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Iatrogenic factors in "managed" psychotherapy.

R L Zuckerman¹

¹Koger Center, Norfolk, VA 23502.

American Journal of Psychotherapy

|January 1, 1989

Summary

The case-manager system disrupts therapy by adding a third person, harming the therapeutic alliance and transference. This interference makes effective psychotherapy impossible, impacting patient care.

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Area of Science:

Psychiatry
Clinical Psychology
Healthcare Management

Background:

The integration of case management systems in clinical settings is increasingly common.
Understanding the impact of these systems on the core therapeutic relationship is crucial for effective patient treatment.

Observation:

A detailed case presentation illustrates the clinical scenario.
The introduction of a third party, the case manager, into the established therapeutic dyad was observed.

Findings:

The presence of a case manager significantly compromises the therapeutic alliance between patient and therapist.
Transference dynamics are negatively affected, hindering the depth of psychotherapeutic work.
Psychotherapy becomes untenable under these conditions, questioning the feasibility of the case-manager model.

Implications:

Clinical practice must carefully consider the potential detriments of third-party involvement in psychotherapy.
Alternative models for case management that preserve the therapeutic relationship may be necessary.
Patient outcomes may be adversely affected by compromised therapeutic alliances in managed care settings.

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