In Irving Yalom's book, The Gift of Therapy, in Chapter 2, he briefly discusses the issue of psychiatric diagnoses which often interfere with good psychotherapy because they objectify the patient rather than allow for a human relationship based on unique characteristics and subjective experiences.
Once a psychotherapist assigns a diagnosis to the client's condition it becomes the lense and the filter through which information is filtered. The diagnosis is the organizing framework within which to formulate the client, the client's situation, and the treatment plan. This model is crude, rude, subjugating and while insurance companies love it, it is disrepectful to the dignity and humanity of the client.
And so, psychotherapists who work for insurance companies must be polylingual. They must speak one language for the insurance companies and regulators and another language with clients and sometimes a third language with colleagues.
It is a crazy making business, this modern health care system, based on a medical model which has intrinsic iatrogenic consequences. The sad thing is that there are fundamentalists who take this model literally and they are not good psychotherapists. Good psychotherapists recognize that they are caught in a dysfunctional system which has compromised their professional integrity and their ethical obligations to "primum non nocere", above all else, do no harm, because the very act of assigning a diagnosis for insurance reimbursement in many instances, if taken seriously, does harm.
Good psychotherapists who collect from insurance companies must be painfully aware that they are duplicitous and have compromised their values on the altar of Mammon. And yet, they treat their relationships with clients with the respect and empathic regard which clients deserve, thus making them hypocrits in the eyes of the payors and regulators. Every good therapist has an ethical obligation to respect the client's right to self determination, and client centered psychotherapy is in a galaxy light years away from the mercenary models of managed care.
This is article #10 in a series on Psychotherapy Reflections.
The whole scenario becomes even more complicated when you begin asking "why should everyone have a right to self determination", "why treat humanity with dignity and respect", and "who says 'do no harm' is the highest standard to which we should be held".
ReplyDeleteHi Ryan:
ReplyDeleteYou raise very interesting questions which provide the back story to the values which most of the helping professions profess to adhere to in their code of ethics. As a Socal Worker the values I mention: the client's right to self determination, their being treated with dignity and respect, and the concern about doing harm are important ethical considerations in the Code of Ethics.
Noticing your interest in theology, these values also are held significanly by most major world religions. Being a Unitarian Universalist myself and a former Roman Catholic these values are an extemely important part of my faith.
I have a feeling you wanted to say more and I am interested in your further comment - i.e. answer your own questions if you would.
All the best and thanks for your comment,
David Markham