"Aghast" is the only word I can use to describe my reaction to reading "Marketplace 101" in the December Monitor. Can it be that we are so co-opted into the managed-care system that we are now preparing students for this "norm"? Frankly, teaching managed care is quite simple and doesn't require a course. Tell your students to never request more than the allotted number of sessions and to be sure to fill out their paperwork using cognitive and behavioral goals. Tell them to pay more attention to what the case reviewer wants than what their patient wants. It's really quite simple.
I cannot believe that we are teaching and therefore endorsing a managed-care system of psychotherapy--a system that compromises the sine qua non of good treatment--confidentiality, a trusting relationship between the patient and therapist, and treatments based on solid research and patient needs and preferences. My colleagues quoted in this article state that their students need "a comprehensive grounding in how the nation's health-care system works...many faculty are tweaking their course to include a managed-care focus...." Let me suggest teaching something a bit more radical:
How about tweaking courses to highlight our national economy, where consumers with discretionary income routinely spend billions of dollars on e-toys, gambling, leisure activities, miracle diet cures and other "must haves"?
How about teaching courses that help new psychologists develop the courage, creativity and basic survival skills that will enable them to thrive outside of managed care?
How about articulating a fundamental truth: "Warning! Managed care may be synonymous with compromised care"?
It saddened and angered me to read this article in the Monitor--the "voice" of psychology. Managed care should not be the "aspirational reality" we are teaching our new psychologists; rather, it should be identified as the sometimes unavoidable cancer of our profession. Rather than helping it metastasize, I would like to see us use our resources to find a cure.
SANDRA HABER, PHD
New York, N.Y.
I very much salute the message of your December article, "Marketplace 101," which focused on giving students more exposure to maneuvering the strange and twisted waters of managed care. However, I would also like to see programs do more on the business of practice--all that stuff that a successful practitioner needs to do (e.g., basic finances, marketing, etc.) in order to do the stuff that we were trained to do (e.g., therapy, assessment, etc.). Without the latter, it's impossible to do the former.
Incidentally, if we do better on promoting the benefits of psychology, we become less dependent on managed care's paltry offerings. After all, it is only by being dependent on managed care that one needs to bow to their unreasonable demands. Psychology has a great deal to offer the world, but too few of us are trained on how to really bring that message out.
ARI TUCKERMAN, PSYD, MBA
After reading the December issue, I note with much approval APA's increasing emphasis on positive psychology, wellness and prevention. This is a welcome change from the illness model that has been dominant in the years past and still occupies a prominent position in our membership and social policy positions. As we move forward into the decade of behavior, it is only fitting that we acknowledge the pioneering work of Marie Jahoda, Seymour Sarason, James Kelly, Julian Rappaport, Emory Cowen, George Albee, Ed Ziegler, Barbara Dohrenwend, Steve Goldston, and John Glidewell, among others. Their contributions have laid the foundation for a richer psychology that will further research and practice to significantly enhance the understanding and improvement of human conditions.
In the otherwise interesting and important article, "Implications of the Boy Scouts of America case" (November Monitor), Mark Phillips and Margaret Bull Kovera use the term "gender-inappropriate behaviors." In the year 2000 this term should surely be regarded as archaic and, if used at all, enclosed in quotation marks. For psychologists, who are often regarded as experts about behavior, to continue this harmful practice is particularly troubling. May I suggest that the editors of the Monitor and other APA publications do their part by eliminating such usage from their publications?
PAULA J. KAPLAN, PHD
A story of survival
I was extremely pleased to see the article in the November Monitor "Remembering the Holocaust" by Nicole S. Crawford. I, too, am what you might call "the child of the Holocaust." I lived in Nazi Germany suffering considerably from persecution, with one side of my family totally annihilated by the Nazis. I came to the United States at the end of 1938 at age 10. I found it most difficult to settle down unlike many other refugees. It is difficult to know the impact of persecution on a child of 10 years old, but one thing is certain, it did not make me into the most sociable of individuals. Despite this I always wanted to help the underdog and who fitted this more than "maladjusted young people."
One might say I suffered from low self-esteem, which drove me in many ways. Most recently I was invited to give a lecture in Austria, and was received very well. I have never blamed the new generation of Germans or any others who were the children of the Nazi regime or ideology. To blame them would have been as base as what the Nazis did to minorities in Germany and elsewhere.
Now I am near the end of my days, although I am in extremely good health, and I am persuaded by personal experience that these early events in my life directed me in ways which were both negative and positive, but I would not wish to repeat them.
L.F. LOWENSTEIN, PHD
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