort of thing,” says Barlow. “As a result, there’s a reluctance to recognize the very strong and robust effects of psychotherapy for disorders.”
In identifying the problem, Barlow has also proposed steps toward a solution. In an article published last December in American Psychologist, Barlow wrote that altering the terminology used to describe mental health care could lead to changes in policy. Changing the way that professional and governmental health organizations refer to psychotherapy, he says, such as replacing the term intervention with treatment, will help distinguish between people who need medical help and those who are dealing with “problems of living and self-actualizing, how to lead a more fulfilling life, and how to love and be loved.”
“It’s an educational process,” he says. “We need to go in front of policy makers and legislators and say, ‘This is an important distinction.’”
Historically, Barlow says, the term psychological intervention has been used to describe every form of “talk therapy,” whether used to help people have more productive relationships or to deal with physical problems. “General unhappiness,” he says, “has been lumped in with identifiable disorders, and the health-care system is continuing to decide whether they’re going to pay for them to be treated.”
The idea that psychotherapy is used exclusively for long-term self-exploration, he says, has led to a disparity in the insurance provided for physical and mental health benefits. A 2000 Bureau of Labor Statistics study found that at companies offering mental health benefits, in 86 percent the coverage limit for outpatient physical services was different from that for outpatient mental health services. In addition, 87 percent of Americans cite lack of insurance coverage as their primary reason for not seeking mental health services, according to a survey by the American Psychological Association.
The APA has dealt with the problem by establishing a task force to study the need for evidence-based practices, which would set guidelines for proving the efficacy of psychotherapy for certain disorders. Barlow believes such guidelines will play a critical role in changing public perceptions of psychotherapy. In the American Psychologist article, he reviewed several studies comparing the effects of psychological treatment with those of medication and routine medical care — illnesses studied included insomnia, stress incontinence, panic disorder, and Gulf War veterans’ illnesses. In every case, he noted, the psychological treatments, sometimes combined with medication, were as effective or more effective than medication and routine medical care alone.
The psychological treatments used were “brief but powerful,” Barlow says, and designed specifically to deal with the patient’s disorder, demonstrating that psychological treatments do not have to go on for years. “There is this conception that it will become an extensive process,” he says. “The fact is, most people get no more than six or eight sessions of treatment.”
Such studies could be key to changing public policies on mental health care, says CAS Psychology Professor Michael Lyons, director of the clinical psychology program. “I think that’s the kind of information that’s most useful to policy makers,” he says. “If you can lay out figures in terms of the effectiveness of that kind of treatment, especially if you can take it a step further and translate that effectiveness into economic impact, that strengthens the argument as well.”
While the change in terminology is an important starting point, Barlow knows that the role of psychotherapy is more than an issue of language. But if treatments can help problems ranging from cardiac disorders to obesity, he says, it is critical to start making people aware of psychotherapy’s benefits, recognizing that it can have the same time limits as any other medical treatment and changing health-care policies to reflect the need for such treatments.
“This wouldn’t happen overnight,” he says. “But this distinction between treating people with health-related problems and the more growth aspect of psychotherapy is a distinction we need to make to policy makers and to the general public.”
18
March 2005
Boston University
Office of University Relations