Comments for Not the TOP - Weblog http://notthetop.wordpress.com An Action Research Project Sun, 28 Sep 2008 20:47:00 +0000 http://wordpress.com/ hourly 1 Comment on www.notthetop.net by Beverly Quint, BCD,LICSW http://notthetop.wordpress.com/2007/10/17/hello-world/#comment-5 Beverly Quint, BCD,LICSW Sun, 28 Sep 2008 20:47:00 +0000 #comment-5 As nineteenth century writer Gustav Flaubert said, personal stories always reflect the larger social currents of the time in which they take place. This is certainly true of his work including the most widely known of his novels, “Madame Bovary”. I thought of this in relation to the surge we have been witnessing in local, teenage pregnancies. Not only has the incidence of eighteen pregnancies among fifteen and sixteen year old Gloucester, Massachusetts high school girls shocked the local residents, the news has spread around the world in every medium: newspapers, radio, television and the Web. It has also been echoed on our national stage by the announcement that our Republican Vice Presidential candidate’s teenage daughter is an unwed mother-to-be, impregnated by a teenage fiancé who describes himself as “a fuckin’ redneck”. How does Flaubert’s theory of a relationship between the local event and the larger world apply? The answer, when it came to me, seemed, at first, so remote that I doubted my own intuition. I am, however, convinced, no matter how many degrees of separation between the social undercurrent in today’s view of individual uniqueness and what we see as an outbreak challenging our view of “behavioral health”, the phenomenon we are witnessing in our backyards and the crisis we are having in health insurance today, in our country, are powerfully connected. In the interest of full disclosure I must reveal that I am a health care provider, a psychotherapist in private practice. I am, after some forty years in private practice and more than half a dozen before that in various social agencies: hospitals, clinics and schools, currently in the process of retiring. I am not financially dependent for survival on insurance companies’ reimbursement. We all have heard by now that there are at least 45 million uninsured in the U.S. and uncounted thousands of underinsured. There is something, however, that people still lucky enough to afford health insurance don’t realize. Without much fanfare, there has been a change in your mental health insurance, which you assume is automatically included in your whole health care package. Insurers no longer pay for psychotherapy. In an attempt to acquire even higher profits, insurance companies, hand in hand with pharmaceutical companies, have redefined mental health treatment. Psychotherapy is no longer called “Psychotherapy” by insurance companies. It is now called “Behavioral Health”. And what is behavioral health? Who defines it? Why, the insurance companies, of course. There is no longer a troubled and searching individual, desperately seeking help with highly confidential questions; torn between trusting a well trained stranger, a psychotherapist, with whom, she/he will, hopefully, feel safe enough as time passes…or suffering, in loneliness, the agony of crippling emotions. Psychotherapists are now asked by insurers to steer patients into conforming to particular patterns of behavior decided by insurers to be correct. There are thousands of studies that prove that the most effective healing for emotional problems is based on the relationship formed between patient and therapist. To cite just one, Wampold, reporting in a study of 20,000 patients and 200 therapists concluded that the client/therapist relationship is the best predictor of good outcome in an emotionally troubling dilemma. The” quick fix” of creating the profile of a “disease” and handing out a pill to repress the symptomatic behavior assumes that one size fits all. All those who fit the Depression profile get pill A, and those who fit the Anxiety profile, pill B. Profiling treats a cluster of behaviors or symptom. It does not get at the root of the individual problem. It is, in the end, a never-ending, non-cure. Though talk therapy takes longer it lasts longer. The quick fix drug that alters behavior leads to the high cost of a lifetime of recurrence of symptomatic behaviors and pill taking. These studies are to be discarded, insurers say, in favor of fast-tracking mental health coverage, cutting visits and steering treatment toward behavior altering drugs. Instead of treating people in all their complexity, only their behavior is tracked and a profile of a “Behavioral Disorder”; not of an individual, is targeted. It is as if all depressed people were the same; all anxious people, the same and so forth. It is behavioral profiling. Psychotherapists are told by those who hold the purse strings, namely insurers, “We will pay you for eliminating the symptoms that we call “unhealthy, or “disordered” and we will ignore the individual patient as a multi-tiered human being. No wonder the public is so eager to read personal stories, memoirs, and blogs. That’s where individuals are seen as individuals; not as abstract representations of a “disorder”. Picture this: a prospective patient arrives, after much anguished self searching at the door of a psychotherapist she/he has heard might help her/him understand her/his troubled feelings and deal with them. Inside, she/he is told that her/his insurance company, for her/his own good, of course, wants her/him to first answer a 72 question questionnaire…and that every three months she/he will be asked to do it all over again. The questionnaire asks, among other things, the patient’s sexual orientation, ethnic group, income, religion whether you’ve been arrested or jailed.. The answers will be forwarded by computer to a behavioral “laboratory” which will then share the outcome with the insurance company so that the company can tell the psychotherapists what to do to make more orderly the patients’ “behavioral disorder”. The suffering human is thus labeled as a specimen of a medically stigmatized group. Quick: get the pill that deals with the “disordered” behavior. Overlook the fact that it is an expensive medication on which the patient may very likely be dependent for the foreseeable future. Don’t get me wrong. I am not “against” all medication prescribed for emotionally troubled patients. It is something a responsible therapist recommends after due consideration with the patient and a careful collaboration between the prescriber and the referring therapist. However, there is distinct pressure on therapists to suggest a pill as soon and insistently as possible.. (Here’s just one of many news reports on the link between drugs and psychiatrists: “Psychiatric Association Faces Senate Scrutiny Over Drug Industry Ties”; headline from The New York Times on 07-12-2008…) Drugs are such a handy and pharmaceutically profitable alternative. They’re such a useful shortcut so that there won’t be a lot of visits to therapists for insurers to cover. It’s true that therapists do take time to get to know the patient and help her/him understand the feelings that produce the troubling behave Repressing feelings and suppressing behaviors amounts to converting psychotherapists into social engineers. It is a plan rife with ethical violations. As a psychotherapist in Massachusetts, I have received news from the latest entry in the field, Blue Cross/Blue Shield of Massachusetts, the largest mental health insurer in the State. Here is a list of some of the ethical violations inherent in this plan. 1-The first ethical violation occurs in giving patients’ records to a company called Behavioral Health Laboratory (BHL). BHL then creates a profile of various behavioral disorders; a profile which it calls Treatment Outcome Program (TOP). Thus the individual is dehumanized and becomes a statistic. 2-A variation on this ethical violation, which is all done on computers, is inherent in the knowledge that all kinds of private medical records have disappeared from computers. I have gotten notices to that effect concerning patients of mine in the armed services. 3-Blue Cross/Blue Shield has stated that therapists whose patients do not comply with the profiling questionnaires will be paid less per visit than therapists whose patients do comply. This leads to an intricate series of unethical choices. For example, if a therapist does not disclose to the patient the insurer’s payment plan, and, perhaps, even nudges patients to “tell all” to the insurance company for the therapist’s, own financial advantage, the therapeutic relationship is irrevocably compromised by the therapist’s secrecy. 4-An ethical violation can occur if the therapist does fully disclose to the patient the insurer’s plan to financially reward therapists who promote the idea of patients “telling all” to the insurance company every three months. This puts the patient in the middle of an impossible choice. I experimented with my patients. I showed them the questionnaire and asked them how they felt about participating. Each was strongly opposed. I then told them that I would be paid less if they did not participate. Their response, one by one, was, “O. maybe it’s not so bad. You can tell us how to fake the answers”. 5-Thus we get the fourth ethical violation, namely, the falsification of information on which the insurer’s profile of a disorder is based. 6-There was obvious relief among my patients when I said that I was not really comfortable in supporting the plan. Some harm to the therapeutic relationship still lingered, however, in that my patients might now see me as a self chosen martyr to whom they are indebted. 7-This brings us to another ethical violation. Filling out the questionnaire takes half a therapeutic session, often in the midst of what may be a very tender situation that the patient and therapist need to discuss; the most intrusive moment to whom they were indebted. 8-Yet another ethical violation can occur when such an intrusive questionnaire is handed to a highly suggestible child or adult. Such questionnaires have been known to encourage acting out some of the suicidal impulses described among the 72 questions. “But”, you say, “How does all that affect the pregnant girls? Here’s how: Girls that age need to be able to share feelings with someone who cares, but is not a family member; someone, professionally trained, whom they get to know and trust over time. There is always a reason behind every pregnancy. Yet, to whom can the girls turn for a frank heart-to-heart talk about feelings? Parents are busy working two jobs. Peers are often as confused as they are. If it is increasingly the policy of insurance companies to deny help with individual feelings by dealing only with behaviors, where can troubled girls turn for a relationship of trustworthy and caring listening? Such relationships must be given time to grow, to develop. Trust is based on accepting feelings; not on repressing behaviors. A heart-to-heart confiding with one’s peers, a closeness and warmth obtained by offering one’s body sexually, the adoration in a baby’s gaze at mother’s face! These are not the answer, but they represent for some young girls a relationship of intimacy they can count on. What do we really know about the feelings that drove teen age girls to choose a life outside the “behaviorally correct” model? We know a little about the Palin daughter. She has an ambitious and rigid mother (“I don’t blink”.) and a boyishly, sports active father, who has been driving while drunk and had not voted till age 25. Most young people in her parents’ state go no further than tenth grade. These things, taken individually, may have many meanings, but in forming a relationship of trust with a psychotherapist they will add up to a helpful pattern; one that can help this young girl blossom into a responsible adult, capable of making thoughtful choices. Dealing only with the surface, her behavior, rather than finding out what she needs. And that is the crux of it: psychotherapists deal with our individual feelings, our individual stories! Who listened to the stories of the eighteen pregnant teen age girls and sensed a need to help them find an array of options for a future all their own before they chose pregnancy? Since nobody heard their feelings of uncertainty about themselves, and everybody stressed their acts, they complied with the one way in which somebody would notice them. They acted by getting pregnant and we still don’t know why. Many psychotherapists have refused to participate in coercing patients to turn over reams of personal data to insurance companies, which then dictate how the patient should be treated. The therapists who refused have accepted lower fees as their burden for doing this. The worst burden, though, is borne by the girls who have no trained, professional psychotherapist, who will take time to find out why the girls chose pregnancy. There can be many other productive choices…many other possible, happy endings to each story. “But”, you say, “don’t the schools have Guidance Counselors to listen to troubled teens?” Yes; they do. There are tender, understanding adults sprinkled throughout the school. There are teachers who go the extra mile every day to be available to students. Guidance Counselors are among the unsung heroes and heroines of the school year as they try to climb out from under the piles of paper work increasingly required of them, not to mention the impossibly large case loads. And why stop there: school nurses, for example?! and an enlightened MD, informed, but non-judgmental adults to whom teens open up; someone they can trust! Unfortunately, there are two chief problems. School budgets never allow the time required to really know the students in the intensive way required. Second, no matter how much an individual counselor is admired, he/she is still seen as part of “the system”; the school system. Though this initial barrier to revealing oneself can be overcome, it does represent a hurdle, especially for taking the first steps. There is also a very real problem in that emotional crises do not happen in conformity with the school calendar when counselors are available, Many, for example, can happen during Christmas vacation. In the bad, old days, individuals whose behavior made the group in power uncomfortable were labeled as possessed by The Devil. The Devil must be exorcised. Today, individuals whose behavior makes the group with the power of the purse strings uncomfortable are labeled as possessed by a “Behavioral Disorder”, which needs to be exorcised; too often, sadly by behavioral change alone, bolstered by prescription drugs. This, tragically, leaves teen agers little choice but to act. Finally someone will pay attention and listen to their needs. So we get an escalating extreme in teenage behaviors: the mass murders by teen agers at Columbine and the mass pregnancies of kids in Gloucester. At least the Gloucester girls are choosing life. Let’s hope someone listens to why they feel it’s worth living after all. Let’s get some trained and nurturing therapists to listen to feelings that make humans human…and let’s confront insurers and ask for their support in reimbursing for pre-crisis work with teenagers. There are many psychotherapists who have sliding scales of payment Some connection might be established that permits girls…and boys…to discuss pregnancy and other life choices in regular, private sessions These therapists ask only that they be allowed to practice what they have been trained to do; help people get more secure emotionally, and ultimately, more functional. They are being told more and more often that their training is marginal. It is your insurance company who is now your family’s therapist and you are paying more dearly than you know. For more information about an example of the insurance picture in Massachusetts which is being readied to spread to every state in the country, there is a Website called, www.notthetop.net. Visit it and decide some things for yourself. As nineteenth century writer Gustav Flaubert said, personal stories always reflect the larger social currents of the time in which they take place. This is certainly true of his work including the most widely known of his novels, “Madame Bovary”.
I thought of this in relation to the surge we have been witnessing in local, teenage pregnancies. Not only has the incidence of eighteen pregnancies among fifteen and sixteen year old Gloucester, Massachusetts high school girls shocked the local residents, the news has spread around the world in every medium: newspapers, radio, television and the Web. It has also been echoed on our national stage by the announcement that our Republican Vice Presidential candidate’s teenage daughter is an unwed mother-to-be, impregnated by a teenage fiancé who describes himself as “a fuckin’ redneck”. How does Flaubert’s theory of a relationship between the local event and the larger world apply? The answer, when it came to me, seemed, at first, so remote that I doubted my own intuition. I am, however, convinced, no matter how many degrees of separation between the social undercurrent in today’s view of individual uniqueness and what we see as an outbreak challenging our view of “behavioral health”, the phenomenon we are witnessing in our backyards and the crisis we are having in health insurance today, in our country, are powerfully connected.
In the interest of full disclosure I must reveal that I am a health care provider, a psychotherapist in private practice. I am, after some forty years in private practice and more than half a dozen before that in various social agencies: hospitals, clinics and schools, currently in the process of retiring. I am not financially dependent for survival on insurance companies’ reimbursement.
We all have heard by now that there are at least 45 million uninsured in the U.S. and uncounted thousands of underinsured. There is something, however, that people still lucky enough to afford health insurance don’t realize. Without much fanfare, there has been a change in your mental health insurance, which you assume is automatically included in your whole health care package. Insurers no longer pay for psychotherapy. In an attempt to acquire even higher profits, insurance companies, hand in hand with pharmaceutical companies, have redefined mental health treatment. Psychotherapy is no longer called “Psychotherapy” by insurance companies. It is now called “Behavioral Health”. And what is behavioral health? Who defines it? Why, the insurance companies, of course. There is no longer a troubled and searching individual, desperately seeking help with highly confidential questions; torn between trusting a well trained stranger, a psychotherapist, with whom, she/he will, hopefully, feel safe enough as time passes…or suffering, in loneliness, the agony of crippling emotions.
Psychotherapists are now asked by insurers to steer patients into conforming to particular patterns of behavior decided by insurers to be correct. There are thousands of studies that prove that the most effective healing for emotional problems is based on the relationship formed between patient and therapist. To cite just one, Wampold, reporting in a study of 20,000 patients and 200 therapists concluded that the client/therapist relationship is the best predictor of good outcome in an emotionally troubling dilemma. The” quick fix” of creating the profile of a “disease” and handing out a pill to repress the symptomatic behavior assumes that one size fits all. All those who fit the Depression profile get pill A, and those who fit the Anxiety profile, pill B. Profiling treats a cluster of behaviors or symptom. It does not get at the root of the individual problem. It is, in the end, a never-ending, non-cure. Though talk therapy takes longer it lasts longer. The quick fix drug that alters behavior leads to the high cost of a lifetime of recurrence of symptomatic behaviors and pill taking.
These studies are to be discarded, insurers say, in favor of fast-tracking mental health coverage, cutting visits and steering treatment toward behavior altering drugs. Instead of treating people in all their complexity, only their behavior is tracked and a profile of a “Behavioral Disorder”; not of an individual, is targeted. It is as if all depressed people were the same; all anxious people, the same and so forth. It is behavioral profiling.
Psychotherapists are told by those who hold the purse strings, namely insurers, “We will pay you for eliminating the symptoms that we call “unhealthy, or “disordered” and we will ignore the individual patient as a multi-tiered human being. No wonder the public is so eager to read personal stories, memoirs, and blogs. That’s where individuals are seen as individuals; not as abstract representations of a “disorder”.
Picture this: a prospective patient arrives, after much anguished self searching at the door of a psychotherapist she/he has heard might help her/him understand her/his troubled feelings and deal with them. Inside, she/he is told that her/his insurance company, for her/his own good, of course, wants her/him to first answer a 72 question questionnaire…and that every three months she/he will be asked to do it all over again. The questionnaire asks, among other things, the patient’s sexual orientation, ethnic group, income, religion whether you’ve been arrested or jailed.. The answers will be forwarded by computer to a behavioral “laboratory” which will then share the outcome with the insurance company so that the company can tell the psychotherapists what to do to make more orderly the patients’ “behavioral disorder”. The suffering human is thus labeled as a specimen of a medically stigmatized group. Quick: get the pill that deals with the “disordered” behavior. Overlook the fact that it is an expensive medication on which the patient may very likely be dependent for the foreseeable future.
Don’t get me wrong. I am not “against” all medication prescribed for emotionally troubled patients. It is something a responsible therapist recommends after due consideration with the patient and a careful collaboration between the prescriber and the referring therapist. However, there is distinct pressure on therapists to suggest a pill as soon and insistently as possible.. (Here’s just one of many news reports on the link between drugs and psychiatrists: “Psychiatric Association Faces Senate Scrutiny Over Drug Industry Ties”; headline from The New York Times on 07-12-2008…) Drugs are such a handy and pharmaceutically profitable alternative. They’re such a useful shortcut so that there won’t be a lot of visits to therapists for insurers to cover. It’s true that therapists do take time to get to know the patient and help her/him understand the feelings that produce the troubling behave Repressing feelings and suppressing behaviors amounts to converting psychotherapists into social engineers. It is a plan rife with ethical violations.
As a psychotherapist in Massachusetts, I have received news from the latest entry in the field, Blue Cross/Blue Shield of Massachusetts, the largest mental health insurer in the State. Here is a list of some of the ethical violations inherent in this plan.
1-The first ethical violation occurs in giving patients’ records to a company called Behavioral Health Laboratory (BHL). BHL then creates a profile of various behavioral disorders; a profile which it calls Treatment Outcome Program (TOP). Thus the individual is dehumanized and becomes a statistic.
2-A variation on this ethical violation, which is all done on computers, is inherent in the knowledge that all kinds of private medical records have disappeared from computers. I have gotten notices to that effect concerning patients of mine in the armed services.
3-Blue Cross/Blue Shield has stated that therapists whose patients do not comply with the profiling questionnaires will be paid less per visit than therapists whose patients do comply. This leads to an intricate series of unethical choices. For example, if a therapist does not disclose to the patient the insurer’s payment plan, and, perhaps, even nudges patients to “tell all” to the insurance company for the therapist’s, own financial advantage, the therapeutic relationship is irrevocably compromised by the therapist’s secrecy.
4-An ethical violation can occur if the therapist does fully disclose to the patient the insurer’s plan to financially reward therapists who promote the idea of patients “telling all” to the insurance company every three months. This puts the patient in the middle of an impossible choice. I experimented with my patients. I showed them the questionnaire and asked them how they felt about participating. Each was strongly opposed. I then told them that I would be paid less if they did not participate. Their response, one by one, was, “O. maybe it’s not so bad. You can tell us how to fake the answers”.
5-Thus we get the fourth ethical violation, namely, the falsification of information on which the insurer’s profile of a disorder is based.
6-There was obvious relief among my patients when I said that I was not really comfortable in supporting the plan. Some harm to the therapeutic relationship still lingered, however, in that my patients might now see me as a self chosen martyr to whom they are indebted.
7-This brings us to another ethical violation. Filling out the questionnaire takes half a therapeutic session, often in the midst of what may be a very tender situation that the patient and therapist need to discuss; the most intrusive moment to whom they were indebted.
8-Yet another ethical violation can occur when such an intrusive questionnaire is handed to a highly suggestible child or adult. Such questionnaires have been known to encourage acting out some of the suicidal impulses described among the 72 questions.
“But”, you say, “How does all that affect the pregnant girls?
Here’s how: Girls that age need to be able to share feelings with someone who cares, but is not a family member; someone, professionally trained, whom they get to know and trust over time. There is always a reason behind every pregnancy. Yet, to whom can the girls turn for a frank heart-to-heart talk about feelings? Parents are busy working two jobs. Peers are often as confused as they are. If it is increasingly the policy of insurance companies to deny help with individual feelings by dealing only with behaviors, where can troubled girls turn for a relationship of trustworthy and caring listening? Such relationships must be given time to grow, to develop. Trust is based on accepting feelings; not on repressing behaviors. A heart-to-heart confiding with one’s peers, a closeness and warmth obtained by offering one’s body sexually, the adoration in a baby’s gaze at mother’s face! These are not the answer, but they represent for some young girls a relationship of intimacy they can count on.
What do we really know about the feelings that drove teen age girls to choose a life outside the “behaviorally correct” model? We know a little about the Palin daughter. She has an ambitious and rigid mother (“I don’t blink”.) and a boyishly, sports active father, who has been driving while drunk and had not voted till age 25. Most young people in her parents’ state go no further than tenth grade. These things, taken individually, may have many meanings, but in forming a relationship of trust with a psychotherapist they will add up to a helpful pattern; one that can help this young girl blossom into a responsible adult, capable of making thoughtful choices. Dealing only with the surface, her behavior, rather than finding out what she needs.
And that is the crux of it: psychotherapists deal with our individual feelings, our individual stories! Who listened to the stories of the eighteen pregnant teen age girls and sensed a need to help them find an array of options for a future all their own before they chose pregnancy? Since nobody heard their feelings of uncertainty about themselves, and everybody stressed their acts, they complied with the one way in which somebody would notice them. They acted by getting pregnant and we still don’t know why.
Many psychotherapists have refused to participate in coercing patients to turn over reams of personal data to insurance companies, which then dictate how the patient should be treated. The therapists who refused have accepted lower fees as their burden for doing this. The worst burden, though, is borne by the girls who have no trained, professional psychotherapist, who will take time to find out why the girls chose pregnancy. There can be many other productive choices…many other possible, happy endings to each story.
“But”, you say, “don’t the schools have Guidance Counselors to listen to troubled teens?” Yes; they do. There are tender, understanding adults sprinkled throughout the school. There are teachers who go the extra mile every day to be available to students. Guidance Counselors are among the unsung heroes and heroines of the school year as they try to climb out from under the piles of paper work increasingly required of them, not to mention the impossibly large case loads. And why stop there: school nurses, for example?! and an enlightened MD, informed, but non-judgmental adults to whom teens open up; someone they can trust!
Unfortunately, there are two chief problems. School budgets never allow the time required to really know the students in the intensive way required. Second, no matter how much an individual counselor is admired, he/she is still seen as part of “the system”; the school system. Though this initial barrier to revealing oneself can be overcome, it does represent a hurdle, especially for taking the first steps. There is also a very real problem in that emotional crises do not happen in conformity with the school calendar when counselors are available, Many, for example, can happen during Christmas vacation.
In the bad, old days, individuals whose behavior made the group in power uncomfortable were labeled as possessed by The Devil. The Devil must be exorcised. Today, individuals whose behavior makes the group with the power of the purse strings uncomfortable are labeled as possessed by a “Behavioral Disorder”, which needs to be exorcised; too often, sadly by behavioral change alone, bolstered by prescription drugs.
This, tragically, leaves teen agers little choice but to act. Finally someone will pay attention and listen to their needs. So we get an escalating extreme in teenage behaviors: the mass murders by teen agers at Columbine and the mass pregnancies of kids in Gloucester. At least the Gloucester girls are choosing life. Let’s hope someone listens to why they feel it’s worth living after all. Let’s get some trained and nurturing therapists to listen to feelings that make humans human…and let’s confront insurers and ask for their support in reimbursing for pre-crisis work with teenagers.
There are many psychotherapists who have sliding scales of payment Some connection might be established that permits girls…and boys…to discuss pregnancy and other life choices in regular, private sessions These therapists ask only that they be allowed to practice what they have been trained to do; help people get more secure emotionally, and ultimately, more functional. They are being told more and more often that their training is marginal. It is your insurance company who is now your family’s therapist and you are paying more dearly than you know.
For more information about an example of the insurance picture in Massachusetts which is being readied to spread to every state in the country, there is a Website called, http://www.notthetop.net. Visit it and decide some things for yourself.

]]> Comment on www.notthetop.net by Robyn Bernstein http://notthetop.wordpress.com/2007/10/17/hello-world/#comment-4 Robyn Bernstein Wed, 24 Sep 2008 01:41:58 +0000 #comment-4 I think the TOPS is a tedious and ineffective tool. Many of the new patients I speak with are very put off by the instrument, which takes them quite a while to fill out. They also complain that the questions require them to give too much private information to their insurance company. If there is not a more reliable outcome measure that has validity, maybe this data just shouldn't be taken. I think the TOPS is a tedious and ineffective tool. Many of the new patients I speak with are very put off by the instrument, which takes them quite a while to fill out. They also complain that the questions require them to give too much private information to their insurance company. If there is not a more reliable outcome measure that has validity, maybe this data just shouldn’t be taken.

]]> Comment on www.notthetop.net by Paul K. Ling, PhD http://notthetop.wordpress.com/2007/10/17/hello-world/#comment-3 Paul K. Ling, PhD Tue, 23 Sep 2008 06:01:46 +0000 #comment-3 Upon reflection of the data it is clear that the TOP is the wrong approach to evidence based treatment. Many reasearchers I have discussed this with conclude good EBT is diagnosis specific and should not take an accurarial approach. In addition the TOP is way too long and cumbersome in regular practice. Upon reflection of the data it is clear that the TOP is the wrong approach to evidence based treatment. Many reasearchers I have discussed this with conclude good EBT is diagnosis specific and should not take an accurarial approach. In addition the TOP is way too long and cumbersome in regular practice.

]]> Comment on www.notthetop.net by Candace Foster http://notthetop.wordpress.com/2007/10/17/hello-world/#comment-2 Candace Foster Wed, 16 Apr 2008 22:10:44 +0000 #comment-2 In addition to all the other reasons to see the TOP form for what it is, an intrusive, coercive, insurance company marketing device, I'd like to add that the company's ostensible reward of a 5% fee increase for the therapists who would use it, was cagily worded and misleading at best, and, more likely, intentionally deceitful. For anyone who worried about the ethics of accepting this bribe, but decided to sign on in order to protect his income from further erosion after the fee cut earlier in the year, there was a big surprise when in many cases fees actually went down, and rarely, if ever, did they go up by more than a few cents an hour. Apart from the dubious ethics of the forms themselves, from the start the payment issue, including the fee cut back in Jan 2007 which helped to set the stage by stirring up anxiety in therapists about their incomes diminishing faster than they can dream up ways to replace them, was designed to manipulate the public and providers into complying with BCBS's marketing plan. BCBS reportedly felt they had made a mistake in the way they handled marketing the TOP, but has also said they have no intention of trying to remedy things in response to therapist and patient complaints. In addition to all the other reasons to see the TOP form for what it is, an intrusive, coercive, insurance company marketing device, I’d like to add that the company’s ostensible reward of a 5% fee increase for the therapists who would use it, was cagily worded and misleading at best, and, more likely, intentionally deceitful. For anyone who worried about the ethics of accepting this bribe, but decided to sign on in order to protect his income from further erosion after the fee cut earlier in the year, there was a big surprise when in many cases fees actually went down, and rarely, if ever, did they go up by more than a few cents an hour. Apart from the dubious ethics of the forms themselves, from the start the payment issue, including the fee cut back in Jan 2007 which helped to set the stage by stirring up anxiety in therapists about their incomes diminishing faster than they can dream up ways to replace them, was designed to manipulate the public and providers into complying with BCBS’s marketing plan.

BCBS reportedly felt they had made a mistake in the way they handled marketing the TOP, but has also said they have no intention of trying to remedy things in response to therapist and patient complaints.

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