Letter from 110 therapists to BCBSMA:
Jeffrey Simmons, M.D.
Medical Director for Behavioral Health, BCBS of MA
Landmark Center
401 Park Drive
Boston, MA 02215
Dear Dr. Simmons,
We are committed mental health clinicians, psychologists, social workers and psychiatrists who treat some of the most vulnerable patients covered by Blue Cross and Blue Shield. We wish to voice our strong objections to a seriously flawed outcome measures instrument and process.
We do not object to outcome measures in psychotherapy. In fact we approve of outcome research that benefits our patients and improves the treatment process. However, as proposed, both the process and the instrument have the potential to harm our BCBS patients and to undermine the psychotherapy process. We are deeply concerned about placing destructive burdens on the therapist/client relationship that, current research shows, is critical to therapeutic outcome.
Our objections are summarized below:
1. Tying therapist income to patient compliance places therapists in a dual relationship with their clients. Dual relationships are expressly prohibited in the codes of ethics of all mental health disciplines. The reasons are obvious: Using patients for our own financial or social gains warps the therapeutic process. Tying clinician reimbursement to patient ratings creates a clear conflict of interest between the needs of the patient and those of the therapist: Patients who do not wish to comply deprive their therapists of increased income. This is directly counter to our code of ethics.
2. We believe that this instrument and the method employed to gain client compliance cannot produce valid findings. Tying patient responsiveness to their therapist’s income cannot help but distort the data. Furthermore, the instrument asks our clients, many of whom have a history of boundary violations, to expose their intimate issues to an unknown entity with unproven confidentiality.
3. To establish safety in the healing process, the clinician must carefully control the pace of treatment. This is essential for all clients and a basic component of treatment protocol for people with a history of trauma. We are concerned that the intimate nature of the questions in the current instrument can be intrusive, potentially activating charged material before the client is ready handle the accompanying affect. Established standards of trauma treatment dictate that the therapist carefully modulates the presentation of charged material. Triggering our patients is counter to good therapeutic practice. Some of us familiar with this particular instrument are also concerned that the instrument itself is not valid for our patients with DID.
We are aware that BCBS is ready to roll out this process. However, in light of these significant objections, we urge you to redesign the process so that compliance is not tied to therapist well-being in any way. We also urge you to gather input on the actual instrument from clinicians skilled in the treatment of trauma and dissociative identity disorder.
Again, we support outcome measurement that will benefit clients and the practice of psychotherapy rather than potentially harming both. We would be willing to gather a group of clinicians to discuss these necessary modifications and to work with you to improve this process. Meanwhile, we feel it is imperative to stop the process until these concerns are dealt with satisfactorily.
