Summer 2000

First Session - The Consultation

For many people today the experience of  “psychotherapy” is an all-inclusive term meaning a short series of absurd encounters with a “professional”. 

There are fewer and fewer professionals trained in long term therapy and most of those that are qualified have either conformed to the managed care system or have left the profession completely.  The few dedicated therapists that remain can, for the most part, only be found in very select areas of the country.

With the current unavailability of long term therapists, especially psychodynamic and psychoanalytic specialists, it’s no wonder (and no coincidence) that more and more consumers are turning to psychotropic drugs to address their emotional pain.  The only alternative, short-term therapy, when administered inappropriately, can often end in a re-creation of trauma similar to what brought the patient to therapy in the first place; rejection, humiliation, stripping of privacy, invalidation of feelings, etc.

With the current cost-cutting demands from health insurance companies and the resulting compliance by graduate school training programs, patients must either “fit” into short-term crisis therapy or go without. Paying cash is not an option even for those that might afford it because psychologists do not disclose from the beginning that there is any lacking of service in the managed care system.  Without this disclosure, patients continue to believe that their health insurance provides the best that money can buy.

Psychologists, however, struggle to tactfully (invisibly) filter OUT patients that do not “fit” the assembly-line criterion, often having no other recourse but to refer patients to the local bookstore for self-help and motivational books.

On the other hand, the pharmaceutical companies, according to the media, have just the right “medicine” to welcome the suffering “ back to life”.  And if short-term crisis therapy, motivational materials, and prescription drugs are STILL not enough, the true “relationship people”, we have been told through the media, are waiting for us down the street at the local bank! 

Dr. MC -

You mentioned over the phone that you are looking for long-term therapy?

PT -

Yes.  And I do have insurance.

Dr. MC -

Tell me PT, what’s going on in your life and how can I be of assistance?

PT -

Well, of course, it is difficult to express-and I don’t even know where to begin.  It usually takes me a few years before I feel comfortable around people.  I’ve been in therapy a number of times and it helps.  I never really understood the reason for living. Now, the world is coming to an end and so there’s not even the future of my children to consider.   I can’t work anymore…People think I’m lazy, I know…but there’s just no reason to get up.  It is difficult to move and talk.  My children hate me because I can’t be there for them.  Every encounter with another person is a failure and means another grueling night’s sleep.  Sometimes I have started having panic attacks in traffic and I am afraid that someday I am going to floor the accelerator and smash through everybody!  People say I have a lot of  “excess baggage” and just need to “get over it” or “shake it off”…. So, Doctor, how long do you think it will take?

Dr. MC-

I think that you will need about seven sessions.

PT -

Seven sessions? 

Dr. MC -

Well, maybe six.  I want you to know that I don’t have an agenda.  If you need more time-nine or ten sessions-I am here for you.  I would be happy to see you for therapy.  I’m sorry our time is up for today

PT-

What is my diagnosis?

Dr. MC-

Diagnosis?

PT-

Yes.  What code will you use on the insurance claim form?

Dr. MC-

We use “adjustment disorder”.  That is standard in this office.  I would like to schedule you again in about four weeks-but unfortunately that is when I’ll be leaving on vacation for two weeks.  That will put us at about six weeks from now for our next session.  You will need to check with the secretary on the way out to see if I’m accepting any new patients at that time.

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