Saving Talk Therapy: How Health Insurers, Big Pharma, and Slanted Science Are Ruining Good Mental Health Care

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, veteran psychologist Dr. Enrico Gnaulati presents evocative 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, Gnaulati goes on to dissect the factors that have eroded it. Psychotropic drugs, if no longer thought of as a magical cure, are still overprescribed and shunt health-care dollars to drug companies. Managed-care companies and mental health “carve outs” send these same dollars to administrators and slash payments to therapists, driving many talented ones away and overburdening those who remain in the system. Drawing back the curtains on cognitive behavioral therapy (CBT)—a short-term, goal-oriented form of psychotherapy that is preferred in the managed-care world—Gnaulati shows that, while it might prove effective in the research lab, those findings don’t readily apply to people’s complex emotional problems. Gnaulati also casts a spotlight on how CBT’s favored status in graduate programs prevents trainee therapists from acquiring the relationship skills necessary to caringly and carefully treat patients.

Saving Talk Therapy is a passionate and deeply researched case for in-depth, personally transformative psychotherapy that incorporates the benefits of evidence-based practice and psychotropic drugs without over-relying on them.