Lazar Susan G
Clinical Professor of Psychiatry: Georgetown University School of Medicine, George Washington University School of Medicine, Uniformed Services University of the Health Sciences; Supervising and Training Analyst, Washington Psychoanalytic Institute.
Psychodyn Psychiatry. 2014 Sep;42(3):423-57. doi: 10.1521/pdps.2014.42.3.423.
Psychotherapy is an effective and often highly cost-effective medical intervention for many serious psychiatric conditions. Psychotherapy can also lead to savings in other medical and societal costs. It is at times the firstline and most important treatment and at other times augments the efficacy of psychotropic medication. Many patients are in need of more prolonged and intensive psychotherapy, including those with personality disorders and those with chronic complex psychiatric conditions often with severe anxiety and depression. Many patients with serious and complex psychiatric illness have experienced severe early life trauma in an atmosphere in which family members or caretakers themselves have serious psychiatric disorders. Children and adolescents with learning disabilities and those with severe psychiatric disorders can also require more than brief treatment. Other diagnostic groups for whom psychotherapy is effective and cost-effective include patients with schizophrenia, anxiety disorders (including posttraumatic stress disorder), depression, and substance abuse. In addition, psychotherapy for the medically ill with concomitant psychiatric illness often lowers medical costs, improves recovery from medical illness, and at times even prolongs life compared to similar patients not given psychotherapy. While "cost-effective" treatments can yield savings in healthcare costs, disability claims, and other societal costs, "cost-effective" by no means translates to "cheap" but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses. In the current insurance climate in which Mental Health Parity is the law, insurers nonetheless often use their own non-research and non-clinically based medical necessity guidelines to subvert it and limit access to appropriate psychotherapeutic treatments. Many patients, especially those who need extended and intensive psychotherapy, are at risk of receiving substandard care due to inadequate insurance reimbursement. These patients remain vulnerable to residual illness and the concomitant sequelae in lost productivity, dysfunctional interpersonal and family relationships, comorbidity including increased medical and surgical services, and increased mortality.
心理治疗对于许多严重的精神疾病来说是一种有效的、且通常具有很高成本效益的医学干预措施。心理治疗还能节省其他医疗和社会成本。它有时是一线且最重要的治疗方法，有时则可增强精神药物的疗效。许多患者需要更长期、更密集的心理治疗，包括患有个性障碍的患者以及患有慢性复杂精神疾病（常伴有严重焦虑和抑郁）的患者。许多患有严重复杂精神疾病的患者在家庭成员或照料者自身患有严重精神疾病的环境中经历过严重的早期生活创伤。有学习障碍的儿童和青少年以及患有严重精神疾病的儿童和青少年也可能需要的不仅仅是短期治疗。心理治疗有效且具有成本效益的其他诊断类别包括精神分裂症、焦虑症（包括创伤后应激障碍）、抑郁症和药物滥用患者。此外，患有合并精神疾病的内科患者接受心理治疗后，与未接受心理治疗的类似患者相比，往往能降低医疗成本、改善疾病康复情况，有时甚至能延长寿命。虽然“具有成本效益”的治疗方法可以节省医疗保健成本、残疾索赔和其他社会成本，但“具有成本效益”绝不意味着“便宜”，而是描述那些临床有效的治疗方法，并且鉴于其提供的益处，其成本被认为是合理的，即使这些治疗方法会增加直接费用。在当前心理健康平权成为法律的保险环境下，保险公司仍然经常使用他们自己基于非研究和非临床的医疗必要性指南来破坏这一法律，并限制获得适当心理治疗的机会。许多患者，尤其是那些需要长期和密集心理治疗的患者，由于保险报销不足而面临接受不达标治疗的风险。这些患者仍然容易受到残余疾病以及随之而来的生产力丧失、人际关系和家庭关系功能失调、合并症（包括增加的医疗和外科服务）以及死亡率增加等后遗症的影响。
