Beyond the One-Way Mirror - Page 2


Family therapy itself was finally abandoned because new Medicaid regulations made it more practical to see individuals and conduct 15-minute medication checks. It had become easier to just take an individual child or teenager out of class and bill the same fee as for an after-hours family session.

"Money and billable hours are now driving our treatment methods," John added. "Individual psychotherapy with meds as the quick fix is now the standard. Psychotherapy is dead at this agency. We feel we're just cogs in a wheel. Our burnout rates are skyrocketing, and the average therapist only stays around until finding something better."

The other therapists nodded agreement. Even though John was the only one who remembered the old days, everyone agreed that better training and more supervision were needed, but no one felt there was much likelihood of that happening.

Things Sure Have Changed

The one-way mirror observation room that's now become a storage closet is a metaphor not only for the transformation of the profession of therapists like John in the public sector, but for many of us in private practice as well. Psychotherapy as we all knew it in the 1970s, 1980s, and 1990s—with its emphasis on quality care, innovative approaches, and patient advocacy—has gone the way of the one-way mirror. Managed care, the relentless push for briefer treatment, and exponential growth in the use of medication have placed the field in crisis.

The private practitioner who says, "Who cares what happens in the public sector? It doesn't affect me" is like the noninvestor who asks why she should care whether the stock market crashes. The psychotherapy field isn't neatly compartmentalized into public and private sectors. When one part is in decline, it's only a matter of time before the ripple effects are felt in the other.

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