Wednesday, April 6, 2011

The Subtle Evil I Encountered Today

It's been an emotional day or two. Two former clients, one recent and one in the past, passed away this week. They both were good people and both moved me as a therapist with their spirit and their resiliance. The one from the past was one of the first clients I saw shortly after completing graduate school in 1991 and our work together gave me confidence in myself as a new psychologist. I paused today to remember him with gratitude. My work continues twenty years later. I have more experience now but the basics of respecting my client, listening mindfully and engaging in an active partnership for change remains the same. Today however, the realities of this brutal era in American history confronted me head on. In my perception, we have grown into a much more polarized society- Democrats over here, Republicans over there, corporations and profit versus individuals and well being. Almost every day, I hear stories of callous disregard for others and a new spirit of selfishness that seems to be gaining traction as the "new self-esteem". I became a psychologist I think because I deeply care about people and their suffering. Yes, I'm sure I had my own "selfish" reasons for pursuing this field- maybe to understand myself better, to ease my own pains, and maybe even searching for validation as a person worthy of the gratitude of others. I admit it. But I really do care. I couldn't do this work if I didn't care and I didn't hold myself to the highest standards that I can possibly reach in the work that I do. Compromising my values has never been something I could do without personal strife. That why today felt a bit like a body blow for a little while. I accepted a new client two months ago who was in desperate need of individual attention. She had been injured, was living in pain and was now in her third trimester of pregnancy. She had recently made a committment to herself to stop relying on medications, both for the sake of her baby and for her own quality of life. I've learned over the years in this field that living with pain is hard, VERY hard. Every fiber of our being tells us in every moment we feel pain that something is wrong and that danger is nearby. It is an exhausting, frightening and intense experience to have constant pain that doesn't go away and perhaps even has gotten worse with treatment. That's why today was particularly heinous in my opinion. My young client was injured on the job and was referred to me by her primary treating physician for six individual sessions. They pick the number six somewhat randomly, mainly because it is easier to obtain authorization for a lower number than to go for more. When clients come to me with a set number of authorized visits, if I need less, I use less and if I need more, I request more. It's very difficult to estimate exactly how many visits it takes to help someone feel better despite over twenty years of experience because each person is an individual- some with layers and layers of protection that come off slowly and some who open up quickly and are ready to make change when they walk in. In this case, she is a lovely, intelligent and articulate person who sincerely came for help. A bundle of fears and new skills for managing pain that she had yet to fully implement into her lifestyle. Near the end of our six sessions, she anxiously inquired about where we go from here. I reassured her that I would request more and that I would not leave her dangling as she approaches delivery. Within a week, I received notice that my request was denied by a physician with no mental health training or qualifications, a bizarre system from the start that allows health care professionals who have no contact with the actual client to make decisions that impact their treatment and their future (and get paid for it). I, of course, appealed on the grounds that a non-mental health professional could not ethically make the determination of what what necessary treatment and what was not. My appeal led me to a conversation by phone with another psychologist, who lives in Texas, who claims to have pain management expertise and sounds like she could be my daughter. Far from warm and empathic, she listened quietly to my rationale for continuing treatment, especially with delivery two weeks away and pain levels increasing as her spine tries to bare the extra load she adds each day. She's doing this without pain medication, I explained, and her fear about the delivery contributes as well. She replied with a cold "how has her function improved during the six sessions in which you have been seeing her"? "Improving function" is the new catch phrase in the Workers' Comp industry that signals whether treatment is a "success". I reminded her that improving function would be quite difficult during anyone's third trimester and that my major goal had been to help her reduce her worries and set reasonable expectations for herself. I shared my concerns that the delivery itself might be overwhelming psychologically, given hormonal shifts and the physical stress of it all. I guess I expected someone with similar values to mine as a psychologist, or as someone who had empathy for suffering or compassion for people in crisis. I found none of these qualities as she hastily stated that I would hear by the end of the week of her decision. Two hours later, I received a phone message from the insurance company consisting of a simple and impersonal "your appeal for more visits has been denied." My first response was to feel personally assaulted. It's hard to be in this business as long as I have, dealing with complex clients every day and trying to unlock the barriers to health and wellness, only to have someone who doesn't know you or your client decide that treatment is denied. I wonder why this person became a psychologist and how she lives with herself every day. The ego that it takes to believe that you can make the most intimate of decisions about a person in another state that you've never seen, never spoken with or taken the time to assess is mind boggling. To ignore a central ethical code of "do no harm" is unacceptable. Stopping treatment now would be devastating. To accept money for it is, well, just evil. Do not depair readers!! My ethics are still stronger than my desire for profit. I will see my client through her delivery no matter what. I am a human being with a soul and with empathy. We will look for other ways to get her treatment regardless of what Dr. Texas thinks. There's something very wrong with this system. I will continue to fight for what is right.