A psychodynamic perspective on the clinical impact of insurance review

Article Abstract:

Managed care and close scrutiny of third-party reimbursement have had a significant impact on the practice of inpatient psychiatry. Treatment plans are often undermined by untimely loss of coverage. Impulsive, aggressive patients who require long stays in highly structured environments are often discharged prematurely because reviewers insist on discharge as soon as they demonstrate signs of improvement. Several case examples are presented to illustrate ways in which insurance reviews can adversely affect patients. Suicidal patients often react to an impending review as a threat to their treatment and safety. This type of stress has been shown to lead to hopelessness and suicide attempts. Borderline patients, who use primitive defenses such as projection and splitting (tending to see people, oneself or situations as either all good or all bad), are also affected by insurance review. For example, a hostile reviewer becomes an easy target for the patient's negative projections, and can be viewed by the patient as a container for all that is evil and bad, so that the treatment staff then becomes viewed as representing all that is good. This leads to problems during hospital discharge, because such patients cannot successfully separate from caretakers viewed so idealistically. Clinicians given time constraints can unconsciously push patients towards a speedy recovery. This pressure can make patients more oppositional, or make them feel alone and misunderstood. Sometimes, patients who resist or resent treatment can ally with insurance reviewers and demand premature release. Family members may also collude with the reviewers to ensure a release that is not necessarily in the patient's best interests. The point is made that cost-effective and psychodynamically effective solutions will require negotiations and compromise between payers and treatment providers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Insurance, Psychiatric hospital care, Psychiatric hospital patients, Psychiatric hospitals, Mental health benefits, Psychiatric disability evaluation

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Behavioral treatment of child stutterers: replication and extension

Article Abstract:

The effectiveness of behavioral treatment for child stutterers was assessed. The treatment regimes were based on Azrin and Nunn's Regulated Breathing Method, which considers breathing management as a crucial therapeutic agent. The results showed that the behavioral treatment program was effective for child stutterers. Corollary to this is the conclusion that awareness training is a prerequisite to modify behavior of child stutterers. Self-correction is a key factor which can increase the probability of maintaining the progress achieved at the completion of behavioral treatment.

Care and treatment, Children, Behavior therapy, Behavior therapy for children, Stuttering

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