Cummings correctly identifies the "skill" of outcomes research as being a very important component of the psychologist's "survival". Outcomes research is a scientific methodology which is taught to the graduate level academician and serves to give the illusion of objectively ascertaining the effectiveness of psychological interventions. The psychologist who can demonstrate, wearing the cloak of science, that the quick and inexpensive therapy is the effective therapy will be highly sought in the managed care industry. For it is this person who will ultimately argue the lie of managed care that we can be primarily concerned with money and still provide the best possible care for the needy or sick. The psychologist becomes the illusionist and mythically weaves the pseudoscience's outcomes research to sooth everyone's guilt and anxiety about their primary value of monetary gain. In their psychologist, managed care companies have the P.R. representative to defend their cost cutting managing. The psychologist is compensated by getting the coveted position of mental health professional and is still able to give lip service to the myth of healing. Class protects class and the world continues.
The problem with managed care is that the therapies are not chosen based on beliefs about healing effectiveness but rather based on cost effectiveness. Cummings writes, "A growing body of outcomes research demonstrates that efficient therapy can also be effective (Bennett, 1994)." The language here shows efficient (short-term) therapy to be a potential equal to non-efficient (long term) therapy. As used here, outcomes research does not seek to discover what is the most effective way of doing therapy but rather attempts to justify efficient therapy, arguing it to be effective. The value of outcomes research becomes clear, to rationalize managed care. When the scientist has an investment in the outcome of the research, we can not pretend that the scientist is operating within the myth of objectivity. The researcher has her professional livelihood at stake when her research results need to be agreeable with managed care. In the modern era of managed care the psychologist who can "prove" that efficient therapy is effective will have a job and the psychologist that demonstrates otherwise will not. In an atmosphere that combines profit minded managed care with a culture in which professional success has the utmost value, it is laughable to consider any research that would result as having meaning.
Even though Cummings is trying to live in the cold business consciousness of the managed care, he makes the typical Psychologist's emotional error of believing his ideas to be deeper than they really are. For Cummings it is not enough for the psychologist to kiss ass to get (a)head; as all business people do. He feels there needs to be a change in personality as well. He writes:
Over the past decade I have retrained literally hundreds of psychiatrists, psychologists, social workers, and counselors in a 130 hour module over a 2 week period and observed that for retraining to be successful there must be significant changes in the practitioner attitudes and belief systems.
He considers these new attitudes to be "enabling attitudes" and further emphasizes the deeper nature of his retraining when he quotes Balint's "monumental work", "...the acquisition of psychotherapeutic skill does not consist only of learning something new, it inevitably also entails ... a change in the doctor's personality."
Besides advertising his own courses, Cummings is suggesting that for the psychologist to survive professionally he must not only change his therapeutic approaches but also make a shift in his personality to meet managed care's need for greater profit. What is simply a need to change therapy methods, if you want to make money, somehow becomes a need for personality transformation. The enabling attitudes are the attitudes that enable you to ignore all fantasies of science, helping or healing so that you can embrace the image of professional prestige. Hopefully, for most of us, this would require a change in personality.
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Balint, M. (1957). The doctor, his patients and the illness. New York: International Universities Press.
Bennett, M. J. (1994) Can competing psychotherapists be managed? Managed Care Quarterly, 2, 29-35.
Cummings, Nicholas. (1995) Impact of Managed Care on Employment and Training: A Primer for Survival. Professional Psychology. Research and Practice Vol 26, 1, 10-15