Can Psychotherapy Relieve the Societal Burden of Psychopathology?

From Freudian origins where free association was the agenda of most sessions, psychotherapy has moved toward more use of educational methods, as for example in cognitive behavior therapy. Manuals, curricula, workbooks, and homework assignments (a.k.a. action plans) are common. And the evidence for the efficacy of psychotherapies for a variety of conditions has been established without question, although such evidence usually does not report large fractions of complete remissions or cures. When research studies “psychotherapy,” it usually means around 12 to 20 h of contact. This number has been arrived at more to ensure timely completion of studies than to address adequately the number and complexity of the skills needed for psychological health. The times on task required by other skills, such as sports, music, mathematics, and language learning, lead to doubt that 12 to 20 h should be sacrosanct. But even if 12 to 20 h of contact were sufficient, research strongly suggests that only small fractions of the total population with a given condition obtain that much treatment. High utilizers of psychotherapy absorb a large fraction of the total professional labor. Given economic forces and current distributions of psychotherapeutic effort, psychotherapy cannot relieve the societal burden of psychopathology.