Third-party payment for psychotherapy: (2) Medical necessity

In my last post I outlined some complexities of third party payment for office psychiatry, and especially for psychotherapy. As my example I used Medicare, the only third party payer I bill. Some of the problems include complex billing (i.e., collecting from multiple parties), partial reimbursement, unrealistic documentation requirements, loss of patient confidentiality, and a […]

Third-party payment for psychotherapy: (1) "Do you take Medicare?"

From late 1996 to early 2007 I was medical director of a low-fee mental health clinic where psychiatry residents and psychology interns receive training. Since the clinic accepted Medicare for payment, I did as well. I signed on as a Medicare “preferred provider” and have remained on the panel ever since, even though I left […]

Online psychotherapy

Telepsychiatry is clinical evaluation and psychiatric treatment at a distance. It brings a specialist’s expertise to otherwise inaccessible populations in prisons, military settings, and distant rural communities. Introduced decades ago, it is perhaps the most successful example of the more general field of telemedicine. Telepsychiatry traditionally treats patients at supervised sites and makes use of […]

Resistance: "I have nothing to talk about today"

There comes a time, fairly early in many psychotherapies, when there is nothing left to talk about. The identified problems have been named and discussed, there is no more need to bring the therapist up to speed on one’s history. In essence, the patient’s conscious agenda for coming to therapy has been exhausted. I tell […]

Psychotherapy branding and marketing

I just read a mildly disturbing article in the New York Times called “What Brand Is Your Therapist?” The author Lori Gottlieb was a full-time journalist who took six years to retrain as a psychotherapist — her website, but not the article, says she has a master’s degree in clinical psychology. Yet she found herself […]

Psychotherapy as generic conversation — Sloppy thinking in psychiatry 4

This fourth installment in my “sloppy thinking” series turns to psychotherapy, or what passes for it in some psychiatric practices. A very brief history: Sigmund Freud, a neurologist, invented psychoanalysis and its offshoot, psychodynamic psychotherapy, about 120 years ago. It was, first and foremost, a treatment that involved talking — not merely a conversation that […]

Movie review: "A dangerous method"

Tonight I was invited to an advance screening of “A Dangerous Method,” a film about the early days of psychoanalysis. It stars Keira Knightley, Michael Fassbender, and Viggo Mortensen, and will be in wide release by Sony Pictures Classics this month. The invitation was extended to Psychology Today bloggers, among others, in the hope we’ll […]