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Have you ever had a well-educated patient who, it turns out, is clueless about what distinguishes your training as a psychologist or psychiatrist? Have you ever had a patient request that you use cognitive-behavioral techniques because he or she has read that they provide the most effective psychotherapy? Have you ever been told that psychodynamic psychotherapy is old-school, and that no evidence exists to support its efficacy? Has a patient ever expressed the wish that you try to conduct yourself like a life coach? The public is often unaware and even ignorant about the mental health profession, and we ought to recognize that psychoanalysts are especially imperiled by the mounting confusion about treatment options.
Enrico Gnaulati's Saving Talk Therapy: How Health Insurers, Big Pharma, and Slanted Science Are Ruining Good Mental Health Care is a courageous attempt to take stock and to reflect on the current state of mental health treatment. Gnaulati recalls the popular writings of psychoanalysts from an earlier era who defended the value of psychotherapy without jargon or technical language, and hopes to follow in their footsteps in claiming that talk therapy remains a valid way to enhance our sense of agency and to live more authentically and lovingly. Bucking major trends in the world of mental health, Gnaulati takes a stand against how “the entire enterprise of seeing a shrink has been shrunk” (p. 4).
There are three prongs to Gnaulati's critique, following the subtitle of the book: insurance companies, pharmaceutical companies, and bad science. The case against insurance companies focuses on “managed care,” an allegedly cost-conscious strategy that in reality has functioned to limit reimbursement. Underfunding of psychotherapy has made the relation between providers and insurers adversarial. Insurance companies require diagnoses for reimbursement and reflexively try to limit or deny treatment. What they never seem motivated to do, as Gnaulati notes, is to engage