May 24

Short-Term Therapy Vs. Long-Term Therapy

Is short-term therapy better than long-term therapy? Or is it vice versa?

It depends who you’re asking.

If it’s clients, on one end of the continuum are those who prefer the briefest of therapies (à la Bob Newhart‘s “stop it!”)—or even no therapy at all—while, on the other end are those who love having a therapist to see over the course of their lifetime, if not continuously at least on an as-needed basis.

But then there’s the money factor. For some without means (underinsured, uninsured, or unable to pay) it doesn’t feel like a choice: short-term therapy is a cost-saver and therefore preferable.

Enrico Gnaulati‘s Saving Talk Therapy: How Health Insurers, Big Pharma, and Slanted Science are Ruining Good Mental Health Care (2018) cites a number of other factors that work against longer-term therapy. They include Big Pharma‘s pushing of psychotropic medications directly to consumers via TV and other ads, the ability to get such medications from one’s physicians versus having to see a mental health practitioner, and the fact that health insurers push quicker treatments (again, the money issue).

Gnaulati believes (Psychology Today) talk therapy is “seriously under threat; at least as it applies to varieties of talk therapy that are relatively non-directive, time-intensive, in-depth, and exploratory in nature—typically under the psychodynamic and humanistic umbrellas of care.”

The newer trend, indeed, is to provide “evidence-based” treatments, which according to Gnaulati are “CBT-type, short-term psychotherapies supposedly tailored to reduce the symptoms associated with a given diagnosis.” He regards the studies that tout such treatments as somewhat misleading, however:

Evidenced-based treatments such as these are problematic because they measure progress strictly in terms of symptom reduction over the short term, not greater social and emotional well-being over the long term.
It turns out that evidenced-based really is evidenced-biased because the bulk of current empirical evidence substantiates that ‘contextual factors’ in psychotherapy are most predictive of positive outcome—empathy, genuineness, a strong working alliance, good rapport, favorable client expectations. And when you survey clients they overwhelmingly want a therapist who is ‘a good listener’ and who has a ‘warm personality,’ not someone skilled in the latest techniques.  So, CBT-type evidenced-based treatments should not be monopolizing the field right now in the way they are.

Whether shorter or longer, talk therapy, I agree, does need to be saved. “Fifteen Facts About Mental Health That Show Why We Need to Save Talk Therapy” was posted by Gnaulati’s publisher, Beacon Press. A sampling:

  • 90% of people claim they would rather meet with a therapist to talk about their problems than take medications.
  • Only about 3% of Americans ever enter psychotherapy, even though roughly half the population meet lifetime criteria for a serious emotional problem.
  • Of the approximately 49,000 psychiatrists in the United States, the vast majority exclusively prescribe medications. Fewer than 11% provide talk therapy to their patients.
  • 58% of emotionally troubled people take medications only, with no psychotherapy. About 10% of emotionally troubled people attend psychotherapy only and opt out of medication usage.
  • 50% of research articles in the field of psychiatry are ghostwritten in some shape or form, penned by outsiders and published under the names of prominent academics, all whom draw paychecks from pharmaceutical companies.

In sum, as a talk therapist myself, I don’t believe one size (of therapy) fits all. Medications may be all some people need, while others may need to talk things out, some over a longer period than others. When talk therapy is the choice, the relationship between each particular therapist and client is what often matters the most. And last but not least, money should not have to be an issue—needed therapy should be made affordable for all.

Sep 09

Bob Newhart As Brief Therapist in Hilarious Spoof: “Stop It!”

Before Fiona Wallice‘s (Lisa Kudrow) three-minute sessions on Web Therapy, there was Bob Newhart as a shrink offering a different brand of brief therapy called “Stop It!”

In the Madtv comedy sketch of several years ago, the shrink played by Bob Newhart is considerably more old-fashioned. Whereas Fiona takes advantage of the internet, not seeing her clients in person, Newhart’s shrink sits behind his desk, his client on the other side. Mo Collins plays the bewildered, not-at-all-amused client.

For those of you short on time, you’ll need over six minutes to watch the full clip below—longer, actually, than the type of therapy advocated by this shrink. If for some reason you’d rather read the script, scroll down below the video:

According to Realtime Transcription, the following is the actual script featuring Bob Newhart as Dr. Switzer:

KATHERINE: Dr. Switzer?
DR. SWITZER (Bob Newhart): Yes, come in. I’m just washing my hands.
KATHERINE: I’m Katherine Bigmans. Janet Carlisle referred me.
DR. SWITZER: Oh, yes. You dream about being buried alive in a box.
KATHERINE: Yes, that’s me. Should I lay down?
DR. SWITZER: No, we don’t do that anymore. Just have a seat and let me tell you a bit about our billing. I charge five dollars for the first five minutes and then absolutely nothing after that. How does that sound?KATHERINE: That sounds great. Too good to be true as a matter of fact.
DR. SWITZER: Well, I can almost guarantee you that our session won’t last the full five minutes. Now, we don’t do any insurance billing, so you would either have to pay in cash or by check.
KATHERINE: Wow. Okay.
DR. SWITZER: And I don’t make change.
KATHERINE: All right.
DR. SWITZER: Go.
KATHERINE: Go?
DR. SWITZER: Tell me about the problem that you wish to address.
KATHERINE: Oh, okay. Well, I have this fear of being buried alive in a box. I just start thinking about being buried alive and I begin to panic.
DR. SWITZER: Has anyone ever tried to bury you alive in a box?
KATHERINE: No. No, but truly thinking about it does make my life horrible. I mean, I can’t go through tunnels or be in an elevator or in a house, anything boxy.
DR. SWITZER: So, what you are saying is you are claustrophobic?
KATHERINE: Yes, yes, that’s it.
DR. SWITZER: All right. Well, let’s go,Katherine. I’m going to say two words to you right now. I want you to listen to them very, very carefully. Then I want you to take them out of the office with you and incorporate them into your life.
KATHERINE: Shall I write them down?
DR. SWITZER: No. If it makes you comfortable. It’s just two words. We find most people can remember them.
KATHERINE: Okay.
DR. SWITZER: You ready?
KATHERINE: Yes.
DR. SWITZER: Okay. Here they are. Stop it!
KATHERINE: I’m sorry?
DR. SWITZER: Stop it!
KATHERINE: Stop it?
DR. SWITZER: Yes. S-T-O-P, new word, I-T.
KATHERINE: So, what are you saying?
DR. SWITZER: You know, it’s funny, I say two simple words and I cannot tell you the amount of people who say exactly the same thing you are saying. I mean, you know, this is not Yiddish, Katherine. This is English. Stop it.
KATHERINE: So I should just stop it?
DR. SWITZER: There you go. I mean, you don’t want to go through life being scared of being buried alive in a box, do you? I mean, that sounds frightening.
KATHERINE: It is.
DR. SWITZER: Then stop it.
KATHERINE: I can’t. I mean it’s —
DR. SWITZER: No, no, no. We don’t go there. Just stop it.
KATHERINE: So, I should just stop being afraid of being buried alive in a box?
DR. SWITZER: You got it. Good girl. Well, it’s only been three minutes, so that will be three dollars.
KATHERINE: Actually, I only have five so —
DR. SWITZER: Well, I don’t make change.
KATHERINE: Then I guess I’ll take the full five minutes.
DR. SWITZER: Fine. All right. What other problems would you like to address?
KATHERINE: I’m bulimic. I stick my fingers down my throat.
DR. SWITZER: Stop it! Are you a nut of some kind? Don’t do that.
KATHERINE: But I’m compelled to. My mom used to call —
DR. SWITZER: No, no. We don’t go there.
KATHERINE: But I —
DR. SWITZER: No, we don’t go there either.
KATHERINE: But my horoscope did say —
DR. SWITZER: We definitely don’t go there. Just stop it.What else?
KATHERINE: Well, I have self-destructive relationships with men.
DR. SWITZER: Stop it! You want to be with a man, don’t you?
KATHERINE: Mm-hmm. Mm-hmm, yes.
DR. SWITZER: Well, then, stop it. Don’t be such a big baby.
KATHERINE: I wash my hands a lot.
DR. SWITZER: That’s all right.
KATHERINE: It is?
DR. SWITZER: I wash my hands all the time. There’s a lot of germs out there. Don’t worry about that one.
KATHERINE: I’m afraid to drive.
DR. SWITZER: Well stop it. How are you going to get around? Get in the car and drive you, you kook. Stop it.
KATHERINE: You stop it. You stop it.
DR. SWITZER: What’s the problem, Katherine?
KATHERINE: I don’t like this. I don’t like this therapy at all. You are just telling me to stop it.
DR. SWITZER: And you don’t like that?
KATHERINE: No, I don’t.
DR. SWITZER: So you think we are moving too fast, is that it?
KATHERINE: Yes. Yes, I do.
DR. SWITZER: All right. Then let me give you ten words that I think will clear everything up for you. You want to get a pad and a pencil for this one?
KATHERINE: All right.
DR. SWITZER: Are you ready?
KATHERINE: Mm-hmm.
DR. SWITZER: All right. Here are the ten words: Stop it or I’ll bury you alive in a box!