HOW LONG HAVE YOU BEEN A THERAPIST?

I worked in various outpatient social service agencies and community psychiatric clinics for 5 years full time and then part time, after graduating with my MSW from Columbia.  I then went into private practice and have been solely in private practice for about 20 years.  I am part owner of a treatment and referral service, The New York Psychotherapy Group (nypsychotherapy.com) since 1976) and this has offered exposure to changes in the field as well as collegial contact.

I’ve also attended two post degree/license institutes from which I’ve received certificates:  Manhattan Institute for Psychoanalysis (Certificate in Psychoanalysis – interpersonal and relational in orientation), and the National Institute for the Psychotherapies, from which I received a Certificate in the Supervision of Psychotherapy and Psychoanalysis. My interest in trauma also led to a Certificate from another program in the Treatment of Trauma. After approximately 12 years, I decided to study a somewhat different orientation so as to continue to broaden my perspective.  Therefore, I am presently a part-time Candidate in Psychoanalysis at the Contemporary Freudian Society.

HOW LONG HAVE YOU KNOWN YOU WANTED TO BE A THERAPIST?

This is a rather unusual story:  I was about 11 years old, standing with my mother who was talking to a neighbor.  Someone said the word Psychotherapist and I asked what that was.  I was told it was someone who talked to people about their problems and helped them to deal better with them.  My response: “OH – that’s what I want to do”!  I never seriously wavered over the next 15+ years it took to achieve the training credentials.  And I haven’t doubted my choice.

It should be acknowledged that my intense and immediate response to this field of work was in part, a response to a difficult family situation and my longings to make things better at home – for my family – and in retrospect, very much for myself as well.

WHAT WAS THE MOST CHALLENGING THING ABOUT BECOMING A THERAPIST?

I find the biggest challenge is that you never “become” a therapist.  There is never an end-point where you can feel comfortable that you know “everything”.  I think good therapy always requires asking questions so that a deeper understanding can be achieved.  There are many ways to interpret feelings, many sound theoretical approaches, and every person who comes into your office has his/her own individual story.  New research, more recently on brain function and on trauma, also changes the landscape.  As a therapist you also have to stay aware of yourself and your own feelings so that you are sensitive to the potential for having your feelings influence your perception of the treatment.

I want to add that for me, this is an exciting “challenge”.  I appreciate being able to learn,  and I cherish the ongoing opportunity to do so

WHAT IS THE MOST REWARDING THING ABOUT BEING A THERAPIST?

The reward is in the work.  The patient and I are working together to understand and alleviate their unwanted reactions that often belong to the past and not the present.  The more we can accomplish this, the more freedom they will experience in every aspect of their lives.  Their ability to make choices, freed of their past, will increase.

The greatest reward, if I had to choose one, is that I have found work that has meaning and has potentials I do not even know the limits of.

IF YOU COULD GET A CAREER DO-OVER, WHICH CAREER WOULD YOU PICK AND WHY?

I would probably choose the same general line of work.  Greater involvement in the community would be important and I might do that at some point in the future.

I’ve also found that I am very good as a couples/marriage counselor and I  want to be sure that a certain part of my practice always involved this kind of treatment.  I hadn’t planned on this when I started.

Of course, in all these years, many other interests have developed such as computers and various technologies, the medical/neurological aspect of illness (mental and physical).  I have become a serious photographer in recent years and spend many pleasurable hours taking photos and editing them in my “virtual darkroom” consisting mostly of Adobe Photoshop and Lightroom.  I have had a few small shows and hope to have more.

So in theory, I might have chosen any of the above fields, but I think not.  Psychotherapy, Psychoanalysis and Couple Counseling have continued to hold my interest and involvement, no matter what else might be happening in my life.

WHAT TYPE OF PATIENTS DO YOU USUALLY DEAL WITH?

I enjoy the enormous variety of working in this field and therefore, see many different types of patients.  I see some in psychoanalysis who have had seriously impacting histories, often of trauma.  I also see people of all ages who are dealing with crises that have arisen in their lives.  Often, these crises emphasize lifelong styles of coping with pain, fear, anger or stress.  These styles may have been somewhat problematic,  but now, during a serious crisis, these ways of coping are simply not working and they feel very confused and overwhelmed.

I also see people in marriage or couple counseling.  They are in all phases of relationship and usually come to couples therapy when they experience the need for some kind of serious change, and cannot understand each other, or how to move ahead constructively.

THIS IS A PERSONAL QUESTION AND I UNDERSTAND IF YOU CHOOSE NOT TO ANSWER:  HOW HAS BEING A THERAPIST AFFECTED YOU EMOTIONALLY?

I’ll outline a few ways I can actually put into words:

It has provided me the gift of having work that I’ve done every week and every year, which I actually enjoy.  Many people don’t have this opportunity and I’m grateful for it.  It has been a wonderful gift to work with  people in this way.

Working as a therapist and psychoanalyst has also made me much more understanding and tolerant of all kinds of behaviors that might otherwise have simply made me angry.

Because of Institute Training requirements,  and my belief in the extensive possibilities of psychoanalytic treatment, my own understanding of myself – the lovable and the “not-so-lovable” parts, has increased enormously.  As a result, I hope, and believe, that it has made me a better human being toward all I’ve come into contact with.

Given the above, I hadn’t expected to write about insurance or law or politics – especially not in my first post. Nevertheless, I feel deeply compelled to write a summary of the legal issues regarding our present health care delivery system (often referred to as Managed Care), and the law that contributed, and still contributes, to the present situation. I look forward to a dialog,  should one develop.

The McCarran–Ferguson Act 15 U.S.C. §§ 1011-1015

My patients are often confused by their insurance coverage and do not understand why their doctors, and therapists feel they can do very little to influence a decision made by the patient’s insurance company. Nor do they understand the reluctance, if not outright refusal, of many health-care “providers” to accept managed care insurance at all.

A good part of the population, myself very much included, believe that the Managed Care Insurance Companies are quickly and successfully becoming monopolies. And that as a result of their enormous control, the managed care insurance companies are able to set regulations that almost every physician and medical practitioner must follow if he or she wishes to work with a variety of patients and receive reasonable payment for their services.

I’ll provide just a few examples of what the insurance companies regulate. And I need to add that their regulations are more similar than not. The more expensive policies offer more benefits, and the less expensive ones offer less. But within their price range, the differences in benefits are almost non-existent and the companies appear to barely compete with one another.

• The kind(s) of treatment you’re permitted for a given diagnosis.
• What medications are available through the insurance company for your condition and the accompanying co-pay.
• Whether you are in need of psychotherapy or counseling. The Insurance Company’s assessment is based largely upon your behavior and ability to function in the outside world, without attention to how or what you feel inside.
• The total cost of any treatment(s) you receive (referred to as “usual and customary”).
• Their determination of full cost dictates the total amount your “provider” is permitted to receive for their services (from you and from your insurance company, combined).
• Your co-pay for each service and medication.
• The monthly cost of the insurance policy paid by you, your employer, or a combination.

At this point you might say “But how can they all do this? Don’t we have anti-trust laws?”

And This is What I Wanted to Tell You About

In 1945 Congress passed a bill called the McCarran-Ferguson Act 15 U.S.C. §§ 1011-1015, a United States federal law that exempts the business of insurance from most federal regulation, including federal anti-trust laws.

I believe this law, which has remained on the books unaltered for sixty-seven years, has allowed our health insurance companies to avoid competition and to provide policies that are eerily similar to one another. It has also provided them the opportunity to set the fees that doctors and other health care professionals are permitted to charge, thus preventing normal competition amongst “providers” as well.

In the last several years efforts have been made to amend, repeal or rewrite the law. Senator Robert Byrd presented a bill to Congress and Representative John Conyers has recently presented a bill. President Obama, during his first campaign for the Presidency also spoke about the bill and stated he would make efforts to repeal it.

So, the next time you may want to enter into psychotherapy, or get a test from your doctor, I hope you will remember the McCarran–Ferguson Act and its potential effect upon your efforts to take care of yourself in what you believe to be the best ways possible.

Madeline

Addendum 11/15/2012

Under the McCarran–Ferguson Act, the States regulate insurance. Since President Obama’s re-election, it appears that Obamacare will be implemented. Much is being written in legal circles about a potential legal conflict between the Federal implementation of Obamacare and the continued existence of the McCarran-Ferguson Act. Many legal scholars question whether the Federal Government has the legal right to set up Health Care Exchanges if the States, citing their regulatory rights under the McCarran-Ferguson Act, refuse to cooperate in creating such Exchanges. This could lead to many court battles which will slow the implementation of at least some parts of the Obamacare Plan.