Psychotherapy and Managed Care: Reconciling Research and Reality

I.INTRODUCTION: PSYCHOTHERAPY IN THE AGE OF MANAGED CARE. 1.The End of Psychotherapy as It Was: Evolution or Revolution? Reconciling Research and Managed Care Practice. Becoming a Practitioner-Scientist. The Hierarchy of Tx Restrictiveness and Intrusiveness. Steps of the Speed Sequence. Making Managed Care Work. 2.The New Era of Psychotherapy: What Is Managed Care? History: Why Did Managed Care Emerge? The Evolution of Behavioral Managed Care. Points to Remember: Fifteen Potential Advantages of MBHC. II.THE MANAGED CARE MAELSTROM: THE BATTLE, PROTESTS, AND REFORMS. 3.A House Divided: How Managed Care Has Fractured the Field. Twelve Arguments from the Advocates of Managed Care. Twelve Arguments from the Opponents of Managed Care. The Despair: The Battle against MBHC Problems. The Downside for Patients: Cost-Cutting Compromises Care. The Downside of Managed Care for Providers. Reform Efforts: Working toward a Better Balance. The Backlash Has Begun! Litigation and Legislative Reforms. Regulation and Standards. Managed Care Criticism of Its Critics. 4.Being Fair: Looking Critically at Our Nostalgia and Revisiting Assumptions about Therapy. Combatting Nostalgia for What Never Was. Revisiting Assumptions. Is Traditional Psychotherapy Always Therapeutic? Do No Harm! Less Can Be More. The Unfairness of the Previous System. Perhaps Reimbursed Therapy Shouldn't Be for All. Who Knows Best What Clients Need from Treatment? What Do Clients Want? Focus on the Consumer: Treating the Presenting Problem. A Caveat: Clients Don't Always Know Best. How Can We Best Facilitate Change in Clients? Points to Remember: Summary of General Considerations about Psychotherapy. 5.Making Peace with Managed Care. Did Psychotherapists Ask for It? Weighing the Pros and Cons: Better Research Needed. The Positive Impact of Managed Behavioral Health Care. Constructive Strategies for Improving Managed Care. Developing a Balanced Perspective: Resolving Ambivalence. Coping with the Ambiguity: Achieving Commitment. Points to Remember: Managed Care: Friend or Foe? The Risks of an Adversarial Stance. Still Enjoying Your Work. Conscientious Streamlining: Cutting the Right Corners. III.PREPARING FOR THE NEW DEMANDS OF MANAGED CARE. 6.What Managed Care Expects from Providers. The Managed Care Mindset. Points to Remember: Ten Key Concepts Underlying Managed Behavioral Healthcare. The Heart of Managed Care: Focused Treatment Planning. Partnering with Managed Care Companies. 7.Joining Managed Care. Coping Constructively with New Constraints: Provider Accommodation Research. Joining Managed Care. A Triage Mentality Can Keep You Afloat: Evolving Criteria for Outpatient Treatment. Evaluating Candidates for Therapy. Legal and Contractual Issues. Providing the New Continuum of Care. Points to Remember: The New Continuum of Care. Delivery Methods and Manpower. Using Empirical Research to Improve Psychotherapy: Cutting Corners with Savvy. Points to Remember: The Speed Sequence as It Relates to the Literature. 8.Justifying Care as Medically Necessary. Working with Utilization Reviewers. Points to Remember: Ten Tips for Expediting Utilization Reviews. Medical Necessity: Defining Insurance-Covered Problems. Using Diagnoses Most Constructively: Avoiding the Dangers. Impairment Ratings and Severity Ratings. The Problem of Ambiguous Jargon. Research on the Cost-Effectiveness of Psychotherapy. 9.Individualizing Treatment. Applying Knowledge about Specific Groups of Consumers. Tailoring Treatment. Accommodating Cultural Differences. Points to Remember: Summary of Strategies for Helping Special Populations. IV.JUSTIFYING PSYCHOTHERAPY TO MANAGED CARE. 10.A Review of Relevant Psychotherapy Outcome Research. Outcome Studies. Effectiveness Studies: Naturalistic Research. Efficacy Studies: Randomized Clinical Trials. Empirically Supported Treatments (ESTS). Meta-Analyses. Debates about Psychotherapy Outcome Research. Points to Remember: Twenty Problems That Limit Reliance on Outcome Research. 11.Squaring Off: The Great Specificity Debate. Specific Techniques versus Common or Placebo Factors. Common Factors and Placebo Effects. Applying Empirical Research: Using a Research-Based Rational Progression. Points to Remember: Summary of the Great Psychotherapy Debate. V.GENERAL PSYCHOTHERAPY STRATEGIES. 12.Psychotherapy Based on Common Factors. Common/Nonspecific/Universal Therapy Elements. Client and Therapist Factors Contribute the Most. Therapeutic Conditions: What Constitutes Quality Treatment? Using Common Factors in Individualizing Treatment. Points to Remember: Summary of Common Factors. 13.Solution-Focused Treatment Methods. Working Backwards and Building on Clients' Strengths. Why Managed Care Favors Solution-Focused Therapy. Solution-Focused Concepts. Positive Therapist Expectations. Recognizing Both Individual and System Strengths. Identifying Healthy Exceptions: What's Working? Solution-Focused Methods. Points to Remember: Five Basic Steps of Solution-Focused Therapy. Applying Techniques to Challenging Patients. Learning to Be Solution-Focused. Criticism of the Solution-Focused Approach. 14.Brief Problem Solving Methods: Integrating Outcomes Assessment and Treatment. Single Session Treatment (SST): Once May Be Enough! Many Common Problems Are Suitable for Brief Treatment. Being Brief: How-To Tips for Streamlining. Twelve Basic Steps of Brief Therapy. Attacks and Defense of Brief Therapy: Quality and Expediency Are Not Mutually Exclusive. When Not to Use Brief Treatment: Contraindications for Brief Treatment with Adults and Children. "Buying Time" for Those Who Need It. Points to Remember: Summary of the Twelve Basic Steps of Brief Therapy. VI.SPECIALIZED PSYCHOTHERAPY STRATEGIES: EMPIRICALLY SUPPORTED TREATMENT APPROACHES (ESTS). 15.Summaries of ESTs for Common Serious Mental Disorders. Anxiety Disorders. Depression. Post-Traumatic Stress Disorder. Eating Disorders. 16.Summaries of ESTs for Severe Mental Illnesses and Serious Refractory Problems. Schizophrenic Disorders. Borderline Personality Disorder and Suicide. Substance Abuse/Chemical Dependency. 17.Summaries of ESTs for Problems in Living. Marital Therapy. Sexual Dysfunctions. Parenting/Childhood Problems. VII.SUMMARY. 18.Conclusions: Meeting the Demands of the Future. Thinking about Therapy from a Managed Care Perspective. Responding to Managed Care's Demand for Efficiency. Streamlining the Treatment Process: Making Less More. Glossary: A Primer of Managed Care Terminology. Listing of Empirically Supported Psychological Treatments. Listing of Pharmacotherapies for Different Disorders. Bibliography.