Managed Care: Path to Professional Disillusionment Dr. Barbara Becker Holstein

Those of us who became clinicians 15, 20, 25 and 30 years ago did so because we had a mission. Each in his or her own fashion had a reason for becoming a clinician that tapped into a need to be of service to humanity, dedicated to utilizing skills that stressed talking and listening as an art/science. We served internships, wrote dissertations and gladly entered what we saw as a “healing” profession. In fact, we achieved what I refer to as The Enchanted Self (i.e. achieving positive states of being that are a reflection of each person’s uniqueness).

Each was able to utilize the uniqueness of one’s personal history, and talents, serving the public in a meaningful and skilled manner. As private as the treatment room had been, most can look back on those early years as years of collegial support and understanding. Whether one became an ego-psychologist, a behaviorist, or a family therapist, etc., each of us knew the mentoring, and the success that went with each discipline. We were able to achieve some form of enchantment within the treatment room, offering our clients the best of ourselves, psychologically supported by our colleagues and society at large. We were confident to encourage our clients to stay for the appropriate length of treatment, comfortable making clinical judgments, and enthused about learning new techniques and clinical skills. We offset our sleepless nights, our anxieties around difficult clients, with elation and moments of pure joy, as we saw clients grow and heal.

Those days seem long gone. Now we are in an era of disenchantment. By that I mean, we suffer the emotional and financial devastation of Managed Care. Whether a clinician chooses to practice within Managed Care or not, he or she is not protected from disenchantment. Disenchantment is all around. The public does not respect or understand the art/science of psychotherapy as they used to. Nor are the younger clinicians trained and mentored professionally to the standards that we took for granted. Clients come into psychotherapy, often with lowered expectations as to what therapy is, motivated primarily by their pocketbook or their Managed Care’s pocketbook. They expect cures within 4, 6 or 8 sessions. After all, that is what their plan offers. They are led to believe that a few sessions are an adequate number of contact hours with a therapist. They expect miracles while no longer having a cursory understanding of what talking therapy is all about. They, like most of America, want a quick fix, and they want it now!

As we find ourselves as “mental health providers” in a state of disenchantment, how can we utilize what we know about human potential to offset our own emotional and spiritual malaise? We know from the study of human potential that optimism and hope are extremely important factors in staying well both physically and emotionally.

How can we hold on to these capacities within ourselves? How can we at the same time fight Managed Care? In my book, The Enchanted Self, A Positive Therapy, I discuss how important our own histories are. Each of us has accumulated many memories. Our memory banks are unique to ourselves and hold within them, the potential for hope and optimism. Let me explain.

Only you can review your life’s history. Rather than looking for dysfunctional aspects of your past, search out and discover moments when you displayed talents, strengths and/or wonderful coping skills. Only you can review your life, discovering and recognizing the moments when you were filled with the potential for growth and success even if you were stymied. Now is a golden opportunity to look through your past and recognize these wondrous moments. Perhaps as a child you excelled at chess or playing tennis. Perhaps you were the child that brought home and nurtured abandoned birds and animals. Perhaps you longed to study the piano but there was no money and you could not take lessons. Yet even now you may remember the longing you had to play, or, perhaps to fend off feelings of anxiety in a quarreling family, you developed marvelous organizational skills. Were you the adolescent that displayed leadership skills, becoming president of the junior high school student council? Or were you the child that loved to dance or write poetry or just sit and daydream? You, who have guided so many others in finding their paths, can take the time to review your own history to find what is most positive about yourself.

Once you have begun to review and itemize your talents, strengths, coping skills, and potential, you are well on your way to bringing enchantment back into your life. Even during these dark days of Managed Care you can utilize your own enchantment in several fashions. You may discover in reviewing your past that you have much more potential to help in the fight for Managed Care then you thought was possible. Directing yourself to be a clearer and stronger warrior in the battle will in and of itself decrease anxiety and lessen the likelihood of depression. We all know that from what we advise our clients.

If a review of your past makes clear that you are not cleared to be a warrior in this battle, you can still access long forgotten talents and pleasures which can make your life more fulfilling. Perhaps it is time to take up tennis again. After all, you may have a few more open hours. Perhaps it is time to join a writer’s group or offer volunteer services on the local first aid squad. Perhaps it is time to finally make those plans for a walking or biking tour next summer and use extra hours to strengthen those old leg muscles. In reviewing your talents you may discover new avenues to provide mental health services to your local community.

Remember, whatever way you go you will find yourself most successful if you are utilizing your own specific talents, and coping skills. You will soon find that you are able to expand your horizons and have a more positive sense of yourself. You will be back on the road to enchantment.

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