DOES ANYBODY REALLY KNOW WHAT'S HAPPENING TO LONG TERM THERAPY? DOES ANYBODY REALLY CARE? ~ by Joel Rachelson, Ph.D.

As I was walking in the park one day, I realized that there seems to be a significant trend away from long term psychotherapy; that forces in the insurance industry, the government and our own profession are denying the need, value and place for this form of therapy. It wasn't really in the park that this foreboding occurred. It was while I was on hold for several minutes waiting for the appointment counselor to give me a time to speak with the reviewer so that I could pre-certify for six, count 'em six, more sessions. Or maybe it was the circumstance where a fairly long term client's managed care doctor decided that my client was not making enough progress, based on a number (a GAF score), to justify continuing to approve coverage. Or maybe it was getting a handout at the last GPA conference from the American Psychological Association on how to market and be more attractive to managed care companies and PPO's. At any rate, it seems painfully obvious to me that long term psychotherapists are faced with increasing demands to justify this approach and constraints on the the supported or certified practice of psychotherapy. Colleagues, when asked about this situation, seem to just shake their heads as if the demise of this therapeutic form is inevitable. It's just getting all too easily swept aside. Why is this happening? Can anything be done about it?

I'm not sure exactly why this is happening, however there do seem to be some explanations. One reason seems to be a reaction to skyrocketing costs and a lumping all providers together as irresponsible, unbridled money gobblers who warrant close supervision. There doesn't seem to be an understanding that different treatment philosophies differ also in cost. A $25,000 lifetime mental health coverage limit can be apportioned in any number of ways covering 2-5 weeks in an inpatient stay or as much as 3 years of outpatient visits. There also seems to be no awareness of the data suggesting that psychotherapy clients tend to use other other health care professionals less.

Another major reason for this situation is a continued, massive cultural misunderstanding and discounting of the purpose of psychotherapy, specifically long term therapy. Psychotherapy is hugely valuable and probably cost effective for someone whose priorities are personal happiness and interpersonal health. Long term psychotherapy is an art and it helps to heal people who have deep hurts (which is most of us). It takes some time for someone to feel safe enough to get to the broken places and even more time to let therapeutic healing occur.

To expect this to happen quickly is unrealistic and doesn't acknowledge the need for time to mend those broken places. Further, it can repeat a history of negation by impatient, neglectful caregivers. Short term therapy that focuses on "measurable" outcomes offers only band aids that end up reinforcing denial or continued unawareness. What's missing in our culture is an attitude and a value of the importance of the kind of personal healing that happens primarily in long term therapy. That its not about helping people not be crazy it about helping people have the kind of satisfaction and pleasure in living that is their birthright.

We seem to be living in a society populated by wounded souls who are resistant to , almost phobic about engaging in the therapeutic process that offers a real healing. This healing can be very beneficial to society because adults that aren't carrying around their pain can make a better world. What can we do? I'm interested in forming a committee force to see about how to change this cultural trend, societal belief, or business/governmental policy that doesn't highly value psychotherapy, especially the art of long term psychotherapy.

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