Psychotherapy: Do

We Have Enough
People Invested?
Andrew Tsai
Intern/Mentor GT
January 15, 2016
Mrs. Bagley
Period 6

After seeing several lacerations, staph infections, and an injured pinky, Dr. Choo said to
wait while he checked up on a psych patient. Walking back into the doctors cubicle, I could tell
that there was a slight moderation to his subtle smile that often he often carried around with him,
and I inquired about the patient. A minor at seventeen years old had recently had sexual
intercourse with a twenty-eight year old man, apparently the side-effect of a long lasting case of
suicidal intentions. This arose from molestation at age thirteen, according to report, and this early
case of sexual exposure led her to begin using Tinder at a young age. She had been leaving at
3AM at night for the past two years since she was 15 years old and reportedly has many
stressful life events. Her father is an alcoholic and she lives with her mother. Almost always,
patient names are blurred out with asterisks for anonymity, and these are often the psych patients
that show up at Howard County General Hospital. My mentor constantly says to me how there is
a lack of psychology professionals, which is the reason why so many end up in the general
Pediatric Emergency Room.
Though just a single case, this is an example of the myriad teenagers who are enduring a
constant inner turmoil with what they believe to be their greatest enemythe imperfect image of
their lives. In terms of psychological illnesses, a large majority of the cases are related to
depressive or anxiety-related disorders. Causes include an assortment of cases, from poor family
upbringings to traumatic experiences to the diagnosis of a terminal illness. Even I, at a young
age, suffered turmoil in regard to anxiety and required mild treatment, but a seriously pressing
concern that severely afflicts many patients I see is depression. Suicide is the third highest cause
of death in the United States, and depression is the leading cause of suicide and psychological
illnesses (Rice). One of the most common methods of treatment for any mental illness is
psychotherapy, which involves personal help from a professional. Psychotherapy may be based

on a behavioral level by creating healthier actions to live by, a cognitive level by a psychiatrist
using positive-talk is to alter the mistakes in thoughts, or a combination of both in CognitiveBehavioral Therapy (Wienclaw). Regardless, this involves a trained psychiatrist that has been
educated on how to endorse in therapy. Pharmacotherapy is different, in that it involves
medicated treatments aimed at targeting various neurotransmitters and chemicals in the brain,
depending on the type of disorder. There is less time investment of professionals because
medication does not involve the multi-week, several hour sessions that accompany the profession
of a therapist. Clearly, many teenagers are suffering from psychological illnesses including
depression, and although both psychotherapy and pharmacotherapy are helpful
treatments, there is a need for increased investment in the training of psychotherapy
because it is harmless, there is a lack of psychology-trained medical doctors, and it is best
used in conjunction with medication for depression.
Depression is commonly known to be the most common psychological illness. The
chance for an individual to have a Major Depressive Episode during their lifetime is very high
20% of individuals. Especially for adolescents, this is very worrisome because of an increased
risk of death by suicide, suicide attempts, and recurrence of major depression by adulthood.
(Williams). Dr. Williams, using this data, developed a study on how psychotherapy differed from
medications using various Selective Serotonin Reuptake Inhibitors (SSRIs). By using
information from the Database of Abstracts of Reviews of Effects (DARE) and the Cochrane
Database of Systematic reviews (CDSR), Williams was able to acquire data regarding results of
medical tests for patients treated with SSRIs, psychotherapy, or both. Results showed that 90%
of psychotherapy tests had high trends in the quick reduction of depression symptoms, and for
medication therapy, between 36% and 69% of the tests resulted in positive outcomes, when

compared across 9 different trials (Williams). This is a fairly significant gap in terms of
effectiveness, leading to the question of whether pharmacotherapy can be completely trusted on
its own. In addition to this information regarding pharmacotherapy, there are also widespread
beliefs in the public on metabolic risks of antipsychotics in children and adolescents
concerning the long-term safety on the developing brain (Finnerty). Unfortunately, for kids
who have ADHD or other disruptive disorders, they tend to receive medication treatment due to
the pressing need to restore a balance of brain chemicals. There is a certain amount of efficacy
that must be considered when children with developing brains are exposed to medical treatments.
In terms of adverse effects, there was a minute trend that was seen in Williams studiesa 1-2%
increase in Suicide-Related Adverse Effects (SREs) from patients who took SSRIs. The data
showed that this jump increased when patients were given placebo medications versus
fluoxetine, a common depressive SSRI. Suicidal ideations increased from 4% to 6%; however,
no suicide attempts actually occurred, meaning there is not significant proof on the actual
adverse outcome (Williams). Regardless, the fact that there is a moderate increase raises the
ethical concern of whether adolescents should be exposed to a potentially unnatural outside
substance when therapists are available to help. This leans slightly toward treatment through
psychiatrists, yet the accessibility of specific psychological therapists is hard to come by.
Most of the complaints about psychotherapy are simply that there are not enough
medically trained doctors who are specialized at treating psychological disorders. 64% of the
American Pediatric residents claim that their education related to treating depression is
inadequate (Rice). Primary care doctors who treat patients with depression are broadly trained in
pediatrics based on a medical model that fails to address substantial information on depression;
this results in an inability to detect depressed adolescents as it has been proven that just under

one third of depression cases are caught by primary care doctors (Rice). In Edlunds study on the
helpfulness of various treatments, he took a sample of 9,100 adolescents with depression, and
discovered that 62% of them have received no medication or counseling. That is an abnormally
high amount of untreated individuals who have failed to receive any help from societys
psychology specialists. Although Edlund tested the effects of psychotherapy versus
pharmacotherapy, which will soon be mentioned, the most startling data he discovered was that
well over half of the adolescents continued suffering without anyone to consult. Finnerty, from
research for looking at access to psychosocial services, illuminated some reasons for the lack of
professional advice. Although Medicaid-insured families were recommended by many
professionals that a conjunction of psychotherapy and pharmacotherapy is useful, it was
discovered that less than one half of children receives psychotherapy before administered
medication. Antipsychotic medication is provided through Medicaid, but physical services
should accompany the insurance. Children age 6-17 were proportioned so that approximately
50% in 1999-2001 utilized psychotherapy; this percentage dropped to 41.4% in 2007. The reason
for a decrease in social services may be attributed to the increase in population. Youth in nonmetropolitan areas were found to be less likely exposed to a psychosocial treatment than children
in metropolitan areas (Finnerty). Regardless, many of the current insurance holders have not seen
a professional therapist in over three months. This further prompts the need for a stronger
schooling focus in the psychology department to emphasize the importance of psychotherapy.
Medication alone does not provide as sufficient results.
There are definitely trends showing that for depression, a combination of psychotherapy
and pharmacotherapy are much more effective when paired together. In specific cases, such as
OCD, psychotherapy is much more effective alone (Cuijpers); for depression cases, however,

there is a trend that emphasizes a combination. As aforementioned, depression is the leading

cause of suicide in the United States, and although mild depression may be fixed through strong
family support, severe depressions require extensive treatment. Treatment for Adolescents with
Depression Study (TADS) discovered that between cognitive behavioral therapy and medication,
there was not a very large increase of the effectiveness of one over the other. However, a
combination of the two revealed that a conjunction of the two treatments resulted in the shortest
time to response, was most cost effective, and had the most significant impact upon suicidality
rates (Rice). Mark Edlunds research confirms this assertion. In addition to the aforementioned
62% of individuals who have not received treatment, 22% have reports of counseling without
medication, 13% have a combination of counseling and medication, and only 3% take
medications without any counseling. When given self reports to measure the helpfulness of their
treatments, less than half of the individuals in pure counseling and pure medication individuals
reported the treatments as extremely helpful or helped a lot. Interestingly though, a significant
71% of adolescents showed that receiving both the fluoxetine medication and Cognitive
Behavioral Therapy in unison resulted in much improved on the basis of the Clinical Global
Impressions improvement score (Edlund). This research has definitely called attention to the
importance of minimizing depression, for it causes an abnormally high amount of adolescent
deaths. The trends reveal that for the most effective treatment, there needs to be psychotherapy
specialists not only to treat individuals, but to diagnosis them as well.
When studying the prevalent disease of depression in the United States, it is important to
realize that many of current treatments have gone on a downward sloping trend due to the lack of
efficient psychotherapy. Although it could be argued that psychotherapy is ineffective, studies
have shown that there are several cases in which psychotherapy is preferred to pharmacotherapy,

and that a combination of the two treatments is most beneficial for depressive disorders. Thus, it
can be concluded that a large portion of the problem is the lack of professional psychotherapists
that are available to not only treat, but also to diagnosis depression. In Edlunds work, the
significant jump of almost 20% between individuals who use psychotherapy to pharmacotherapy
reveals correlations to Williams study about the effectiveness of psychotherapy to SSRIs, and
confirms that many individuals seek psychosocial treatment whether they decide to take
medications or to not take medications. Furthermore, this reinforces both Finnerty and Edlunds
comments about decreasing availability of psychotherapists in the United States. Although I did
not have depression, I had treatment for mild anxiety disorders at a young age, and part of my
overcoming adversity involved both treatment and counseling. However, in my recollections,
medication was always accessible to me in a cupboard. Counseling, on the other hand, required
me to drive all the way to Johns Hopkins to see a specialist, confirming the difficulty in finding
therapists in the suburban area. Personally, some of the talk sessions remain the most memorable
when I pull the moments from my mind. Parallel to Finnertys findings, therapists really only
were accessible in the metropolitan city of Baltimore. I truly find it imperative that for the future
generations who may be enduring mental strife, that there are easily accessible psychiatrists in
the nation so that their situation will be diagnosed early and treated with a full-on utilization of
resources at hand.

Works Cited
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Finnerty, Molly et al. Access to Psychosocial Services Prior to Starting Antipsychotic
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