|Beyond the One-Way Mirror - Page 3|
At the same time, recent developments within the field hold great promise for public sector therapy. There's a growing body of empirical evidence that didn't exist in the glory days of the community mental health movement—evidence demonstrating that a wide variety of time-limited approaches can be clinically effective. These models, such as cognitive-behavioral therapy, multisystemic therapy, and structural family therapy, are now called evidence-based practices. Unfortunately, because of depleted budgets, excessive caseloads, inadequate training and supervision, and bureaucratic inertia, therapists in the public sector typically don't have the time, energy, or motivation to learn how to use these evidence-based models. In addition, a lot of the models lack "transportability"—meaning that it's difficult or impossible to integrate them successfully into public or community mental health.
The CEO of a major community mental health center in the Southeast once bluntly explained to me why public sector psychotherapy isn't feeling any particular pressure to keep up with the times: "Let's face it: we get a constant and steady flow of referrals, whether we're effective or not. We're a monopoly, the only place in our local area that accepts Medicaid." His voice turned sarcastic. "In fact, our center is so poorly run that if this were a private business, we'd have gone bankrupt long ago. But why should I purchase and use an evidence-based model to make us more effective? No one cares. We have a culture of clinical minimalism. Our therapists do the minimum because that's all they have to do."