Phoenix32890 wrote:Quote:But Dr. Arnold Goldberg, director of the Chicago Institute for Psychoanalysis, expressed concern that "some insurance companies balk at reimbursing non-M.D.'s." Many insurers are cutting back the coverage of mental illness in general, even when the treatment is given by a physician. However, some states require insurance companies to accept claims from both psychiatrists and psychologists.
Not even considering the efficacy of psychoanalysis, I think that that paragraph sums up the issue. The health insurers are much more likely to pay for a psychotropic medication, than spring for a long course of analysis. So, I would suspect that a goodly percentage of folks who go in for analysis, are bored and wealthy.
Maybe I am looking at this from a prejudiced point of view. I have been always been leery of those therapists, of any discipline, including analysis, that "keep the patients on the payroll" for a long period of time.
There seems to be a co-dependency between patient and therapist, that I don't think, of itself, is healthy. For the therapist, it is comforting to know that he has a steady income coming in from clients who remain dependent. For the patient, I have known too many who, after many years of therapy, are unable to function, or make decisions, without the input of the therapist. That to me, in itself, is a good reason to stay away from any long term therapy modalities.
I myself favor the directive, cognitive approach of a therapy such as REBT.
While I am becoming more respectful of some analytic concepts and analysis' efficacy with certain problems, or for anyone, if they can afford it. I do not think that, practiced properly, it promotes "dependency" for longer than is therapeutically necessary...of course, as with any skill and art, there are many who practice not so well.
That said, I practice briefer therapies, generally, but am increasingly informed by analytic theories, as some of them make more sense in the light of research...a fascinating thing to see!
However, for some very deep and global trauma, do think that several years of therapy are necessary...and research bears this out...eg with the kind of kids I see at the hardest end, less than a minimum of two years therapy seems to have little effect, though we are working with techniques that seem to speed things up.
I think managed care is inimical to good practice in many areas, not just therapy...and for therapy of truly traumatised people I think it will be disastrous.
Here, medicare still provides for analysis by therapists who are also psychiatrists.... but for how long?
As with all methodologies, different things suit different people. Frankly cognitive stuff is a part of any good therapy, I think.....but not enough in some cases.