I have a strong bias in favor of psychotherapy ("talk therapy" or "talk treatment"). This partiality may stem from my (limited) experiences dealing with psychiatric patients when I was a medical student, at a time when no effective medications existed for their disorders. Back then, I witnessed some notable transformations brought about by psychiatrists in some of these difficult patients.

Because of my bias toward psychiatry, I was a bit dismayed recently to read about a survey of office-based psychiatrists published in Archives of General Psychiatry. This study found that between 1996-1997 and 2004-2005 the percentages of patient visits involving actual psychotherapy were cut nearly in half. As a result, from 1996 through 2005, psychiatrists used psychotherapy in fewer than 30 percent of their office encounters with patients.

And over the same 8-year period, the number of psychiatrists who provided psychotherapy to every single one of their patients also declined by half, so that by 2004-2005 only about 11 percent of psychiatrists were treating all their patients with talk therapy.

In their training nowadays, fewer psychiatrists are specializing in psychotherapy; more of them are learning the ins and outs of drug treatments. This sea change in psychiatrists' general treatment strategy is largely due to the growing number of medications now available to treat psychiatric disorders; however, a number of other factors have also contributed.

The change in psychiatric methodology has also been motivated by financial incentives. For example, the lead author of the Archives report, Dr. Ramin Mojtabai from the Johns Hopkins Bloomberg School of Public Health, points out that insurance companies are now reimbursing psychiatrists (and other doctors, like internists, who spend time talking with their patients rather than doing some procedure) more generously for three 15-minute medication visits than for one 45-minute psychotherapy visit.

This means that psychotherapists have a large disincentive to perform talk therapy, and so most of the patients who are receiving bona fide talk therapy these days are ones who can afford to pay for their treatment themselves.

The drug cures promised for psychiatric problems on TV and in newspapers have also added to this general turning away from the couch (though quite frankly, I have never seen any psychiatrist at Hopkins using a couch) and toward medications.

Psychotherapy is painstaking and arduous work. My dealings with patients suffering from serious psychiatric illness have convinced me that a great deal of time is usually required to understand the nature of an individual's psychiatric problems. Additionally, a psychiatrist must of course then be able to blend considerable experience and imagination to figure out exactly how to talk with that patient in a way that will overcome the manifestations of his or her psychiatric illness. I suspect that some psychiatrists prefer prescribing medications because they have come to recognize their own limited effectiveness as psychotherapists.

So while medications can often work wonders, I still firmly believe that exploring patients' emotions, thoughts, and behaviors with psychotherapy can help some of them to improve symptoms, change destructive actions, and overcome damaging mental attitudes.

What is my advice to people who have a psychiatric illness and feel their psychiatrist is not spending enough useful time with them? One approach would be to find another psychiatrist who will talk through their problems with them — but such a psychiatrist may be difficult to find. An alternative is meeting with a trained psychologist or other mental health counselor in addition to taking the medication prescribed by your psychiatrist.