PHILADELPHIA -- Psychiatrists who want to practice psychotherapy but are constrained by economic pressures should explore the possibilities of an abbreviated format, Dr. Jesse H. Wright said at the annual meeting of the American Psychiatric Association.
"Managed care steered psychiatrists away from psychotherapy; an adaptive response is using therapy in brief sessions," said Dr. Wright, professor and associate chairman of psychiatry at the University of Louisville (Ky.).
It is clear that managed care reimbursement schedules create a strong disincentive for the practice of psychotherapy by psychiatrists. In the Louisville area, for example, hourly reimbursement for a 50-minute examination and management session is roughly half what it would be for 15-minute medical management under Medicare, Medicaid, and some private carriers, Dr. Wright said.
An alternative to giving up psychotherapy, refusing to accept insurance, or reconciling oneself to reduced compensation is employing therapy techniques in sessions of half an hour or less. "Psychotherapy can be practiced in different clinical interactions, including evaluations and even medical management," he said, and finding ways to do so could be regarded as "an interesting and worthwhile challenge." Dr. Wright presented ideas for modifying therapy that he developed from his own experience as a cognitive therapist, as well as suggestions from colleagues who primarily practice psychodynamic, interpersonal, and integrative psychotherapy While transference must be deemphasized in this context, other common factors that promote the therapeutic relationship--empathy, understanding, interpersonal effectiveness, and support-- deserve close attention. The role of a therapist as "friendly teacher" or "coach" is effective and valued by patients, and an increased level of activity on the therapist's part is rewardi ng. …