still churning

Since I wrote the last post there has been a lot of discussion on some of the lists I am on about the future of our profession.  The pressure is building on any kind of health care provider like us, to cut costs, or to justify the added price.

The truth is that it will not be an easy task for our profession.  Not that psychotherapy is not worthwhile, and we are actually a contributing factor in keeping of health care costs down.  But, as I have said, I have hardly gotten an increase in payments in twenty years, and the one company that had increased payments on occasion, this year made some significant cuts.

That does not make me feel loved -- not here in America, where money is how we measure worth.

There are some studies that show that people who come for therapy have lower health care costs overall, mostly because they deal with their problems in life directly, and therefore develop fewer stress related disorders, or don't somaticize their complaints.  But most health insurance companies don't look at anything over-all or long-term; they see that the cost of mental health services has been rising, so they want to cut it.  For twenty years they have been trying to find ways to cut services, by limiting sessions, or limiting who they would pay, or trying to track diagnoses, or treatment outcomes.  But all that gets very complicated, and people keep demanding to use our services, so now they just cut the fees.

The real question however, is how can we show what we do is effective, and is there a kind of therapist that does it better?

Well, I have found the answer to the first one, and I like it, but I'm not sure the insurance companies will accept it.  Three psychological researchers, Duncan, Miller and Sparks have come up with a method to track how much the therapy is helping the client.  Their basic method is this, and it's amazing:  They ask the client "Is this therapy helping?" and a few, very few, other similar questions.
Their research shows that this method really can measure success.  That's science, at its best.

Now, as to the question of who is a better therapist, well this is where the therapistmumbles begins to mumble. As people have reacted to my last post, it seems that getting a Ph.D. offers no certainty that it will make you a better therapist.

I am sure that it takes many qualities to be a good therapist.  I think that the knowledge and understanding that a more comprehensive education, such as I got in graduate school, is one of them.  But there are qualities, such as compassion, empthy and patience, that often come naturally to some people, and others can learn to be that way, to some extent, but you don't need five years and a dissertation to obtain those kinds of skills.

I also know that a large amount  of what I learned in graduate school, those many years ago, I consider worthless information now.  I also think that a great deal of what they are teaching now will suffer the same fate.

I got a Ph.D. because it seemed to add some wight and heft to my credentials. Mental health issues were still seen as almost mystical and incomprehensible then.  Also, getting a MSW just seemed wimpy.  I think my big degree helped me get esttablished in a private practice.  Many (most?) people still don't really know the difference between a psychologist and a psychiatrist, but they also get confused between an LICSW and a welfare worker.

But the trend now is much more based on cost, and most Ph.D.s think they should get paid more than people who did not survive the obsticle course of obtaining that degree.  That may put us at a disadvantage unless we can make a stronger case that demonstrates our superiority. So far, we have not done a convincing job.

I am afraid that a lot of wimpy people also can be good therapists.