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Psychotherapy in a Rapidly Changing World


Journal of Psychiatric Practice®: January 2016 - Volume 22 - Issue 1 - p 1
doi: 10.1097/PRA.0000000000000123


Several years ago, I wrote a column for Psychiatric News of the American Psychiatric Association, as well as a “From the Editor” column for the Journal of Psychiatric Practice, both entitled “Psychotherapy in a Changing World.”1,2 In those pieces, I tried to endorse the need to harness new technologies as ways to reach greater numbers of people needing help who may be homebound or who may have limited or no access to professionals. Rural areas are often vastly underserved, but health care services in high-density urban areas can also be overloaded, intake procedures can seem daunting or impenetrable, and it can take months for a first or a follow-up appointment.

In the meantime, social media, communication networks, and new technologies are exploding worldwide. Hence, I added a word to the title of this column—the world is not just changing but rapidly changing, and we’ve got to get with the program. It somehow seems out of sync that we are all glued to the small screen tracking a blizzard of messages, yet we land on medical appointment waitlists instead of obtaining urgently needed help when we need it. In-person care and electronic messaging are not equivalent, of course, and, at least so far, nothing can replace the value of one-on-one care. But let’s keep trying to leverage the new technology to provide added value and efficiency if there are valid and proven ways to do so. Valid and proven, I repeat, because at the same time, the wild west of the Internet is still cowboy territory (pardon my Texas terms!), saturated with villains and charlatans.

A recent Baylor Psychiatry Grand Rounds was entitled “Electronic Communications with Patients: Helpful Tool or Legal Quagmire?” presented by the Associate Director of Residency Training in Psychiatry and the Associate General Counsel of Baylor College of Medicine. They reviewed the therapeutic, ethical, and legal implications of various patient communication options. My take on the bottom line of this program was that we are now squarely in this electronic world and will be using it more and more—and that we can do so effectively but must also do so wisely and professionally. In this issue of the journal, Alavi and colleagues present a study evaluating the effectiveness of a structured online program of cognitive-behavioral therapy for depression. Patients with depression as evaluated by the Beck Depression Inventory were randomly assigned to an index group receiving 10 to 12 weekly sessions of email-delivered cognitive-behavioral therapy or to a control group. Beck Depression Inventory scores were significantly reduced in the treatment group, compared with controls. Studies like this should increasingly guide us in our efforts to use long-range technologies to reach and help larger numbers of patients in need.

John M. Oldham, MD


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1. Oldham J. Psychotherapy in a changing world. J Psychiatr Pract. 2012;18:393.
2. Oldham J. Psychotherapy in a changing World. Psychiatric News. November 18, 2011.
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