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A hard-hitting critique of how managed care and the selective use of science to privilege quick-fix therapies have undermined in-depth psychotherapy—to the detriment of patients and practitioners
In recent decades there has been a decline in the quality and availability of psychotherapy in America that has gone largely unnoticed—even though rates of anxiety, depression, and suicide are on the rise. In Saving Talk Therapy, master therapist Dr. Enrico Gnaulati presents powerful case studies from his practice to remind patients and therapists alike how and why traditional talk therapy works and, using cutting-edge research findings, unpacks the problematic incentives in our health-care system and in academic psychology that explain its decline.
Beginning with a discussion of the historical development of talk therapy, Dr. Gnaulati goes on to dissect the factors that have undermined it. Psychotropic drugs, if no longer thought of as a magical cure, are still over-prescribed and shunt health-care dollars to drug corporations. Managed-care companies and mental health “carve outs” send health-care dollars to administrators, drive many practitioners away, and over-burden those who remain. And drawing back the curtains on CBT (cognitive behavior therapy), Dr. Gnaulati shows that while it might be effective in the research lab, its findings are of limited use for the people’s complex, real-world emotional problems.
Saving Talk Therapy is a passionate and deeply researched case for in-depth, personally transformative psychotherapy that incorporates the benefits of an evidence-based approach and psychotropic drugs without over-relying on them.
“Saving Talk Therapy is a compelling, meticulously researched, and accessible account of how the machinations of two very powerful industries—health insurers and pharmaceutical companies—have undermined the viability of the practice of talk therapy and corrupted the research paradigms in use to evaluate the effects of all mental health treatments. Moving beyond critique, Gnaulati provides clinical vignettes from his own practice to illustrate what is beneficial about psychodynamic/humanistic psychotherapy. For the millions of mental health patients who are dissatisfied with the dehumanized treatments they have received, and for the thousands of young mental health professionals who know the work they are doing feels much less rewarding than they had thought it would be, this is the book to read.”
—Ronald B. Miller, professor of psychology, St. Michael’s College, and author of Not So Abnormal Psychology: A Pragmatic View of Mental Illness
“In this remarkable and highly readable book, Dr. Enrico Gnaulati, an eminent author and seasoned clinical psychologist, provides a compelling and spirited argument for the value of psychotherapy for individuals and for society. Drawing upon a wide range of research, he also does the public and mental health professions a great service by questioning the often extravagant claims made for the effectiveness and safety of psychiatric medication, and the overstated benefits of quick-fix therapies.”
—Steen Halling, professor of psychology emeritus, Seattle University, and author of Intimacy, Transcendence, and Psychology: Closeness and Openness in Everyday Life
“Saving Talk Therapy is an impassioned defense of the emotionally evocative form of psychotherapy that many people still seek. It is now vanishing. Dr. Gnaulati brilliantly lays out the history of the field and provides incisive analysis of the forces—political, economic, and cultural—that have endangered its future. This is a compelling and essential read for mental health professionals and consumers alike.”
—Ben Gorvine, assistant chair, Department of Psychology, Northwestern University
“Saving Talk Therapy is a brilliant exposé of what has happened to the field of psychotherapy and should be required reading for therapists and patients alike. Both authoritative and engaging, Dr. Gnaulati masterfully lays bare the deceits and disinformation that prevent most people from ever getting meaningful therapy and most therapists from learning how to provide it.”
—Jonathan Shedler, PhD, Clinical Associate Professor of Psychiatry, University of Colorado School of Medicine and author of The Efficacy of Psychodynamic Psychotherapy