Individual and Couple Therapy
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parke@parkeburgess.com



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Wednesday
Nov062013

Is Psychotherapy a Medical Procedure?

I think if you asked almost anyone on the street whether psychotherapy is a medical procedure, the great majority would think that a very strange idea. Frankly, the same is true among legions of psychotherapists and counselors. It’s a goofy notion.

But a whole branch of our field has dedicated itself unceasingly to promoting this very idea. Why? In part, these professionals worry that therapy doesn’t have the respect among the general public and, worst of all, other healthcare providers that it should. But mostly, it’s because this field wants to have access to health insurance coverage.

Health insurance carriers only cover medical procedures, so if therapy is not a medical procedure it is not covered. Simple as that. Therefore, therapy must be a medical procedure, right? Wrong.

I could go on at great length about how poorly therapy fits the medical model once you really think about it. Maybe another time. What matters here is that trying to pretend that therapy is a medical procedure involves twisting everything inside out and doesn’t serve anyone very well.

So, yes, I am saying it: psychotherapy should not be covered by conventional health insurance, as long as the insurer subscribes exclusively to a medical model.

But am I saying that psychotherapy should not be covered by some kind of insurance? Absolutely not. Indeed, the same case that argues for coverage of medical procedures applies equally well to therapeutic work; it’s just that these are two different kinds of thing. Auto insurance and flood insurance, for example, may both make a lot of sense, but it wouldn’t make sense to pretend that they are the same thing and should be covered under the same policy.

Psychotherapy should be covered because it’s a human right. We as a society know how to alleviate emotional pain and have trained and licensed professionals qualified to do it. Everyone should have access to that, just as we believe everyone should have access to healthcare for physical pain—it’s a basic right.

And psychotherapy should be covered because the social costs of excluding people from this benefit are much greater than the costs of including them. The social costs of crime and violence, substance abuse, lost productivity—not to mention the unfathomable human and social costs of passing depression or abuse down from generation to generation—can be measured in the billions of dollars per year.

What would make far more sense than no insurance for therapy or our current medical insurance for therapy is a separate psychotherapy insurance. Medications would still be covered under health insurance, but this insurance would cover therapeutic office visits and residential (in-patient) programs.

As long as we’re dreaming, let’s throw out a few numbers. The standard policy would provide 24 hours of individual psychotherapy per year at 100% and an additional 24 hours at 80%; it would cover couple therapy for ten 75-minute sessions per year at 100% and another ten at 80%; and for families with children, it would cover ten 90-minute family therapy sessions per year at 100% and another ten at 80%. The plan would have, say, a $400 deductible.

Although I made these numbers out of whole cloth, they represent what I would consider adequate coverage for those in need of out-patient therapeutic support. The relatively scanty coverage of current plans reflects “parity” with medical coverage but not the well documented realities of actual psychotherapeutic work. With support such as I have proposed, people in need might actually be able to get the help that would dramatically improve their own lives, the lives of those who depend on them, and the society that they help comprise.

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