How Managed Care Can Help Couples Cope

ABSTRACT

This article traces how managed care became a quick fix to curb out-of-control healthcare costs rather than a real effective approach to managing care. To date, the impact has been not only a negative experience, but impediment to treating couples facing relationship and related problems. The author is optimistic about how managed care will evolve to recognize the importance of couples and family treatment as we enter the future with integrated systems of healthcare. ? The future will also require significant shifts in the thinking and practice patterns of providers and an emphasis on quality and outcomes.     

The Impact of Specific Psychotherapist Beliefs Regarding Managed Care on Prospective Psychotherapy Clients

The purpose of this study was to investigate the separate impact of each of thirteen therapist beliefs that, presented collectively, were previously found to have a significantly negative impact on prospective clients' attitudes toward managed care psychotherapy (Pomerantz, 2000). Participants in this study initially completed a brief questionnaire measuring their willingness to enter psychotherapy and their expectations regarding psychotherapy under managed care. Participants subsequently completed the same brief questionnaire again after being instructed to imagine seeing a hypothetical psychologist and being presented with the psychologist's supposed beliefs regarding managed care (which were actually derived from survey data by Murphy et al., 1998). Results suggest that almost every discrete therapist belief had a significantly negative impact on participants' attitudes toward managed care psychotherapy. Several specific therapist beliefs produced particularly salient negative effects. Implications regarding ethics and informed consent are discussed.     

Women,Mental Health,and Managed Care

Abstract

Managed care has changed the way that mental health care is provided. These insurers manage such factors as length and type of therapy made available, access to therapy, and level of payment for therapy. Women, as the majority of those insured by managed care and as consumers of mental healthcare, are differentially affected by these changes.     

Poetry in Existential Psychotherapy with Couples and Families

The use of poetry during the process of existential psychotherapy with couples and families is described and illustrated. In this approach, poems can be utilized to help the couple and/or family notice meaning potentials in the future, actualize and make use of such meaning potentials in the here and now, and re-collect and honor meanings previously actualized and deposited in the past.     

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.     

Group Psychotherapy and Existential Concerns: An Interview with Irvin Yalom

Group psychotherapy can be used to help clients deal with most forms of emotional distress or problems with interpersonal functioning. Also, group therapy can be useful when helping clients to confront existential concerns such as isolation or meaning in ones life. During a recent interview, Irvin Yalom discussed a variety of issues related to group processes and existential matters that are involved in effective psychotherapy.     

Managed Care and Psychoanalytically-Oriented Psychotherapy

This paper compares the conceptual base of psychoanalytically-informed psychotherapy with that of managed care. It is proposed that each is rooted in a discrete and incompatible system of thought and professional culture-one in psychoanalysis and the other in business. Differences exist between these cultures in the meaning of time, therapeutic goal, and clinical role. Case material illustrates the impact of managed care culture on the development of transference in both patient and therapist. The transitional space of treatment is expanded to a five party object relational system-patient, therapist, case manager, insurance company, and employer-that manifests culture clash.     

Integrating Cognitive and Existential Treatment Strategies in Psychotherapy With Dependent Patients

A dependent personality orientation is associated with increased risk for a broad array of Axis I and Axis II disorders. Although traditional treatment interventions have modest ameliorative effects on problematic dependency, the multifaceted nature of dependency suggests that integrated treatment strategies may hold more promise than traditional treatment approaches. This article outlines one potentially useful integrated treatment strategy, combining elements of cognitive and existential therapy to alter dependency-related thought, behavior, and emotional responding. Procedures for implementing an integrated cognitive-existential treatment model are outlined, and challenges in use of the model are discussed.     

Re-Collection in Existential Psychotherapy with Couples and Families Dealing with Death

Re-collection is a treatment dynamic in existential family therapy in which the client family is helped to remember and honor meanings that family members have previously actualized and deposited in the past. This shrinks the family meaning vacuum and those symptoms and problems that grow and flourish in a family meaning vacuum. In this article, an existential orientation to re-collection with families who are dealing with the death of a loved one is presented, described, and illustrated with case material.     

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.     

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 Ethics of Mandatory Personal Psychotherapy for Trainee Psychotherapists

Although the psychotherapist's personal psychotherapy has received considerable research attention in recent years, little systematic investigation of the ethical issues involved has been published. This article provides a rigorous interrogation of mandatory personal psychotherapy (MPP) as a training requirement for mental health professionals, a topic that remains ethically contentious. The article begins with a discussion of why MPP is an explicitly ethical issue, before debating the ethics of MPP under six questions, each worded to capture a salient ethical issue relevant to the appropriateness of making personal treatment a mandatory training requirement. Using principle, virtue, and care ethics perspectives, the arguments for and against MPP are critically investigated. The article concludes with an ethical position statement.     

Spiritual Beliefs and Barriers Among Managed Care Practitioners

Purpose: Ninety percent of American adults believe in God and 82% pray weekly. A majority wants their physicians to address spirituality during their health care visit. However, clinicians incorporate spiritual discussion in less than 20% of visits. Our objectives were to measure clinician beliefs and identify perceived barriers to integrating spirituality into patient care in a statewide, primary care, managed care group. Methods: Practitioners completed a 30-item survey including demographics and religious involvement (DUREL), spirituality in patient care (SPC), and barriers (BAR). We analyzed data using frequencies, means, standard deviations, and ANOVA. Findings: Clinicians had a range of religious denominations (67% Christian, 14% Jewish, 11% Muslim, Hindu or Buddhist, 8% agnostic), were 57% female and 24% had training in spirituality. Sixty-six percent reported experiencing the divine. Ninety-five percent felt that a patients spiritual outlook was important to handling health difficulties and 68% percent agreed that addressing spirituality was part of the physicians role. Ninety-five percent of our managed care group noted 8lack of time as an important barrier, lack of training was indicated by 69%, and 21% cited fear of response from administration. Conclusions: Managed care practitioners in a time constrained setting were spiritual themselves and believed this to be important to patients. Respondents indicated barriers of time and training to implementing these beliefs. Comparing responses from our group to those in other published surveys on clinician spirituality, we find similar concerns. Clinician education may overcome these barriers and improve ability to more fully meet their patients expressed needs regarding spirituality and beliefs.*This material has previously been presented as an abstract at the Culture and End of Life Conference, Association of Medical Colleges Spirituality, Kansas City, MO, September 12–14, 2002.Project supported by the Foundation for Spirituality in Medicine, Baltimore, MD     

长期护理保险居家护理项目的伦理基础与制度保障

长期护理保险居家护理项目包括家庭照护类和上门护理类,以孝道文化和尊老敬老文化为伦理基础。各地试点政策均对居家护理项目进行了规定。但家庭照护类项目中参保人家属在确定非正式护理人员和维系家庭照护质量中承受着伦理压力,上门护理类项目中上门护理员在维系护理质量和上门护理市场中承受着伦理压力。制度解决相关伦理问题,应允许参保老年人自由选择现金或服务支付,推进家政行业建设,对家庭照护质量维系提供支持,并建立统一的居家上门护理质量标准和考核制度,建立针对养老服务机构上门护理的惩罚和退出制度。

     

存在主义心理治疗及其儒学解读

受存在主义心理治疗理论的启发,阐述了其理论在以儒学为基础的传统文化下的解读,强调儒家的为己修身之学从家庭的领域扩散出去,通过人伦教化的落实对主体自觉性的激发,形成对自我心性的超越.这一过程正是对本体存在意义的诠释与实践,也使存在主义的治疗理论落实到日常的修身实践当中.     

存在主义心理治疗的两个哲学教条

作为基本信念的两个哲学教条,即“存在先于本质”和“人是绝对自由”,导致存在主义心理治疗遭受各种诟病。前者造成人的存在与本质分裂,过分夸大个体选择意义和忽略人的现实性等问题;后者造成自由与必然关系的割裂,忽略自由的条件性和抽掉人的社会历史性等问题。基于对两个哲学教条的反思,存在主义心理治疗要求“抽象人”与“具体人”,“个体性”与“社会性”,“此在性”与“历史性”的辩证统一,从根本上实现对人的科学理解,进而提升实效性。