Ms. King,
Thank you for your prompt response.
I apologize for the lack of specifics in my previous message...
[My therapist] and I have discussed this matter several times, and we share the same frustration. Earlier this year, VA upper management changed how psychotherapy appointments are scheduled. Therapists no longer schedule their own patients; appointments must now go through administrative staff.
As it was explained to me, the change has more than one purpose. It is said to benefit therapists by relieving them of what policymakers see as a routine administrative task. It is also an attempt to cap psychotherapeutic treatment, ostensibly so that more patients can be treated in less time.
This policy ignores at least two factors that are essential to understanding mental illness and treating it effectively.
The first is that mental illness is typically a chronic condition, and its treatment differs fundamentally from the treatment of an acute physical ailment. Recovery from an injury or a viral infection follows a predictable course. Progress can be charted and measured against similar past cases until a physician can confidently declare the patient healed. The same cannot be said of mental illness. Its treatment has no fixed endpoint, and terms like "recovery" and "healing" describe ongoing processes that require long-term care, of which the medical component is only a small and complicated part. The VA does its veterans a grave disservice when it treats depression, anxiety, and neurodevelopmental disorders as though they could be managed like the flu.
The second factor, which I alluded to in my previous message, concerns scheduling itself. For someone recovering from a physical injury or a prolonged illness, a treatment schedule is mainly an administrative matter. In psychotherapy, booking the appointment is incidental to what is integral to the treatment. Deciding how often and when a patient should be seen requires the therapist and client to work it out together. That collaboration is essential to the therapeutic process and to maintaining trust between therapist and client, which can at times be extremely fragile. Competent therapists understand this; it is fundamental to their education and training.
Moving scheduling to administrators does not help therapists. It disrupts patient care. To put it bluntly, VA leadership is harming patients for the sake of efficiency, using an unethical solution to an imagined administrative problem.
Joe Puente
...since 1974
