Selling Bad Therapy to Trauma Victims

[Kizzie]

Thought provoking article about sketchy/skimpy research and the way it affects health insurance coverage for therapy  in the US:


Many health insurance companies discriminate against psychotherapy. Congress has passed laws mandating mental health "parity" (equal coverage for medical and mental health conditions) but health insurers circumvent them. This has led to class action lawsuits against health insurance companies, but discrimination continues.

One way that health insurers circumvent parity laws is by shunting patients to the briefest and cheapest therapies. Another way is by making therapy so impersonal and dehumanizing that patients drop out. Health insurers do not publicly say the treatment decisions are driven by economic self-interest. They say the treatments are scientifically proven.

It's bad enough that most Americans don't have adequate mental health coverage, without also being gaslighted and told that inadequate therapy is the best therapy.


Read the full article :

Shedler, J. (2017). Selling bad therapy to trauma victims: Patients and therapists should ignore new guidelines for treating trauma. - https://www.psychologytoday.com/blog/psychologically-minded/201711/selling-bad-therapy-trauma-victims

[Dee]

I agree with this.  When I was inpatient I found I was fortunate.  I saw person after person leave far before they were ready because of insurance.  Many were waiting until the last minute to see if they could stay or have to leave.  They had their bags packed waiting on a decision.  Most, I am sad to say, had to leave.

[sanmagic7]

unfortunately, this has been going on for as long as i can remember, from even before i was a therapist.  when my eldest daughter was at her worst, (some 30 yrs. ago)  she was allowed 12 days/yr. inpatient treatment.  basically, they kept her 2 to 3 days at a time, long enough to stabilize her and sent her home with no follow-up recommendations for us (her parents).  the frustration at not getting adequate treatment for her was agonizing.

at one time we considered having her committed, thinking that she would get the care she needed that way.  those were some of the most heartbreaking conversations ever.  it didn't come to that, but she has suffered immensely all her life due to inadequate care.

i've also written about therapists having to get 'creative' in order to make sure their clients could get enough time/weeks of therapy paid for by their ins. companies.  it is extremely disheartening to me to see this horrible situation continues.  with all the recent clamor about mental health in relation to the mass shootings that have been going on the past several years, one would think mental health issues would have priority.

the madness is not within after all.

[Kizzie]

The madness is not within after all

  Truer words San .....  Perhaps together we here at OOTS will be enough of a voice at some point to demand change 

[sanmagic7]

we can only fight for it and hope.

[ah]

One way that health insurers circumvent parity laws is by shunting patients to the briefest and cheapest therapies. Another way is by making therapy so impersonal and dehumanizing that patients drop out.

This gave me shivers. Making therapy dehumanizing... that's beyond cynical, beyond macabre.

[Kizzie]

Unfortunately, a lot of things come down to dollars and cents and it's something  I find really disturbing too 

What will hopefully go a long way toward time and effort and money spent on us is the inclusion of CPTSD as a distinct diagnosis in the World Health Org's ICD-11. There are a group of researchers/clinicians (one of whom is Judith Herman who came up with the term in the 1990's), working hard to legitimize CPTSD as a diagnosis distinct from PTSD through studies which produce empirical evidence. It was largely due to their efforts that it is going to be in the ICD.  Hopefully now they will turn their attention to the APA's DSM, the other diagnostic bible mental health professionals, physicians, insurers, etc.,  use. 

There has been push back,  but I personally think the tide is turning in our favour or will within a few years. There are just too many of us connecting on forums like this, blogging, showing up in GPs/therapists offices needing help, etc. I am old enough to remember when those with PTSD were first showing up - lots of skepticism and similar disregard by insurers and so on. Now there are all kinds of services, better treatment, organizations, support groups in so many countries. 

One example of a shift I've been seeing when I look around online is a growing recognition that firefighters, police, emergency service workers and soldiers are suffering from an accumulation of trauma (i.e., Complex PTSD versus PTSD).  These professionals  have powerful unions in most cases and are respected by the public so if they begin to demand better treatment and services, it is likely to pave the way for those of us who developed it for other reasons.  We'll see    but I am hopeful 

[radical]

You're right, Kizzie,
It is only recently that the cumulative nature of trauma has started to be understood.  This knowledge could make people with CPTSD make sense to others, particularly service providers.

The original formulation of PTSD as a single event has always been a huge barrier.  My suspicion is that traumatic conditions, where they last beyond the immediate aftermath, rarely, if ever, relate to a single event.  Even in warfare, it might be a single event that pushes a person over the edge, but the biggest risk factor for  PTSD is a history of childhood trauma.

I hope this kind of understanding can lead to an understanding of how a history of interpersonal trauma very often leads to not just a sensitvity to the effects of adult circumstances, but also to negative exacerbating circumstances themselves in adulthood, whether it be abusive relationships, poverty, bullying, exploitation, social exclusion,...... and how vicious cycles, in many cases are created with ever worsening effects on the person affected.

Also, I wish people could understand that people who have already been traumatised can be very vulnerable to serious harm from later adverse events, because these experiences add-on to the previous trauma.  It doesn't seem to be understood that like a broken bone that never properly healed, additional damage to the site of the injury is causing and accumulation of harm to the original unhealed wound, not a separate injury.

I don't feel that the effects of traumatic experiences are separate and discrete.  The effects of new events widen the network of effects further into our minds and our lives.

[Slackjaw99]

Compounding the insurance industry problem is the fact that many psychiatrists want to make a name for themselves by inventing new personality disorders for inclusion in the DSM that are really just symptoms of cPTSD, and the DSM make nearly a billion dollars for the APA with every edition released.