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Psychotherapy and Managed Care
Samuel B. Guze, MD
Arch Gen Psychiatry. 1998;55:561-562.
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Managed care has affected psychiatric care more radically than it has other medical fields, by shaping care so that psychiatrists are paid primarily for making a diagnosis and prescribing medication while other professionals, most typically social workers, are paid for providing psychotherapy. This pattern is fostered because social workers, who have not undergone lengthy and expensive medical education and training, are not as costly. In addition, this pattern probably reflects the continued belief that psychotherapy is designed to uncover and treat the causes of psychiatric disorders rather than to provide psychological support and help the patient cope with manifestations and consequences of the illness.
Many psychiatrists are skeptical about the validity of a causal approach to psychotherapy and believe that the etiology of most psychiatric disorders is largely unknown—though they expect extensive genetic, epidemiologic, and neurobiologic research to ultimately identify important causal factors.1 Many of these . . . [Full Text of this Article]
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