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Letters to the Editor
April 2009

Psychiatry Without Psychotherapy?

Arch Gen Psychiatry. 2009;66(4):452-453. doi:10.1001/archgenpsychiatry.2009.11

In their survey of psychotherapy practice by office-based psychiatrists, published in the August 2008 issue of the Archives, Mojtabai and Olfson report a significant decline in the provision of psychotherapy by psychiatrists (from 44.4% to 28.9%) over the 10-year period of 1996 to 2005.1 They interpret this change as reflecting an ongoing shift away from integrated care (psychiatrists providing both psychotherapy and pharmacotherapy) that is largely driven by financial disincentives to the provision of psychotherapy. For example, they point out that psychiatrists are reimbursed 41% less for a 45-minute psychotherapy session than for three 15-minute sessions of medication management. They also point out that the decline in the provision of psychotherapy is accompanied by an increase in the prescription of medications.

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