Table of Contents :

Preface

SECTION ONE : Psychotherapy in the Age of managed Care
Protests against Managed Care Practices
The Successes of Managed Care Companies
Not All Managed Care Companies Are Alike
Not All Providers Are Alike, Either
Accountability Is Here to Stay
A Caveat: Managed Care Won`t Affect Private-Pay Clients

The End of Psychotherapy As It Was: Evolution or Revolution? Reconciling
Research and Managed Care Practice
Becoming a Practitioner-Scientist The
Hierarchy of Treatment Restrictiveness and Intrusiveness
Steps of the Speed Sequence
Making Managed Care Work

The New Era of Psychotherapy: What Is Managed Care?
Different Managed Care Delivery Systems
Appreciating the Variability among MCOs
For-Profit versus Nonprofit MCOs
History: Why Did Managed Care Emerge? The
Evolution of Behavioral Managed Care
The Hopes and Dreams: The Rationale for Managed Care

SECTION TWO The Managed Care Maelstrom: The Battle, Protests, and
Reforms

A House Divided: How Managed Care Has Fractured the Field
The Despair: The Battle against MBH Problems
The Downside for Patients: Cost Cutting Compromises Care
The Downside of Managed Care for Providers
Reform Efforts: Working toward a Better Balance
The Backlash Has Begun
Litigation and Legislative Reforms
NCQA Regulations and Standards
Managed Care`s Criticism of Its Critics

4. Being Fair: Looking Critically at Our Nostalgia and Revisiting Assumptions about Therapy
Combatting Nostalgia for What Never Was
Revisiting Assumptions
Is Traditional Psychotherapy Always Therapeutic?
The Previous System`s Unfairness to Providers
Who Knows Best What Clients Need?
A Caveat: Clients Don`t Always Know Best
How Can We Best Facilitate Change in Clients?

5. Making Peace with Managed Care
Did Psychotherapists Ask for It?
Weighing the Pros and Cons: Better Research Needed
The Positive Impact of Managed Behavioral Healthcare
Constructive Strategies for Improving Managed Care
Developing a Balanced Perspective: Resolving Ambivalence
Coping with the Ambiguity: Achieving Commitment
Risks of an Adversarial Stance
Enjoying Your Work
Conscientious Streamlining: Cutting the Right Comers
Managed Care: Friend or Foe?

SECTION THREE Preparing for the New Demands of Managed Care

6.What Managed Care Expects from Providers
The Managed Care Mindset
The Heart of Managed Care: Focused Treatment Planning
Partnering with Managed Care Companies

7. Joining Managed Care
Coping Constructively with New Constraints: Provider Accommodation Research
Joining Managed Care
A Triage Mentality: Evolving Criteria for Outpatient Treatment
Legal and Contractual Issues
Providing the New Continuum of Care
Delivery Methods and Manpower
Using Research to Improve Psychotherapy: Cutting Corners with Savvy
Using a Research-Based, Rational Progression

8. Justifying Care as Medically Necessary
Working with Utilization Reviewers
Medical Necessity: Defining Insurance-Covered Problems
Using Diagnoses Most Constructively
Impairment Ratings and Severity Ratings
The Problems of Jargon and Paperwork
Research on the Cost-Effectiveness of Psychotherapy

9. Individualizing Treatment
Applying Knowledge about Specific Groups of Consumers
Tailoring Treatment
Accommodating Cultural Differences

SECTION FOUR Justifying Psychotherapy to Managed Care

10. A Review of Relevant Psychotherapy Outcome Research
The History of Outcomes Research
Outcome Studies
Debates about Psychotherapy Outcomes Research

11. Squaring Off: The Specificity Debate Specific
Techniques versus Common or Placebo Factors
Common Factors and Placebo Effects
Applying Empirical Research: Using a Research-Based
Rational Progression

SECTION FIVE General Psychotherapy Strategies

12. Psychotherapy Based on Common Factors
Common/Nonspecific/Universal Therapy Elements
Client and Therapist Factors Contribute the Most
Therapeutic Conditions: What Constitutes Quality Treatment?
Using Common Factors in Individualizing Treatment

13. Solution-Focused Treatment Methods
Working Backward and Building on Clients` Strengths
Why Managed Care Favors Solution-Focused Therapy
Positive Therapist Expectations
Solution-Focused Methods
Applying Techniques to Challenging Patients
Learning to Be Solution-Focused
Criticism of the Solution-Focused Approach

14. Brief Problem-Solving Methods: Integrating Outcomes Assessment and Treatment
Single-Session Treatment: Once May Be Enough!
Many Common Problems Suitable for Brief Treatment
Being Brief: How-To Tips for Streamlining
Attacks on and Defense of Brief Therapy
When Not to Use Brief Treatment
``Buying Time`` for Those Who Need It
Partnering with MCOs for Optimum Patient Care
Can Idealism Survive Constraints?

SECTION SIX Specialized Psychotherapy Strategies:
Empirically Supported Treatment Approaches
The Pressure to Specialize
Using Treatment Guidelines
Using ESTs in Making Managed Psychotherapy Work

15. Summaries of ESTs for Common Serious Mental Disorders
Anxiety Disorders
Depression
Post-Traumatic Stress Disorder
Eating Disorders

16. Summaries of ESTs for Severe Mental Illnesses and Serious Refractory Problems
Schizophrenic Disorders
Borderline Personality Disorder and Suicide
Substance Abuse Chemical Dependency

17. Summaries of ESTs for Problems in Living
Marital Therapy
Sexual Dysfunctions
Parenting/Childhood Problems

SECTION SEVEN Summary

18. Conclusions: Meeting the Demands of the Future
Thinking about Therapy from a Managed Care Perspective
Responding to Managed Care`s Demands for Efficiency: Making Less More
Future Therapy
Glossary: A Primer of Managed Care Terminology
Listing of Empirically Supported Psychological Treatments
Listing of Pharmacotherapies for Different Disorders
References
Index