Health Psychology: A New Form of Psychotherapy?

Joshua Fogel, PhD

Disclosures

Medscape General Medicine. 2003;5(1) 

In This Article

Abstract and Introduction

Psychotherapy in its traditional form is being challenged due to managed care pressures. Psychotherapy using the model of health psychology can adapt well in a managed care environment. Differences between traditional psychotherapy and the psychotherapeutic approach of health psychology are discussed in this article, with a focus on an overview of health psychology and its applications to primary care, and the concept of single-session therapy. A case example of a sample treatment emphasizing the model of brief health psychology treatment is illustrated.

In the current climate, the practice of psychotherapy is challenged for survival. Managed care often dictates the number of sessions one may see a patient. Traditional psychotherapy as defined by the psychodynamic model is often discouraged and not reimbursed as readily in today's healthcare environment. Managed care companies seek quick results with a limited number of sessions, something not traditionally part of psychodynamic therapy, and they do not wish to pay for the long-term relationships that are often necessary for a successful treatment.[1] Typically, for those experiencing major depressive disorder, insurance companies prefer pharmacologic treatment rather than psychotherapy. They typically limit psychotherapy to 4 sessions.[2] Stone[3] attributes this shift in treatment approach to a reduced allowance for short- and long-term psychotherapy. Managed care insurance companies want both scientific efficacy and cost effectiveness before they consider treatments as "medically necessary." Even with clinical trials demonstrating evidence for improved benefits with the addition of cognitive-behavioral therapy (CBT) to a treatment regimen, insurers may not necessarily allow for this CBT treatment as they must first evaluate if this is a "rational" allocation of resources. In a recent study[4] screening 17,187 patients seeing primary care physicians, managed care was not associated with a decreased number of referrals to mental health practitioners. However, the researchers suggested that managed care insurers had an interest in imposing controls by limiting the number of visits.

Various methods are advocated for the survival of psychotherapeutic techniques. One of the more popular approaches is to focus on "self-pay" patients. Therapists can treat these individuals using their therapeutic techniques without the constraint of a managed care company dictating the treatment plan and maximum number of sessions. This approach can work for some therapists. However, this strategy is limited by the number of patients who are able to independently pay for their treatment.

There is perhaps a new approach to psychotherapy. Some of the techniques are old, but the applications are new. The paradigm of psychotherapy is constantly changing,[5] and psychotherapists need to adapt in order to succeed in their profession. This new approach can perhaps help psychotherapists succeed in the 21st century.

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