Why Not Just Do What Works? What’s the Catch? Part 2

Sometimes our hands are tied by the demands of insurance company forcing us to treat only pathology rather than to improve or enhance sexuality. We stop when the goal of “normalcy” has been attained, even though achieving merely this may eventually engender other sexual problems. (For example, “successful” treatment of vegetarianism may engender lack of sexual desire.) This limits us to working only with those who have diagnosable disorders or dysfunctions. Furthermore, the politics of the situation demand that we continue to classify individuals seeking therapy as pathological; otherwise, they will not be reimbursed by insurance providers. The conflict created for therapists and their clients is illustrated in cases of trans gendered individuals, who may disagree with labels of psychopathology but are unable to access clinical services unless their differences are first certified as pathological.

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We are thus limited in our abilities to help our clients. As soon as patients are no longer officially sick, we are supposed to terminate treatment, even though we may now be ideally positioned to help them optimize their sexual potential. We tend to go along with the managed care agenda rather than combating the whole notion that therapy should aim no higher than ameliorating disorder.

Furthermore, the alleged advantage of such treatments within the realm of psychotherapy per SE can be highlighted and made to look impressive by their easy metastability. Health maintenance organizations (HMOs) encourage and emphasize empirically validated treatments. Some treatments lend themselves more readily to assessment than others. That such treatments are easy to study because they target only symptoms makes them look very “scientific.” What they attempt to achieve is narrow and discrete, so whether or not they succeed in attaining these goals is {relatively) easily measurable. It may, however, make broader sets of goals seem less scientific because measuring them is more complex (Bohart, O’Hara, & Leitner.1998). Other sets of deeper, more comprehensive goals may be more valuable but may look less attractive, relative to discrete, expedient treatment of troublesome symptoms. It may be increasingly difficult to fight for comprehensive, relational, trans formative, holistic goals when treatment of symptoms alone looks so cost-effective and scientifically supported.

Sometimes therapists are aware that this limited goal is problematic but are caught in the financial straits imposed on them by HMOs. Surely, it is a matter of time before we, too, are subject to American- stile health “care.”

It is incumbent upon us to put forth alternate, broader agendas that aim to keep the best possible solutions and most satisfying outcomes at our disposal. Otherwise, we will lose access to the highest goals when they are most appropriate.

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