Tuesday, June 14, 2022

Your provider will be with you shortly

 Clearly there must have been “something in the air” in the mid and late 1980s, some shift in the zeitgeist of psychotherapy, that made psychotherapists and their development more salient in the minds of researchers. Previously almost all scientific attention in the field had focused on therapeutic procedures, the “techniques” that therapists used (e.g., “interpretation” or “accurate empathy”), the processes that evolved in therapy from their use (e.g., “insight” or “self-acceptance”), and their impact on the patient’s mental and emotional condition (i.e., “outcome”). In many ways this model still largely persists, based on the assumption (imported from biological medicine) that the “curative effect” of psychotherapy derives from effective treatment procedures correctly applied to specific disorders. In this highly sanitized “laboratory” model, physician-therapists are viewed as well-trained administrators of the therapeutic procedure, with all other personal and professional characteristics an irrelevance; and they are essentially interchangeable. 8

Orlinsky, David E.. How Psychotherapists Live (p. 4). Taylor and Francis. Kindle Edition. 

The bolding has been added.

The commodification of psychotherapy based on medical “procedures” is inherently flawed and yet drives the reimbursement systems from health insurers. It has led to the corporatizing of “psychotherapy” in on-line schemes to provide psychological advice even via text messages for monthly service fees charged to a credit card.

What do you make of this?

Recently, at my last medical check-up the LPN took my weight, my temperature, my blood pressure, checked my medication list, and then got up to leave saying “Your provider will be with you shortly.” I was startled by the choice of the word “provider.” I wonder who had scripted her to say instead of “your doctor” or “Dr. Alweis”, “provider.”. And then it dawned on me that this is a large practice and she is “rooming” several patients all day long some of whom are seeing physicians, other P.A.s, some NPs, and some residents. “Provider” covers a lot of roles and professions and is a safe word to use when the discipline of the “provider” isn’t certain. They all to some extent are interchangeable. 

In my solo private practice of psychotherapy, there are no “providers.” There is only one Licensed Clinical Social Work Psychotherapist. I ask, “How did you get my name?”

 “Oh, my parents saw you twenty years ago. They told me you are good. You helped them.”

“You could go online and talk to someone like BetterHelp.”

“Oh I tried them for six visits. I decided I wanted to talk to a real person.”

“It’s nice to meet you.”

“Same here.’

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