PSYCHOANALYSIS AND FEES

The therapeutic value of fees: what do practitioners believe?

Theorists have proposed that out-of-pocket fee payment helps clients benefit from psychotherapy. 159 staff members of a public mental health agency completed a fee attitude survey. Aggregate results indicated neutral beliefs. Significant differences appeared by gender, population served, and organizational role. Women were less likely than men to endorse TVF beliefs. Addiction services staff held strongest TVF beliefs, child and adult mental health staffs were neutral, and victim services staff rejected TVF beliefs. Clinical service providers were less likely to endorse TVF concepts than were clinicians in management roles, and non-clinical support staff held the strongest TVF beliefs. By understanding the relationships between fee attitudes, organizational role, and populations served, mental health administrators may be better able to manage changes in fee procedures.

On direct patient participation in the cost of their psychiatric care. Part I. A review of the empirical and experimental evidence

In the midst of a sociopolitical debate regarding access to health services, an evaluation is required of the therapeutic impact of the direct participation by some patients in the cost of their psychiatric treatment. Empirical clinical concepts regarding the need for a direct payment of treatment by the patient have evolved. Initial rigorous practice systems have lead to more flexible methods allowing for the recognition of third-party financing. Psychoanalytic theory has addressed the issue most extensively, but other conceptual frameworks have reached similar conclusions as well. The experimental evidence to either support or refute the position that the direct payment of a fee has a beneficial effect on therapeutic outcome remains limited. The focus has been on studying the impact of fee manipulation, but a tested correlation of other motivators such as patient's insight, therapist's attitudes and behaviour and social pressures is mostly lacking. Two patient populations appear to be delineated. Fee participation is of particular value to the financially secure and to the educated while patients in need of less intensive involvement, with reality testing disturbance and limited insight benefit particularly from third party insurance. Different patient populations should have the right to choose different payment options.

Peer review, third-party payment, and the analytic situation: a case report

The complexities of insurance coverage and peer review as they intrude into the analytic situation were discussed. The basic question was raised of whether becoming acceptable to major health providers through the peer-review program is truly a compromise of the analytic pact and a threat to the future of psychoanalysis. Practical as well as technical considerations facing the analyst when he is confronted with having to write a report to the patient's insurance company were elucidated. Countertransference feelings were emphasized. A detailed case illustration was presented to demonstrate that peer review, as it relates to third-party payment, need not compromise an analysis.

Involving clinicians in fee collections: implications for improving clinical practice and increasing fee income in a community mental health center

This paper examines the relationship between a client's payment or non-payment of fees and treatment outcome, diagnosis, and training of the therapist. Clients who pay regularly are more satisfied and have higher goal attainment regardless of diagnosis. A statistical study and clinical case examples are presented which demonstrate that the failure to pay is clinically significant information and that involving clinicians in the fee collection process can improve clinical treatment and increase the agency's fee income.