Literature review on psychotherapy.
Explore the source record for details and available documents.
Cost-Benefit Analysis↗
Biomedical subjects
D B Borenstein
Publications and source records attributed to D B Borenstein.
Does managed care permit appropriate use of psychotherapy?
The author reviews the history of the development of managed care, the restrictions it has placed on psychiatric treatments, including psychotherapy, and the concerns it has raised about access to and quality of care. He discusses research studies documenting that psychotherapy is a fundamental component of psychiatric treatment and that it must be included in all health plans and organized systems of care. Several false beliefs about the use and cost of psychotherapy are considered, such as that dyadic psychotherapy is based on abreaction, a technique that Freud abandoned, and that costs for psychotherapy will skyrocket if it becomes universally accessible. Research has indicated that inappropriate limitations on psychotherapy in prepaid settings lead to poor mental health outcomes. The author emphasizes that cost-based constraints on established psychiatric treatments are not acceptable until carefully constructed scientific outcome studies demonstrate that the use of such constraints does not lead to adverse consequences.
Health Care Costs↗
Managed care: a means of rationing psychiatric treatment.
Some form of patient care review has become an integral component of most health insurance plans. The author describes the numerous ways in which such review negatively affects the therapeutic relationship between the doctor and the patient. Pressured to cut costs, reviewers are unlikely to be objective in their evaluation of the need for treatment. Many are not qualified to review particular types of treatment. Avenues for appeal of reviewers' decisions are weak. The intensity and frequency of review are often disruptive both to the treatment and to the psychiatrist's practice. Some patients discontinue treatment after learning that their care is being reviewed because of fears about loss of confidentiality or other reasons. Informed consent procedures relating to release and protection of confidential information are inadequate. The author emphasizes the need for setting standards for review organizations that will help overcome these and other problems.
Confidentiality↗
Standards of proof for ethics committees of professional organizations.
Explore the source record for details and available documents.
California↗
Availability of mental health resources for residents in academic medical centers.
In a survey on the availability of mental health resources for medical students and residents in academic medical centers, the author found that most centers offer some mental health assistance to medical students but few centers provide any formal mental health assistance to house officers. The structures and limitations of the programs for residents are described in this paper. Therapists lacking comprehensive training are frequently employed in these programs. The author concludes that the emotional needs of residents are not being adequately addressed.
Academic Medical Centers↗
Should physician training centers offer formal psychiatric assistance to house officers? A report on the major findings of a prototype program.
The literature suggests that the emotional needs of interns, residents, and fellows have received inadequate attention. Comprehensive psychiatric services are provided by a model program at UCLA. During the 1981-1983 academic years, 89 house officers were seen. Between 16% and 19% of certain groups sought help each year; depression was the most frequent diagnosis (63%, N = 56), followed by anxiety disorders (24%, N = 21). Over two-thirds of the evaluated residents entered free or low-fee treatment, and these therapies were generally considered quite beneficial. This report reemphasizes the desirability of providing carefully structured, confidential psychiatric assistance to house staff and documents medical trainees' acceptance and use of such programs.
Adult↗
Impairment prevention in the training years. A new mental health program at UCLA.
The new Mental Health Program for Physicians in Training, at UCLA, offers free psychiatric evaluation and short-term psychotherapy to UCLA medical students and house officers, utilizing a large group of physician volunteers from the clinical and regular faculties. The program features complete confidentiality and an off-campus setting and provides help in a number of specialized areas. It also conducts research on stress in medical education. A basic aim is to promote a sense of community in the medical profession by demonstrating the concern of mature practitioners for their young colleagues. It also seeks to foster greater sensitivity among young physicians by educating them about the importance of their own psychological needs. The UCLA program provides a model for mental health services that are low in cost, both to medical trainees and to the training institution, at a time of severe budget shrinkage.
California↗
Postanalytic encounters.
Outside the psychoanalytic situation, there may be numerous adventitious contacts between analyst and analysand. These interactions can be of major importance in determining the result of an analysis, either by stabilizing and reinforcing or by undoing previous analytic work. This paper focuses upon postanalytic encounters and their influence on the resolution of residual transference and the continuing working through and integrative processes. Important issues include (a) the time after termination, (b) the degree of socialization and (c) the extent of transference and/or real relationship. Clinical examples demonstrate that ex-patients can experience postanalytic encounters as pleasurable and helpful or unpleasurable and unsettling. After termination a more human openness is advocated, rather than aloofness, as catalyst for the continued future growth and development of the ex-patient. Further consideration to the important therapeutic potential of these encounters is urged.
Humans↗