Table of Contents : Preface SECTION ONE : Psychotherapy in the Age of managed Care Protests against Managed Care Practices The Successes of Managed Care Companies Not All Managed Care Companies Are Alike Not All Providers Are Alike, Either Accountability Is Here to Stay A Caveat: Managed Care Won`t Affect Private-Pay Clients The End of Psychotherapy As It Was: Evolution or Revolution? Reconciling Research and Managed Care Practice Becoming a Practitioner-Scientist The Hierarchy of Treatment Restrictiveness and Intrusiveness Steps of the Speed Sequence Making Managed Care Work The New Era of Psychotherapy: What Is Managed Care? Different Managed Care Delivery Systems Appreciating the Variability among MCOs For-Profit versus Nonprofit MCOs History: Why Did Managed Care Emerge? The Evolution of Behavioral Managed Care The Hopes and Dreams: The Rationale for Managed Care SECTION TWO The Managed Care Maelstrom: The Battle, Protests, and Reforms A House Divided: How Managed Care Has Fractured the Field The Despair: The Battle against MBH Problems The Downside for Patients: Cost Cutting Compromises Care The Downside of Managed Care for Providers Reform Efforts: Working toward a Better Balance The Backlash Has Begun Litigation and Legislative Reforms NCQA Regulations and Standards Managed Care`s Criticism of Its Critics 4. Being Fair: Looking Critically at Our Nostalgia and Revisiting Assumptions about Therapy Combatting Nostalgia for What Never Was Revisiting Assumptions Is Traditional Psychotherapy Always Therapeutic? The Previous System`s Unfairness to Providers Who Knows Best What Clients Need? A Caveat: Clients Don`t Always Know Best How Can We Best Facilitate Change in Clients? 5. Making Peace with Managed Care Did Psychotherapists Ask for It? Weighing the Pros and Cons: Better Research Needed The Positive Impact of Managed Behavioral Healthcare Constructive Strategies for Improving Managed Care Developing a Balanced Perspective: Resolving Ambivalence Coping with the Ambiguity: Achieving Commitment Risks of an Adversarial Stance Enjoying Your Work Conscientious Streamlining: Cutting the Right Comers Managed Care: Friend or Foe? SECTION THREE Preparing for the New Demands of Managed Care 6.What Managed Care Expects from Providers The Managed Care Mindset The Heart of Managed Care: Focused Treatment Planning Partnering with Managed Care Companies 7. Joining Managed Care Coping Constructively with New Constraints: Provider Accommodation Research Joining Managed Care A Triage Mentality: Evolving Criteria for Outpatient Treatment Legal and Contractual Issues Providing the New Continuum of Care Delivery Methods and Manpower Using Research to Improve Psychotherapy: Cutting Corners with Savvy Using a Research-Based, Rational Progression 8. Justifying Care as Medically Necessary Working with Utilization Reviewers Medical Necessity: Defining Insurance-Covered Problems Using Diagnoses Most Constructively Impairment Ratings and Severity Ratings The Problems of Jargon and Paperwork Research on the Cost-Effectiveness of Psychotherapy 9. Individualizing Treatment Applying Knowledge about Specific Groups of Consumers Tailoring Treatment Accommodating Cultural Differences SECTION FOUR Justifying Psychotherapy to Managed Care 10. A Review of Relevant Psychotherapy Outcome Research The History of Outcomes Research Outcome Studies Debates about Psychotherapy Outcomes Research 11. Squaring Off: The Specificity Debate Specific Techniques versus Common or Placebo Factors Common Factors and Placebo Effects Applying Empirical Research: Using a Research-Based Rational Progression SECTION FIVE General Psychotherapy Strategies 12. Psychotherapy Based on Common Factors Common/Nonspecific/Universal Therapy Elements Client and Therapist Factors Contribute the Most Therapeutic Conditions: What Constitutes Quality Treatment? Using Common Factors in Individualizing Treatment 13. Solution-Focused Treatment Methods Working Backward and Building on Clients` Strengths Why Managed Care Favors Solution-Focused Therapy Positive Therapist Expectations Solution-Focused Methods Applying Techniques to Challenging Patients Learning to Be Solution-Focused Criticism of the Solution-Focused Approach 14. Brief Problem-Solving Methods: Integrating Outcomes Assessment and Treatment Single-Session Treatment: Once May Be Enough! Many Common Problems Suitable for Brief Treatment Being Brief: How-To Tips for Streamlining Attacks on and Defense of Brief Therapy When Not to Use Brief Treatment ``Buying Time`` for Those Who Need It Partnering with MCOs for Optimum Patient Care Can Idealism Survive Constraints? SECTION SIX Specialized Psychotherapy Strategies: Empirically Supported Treatment Approaches The Pressure to Specialize Using Treatment Guidelines Using ESTs in Making Managed Psychotherapy Work 15. Summaries of ESTs for Common Serious Mental Disorders Anxiety Disorders Depression Post-Traumatic Stress Disorder Eating Disorders 16. Summaries of ESTs for Severe Mental Illnesses and Serious Refractory Problems Schizophrenic Disorders Borderline Personality Disorder and Suicide Substance Abuse Chemical Dependency 17. Summaries of ESTs for Problems in Living Marital Therapy Sexual Dysfunctions Parenting/Childhood Problems SECTION SEVEN Summary 18. Conclusions: Meeting the Demands of the Future Thinking about Therapy from a Managed Care Perspective Responding to Managed Care`s Demands for Efficiency: Making Less More Future Therapy Glossary: A Primer of Managed Care Terminology Listing of Empirically Supported Psychological Treatments Listing of Pharmacotherapies for Different Disorders References Index