Cost-Effectiveness in Psychotherapy

Psychotherapy, like the American economy, is in a permanent state of crisis. It is currently being challenged by legislators to prove its cost-effectiveness. It is derided by liberationists who believe it puts a pathological label on their protest movements. It is misinterpreted by journalists seeking controversial issues for their columns. And it is torn to shreds by competing practitioners who aggrandize their unique brands of helping people with a vigor matched in intensity only by the calumnies they heap on alternative approaches. But through all this fuss and clamor we must admit that, while psychotherapy is in a sense ailing, its condition is far from terminal. Perhaps for want of nothing better, it remains the most fruitful means of dealing with emotional problems. Its usefulness is substantiated by many outcome studies which in essence indicate that fully two-thirds of all patients undergoing psychotherapy, irrespective of type, show an improvement in their condition. Considering the fact that so many heterogeneous forms of therapy exist and so many different kinds of therapists are wielding interventions for better or worse, this figure is quite impressive. But it does raise questions about the nature of the elements that enter into the healing process. Why do the dynamic, behavioral, client-centered, existential, cognitive, experiential and other treatment methods show a similar bell-shaped curve of improvement? Are we dealing with different kinds of improvement among the two-thirds beneficiaries or are similar healing forces operating in all forms of therapy, having little to do with their theories and methods? These questions have a direct bearing on psychotherapeutic cost-effectiveness.

“Improvement” is a vague term that covers a variety of conditions. A man with a headache experiencing relief through application to his head of an ice pack will claim “improvement” or “cure.” Instead of this symptom-oriented approach, we may prefer to explore the possible