The managed care movement and the future of psychotherapy.

Cognitive therapy: Looking backward, looking forward

“…Clearly, though, we are now at a point in time where the public generally knows about effective shorter-term methods for dealing with specific problems, and seeks out these treatments. The rise and promulgation of managed care in the United States also has been associated with powerful financial pressures to keep treatments as short term as possible (Austad & Hoyt, 1992). The relative growth of cognitivebehavioral and cognitive therapies in this context, relative to their longer-term cousins, should not be a surprise to anyone with knowledge of market economies.…”

“…Managed Health Care includes any method that regulates the price, utilization, or site of health services (Austad & Hoyt, 1992). It has arisen out of economic circumstances as a means of containing and reducing increasing health-care costs.…”

“…The concept of managed care was introduced by the Nixon administration and was outlined subsequently in the Health Maintenance Organization Act (HMO Act) of 1973 (DeLeon, VandenBos, & Bulatao, 1991). The HMO Act provided federal funding for the development of new HMOs, and included a process to ensure financial and organizational standards (Austad & Hoyt, 1992). The principle methods used to control costs in HMOs include control of the lists of funded services, control of the nature of these services (e.g., session limits in psychotherapy), control of the number and funding of service providers, and trying to capture more-healthy, lowercost populations.…”

The Case Against Licensing Health Professionals

“…In order to achieve parity with psychiatry as a provider of health services, professional psychology has identified itself with medicine (Austad & Hoyt, 1992;Sarason, 1981) and put on the back burner the scientific focus that had been the mainspring of its identity (Schneider, 1990). The shift to professional practice now connects psychology to economic values and has loosened its ties to service values (Smith, 1990).…”

“…Professional psychology has achieved the dream of parity with psychiatry, but at the cost Rogers predicted-licensing has defined acceptability in professional psychology. Professional psychology is increasingly spoken of as a health profession (Austad & Hoyt, 1992;Fowler, 1990;Kiesler & Morton, 1988) and has public and private credentialing for health care providers (Zimet, 1989). Most areas of thirdparty reimbursable practice bar psychologists without specific health credentials and ignore nonpsychologist providers (Cummings, 1990).…”