Is Psychotherapy a Viable Alternative to Psychopharmacology?

In last week’s column it was shown that psychiatric drugs worked, not for their chemistry but because of psychological factors. The main psychological factors are the relationship between the psychiatrist and the client and the client’s expectations of getting better. For those psychiatrists who practise as psychopharmacologists, drugs are supposed to work because of their chemistry, not because of psychological factors. This latter situation challenges the use of psychotropic medication in the treatment of people’s troubled and troubling behaviours. This is not the case for psychotherapy. Psychotherapists are trained to provide an unconditional regard for their clients, along with a search for meaning and an empathic and authentic response to their clients problems in living. Within the caring environment created their intention is to arrive at the affective meaning of their clients’ presenting distress – depression, hallucinations, paranoia, obsessions, etc – and to replace the hopelessness of their inner turmoil with an enduring loving relationship with self, belief in their potential and a sense of hope and faith in their future. These aims are part of the essence of psychotherapy.

There have been hundreds of studies done on the effectiveness of psychotherapy and all point to one inescapable conclusion – it works, both in the short term, but even more so, in the long-term. Whilst there are several different kinds of psychotherapies, for the most part research indicates that the differences in effectiveness are not very large and it is for clients to discover what best fits for the resolution of their unhappy state.

Psychotherapy has a number of advantages over drugs. The glaringly obvious one is that it is not a drug and that it does not have the terrible side effects or other risks that accompany taking drugs. A crucial advantage is that it can be used safely to help children, teenagers and young adults who present with depression, attention-deficit behaviours and other such problems in living – all for whom the risk of suicide is increased when taking drugs.  A further plus is that people are less likely to drop-out of psychotherapy, compared to many who stop taking major drugs due to the upsetting side-effects. The greatest advantage of psychotherapy over drugs is that it reduces the likelihood of relapse after having recovered from the presenting problem. What relates to the preceding advantage is that not only is psychotherapy a relationship and a learning experience but that clients are also reassured that they do not have an underlying biochemical disorder for which they have no control, and that their distress is a creative means of bringing attention to long-term unresolved conflicts. Furthermore, before ending psychotherapy, they will be advised that any future downturns in mood are meaningful and not a return of a sinister underlying bio-chemical disorder, an expectation that is common among people who have been taking medication and are seeking to discontinue its use.

Yet another well-documented advantage is that psychotherapy alone is as great as the combined effects of psychotherapy and medication, so why bother with the drugs?

Surprisingly, psychotherapy costs less than medication. This claim runs contrary to popular belief – the cost of a week’s medication is less (not always, depending on the drug cocktail) than an hour session of psychotherapy. But in the long run psychotherapy is cheaper because many clients are kept on long-term, even life-time medication and warned of a relapse should they stop taking the medication. The issue is that the cumulative costs of medication continue to rise, whereas those of psychotherapy do not. The problem now is that there are not enough psychotherapists available. Currently, in Britain there is in place a ten year plan in which 10,000 psychotherapists will be trained and the creator of the plan, Lord Richard Layard, believes that not only will the programme pay for itself but will actually generate a profit. After two years, this programme’s two pilot studies have been deemed a success and ten new training sites have been established.

In Ireland, where the HSE goes from one crisis to another and where its record on the care of those who are emotionally and socially troubled and troubling is poor, the British initiative will hopefully point the way for the present government where cutting the health budget has become a major challenge. In the meantime, for those individuals who are on long HSE waiting lists for psychotherapy, there are several low-cost counselling centres available throughout the country. What is uplifting about the demise of the chemical-imbalance theory, the stark revelations about drugs not working for their chemistry but because of psychological factors and the undisputed evidence of the effectiveness of psychotherapy is the hope that it will bring to millions of people throughout the world who were without hope of recovery from their ‘problems in living’.

Dr. Tony Humphreys is a Clinical Psychologist/Author, National and International Speaker.  His recent book with co-author Helen Ruddle, Relationship, Relationship, Relationship: The Heart of a Mature Society is relevant to today’s topic.