Managed Care: Ethical Considerations for Counselors

Key factors and trends in health care will have an impact on the ethical practice of counselors. Ethical challenges to clinical practice presented by trends in managed care are discussed in relation to the American Counseling Association (1995) Code of Ethics and Standards of Practice. Recommendations for practice are also included.     

A Systems Perspective on the Introduction of Narrative Practice in Human Services Organizations in the Era of Managed Care

General System Theory is used to examine the structure and activity of human services organizations for conditions which support the introduction of selected narrative ideas in a systemic approach to mental health services. The inquiry includes examination of the influence of larger systems (such as managed care companies and regulatory bodies) on such introduction.     

Integrative Psychotherapy in the Current Managed Care Environment

ABSTRACT

Contact (internal, with the self, and external, with others) is growth-enhancing. When couples improve their ability to be contact-ful with each other, both their relationship and their individual level of emotional well-being are likely to improve. Integrative Psychotherapists help couples to deepen their level of contact by teaching them to utilize inquiry, attunement, and involvement in their transactions with each other/The authors discuss teaching these skills to couples, in the context of eight common relational needs that must be responded to if a relationship is to survive and grow. An extensive clinical example is provided.     

The Benefits of a Self‐Efficacy Approach to Substance Abuse Counseling in the Era of Managed Care

This article examines the clinical value of self‐efficacy theory for substance abuse counselors practicing in a managed care environment. The authors delineate how a self‐efficacy approach can be adapted to provide time‐limited or brief therapy substance abuse counseling.     

The Unmanageability of Characterologic Couples in Managed Care

ABSTRACT

This article explores the issues associated with treating characterologic couples in the managed care environment. The article focuses on the definition of the characterologic couple and the specific issues that emerge when the characterologic couple is attempting brief treatment in the managed care environment. Attention is focused on the difficulties in the two-stage approach to character treatment, the potential for hurting the non-characterologic member of the couple, and the problems that emerge when the character is identified, but not worked with.     

Managed Mental Health Care: Intentional Misdiagnosis of Mental Disorders

Managed health care regulations affect the manner in which counselors provide and deliver services. Counselors are challenged by ethical and legal dilemmas when diagnostic codes in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) are not honored for insurance reimbursement. In this article, the authors examine violations of codes of ethics and legal statutes and the consequences related to intentional misdiagnosis of mental disorders for reimbursement. They explore implications for counselors and offer suggestions for professional conduct.     

Existential Marital Psychotherapy and the Experience of Managed Care

ABSTRACT

In this article the experience of managed care is over-viewed from the perspective of existential marital therapy. It is concluded that managed care disrupts the experiential nature of participation between couple and therapist, dilutes the authentic nature of the treatment relationship, decreases the importance of subjectivity, disturbs the discovery of meaning and purpose in marital life and deters existential communication.     

The Value of Truth and the Care of the Soul

Although the argument against the neo-Darwinian theory of evolution presented by Stephen R. L. Clark in From Athens to Jerusalem is based upon sound principles, it fails to provide an a priori refutation. If it did work, it would refute all objective scientific theories, since all of them make consciousness and subjectivity, as Clark characterises them, incomprehensible. Scientism, the thesis that science is the only source of truth, is Clark's real target, rather than science per se, but he does not diagnose this error as it is made by authors such as Jacques Monod and Richard Dawkins. Scientism is not essential to materialism in general, and a successful version of 'supervenience-materialism'could avoid both reductionism and scientism. However, Clark still has a reply. He may use his discussion of the value of truth to provide a more general critique of materialism, which in my view is far more effective.     

Managed Care and Pastoral Counseling: An Opportunity for Spiritual Growth

Managed care has forced changes on pastoral care. Among these changes are increased demand for and volume of clients. An appropriate response to this demand is for pastoral counselors to adopt a more short-term oriented treatment approach. While this approach has historically been at odds with the pastoral counseling movement, the authors argue that a combination of the therapies of Albert Adler and Albert Ellis provides a framework for addressing the needs of clients. Social Work at the     

Psychoanalytic Perspectives Concerning the Impact of Managed Care on Psychotherapy

Abstract

The impact of managed care insurance coverage on the psychoanalytic situation is explored, using case material to show the particular ways transference and resistance may differ or not differ under this special circumstance. Managed care shapes typical areas of anxiety such as fees, schedules, frequency, and termination into riper opportunities for transference and resistance exploration. However, the so-called reality factor of an external influence easily disguises these potentialities. The analyst may unwittingly act out countertransference feelings using this “reality factor” as a rationale. While managed care does shift the nature of the therapeutic relationship, the emphasis on interpretation of transference and resistance remains at the forefront of technique.     

The Doctor-Patient Relationship in the Post-Managed Care Era

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship (DPR). We now are in a “post-managed care era,” where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes.     

Pediatric Health-Related Quality-of-Life Measurement Technology: Intersections between Science, Managed Care, and Clinical Care

The demand for health care outcomes assessment is increasing, driven by the proliferation of managed care as a form of health care financing. Providers, consumers, and payers can use health care outcomes to improve the efficiency and quality of care, spur performance improvement, and demonstrate accountability. This review introduces health outcomes and focuses on one particular outcome—pediatric health-related quality of life (HRQOL), exemplified by the PedsQL, a brief, practical, reliable, valid, and responsive measure of pediatric HRQOL. HRQOL measurement has the potential, in pediatric clinical practice, to improve assessment, clinical management, and treatment evaluation if practical, conceptual, and empirical challenges are addressed. These issues are discussed and directions for future research are described that would demonstrate the value of HRQOL measurement in pediatric clinical settings.     

Myths and Small Groups: Development, Managed Care, and the Year 2000

In this article, the author defines myth and shows that disguised myths of archaic and primitive peoples can be found in the modern world. He discusses the myths that guide the development of small groups. He sketches out mythic aspects of the encounter between group therapy and managed care. Finally, he suggests the mythic significance of the year 2000 for the future of group development and of group therapy.     

Managed Care, Catholic Vision, and the Claims of Justice

There are numerous challenges posed to Roman Catholic healthcare institutions by recent developments in health care delivery.Some are practical, involving the acceptable limits of accommodationto and collaboration with secular networks of health care delivery.Others, quite often implicated in the first set, are explicitlytheological. What does it mean to be a distinctively Roman Catholichealth care institution? What are the nature and the scope ofRoman Catholic institutional identity? More broadly, what isthe moral relevance of themes in Roman Catholic social teachingto the provision of health care? This issue of Christian Bioethicsaddresses these questions with a spirited exchange among itsauthors. They offer noticeably different perspectives on thegeneral cogency of Roman Catholic social teaching and differentstrategic recommendations for Roman Catholic institutions tomaintain, or recover, their distinctive presence in health caredelivery.     

The Power of Being Vulnerable in Christian Soul Care: Common Humanity and Humility

Journal of Religion and Health - Soul caregivers often hesitate to be vulnerable in their pastoral practices. Jesus, however, embraced his vulnerabilities as a human to redeem humanity even though...