Providing cost-effective psychotherapy in a Health Maintenance Organization

The authors share responsibility for providing psychotherapy for adults and children who are subscribers to the Health Maintenance Plan, Cincinnati. The limited resources in such a setting led them to combine the general-systems-theory proposition that the least expensive defenses against stress should be used first with the principle of effective parsimony, which calls for a particular sequence of action in providing mental health care. Thus their approaches include involving the patient in planning the frequency of therapy sessions, including entire families in the sessions, and setting reasonable goals and time frames for meeting the goals. They also use nonmedical mental health professionals, under the supervision of a psychiatrist, and other primary providers in the HMO who are interested in psychotherapy and are willing to call on a psychiatrist when necessary.