A survey was taken of licensed professional counselors and psychologists in Texas. Their attitudes on managed care, Internet therapy, and their professional therapeutic orientations were addressed. The majority of both types of practitioners had a negative opinion of managed care and indicated that it had adversely impacted the way that they provided counseling services (e.g., limiting the number of sessions). The majority of both types of practitioners felt that Internet counseling will have a negative impact on counseling or psychology and that Internet counseling can neither be provided in an effective nor ethical way. The most popular therapeutic orientation is eclecticism or the blending of multiple therapeutic approaches. However, different therapists define "eclecticism" in different ways. Following eclecticism, the most commonly reported orientation was cognitive-behavioral therapy. With experience, therapists often change their orientation, but there was not a significant change towards or away from a particular orientation.
A Survey of Practicing Psychotherapists
Counseling is a dynamic profession! At any time there are a number of issues and trends that are in a state of flux. Some of these issues are enduring like the popularity of different therapeutic models or orientations (Poznanski & McLennan, 1998). New theoretical models emerge and gain popularity while others wane in support. Some changes are the result of factors external to the profession such as legal and insurance trends (e.g., managed care) or technical advances (e.g., computers and the Internet) (Borenstein, 1996, Banach & Bernat 2000). It is important for counseling professionals, both those working in applied settings and those focused on the training of counselors, to stay informed about current trends in the profession. To this end we examined the perceptions and practices of therapists in the state of Texas on issues related to the impact of managed care, the use of the Internet for providing therapy, and the popularity of different models of counseling or therapy. We will start by briefly introducing each of these topics.
The Impact of Managed Care
Borenstein (1996) expressed concern about the impact of managed care policies on mental health services, particularly limiting the number of sessions. Alperin (1997) suggested that these policies might eventually lead to the extinction of some types of therapeutic orientations, such as psychoanalytic therapy. Anderson and Lambert (2001) found that the median number of sessions needed to produce significant change was 11, but clients with higher levels of distress needed as much as eight more sessions. Novey (2002) confirmed that therapy lasting more than 6 months was 40% more effective than therapy lasting less than 6 months. Seligman and Levant (1998) expressed concern that managed care's insistence on restricting the number of session and the use of less well-trained providers threatens the effectiveness of psychotherapy.
In a survey of Licensed Professional Counselors (LPCs), Smith (1999) found that 47% of practitioners were "somewhat dissatisfied" to "very dissatisfied" regarding their experiences with managed care. However, Smith suggested that managed care in all likelihood was here to stay, and it would be beneficial for therapists to work towards improving relations with managed care through a collaborative rather than adversarial approach. To work with managed care, counselors may need to learn new skills to adjust and minimize the negative impact of managed care policies (Lawless, Ginter, & Kelly, 1999).
Banach and Bernat (2000) note that the use of Internet therapy has increased dramatically in recent years. While this can be of benefit to some consumers, the risks are considerable and involve such issues as compromised confidentiality, an increased possibility of misdiagnosis, and problems regarding …