MANAGED CARE, BRIEF THERAPY, AND THERAPEUTIC INTEGRITY

A major cost-containment strategy of managed mental health care is the mandating of short-term psychotherapy via session limits, dollar caps on mental health benefits, and utilization review mechanisms. It is argued here that while brief therapy is a widely useful treatment modality, when it is mandated by a third party it violates the fundamental integrity of the therapeutic relationship. The construct of therapeutic integrity is defined, and the parameters vulnerable to managed care intrusions are identified. The article then examines the implications of this analysis for: (a) the practice of brief therapy; (b) training in brief therapy; (c) managed care; and (d) organized psychology.