Psychotherapy: A Paradox

Abstract

An editorial appeared in the September 27, 2012, issue of Nature entitled “Therapy Deficit: Studies to Enhance Psychological Treatments Are Scandalously Under-Supported”. Out of character for a leading basic science journal, it argued for the active consideration of psychotherapy for treatment and research, and it emphasized the funding disparities between psychotherapy and medication. The editorial did not describe the psychotherapy paradox. While psychotherapy is fading from consciousness and practice in some developed countries, it is being enthusiastically embraced in developing countries hurt by HIV, natural disasters, wars, or political strife. For example, World Vision, one of the largest international philanthropies, funded two clinical trials of interpersonal psychotherapy for the treatment of depression in Uganda, a country devastated by HIV and civil war. The treatment’s positive results in reducing depression and sustaining the effects were widely disseminated. Another clinical trial was completed in Goa, India, using the initial phase of interpersonal psychotherapy to treat depression in primary care, and the results were the subject of a recent editorial that questioned whether psychiatrists were needed. Verdeli and I responded strongly that psychiatrists were critical for overall quality control, patient evaluation, diagnosis, and program supervision. In fact, most of these global programs are led by psychiatrists