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Excerpt from Clinical Practice Today: July 2015
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Below is an excerpt from a recent "Clinical Practice Today" article. NASW Members can view the full article by clicking here (you must be logged in). Not a member? Join NASW

Therapy Not-in-the Room Part II: 

Behavioral Health Insurance Does Not Cover Phone and Video Therapy (Yet)

Bet MacArthur, LICSW 

In last month’s issue, Part I summarized two recent, unrelated cases in which two seasoned therapists slipped, unwittingly, into doing therapy by phone with familiar clients, while continuing to bill the clients’ medical insurance for in-office visits, an arrangement which is not permitted currently by insurers in Massachusetts.

Complications, both Psychodynamic and Technological

The two therapists mentioned last month were fortunate to encounter colleagues who could provide support in a crunch that came to light accidentally.

Two themes have emerged from these cases, from conversations with the involved clinicians and in online collegial groups run by NASW’s Private Practice community and by the Northeastern Society for Group Psychotherapy (NSGP), two large rosters of skilled professionals.

1. The Therapy Frame

The first theme looks at the current state of our training in understanding the frame of therapy; training that should be provided routinely to assure that the context of treatment is observed as carefully as its content. In our two case examples, how could the significance of the change in therapy structure have eluded the notice of our two seasoned therapists?

As a community we need to review more often the myriad ways that we must remain alert, as partners in therapeutic relationships, to the undertow of potential regression and dependency (in ourselves as well as in our clients) that exists in our work.

We may need periodic reviews of the ways any tweak in our therapy – from changing our meetings to a different room, or day, or time; or the addition or subtraction of insurance, self-pay, or credit cards to the therapy; or a change from weekly to bi-weekly sessions or vice versa; or the introduction of paper instruments or reporting measures within the therapy; or intrusions brought by factors in the therapist’s life (pregnancy, illness, fame, marriage, divorce); to unbidden changes in the client’s life (as in our two examples) that impact the familiar therapy arrangement, such as financial or job losses, relocation, illness or disability – how all of these and many others must be witnessed and examined carefully within the therapy, i.e. openly with the client.

End of Excerpt - READ THE FULL ARTICLE

Full article includes...

  • Complications, both Psychodynamic and Technological
  • The Therapy Frame
  • 'Telehealth' for psychotherapy?
  • Licensing and Jurisdiction
  • Electronic Security and HIPAA
  • Massachusetts Mental Health Policy and Legislation for Tele-health
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6/30/2015

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