Is Three a Crowd? Clients, Clinicians, and Managed Care

How does therapy change when therapists work under managed care plans? To explore this question, the authors conducted in-depth, semistructured interviews with therapists. The interview texts were analyzed using a structured thematic coding system. A central theme in the interviews was a culture clash between managed care companies and these therapists. Working for managed care organizations demanded several practices that violated the therapists ’ standard of care and professional ethics. Also, participants reported that managed care personnel misrepresented the nature of psychotherapy to clients, thereby undermining the therapeutic work and the therapist-client relationship. If these therapists ’ experiences are representative, the growth of managed care has serious implications for the nature of psychotherapy, practitioners ’ integrity and morale, and the public image of the therapy professions