Talk therapy can be a rambling conversation when a person shares distressing life experiences, hopes, dreams and troubles in a jumbled way. That’s exactly why it’s an essential form of healing that helps people move forward in their lives, says psychologist Enrico Gnaulati, author of “Saving Talk Therapy: How Health Insurers, Big Pharma and Slanted Science are Ruining Good Mental Health Care.”
Gnaulati acknowledges that other more focused types of psychotherapy are helpful, but he believes the emphasis on short-term correction of behavior in forms like Cognitive Behavioral Therapy, or CBT, can bypass a critical foundation for healing. CBT is a form of psychotherapy that focuses on helping people change distorted or destructive thinking patterns to more positive thoughts that can change behavior.
Those more direct and goal-oriented types of psychotherapy and talk therapy are not mutually exclusive, Gnaulati says in an interview on the WBUR show “On Point.”
“Talk therapy allows people to unburden themselves emotionally and that takes time,” says Gnaulati. He considers some often-used therapies as “too productive” or “too busy.”
He came to his work as a therapist after his initial plan to be a priest. Gnaulati began going to a psychotherapist while he was in college in the 1950s and says he found it a “quasi-spiritual experience.” He discovered that going through his life story and being honest in the style introduced by Freud changed his plans for his career.
“Accessing and articulating deep emotions is life altering,” says Gnaulati.
One of the obstacles to mental health counseling, especially long-term treatment like talk therapy, is the nation’s insurance system. One development that concerns Gnaulati is the expanding use of medication without counseling for psychological issues. He points to the rise in primary care physicians prescribing the antidepressant Prozac beginning in the late 1980s that developed into an increasing use of these types of drugs without a referral to a therapist. While a primary care doctor is an important connection for a person facing a psychological issue, Gnaulati says that’s just the first step.
An ongoing concern is that many Americans do not have access to health insurance, or if they do, they may not have coverage for mental health treatment. Many therapists express concern about the minimum amount of time or sessions patients are allowed, even if they do have insurance that covers mental health. Deeply-rooted childhood trauma, eating disorders, grief and other types of ingrained emotional or behavioral problems are not quick fix issues.
Gnaulati would like to see insurance companies raise reimbursement rates for psychotherapists so they are financially able to accept more patients, rather than skewing treatment for those who can pay out-of-pocket. Nearly 40 percent of people drop out of therapy after one or two sessions, Gnaulati says. “One or two years, or 20 sessions” would be better to create lasting change, he says.
Providing more insurance coverage for a wide range of mental health treatments will cut down on the long-term costs of health care because issues could be dealt with sooner, before they disrupt physical health and daily functioning, he says.
One essential factor in long-term talk therapy is the empathy that comes with the therapist’s sincere and unrushed listening, says Gnaulati.
“We are fragile creatures as human beings and a therapist can also be a mentor and coach,” he says. “The most likely predictor of successful therapy is sustained empathy.”
Boston University professor of psychology Stefan Hofmann says CBT and other more directed therapies also are based on focused listening and on the therapist’s empathy. Hofmann disagrees that talk therapy is being ignored or phased out.
But Gnaulati argues that the training of therapists lacks diversity, especially in longer form talk therapy. So he is continuing his mission to save the foundation of contemporary treatment for mental health issues, the often rambling, slow paced talk therapy that gives a person time to allow emotions to arise in what may be a jumbled but essential way.
“It’s better to give clients space and time to access emotion,” says Gnaulati. “It’s a very delicate process.”
Gnaulati, Enrico, “One Psychologist’s Mission to Save Talk Therapy,” On Point, WBUR, Jan. 21, 2018