The Traumatic Bond between the Psychotherapist and Managed Care
Cary, Gene L., American Journal of Psychotherapy
KAREN WEISGERBER (ED.): The Traumatic Bond Between the Psychotherapist and Managed Care. Jason Aronson Inc., Northvale, NJ, London, 1999, 254 pp., $44.00, ISNB 0-7657-0180-4.
This book addresses the impact on psychotherapists and their patients, training and treatment setting in the struggle to survive under managed care. The editor, Karen Weisgerber, Ph.D., a faculty member at Harvard Medical School, contends that psychotherapists undergo an identity crisis when faced with financial survival. The feelings of helplessness that force adaptation to managed care practices are compared to the traumatic bond between victim and abuser. Accommodations to the abusive practices subvert the identity of the psychotherapist and the humanistic aims of psychotherapy.
Chapters one to five illustrate the transformation of the psychotherapist whose training in psychodynamic processing has emphasized the meaning of behavior as opposed to symptoms. This reduction of the patient is necessitated by managed care restrictions. The psychotherapist must adhere to time limits, one approach fits all, and intrusive review that disrupts the therapeutic alliance needed for psychotherapeutic work. It crowds out an individual creative approach to the patient and undermines the aim of maximizing autonomy through the psychotherapeutic process. Feelings between the patient and therapist are disconnected and denied by the psychotherapist whose training has supported acknowledgment of them as vital in reducing inner conflict and promoting emotional growth.
Chapters six through nine illustrate the effect on the therapist-patient relationship when the psychotherapist adheres to managed care practices. Consequently he or she becomes a double agent who works for the insurance company rather than the interests of the patient as determined by clinical experience and training. Privacy, vital to the therapeutic alliance, is severely compromised as ownership of the patient is claimed by corporate interests. Appropriateness and designation of referral as well as time-limited strategies are dictated by the same interests with only perfunctory review to establish legitimacy that favors the bottom line. Psychotherapists sometimes exhibit a glimmer of guilt as humanistic values consistent with sound clinical judgment revive. However, the press to survive leads to rationalization, denial, and identification with corporate interests. Consequently, short-term symptom strategies remain prominent.
Chapters ten and eleven note that economic imperative and explosive expansion of neuroscience have driven psychiatry ever further into symptom-focused treatment approaches. Consequently, training programs have adapted to managed care under the guise of the greatest good to the public. …