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.