A little-publicized legal decision was just issued by Judge Joseph C. Spero of the U.S. District Court of Northern California that anyone who plans to use their mental health insurance coverage to secure needed care will want to school themselves on. Ruling on a class action lawsuit brought against United Behavioral Health (UBH), a subsidiary of UnitedHealth Group, the nation’s largest health insurer, Judge Spero drew the conclusion that UBH had reneged on its fiduciary responsibility to policyholders by adopting treatment guidelines that focused on cost savings through limiting coverage to the management of acute mental health episodes.
Would-be seekers of quality psychotherapy ought to be reassured by Judge Spero’s remarkably humanistic assertions: “…it is a generally accepted standard of care that effective treatment requires treatment of the individual’s underlying condition and is not limited to alleviation of the individual’s current symptoms.” He added: “…the appropriate duration of treatment for behavioral health disorders is based on the individual needs of the patient; there is no specific limit on the duration of such treatment.” In essence, Judge Spero sounded his gavel in favor of mental health treatment of sufficient duration to get to the heart of clients’ psychological difficulties, not the all-too-prevalent model endorsed by health insurers and perpetuated by academic researchers: short-term, crisis-management, protocol-driven therapies measuring progress in terms of symptom reduction.
It turns out that when people are surveyed about their psychotherapy expectations, they value overarching qualities like enhanced self-respect, improved work functioning, and more secure relationships with significant others as desirable outcomes, more so than numerically-lower scores on symptoms (e.g., more tired than usual, fewer guilt feelings, less irritability). This squares with my everyday experience as a psychologist. The clients I see who are afflicted with depression tend not to view recovery in terms of fewer pessimistic thoughts, hopeless feelings, and less fatigue. They hold goals for psychotherapy that encompass the enduring presence of self-confidence, optimism, hopefulness, and enthusiasm. Large surveys of mental health professionals reveal they rank symptom reduction far lower than clients’ overall social and emotional well-being regarding what they believe constitutes a desirable psychotherapy outcome. In an international poll of almost 5000 psychotherapists spearheaded by David Orlinsky in the Department of Comparative Human Development at the University of Chicago, “having a strong sense of self-worth and identity,” “improve the quality of their relationships,” and “understand their feelings, motives and/or behavior,” were ranked first, second, and third, respectively, as psychotherapy goals to be attained by clients. “Experience a decrease in their symptoms,” was ranked fifth.
[For more on this story by Enrico Gnaulati, PhD, go to https://www.madinamerica.com/2...tal-health-coverage/]
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