May 14, 2009

How can you continue to invoice an insurance company?

This interesting question came in today:
"Many clinicians here in the USA are cautious on the SF approach deeming it overly simple ... as well as their love and admiration for the "diagnosed problem." In fact a lead at one of the nations leading children's hospital noted that he considers his team's work a "diagnostic mill." So ... the SF approach, which seeks to enhance the functional capacity (regardless of the specific diagnosis) is much too uncomplicated. And ... how can you continue to invoice an insurance company when a person comes to the 'best hopes' in 3 sessions?"

I am no psychotherapist so I am reluctant to answer. Who's got some useful tips on this?


  1. Merriam-Webster Online Dictionary.

    Main Entry: in·teg·ri·ty

    Pronunciation: \in-ˈte-grə-tē\
    Function: noun
    Etymology: Middle English integrite, from Middle French & Latin; Middle French integrité, from Latin integritat-, integritas, from integr-, integer entire
    Date: 14th century

    1 : firm adherence to a code of especially moral or artistic values : incorruptibility2 : an unimpaired condition : soundness
    3 : the quality or state of being complete or undivided : completeness

    It all boils down to the kind of person you choose to be!

  2. Hi Peter, please help further, I don't think I understand how this answers the question..
    Best wishes,

  3. I find it unethical to do less than your best on the pretense that this creates a source of income.

    It is similar in my mind to extortion.

    If you have a method that works better and you know it works better and you don't use it because this means less income for you, your are behaving unethical, you are compromising your integrity. Both professional and social integrity are thrown out the window.

    However, I might be misinterpreting all of this as I don't have the entire information on the situation.

  4. Hi Peter, ah I am beginning to understand. As I said I am not a therapist and cannot judge well how this relates to their situation. But I do see the relevance of what you say in relation to my own work context. When I started to apply solution-focused techniques I noticed that my coaching became briefer and briefer. On the one hand this was fabulous because it was great to client helped so much faster and better than before. But -I must admit - there was suddenly a moment when I realized this and realized that per client I would start to make much less money than before. I thought carefully about this and asked myself: do I really want this? After some good thinking, I concluded wholeheartedly yes. I decided to explicitly choose for the better but apparently commercially less attractive option of solution-focused coaching and I decided to trust that all would turn out okay and that I would end up making enough money. I have never regretted that choice but I cam sympathise with people who have to make such choices and find it hard. After all, there are always lots of financial obligations and things are not always easy and black or white.

  5. I understand the position and... I know that it is too easy for me to be so righteous without mortgages and children to take care of.... :)

    However, I stand by my view on how this world works.

    Great service = great rewards.

    Sometime these rewards might not come in form of money... but hey... I guess it depends also on how you view wealth.

    I view wealth or success as a more complex issue than just money.

    There are some things that no amount of money can buy... like peace of mind.... These things tend to be way more important than money on the long run. They can help you lead a better more fulfilled life, the kind of life that other, altho having tons of money, cannot buy.

    Compromising yourself for some quick cash will most of the time be.... selling your future at discount prices for a questionable present.

  6. I am no psychotherapist either, but it seems no medical advice is requested here. The point is: clinicians focus on diagnoses (=problems) instead of solutions. As many other advisors, health or otherwise, they think that they can find the solution just by exploring the problem. Most energy is spent on labelling the illness, instead of helping the patient. As with many other advisors, they are paid by the hour instead of for getting results. This situation raises the interesting question: has anyone (in or outside the USA) been succesful at implementing SFC in doctor-patient relationships? How did you reach your results? What were important factors? What drove doctors to embrace this, even though they could invoice less to the insurance companies?

    Jan Pieter Boekestein

  7. Rightly said on the diagnosis issue. It seems that the reimbursement systems (be they insurance/medical model/tradition) affirms that if we understand the cause of a problem we will then have the capacity to solve that identified problem. We forget that some solutions have nothing to do with problems.

    One challenge that does exist is that some diseases follow a linear process ... exposure to a bug ... catch that bug ... seek medical advice ... direction by the beloved MD to seek the benefit of a pharmaceutical (e.g. penecillin) ... decide to add to that pharmaceutical rest and nutrition ... leave feeling that this process has healed me.

    One may forget that the rest and nutrition, even the body's ability to find equilibrium, may have had as much to do with my healing as the protocol the beloved MD offered.

    For relational issues, however, they are not so clean ... and as such a linear approach does not always work so we ...

    That being said, those who fund interventions generalize (from my first instance to others - how to manage anxiety/depression/schizophrenia) ...

    I will presume that this is the challenge that de Shazer and Berg faced as they introduced the SFBT model.

    Add to this, the fact that were a client to find resolution more quickly, this would likely result in the decrease in sessions, which would adversely impact therapist income, and the whole thing gets messier as then there is the interplay between client's need (how might I manage my life) and the therapist's needs (how might I pay for my new car, my home, my kids meals for the coming week, etc).

    So Peter is also on target with his words as well!

  8. I am a psychotherapist, specifically, a marriage & family therapist (MFT). I wouldn't dare to diasagree with the perspective that many clinicians focus upon diagnosis. However, I would also add that many clinicians are focused upon outcomes. It is advantageous to be able to benefit from WOM marketing or other medium that you achieve practical results that improve functionality within the world of psychotherapy. Consumers/clients who receive effective and efficient resolution to their presenting complaint speak with others and make recommendations based upon outcomes. A recent study completed at University of Guelph (Ontario) and published in Journal of Marriage & Family Therapy surveyed MFTs across Canada in relation to their practice. The most popular form of therapy provided by this group is Solution Focused Therapy.

    I am less familiar with medicine per se. However, in the blog posting of May 16th, 2009 on Coert's web blog entitled, "I miss the audaciousness of the early years", Gale Miller cites the influence of SFT in medicine among other professions. I would imagine that he would be aware of responses to the questions that have been raised by the original question.

    I think that there is another salient point to raise. It is not unusual for consumers to come to therapy seeking a label in the belief that this will be helpful. It is also true, similar to organizations, and in spite of efforts to engage in a solution focused conversation, people will pursue a conversation that is problem focused. People are educated to solve problems rather than explore solutions. I think that consumers of mental health services have been socialized in this manner of resolving emotionally and psychologically painful experiences.

    Kevin Clouthier
    Owner, Third Space Consulting

  9. Kevin,
    Problem Focused Change has been around for a lot longer than Solution Focused Change, it is only natural for this to be the default.

    Also, I have a feeling that is not SFC that is influencing medicine but that SF type of approaches are being developed in parallel.


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