Making Therapy Harder: When Corporate Forces Interfere with Therapy

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From PsiAN (Psychotherapy Action Network): “Every therapist is familiar with therapy-interfering behavior (TIB). Historically the literature has focused on TIB in the client or patient, such as when a client misses a session, shows up late, sits silently, or even refuses the treatment altogether. Chapman and Rosenthal (2016) define TIB as follows: ‘any behavior that interferes with the client benefiting from therapy could be considered a TIB’ . . .

TIB in the therapist has also been explored, and examples include being late, ending early, changing policies, forgetting information (Vaughn, 2021). And of course, just like clients, the source of these can be conscious or unconscious . . .

What we may not typically frame in this way are behaviors from other entities that clearly interfere with the therapy, and may even be more damaging and pernicious than the TIBs already discussed. A prime example of such ‘corporate TIBs’ stem from the interference from insurance companies and administrative entities that represent attempts to control, constrain, or direct therapy, at times to the point where such individuals or groups are actually practicing without a license.

. . . in an agency setting, TIBs might include the agency establishing unreasonable ‘performance’ targets, onerous documentation requirements, or outcome measures not directly related to therapy. In addition, there may be policies that are contrary to ethical practice and wisdom in the field . . .

For insurance companies or other payors, TIBs can be found throughout their administrative processes and controls. For example, payors interfere with therapy when they set severe limits for coverage (rendering therapy nearly meaningless or neutering it), have a lack of transparency in data sharing arrangements, use overly complicated or convoluted explanations of benefits and reimbursement procedures, and delay processing claims. Beyond these, and perhaps even more problematic, are instances of insurance companies defining therapy itself through the ruse of ‘evidence-based treatments,’ and creating improper and unvalidated ‘equivalents’ for therapists, such as bots and other forms of artificial intelligence.

Given the profoundly negative impacts on the client and the therapy process, our profession must take a firm stand against interference with therapy wherever possible, and call it what it is: TIB, therapy-interfering behavior, which amounts to practicing without a license in many cases. ‘Corporate TIBs’ can often exist for reasons having to do with improper motivations to frame therapy for the benefit of others and not the client, thereby harming the latter.”

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1 COMMENT

  1. To see a licensed psychotherapist bring up this subject is interesting.
    I am sure many therapists would prefer to work unhampered and in a manner that is most beneficial to their clients.

    This website tends to concentrate on instances where the practitioner himself or herself acted in ways that showed they did not have the well-being of their clients at the top of their list of priorities.

    However, there is indeed a whole administrative structure supposedly there to support the work of the therapists that may also have other priorities. In fact, you might expect this. I have even experienced this is in my own case, in an environment where there are strict policies against interfering with the progress of the person being serviced.

    The idea of including this sort of behavior as just another “TIB” seems incorrect at first, but does point out a larger issue: Just how much does society, as a group, want people to get better? Does the group actively encourage excellence and emotional freedom among its members, or does it feel threatened by such people?

    It seems that just 60 years ago, we were at least giving lip service to the idea that our culture should be composed of “the best and the brightest.” Yet already at that time it was becoming obvious that compliance to enforced social norms was what was desired from most people. And these days, this desire is openly stated by leaders in government and in business.

    So, while we still have a mental health system, and we still have leaders claiming they are all for improving mental health (but more precisely, treating “mental illness”) we have a culture that observably would prefer that we stay sick. As if the evils done by the psychiatric profession weren’t bad enough, the society more and more sees the biggest mental problem as noncompliance with enforced norms. And treating that will not result in mental health. Quite the reverse!

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