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Resurrecting Therapy

Even before the recession, when adjusted for inflation, therapists' incomes haven't increased since the 1980s. According to Nicholas Cummings, former president of the American Psychological Association (APA) and founder of the first professional psychology school for therapists, psychotherapists are the lowest-paid doctoral level professionals in the healthcare field. Now he's mounting an ambitious campaign to challenge the professional pecking order within healthcare and boost the economic prospects for mental health practitioners.

For more than five decades, Cummings has been something of a Cassandra for the therapy field—accurately foreseeing the largely negative developments that have shaped therapy's role in healthcare. Well before it showed up on the radar of most other leaders in the profession, he warned that managed care and the medicalization of mental health were going to divert hundreds of thousands of potential clients from therapists' offices to physicians' waiting rooms. Today, he says that more than 60 percent of primary care physicians' caseloads consist of people seeking treatment for somatic complaints and disorders for which physicians find no cause or cure—chronic pain, irritable bowel syndrome, mood disorders—that can be treated more effectively by psychotherapy. A report in the December Archives of General Psychiatry by Mark Olfson found that only 43 percent of people who sought treatment for depression went to see a therapist. In the last decade alone, Cummings says, the percentage of people who've been referred to therapists from physicians dropped nearly 50 percent.

Now Cummings and neuropsychologist John Caccavale are beginning a campaign to reverse this decline and educate the public about the distinctive benefits of psychotherapy. Early in 2011, their organization, The National Alliance of Professional Psychology Providers (NAPPP), is launching a campaign to make the case for psychotherapy through advertisements and public service announcements. They've already produced a print advertisement and several videos, and are seeking an alliance with physicians and the American Medical Association. Rather than seeing therapists as being in conflict with physicians, they believe that they're natural allies, who recognize that in too many cases, the pharmaceutical industry has adversely affected the practice of good medicine and good research. So NAPPP wants to educate the public about the many conditions for which psychotherapy is more effective than meds, and encourage non-psychiatrist physicians to make referrals to therapists before writing prescriptions.

The campaign is an ambitious, costly undertaking. Seeking alliances and money—they hope to raise, at least initially, $200 thousand—NAPPP has already been rebuffed by the American Psychological Association (APA) and National Association of Social Workers (NASW), whose vast membership bases contain so many non-practitioners that they're unwilling to commit their resources to expensive campaigns advocating for therapy. "It's not within the genotypes of APA and NASW to fight for psychotherapy," Cummings scoffs.

Cummings and Caccavale hope to raise funds by generating a grassroots movement among psychotherapists who recognize that, finally, there's a concerted effort to address their struggle for recognition and economic viability. The purpose of this new organization is to promote psychotherapy, and their founders are counting on therapists to join their efforts. Whether NAPPP will succeed remains to be seen—but clearly, someone has to try.

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