The Need for Psychotherapy in the Medically Ill

Many medical and surgical patients have a need for psychotherapy, both because of a high prevalence of psychiatric disorders in this population and secondarily because of the inherent stress of serious illness. Six percent of patients in primary care settings and 11 percent of medical inpatients have a diagnosis of major depression (Katon and Sullivan, 1990). In addition, nearly half of all cancer patients have a diagnosable psychiatric disorder (Derogatis, Morrow, and Fetting, 1983).

Psychotherapy provides a source both of support and interpersonal connection. The need for this among the medically ill is illustrated by the fact that the relationship between social isolation and risk of death is as great as smoking or elevated serum cholesterol and mortality (House, Landis, and Umberson, 1988). In addition, social stress such as job loss or the death of a loved one is associated in several studies with a higher incidence of malignancy and higher relapse rates in cancer patients.

Patients with multiple physical symptoms but no diagnosable physical disease have nine times the average per capita medical care cost (Smith, Monson, and Ray, 1986), which declines after psychiatric