Is Three a Crowd? Clients, Clinicians, and Managed Care

Authors

  • Julie Cohen BA,

    Corresponding author
    1. University of Arizona
      Department of Psychology, University of Arizona, 1503 E. University Boulevard, Building 68, Tucson, AZ 85721. E-mail: jlc5@email.arizona.edu
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      Julie Cohen. BA, Department of Psychology, University of Arizona, Tucson, Arizona; Jeanne Marecek, PhD, Department of Psychology, and Jane Gillham, PhD, Department of Psychology, Swarthmore College, Swarthmore, Pennsylvania.

  • Jeanne Marecek PhD,

    1. Swarthmore College
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      Julie Cohen. BA, Department of Psychology, University of Arizona, Tucson, Arizona; Jeanne Marecek, PhD, Department of Psychology, and Jane Gillham, PhD, Department of Psychology, Swarthmore College, Swarthmore, Pennsylvania.

  • Jane Gillham PhD

    1. Swarthmore College
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      Julie Cohen. BA, Department of Psychology, University of Arizona, Tucson, Arizona; Jeanne Marecek, PhD, Department of Psychology, and Jane Gillham, PhD, Department of Psychology, Swarthmore College, Swarthmore, Pennsylvania.


  • This paper is drawn from a thesis presented to the Department of Psychology, Swarthmore College by Julie Cohen in May, 2002. Jane Gillham and Jeanne Marecek supervised the project. Portions of the thesis were presented at the biannual meeting of the American Psychoanalytic Association, NY, January 2003, and at the American Psychological Association convention, Toronto, August, 2003.

Department of Psychology, University of Arizona, 1503 E. University Boulevard, Building 68, Tucson, AZ 85721. E-mail: jlc5@email.arizona.edu

Abstract

How does therapy change when therapists work under managed care plans? To explore this question, the authors conducted in-depth, semistructured interviews with therapists. The interview texts were analyzed using a structured thematic coding system. A central theme in the interviews was a culture clash between managed care companies and these therapists. Working for managed care organizations demanded several practices that violated the therapists' standard of care and professional ethics. Also, participants reported that managed care personnel misrepresented the nature of psychotherapy to clients, thereby undermining the therapeutic work and the therapist-client relationship. If these therapists' experiences are representative, the growth of managed care has serious implications for the nature of psychotherapy, practitioners' integrity and morale, and the public image of the therapy professions.

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