Managed Care Constraints Present Constant Challenges in Practices. (Therapists Cite Ethical Problems)

Article excerpt

NEW YORK -- Managed care casts a shadow over the practice of psychotherapy from treatment planning to termination, according to a poster presentation at a meeting sponsored by the American Psychoanalytic Association.

Therapists interviewed in a small study said that managed care challenged their principles and led to ethically dubious collusion with patients. In addition, managed care distorted patients' views of therapy and discouraged their active involvement in the process, said Julie Cohen, a researcher at New York University, New York.

Ms. Cohen discussed material from interviews with 16 psychotherapists (15 psychologists and one social worker) who had been in practice for an average of 17 years. Half described their orientation as "psychodynamic or psychoanalytical," and the others as "cognitive-behavioral," "family systems," or "interpersonal-existential."

Each participant was asked a standard set of open-ended questions about his or her managed care experience, in 40- to 90-minute telephone or face-to-face interviews, Ms. Cohen said.

All therapists interviewed reported that aspects of managed care were at odds with their treatment ideals. Beyond setting up an irreducible conflict--the pursuit of profit vs. good care--the system restricted therapy to superficial goals that could be quickly achieved, they felt.

"They want us to normalize the person's behavior and get them back in the workplace.... They don't care if these people go home every night depressed or don't have a social life . …