The Battle To Preserve Ethical And Competent Psychotherapy

By:  Michaele P. Dunlap, Psy.D, President AMHA-Oregon

"The profit of managed care is based on the fraud of telling people they can get more than they will actually get. Once you take away that fraud there’s no profit, so managed care as we know it today, cannot exist. ... Building a bureaucracy to invade the privacy of psychotherapy is not profitable if you still allow good therapy. It’s only profitable if you destroy psychotherapy, take all the money and run. So there’s no way to save this intrusive bureaucracy and make it good. No. Managed Care must be replaced and we need another form of cost containment for consumers."

Ivan Miller, Ph.D., Vice President of The Coalition, Founder, Boulder, CO. Psychotherapists Guild

Nationally there are two parallel organizations fighting to preserve ethical and competent psychotherapy: The American Mental Health Alliance, Inc. (AMHA-USA) and The National Coalition of Mental Health Professionals and Consumers, Inc. (The Coalition). The Coalition focuses on public and professional education, legal and legislative action. AMHA works toward cost containment alternatives to Managed Care by organizing professionals who are committed to ethical practice and the development of ethical financial arrangements with consumers and consumer groups. Both organizations fight to protect patients’ right to create healing, confidential, honest relationships with therapists.

Recently, Mary Kilburn Ph.D., of the Coalition, offered testimony to the Subcommittee on Consumer Rights, Protection and Responsibilities of the President’s Commission on Health Care Quality. Her testimony included these assertions:

"... in addition to the training and experience of the therapist, effective therapy absolutely requires three interrelated things: Time, Trust and Total Confidentiality. These three are being destroyed by Managed Mental Health Care. Time is required to build the relationship of trust between individuals upon which healing is based, as well as to let a process unfold. Total Confidentiality is part of that process too. ... Yet managed mental health care requires the therapist to publicize to unknown, unnamed, often relatively untrained voices at the end of an 800#, the intimate details of their client’s lives in order to get approval for ‘3 more sessions’ of psychotherapy. Ethically the therapist must tell the client that this is taking place. And thus the relationship is destroyed. It is terribly simple."

The American Mental Health Alliance-Oregon is fighting to preserve ethical and competent psychotherapy. Some issues can’t be compromised. Either psychotherapists work for their patients, or they work for the economic forces that ultimately destroy the ethical and competent practice of psychotherapy. The choice is ours as psychotherapists. We can organize and cooperate as professionals to build public awareness of the values and benefits of psychotherapy. We can build the organizational strength to contract ethically with employee groups. We can present ourselves and the ethical practice of psychotherapy as valuable and worth the consumer’s personal dollar. We and the people who buy our services must understand their value. Symptom relief is not psychotherapy.

The commitment necessary to support ethical and competent psychotherapy requires that we:

  • promote public awareness regarding the effectiveness of psychotherapy
  • help the public understand the importance of ethical and competent practice
  • create resources that allow consumers to find ethical, competent and caring professionals
  • promote the real value of ethical, competent and caring mental health services.


To learn more about the fight to preserve ethical and competent psychotherapy and how you can participate as a member professional

Call AMHA-OR: (503) 222-0332