Health Plan and Psychotherapy

Maureen O’Hara, in her Nov. 14 commentary (“Will Psychotherapy Be Reduced to Pill Dispensing?”), is understandably worried about how the Clinton (or any other) health care plan will limit mental health benefits for those in need, and she raises important issues of how psychotherapy will fit in with other treatments, and who will make treatment decisions. Unfortunately, she has fallen into the trap of painting managed care companies, the Clinton health planners, the drug companies and anyone else who questions the value of long-term psychotherapy as greedy, heartless, or both.

Her broad-brush attacks divert the debate from the central issues of 1) setting priorities as to what should be covered, 2) identifying which treatments work for which illnesses, and 3) addressing how mental health professionals can better demonstrate the benefits of good mental health care to society.

Her article would imply that psychotherapy means long-term psychotherapy; this is not only inaccurate, but, for many, it conjures up images of endless, unmeasurable sessions focusing on, as she describes them, “exploring deeper states of consciousness” and the “Promethean struggle to become fully human.” In these intensely cost-conscious times, we cannot rightfully expect those who pay for care to see such pursuits as equally worthy of reimbursement as briefer or intermittent forms of psychotherapy, which can better measure their effects on patients’ well-being and functional levels. Most psychotherapy these days is not about painful childhood trauma. This fact doesn’t mean that victims of abuse are not worthy of our best efforts to help, but it might mean that indefinitely long treatment cannot be guaranteed. I don’t think that this is a necessarily insensitive stance.

Psychotherapists, a non-specific term which encompasses many psychiatrists, psychologists, psychiatric social workers and some less-well-trained disciplines, will need to attend to the values and the priorities of the society as part of the health care reform process. The public, I think, will be willing to pay for what works, but not for what appears excessive or wasteful at the expense of other forms of care.

RICHARD J. MOLDAWSKY MD

Downey

The writer is a psychiatrist .