Therapeutic process in the context of third party determined time limits

Abstract

Background: Psychological services are increasingly provided within a context in which third party payers impose limits on the number of sessions available to the client and therapist. Considerable research has addressed the effect of time limits on therapeutic outcomes, while effects on therapeutic process have received less attention. This article reports on research that assessed the perceived impact of externally determined time limits on therapeutic process from the perspective of practicing psychologists. Methods: This study used a concurrent triangulation mixed‐methods design. Study 1 was a repeated measures questionnaire that was both qualitative and quantitative in nature, and Study 2 utilised qualitative semi‐structured interviews. Twenty‐seven Australian psychologists treating clients within externally imposed time limits were interviewed, and 85 completed a questionnaire to obtain their perspective on the impact of time limits on the therapeutic process. Results: Therapeutic approach was impacted by time limits, including choice of therapeutic modality, shifts in problem definition and approach, and increased directiveness, prompting concern about a focus on symptom removal over facilitating maintenance of treatment gains. Conclusions: This research contributes to an understanding of how temporal constraints influence treatment, and managed care funding policies may need to be considered in the light of this understanding.

Everyday work, working culture and patient care. A qualitative study on professionals’ perceptions of the establishment of a specialized brief therapy unit in a district psychiatric center.

“…Many said that brief treatment approaches complied with treatment guidelines provided by the health authorities, aiming to treat more patients without increasing the resources. It has been argued that third parties, such as health authorities and insurers have an increasing influence on mental health services, for example in limiting the amount of treatment [6,15]. In the present study health authorities, through emphasizing general efficiency and treatment limitations might be viewed as a "third party", influencing the treatment processes in several ways, [19].…”

“…Many studies have investigated the appropriate length and comprehensiveness of treatment to achieve adequate treatment effect for different patient groups [10]. Studies exploring the therapists' perspectives show, on the other hand, skepticism regarding limitation of treatment, fearing that therapy becomes superficial and less client-centered [14,15].…”

Expanding Systems Thinking: Incorporating Tools from Medical Sociology into MFT Education and Research

“…On the micro-interactional level, managed care has been shown to influence providers from a variety of subfields to develop shortterm, problem-focused treatment regimens (Austad, Sherman, Morgan, & Holstein, 1992). Time limits on sessions have been shown to affect therapists' choice of therapeutic modality, shift therapists' definition of the client's problems, and prompt therapists to be more directive with clients, which leads to concern that clinicians become more focused on symptom removal than long-term maintenance of treatment gains (Wright, Simpson-Young, & Lennings, 2012). Practitioners commonly report that managed care decreases the quality of services, increases provider workload without commensurate compensation, hinders provider autonomy and clinical decision-making, and contributes to feelings of burnout and dissatisfaction (Austad et al, 1992;Trudeau et al, 2001).…”

Relational‐Cultural Theory and Reality Therapy: A Culturally Responsive Integrative Framework

“…Furthermore, to comply with school counseling program accountability mandates (American School Counselor Association [ASCA], 2012) and community counseling insurance stipulations (Cohen, Marecek, & Gillham, 2006;Wright, Simpson-Young, & Lennings, 2012), new approaches that allow for behavioral objectivity but also infuse the subjective reality are critical. Furthermore, to comply with school counseling program accountability mandates (American School Counselor Association [ASCA], 2012) and community counseling insurance stipulations (Cohen, Marecek, & Gillham, 2006;Wright, Simpson-Young, & Lennings, 2012), new approaches that allow for behavioral objectivity but also infuse the subjective reality are critical.…”

“…This framework and other integration models that endeavor to meet the needs of culturally diverse clients in this manner are needed. Furthermore, to comply with school counseling program accountability mandates (American School Counselor Association [ASCA], 2012) and community counseling insurance stipulations (Cohen, Marecek, & Gillham, 2006;Wright, Simpson-Young, & Lennings, 2012), new approaches that allow for behavioral objectivity but also infuse the subjective reality are critical. This shift can reposition counselors' theoretical orientation, allowing them to embrace their counseling theory and multicultural and advocacy competencies without using a nonempirical unsystematic eclectic approach (Anghel & Lupu, 2013;Gone, 2010;Moore-Thomas & Day-Vines, 2008).…”