National trends in psychotherapy by office-based psychiatrists

Arch Gen Psychiatry. 2008 Aug;65(8):962-70. doi: 10.1001/archpsyc.65.8.962.


Context: In addition to prescribing medications, providing psychotherapy has long been a defining characteristic of the practice of clinical psychiatry. However, there are indications that the role of psychiatrists in providing psychotherapy may have diminished in recent years.

Objective: To examine recent national trends in the provision of psychotherapy by office-based psychiatrists.

Design: Data from the 1996 through 2005 cross-sectional National Ambulatory Medical Care Survey were analyzed to examine trends in psychotherapy provision within nationally representative samples of visits to office-based psychiatrists. Multivariate analyses examined the time trend, adjusting for patient, visit, and setting characteristics. Practice-level analyses examined time trends in the percentage of psychiatrists who provided psychotherapy to all, some, or none of their patients during a typical week.

Setting: Office-based psychiatry practices in the United States.

Participants: Patients with psychiatric diagnoses visiting outpatient psychiatrists.

Main outcome measure: Provision of psychotherapy in visits longer than 30 minutes.

Results: Psychotherapy was provided in 5597 of 14,108 visits (34.0% [weighted]) sampled during a 10-year period. The percentage of visits involving psychotherapy declined from 44.4% in 1996-1997 to 28.9% in 2004-2005 (P < .001). This decline coincided with changes in reimbursement, increases in managed care, and growth in the prescription of medications. At the practice level, the decrease in providing psychotherapy corresponded with a decline in the number of psychiatrists who provided psychotherapy to all of their patients from 19.1% in 1996-1997 to 10.8% in 2004-2005 (P = .001). Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits, and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often.

Conclusions: There has been a recent significant decline in the provision of psychotherapy by psychiatrists in the United States. This trend is attributable to a decrease in the number of psychiatrists specializing in psychotherapy and a corresponding increase in those specializing in pharmacotherapy--changes that were likely motivated by financial incentives and growth in psychopharmacological treatments in recent years.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Ambulatory Care / trends
  • Cross-Sectional Studies
  • Financing, Personal / trends
  • Forecasting
  • Health Services Accessibility / statistics & numerical data
  • Health Services Research
  • Humans
  • Insurance, Health, Reimbursement / trends
  • Managed Care Programs / trends
  • Mental Disorders / epidemiology
  • Mental Disorders / therapy
  • Practice Patterns, Physicians' / trends*
  • Psychiatry / trends*
  • Psychotherapy / trends*
  • Psychotropic Drugs / therapeutic use
  • Specialization / trends
  • United States
  • Workforce


  • Psychotropic Drugs