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The Psychotherapist's Guide to Cost Containment: How to Survive and Thrive in an Age of Managed Care

Barry Helfmann, Psy.D., C.G.P.

Key Words: Books Reviewed

Bernard Beitman has written a very clear and concise book dealing with the world of behavioral health care. The Psychotherapist's Guide to Cost Containment provides information that the clinical practitioner needs for survival in today's healthcare climate.

The first chapter reviews the basics of how a cost containment system operates. Many of the commonly used terms (coverage limits, UR, UM, PCP, local gatekeepers, provider profiling) are comprehensibly defined. The chapter on organizational structures provides valuable information about different modes of practice. The chapter "Payors, Providers, and the Evolution of Managed Care" provides historical perspective to help clinicians see the bigger picture within which we all operate; it should be required reading in all graduate departments where students are planning to enter the world of psychotherapy.

In the next section Dr. Beitman argues that cost containment systems have changed the entire typology of psychotherapy. He urges the reader to acknowledge that these changes result in a system that must ration care. Therefore, ethics become increasingly important to providers of clinical service. How we come to terms with intrusions into confidentiality, the need to adopt a short-term focus from the initial assessment, and the politicization of healthcare dictates how we will practice in the future.

Perhaps one of the most significant effects of managed care on therapists has been in training programs. School-based programs are asking themselves whom they should train and what they should train them to do. Cost-containment measures have resulted in fewer psychotherapists being needed within third-party payor systems; thus, fewer options are open to new graduates. Moreover, the whole process of psychotherapy is changing, and the stages of psychotherapy seem to be truncated in a time-limited managed system.

The final section, "What Psychotherapists Can Do for Themselves and Their Clients," attempts to offer practical strategies for dealing with a cost-contained system. Beitman continues to focus on the larger system of healthcare in the United States. He lists some of the threats from outside and inside psychotherapy, and he writes of the need to reinvent oneself once again. This sounds similar to basic marketing advice that would be useful in many fields. Like government and industry, he preaches outcomes, outcomes, outcomes, asserting that "psychotherapy now sells outcomes as products."

The Psychotherapist's Guide to Cost Containment is a short journey well worth taking. For all those interested in and worried about the future of psychotherapy, this book offers a wealth of helpful information.

However, a note of caution. The premise of the author is that working with the managed care system is almost a requirement to survive. Longer term care is not really addressed except to say that it cannot be supported. Some of the more arguable tenets of managed care are perhaps too readily accepted. Nevertheless, for most psychotherapists, this book reflects the basic reality within which they will function.

Footnotes

Dr. Helfmann is Managing Partner, Short Hills Associates in Clinical Psychology, Springfield, NJ, and Chair, National Registry of Certified Group Psychotherapists.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Helfmann, B. Search for Related Content PubMed Articles by Helfmann, B.