Psychotherapy - Who pays?

In Chapter One of their book, Eleven Blunders That Cripple Psychotherapy In America, Nicholas Cummings and William T. O'Donahue point out that psychologists in America lost their economic savvy.

They point out that the average income of Ph.D psychologists is less than pharmacists, Podiatrists, Optometrists, Nurse Practioners and that 40% of occupational therapists make more than 30% of psychologists. It is interesting that they don't mention educators or Social Workers.

The largest professional provider group of mental health services in the United States are Social Workers. The largest group of substance abuse treatment services are also Social Workers and Credentialed Alcoholism and Substance Abuse Counselors,CASACs.

All human service work from child care to psychotherapy is very low paid in the United States because as a society we do not value these services, or perhaps should I say, these services have little value, and the supply is not limited and its workers are not unionized.

As Cummings and O'Donahue point out in the next chapter of their book, there has not been much research to provide evidence of the value of psychotherapeutic services and therefore they have not been perceived as important or significant by health care and human service policy makers. However, the evidence is accumulating that psychotherapy does make a positive differance in people's lives and is worth the money as compared to other health care and social interventions such as criminal justice, social welfare, educational programs.

I have always had mixed thoughts and feelings about psychotherapy being a business. On the one hand it clearly is and for practitioners to be stable and proficient they deserve to have an appropriate income which is adequate. However, there is more to psychotherapy than making money. It is a service profession and there are many people in need of psychotherapy who cannot afford to pay the fees and so third party reimbursement is necessary and socially advantageous.

The large question then which Cummings and O'Donahue don't raise is how should psychotherapeutic services be paid for? How should they be paid for when the recipient cannot pay for them themselves? We live in a society which gladly incarcerates over 2 million people at the cost of $35,000.00 per year per person. We gladly provide children with public education whose main goal is to educate their minds, but often their emotional life and mental health is dealt with only superficially because it is not the function of the school to deal with its students mental health per se.

The community mental health movement started by President Kennedy in 1963 was a grand success at deinstitutionalizing our state hospitals and making mental health services available to communities, but when the federal money dried up and Managed Care moved in, the mental health centers were dismantled, the very successful model abandoned, and people left to their own resources in which case those who could afford care accessed it and those without resources went without or were dealt with by the criminal justice system and the social welfare system.

While Cummings and O'Donahue have a point about the lack of economic savy by psychotherapists, I don't see the issue strictly as a business and economic one. I think there is a larger social policy issue and it rests on the premise of what kind of a society do we want to live in and if it involves facilitating the development of good mental health of its citizens, there needs to be an investment of resources to pay for good psychotherapeutic services for people in need.