The future of psychotherapy: trends and perspectives

The future of psychotherapy: trends and perspectives

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What are the world trends that influence and will influence healthcare and psychotherapy in the coming years? Today we will try to see some of them.

In fact, we must bear in mind that the demand in healthcare (the demand) has varied considerably in recent years, and the services (the supply) have had to adapt accordingly – or should have done so for some time.

Psychotherapy is not exempt from this discourse – and it is one of the reasons that led us to talk about Single Session Therapy.

Today I will try to give a concise overview of some reasons that can make us understand the current context of health – and specifically of psychotherapy – to build bridges towards the future and adapt one’s professional practice accordingly.

Of course, it is not the purpose of this article to make a thorough and complete analysis, which would require much more than a few pages. Its purpose is just to draw attention to some interesting points and to understand the implications for Single Session Therapy.


Modernity has changed

In recent decades, Zygmunt Bauman (2000) has introduced us to the concept of liquid modernity. Without pretending to be exhaustive, let’s just say that we are in an era with few solid points: crisis, change and flexibility are the words we have to constantly deal with.

This is true both on an individual level and on a macro-social level, and goes from everyday life to the way of conceiving professional activities. The crisis itself is an example of this (Bauman & Bordoni, 2014), which is no longer a mere economic crisis, but a social, state, value crisis – indeed, the economic crisis is only one of the many forms of crisis, and it certainly has not been the first.

And among these there is also a crisis in the professions, which change both in the way in which people (customers or patients) use different services, and in the way in which the professionals themselves must, consequently, change.

In reality, the process is probably more circular: professional services change because customer approaches change, changed by changes in services… And it is certainly also more systemic, not limited to services and customers. But, regardless of this, here I am interested in emphasizing an essential point: the need for adaptation.


People have changed

Consumers, customers, users, patients … We can call them whatever we want – and we should be careful about the changes in the terms used to designate them – but what interests me is to focus on one detail: the thing that has changed is their way of seeing, knowing and interacting with external reality.

In operational terms, again, this also means that their way of relating to professionals and conceiving and using their services has changed (and probably is changing faster and faster). For example, today more than ever, relationships with the person-client-patient are an essential element of any activity or business model (Osterwalder et al., 2010, 2014; Clark et al., 2012).

And these, of course, also include health activities.


The new healthcare trends

PricewaterhouseCoopers (PwC) is one of the 4 largest auditing firms in the world, and at the end of last year it charted health care trends forecast for 2016 (PwC, 2015).

Although concerning the US context, anyone can easily find parallels with other Western countries, and some trends are definitely in line with those analyzed in the European and Italian contexts (IlSole24Ore SanitĂ , 2012).

In other words, with due proportions, it is not a question of asking whether certain numbers will also be reached in Italy, but rather when this will happen.

Note that I speak of “reaching the numbers”. While taking into account the due differences in the cultural, social and administrative context, I do not even take into consideration the possibility that certain trends (at least the ones I report below) cannot develop, or are not already developing, even here with us.

Let’s see the main ones.


The aware patient

A colleague used to say that once there was God, and immediately after the doctor. “The doctor said so” was the rigorous appeal to an indisputable authority.

It has not been so for some time now (Fabris, 2003), thanks, among other factors, to the dissemination of information that makes the citizen-client-patient a more active protagonist, even in the choice of treatments.

Although this does not mean that he is always able to identify the “most suitable” treatments for his situation, or even simply the “most valid” ones, one cannot simply close this paragraph with the statement that “the person does not know anyway. as a specialist ”and exclude the person from the decision-making process. As true as this statement is, it sounds more like a complaint without pragmatic solutions, and thinking you can work with an uncritical person is a mistake that, among other things, puts your professional stability at risk, that is the possibility of continuing to have an activity with solid foundations and economically sustainable.

First of all, it is necessary to become aware of awareness: that of the patient. Who, as we will see, is today an increasingly active actor, protagonist of his own well-being. This affects the way he will act with respect to how to take care of himself, to the point that one has to see the care process as a partnership (IBM, 2008) which, among other things, definitively breaks the idea of ​​a rigid imposition of one’s own. patient care model, replaced by the need to find the form (ul) a most suitable for / with the patient.


Short times and low costs

But what is it that the client-patient wants today?

Two general trends of great interest emerge from the data (PwC, 2015): the desire to solve one’s own problems (from difficulties to illness, from disorders to psychopathologies …) in a short time and at a low cost.

For example, according to PwC:

  • more than half of people (54%) do not want to travel long distances for treatment
  • over 2/3 (66%) are unwilling to engage in long-lasting care
  • more than 8 in 10 people (81%) do not intend to sustain high economic figures to take care of themselves

The data can be discussed in several ways. For example, the latter does not mean that people are not interested in feeling good (other trends, as we will see, tell us exactly the opposite), but that, more likely, the offer and the accessibility to it today gives the possibility to find numerous and different forms of treatment, also allowing to choose, consequently, the cheapest ones.

Among the many, an example is the spread of portals that allow you to select activities or even individual professionals by choosing, among others, criteria such as cost and social rating (the evaluation made by other consumers).


Willingness to feel good

Despite the economic crisis, the will to feel good has not diminished, quite the contrary. If anything, the way people try to feel good has changed.

For example, do-it-yourself health care is rapidly increasing, thanks to the unstoppable evolution of digital technologies (IBM, 2008; IlSole24Ore, 2012; PwC, 2015). In just two years (2013-2015), the use of apps related to wellness has doubled, from 16 to 32% (PwC, 2015). It should be noted that this data is perfectly in line with the trends of wanting quick and low-cost treatments, manifesting itself in the choice of looking for diagnoses and solutions online.

Again: however debatable (sometimes the web, or some “alternative” forms of treatment, are the cause, rather than the solution, of certain problems) it is a fact that does not even hint at stopping and that it is naive to think to be able to counter or even just neglect.

As already mentioned, if the way in which the person wants to take care of himself (and that he is taken care of) changes, insisting on old forms of assistance or, simply, “not in step”, means not answering the question in course – or not to do it in the most effective and efficient way.

And this question on the one hand calls for greater speed (but not to the detriment of effectiveness) and on the other, it seems to me, opens the possibility of conceiving the “treatment process” differently. No longer a process with a beginning, an unfolding and an end rigorously placed under the attention of a clinician who is present step by step throughout its entire unfolding, but the idea that the clinician, in certain cases, may be in some way an intermittent figure, who enters and exits the person’s life in the moment of need, giving him, among other things, the skills to manage himself in his absence.

In psychotherapy, for example, we already mentioned in the last article the concept of intermittent therapy or therapy along the life cycle (Cummings & Sayama, 1995).


Healthcare (economic) crisis

There would be too much to say about the economic crisis in health systems, nor do I think I have the skills for an in-depth examination, for which we refer to other sources (IBM, 2008; IlSole24Ore, 2012; PwC, 2015). Some general points, however, are good to have in mind.

Among these, the economic difficulty of the public health system (which in Italy occupies 9.1% of GDP – Meridiano SanitĂ , 2015) is well known, to the point that the main competitor of public health is private health (Altroconsumo, 2012 ). Citizens often prefer to spend a little more to get treatment quickly, and even in some cases the cost of private services is lower than public ones.

The fact that you are willing, on certain occasions, to spend a little more, does not conflict with the low cost trend. Paying less, in fact, does not mean “paying as little as possible”. And the choice of the citizen is very often motivated precisely by the possibility of having treatment in a short time. Also because, if you reflect, a long waiting list easily becomes a cost for the patient as well.

One of the advantages found in Single Session Therapy, for example, is that of being able to offer a service that, if necessary, can help the person with just one meeting. If well structured, this is an excellent example of effective help with reduced costs (note that, in the case of freelance, if the total cost of care is reduced for the patient – who pays only one session – the professional can reasonably compensate the apparent number of sessions per single patient both by adjusting the fees according to whether they are Single Sessions or longer therapies, and thanks to the greater number of patients he receives thanks to the offer of the Single Session itself).

If on the one hand all this leads more and more public health systems to policies to reduce costs and implement low-cost services (which, even here, does not have to mean “low quality”), on the other hand it means that the same private services (understood both in the form of institutions, hospitals and, more generally, health companies, and in the form of freelancers or small professional groups) must move in this direction.


The demand for sanity

In terms of expenses, sanity is certainly not a Cinderella, but a sovereign and expensive queen.

For example, in the U.S.A. every year 1 in 5 people have a mental disorder, with costs that reach 440 billion dollars a year (PwC, 2015). And in Italy, the cost is 14 billion euros a year (HPS, 2012).

And if we add the indirect costs, mental health is clearly a not insignificant problem even more. For example, 40% of absences from work are due to psychiatric problems (HPS, 2012).

Or, in terms of “years lost to disability” (YLD), WHO estimates that depression ranks first, “costing” around the world 70 to 80 million lost years : more than how many years would make you lose back pain, diabetes or migraines. And this Top Ten also includes alcoholism and anxiety disorders, in 5th and 6th place. (Smith, K., 2014).

Although in Italy we have to deal with a professional scenario that sees an excess of professionals (to date about 1/4 of the psychologists of the world, and 1/3 of the psychotherapists of Europe, reside in Italy), these data confirm that the request for health care for mental well-being will not suffer any future arrests, indeed.

To this, it should be added that only a small number of people turn to a specialist (in Italy, according to research, they are a maximum of 22.3%, if not only 8%, therefore about 1-2 people out of 10 ; Fiori Nastro et al., 2013, Ambrosi, 2014), and this is probably due, among other things, to forms of psychotherapy perceived as inadequate, because, taking up the trends we have seen above, they are too expensive and / or too long.


 The challenge of psychotherapy

Pay attention to the fact that, given the cost problem, more and more people will apply for mental health care by looking at their wallets. And, of course, more and more entities.

One of the most successful books by Michael F. Hoyt (chief director of the research group on Single Session Therapy, TSS) analyzed, coincidentally, the relationship between brief psychotherapies and managed care (an American term describing techniques, o financial systems aimed at reducing costs in healthcare; the book is Brief Therapy and Managed Care, 1995). Although the contexts and times are decidedly different, Hoyt carefully observed a point common to sanity (mental and otherwise) around the world: the need for cost-effective interventions (without sacrificing quality, as he will repeat several times in the text).

And it is no coincidence that one of the reasons that pushes many entities, including public ones (Weir et al., 2008), to invest in TSS is precisely the reduction of costs.

We will talk about these benefits in another article. Here, now, I would like to underline a self-evident fact: also the freelance therapist (be it psychologist, psychotherapist, psychiatrist or other) is subject to all these changes. Consequently, he must be able to adapt himself, without sacrificing the value of what he offers. Otherwise, the harm to oneself and to the patients will be inevitable.

Psychoanalysis, is a striking example (but it is not the only one), whose long treatment times and high costs required were in stark contrast to the trends I have mentioned, taking on the responsibility of being “increasingly isolated and forced to play an increasingly minimal role in the spectrum of treatments and, last but not least, in medical and psychiatric training ”(De Schill & Lebovici, 1999, emphasis ours). And in fact, even in this field an adaptation is required that takes into account socio-economic changes (Richards, 2015).

And if many health insurers do not already cover the costs of long therapies (American Psychological Association, online), the same citizens are less and less interested in them and more and more aware of the possibility of shorter and equally effective therapies.

Psychotherapy, but above all psychotherapists, will have to take these changes into account. In fact, they should have done it some time ago.


The place of Single Session Therapy

Among the premises that led the Italian Center for Single Session Therapy to divulge Single Session Therapy, there were obviously all these considerations.

In our work there is not only an attention to research, to the clinic, and in general to studies that allow us to understand how to get the most out of every single (and often unique) session, but also a more general attention to social changes. of our age.

If on the one hand we support research that highlights the effectiveness of short and single-session therapies (Hoyt & Talmon, 2014), on the other we do it also, if not above all, because we believe it is vital to be able to respond to social and health needs and trends, using the most appropriate forms.

In future articles, as well as in previous ones (see for example Where to Practice Single Session Therapy and Single Session Psychological Counseling), we will illustrate different forms of application of this form of intervention, and in training courses in Session Therapy Single we explain in detail some ways of integration. Those who already want to get an idea, can also find some ideas in our free EBook.

All this starts from a precise assumption: psychotherapy is a service to the person, and as such it must be able to constantly update and model itself, to respond to the changes and requests of modern citizens.


Flavio CannistrĂ 

Psychologist, Psychotherapist

Founder of the Italian Center

for Single Session Therapy


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Deborah De Luca

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