I'm a psychiatrist who has spent most of the past 30 years treating patients with moderate to severe mental illness. But I've also administered care for the Massachusetts Department of Mental Health, Harvard Medical School and several insurance companies, and so I'm often asked for advice by colleagues who feel their patients need more help than an insurer is willing to pay for. In addition to offering technical advice, I often become, in essence, the therapists' therapist, at least in terms of their treatment choices. And sometimes those interactions are as intense as therapy itself.
Recently, one such colleague was desperately worried about a patient whom he had treated weekly for years after a serious suicide attempt. He felt that they had made great, gradual progress, both through medication and talk therapy. Because she was a victim of childhood sexual abuse, however, there was lingering vulnerability. Now her insurer had decided that she did not need more than 12 sessions a year, and this had thrown her into a panic. It appeared to the therapist that all the years of progress were unraveling before his eyes. He felt that weekly sessions were necessary to prevent her from relapsing, as did she, but he couldn't persuade the insurance company, and now his panic level was matching hers.