In the contemporary health care climate, which has suffered serious degradation of both privacy and confidentiality, clinicians are continuously challenged to maintain a secure psychoanalytic identity that allows them to do what is needed to provide quality care to patients. Laws and regulations requiring release of individually identifiable health care information to third parties continue to be enacted and tend to support the agendas of managed health care and other governmental interests.
Members do not need to face these challenges alone or in isolation. The APsaA's psychoanalytic practice guidelines offer support for analysts who wish to maintain safety, privacy, confidentiality, and hope for their patients' psychoanalytic treatment. They can use our practice guidelines to show and substantiate the professionalism of their approach to treatment in the face of criticism and challenges from third party payers and government regulators.
These practice guidelines are created to support the broad range of good psychoanalytic clinical work. Colleagues who use them demonstrate by example their commitment to quality patient care. When matters of third party involvement in treatment are raised, as is common at the time of referral or during the early evaluation phase of treatment, the guidelines offer a proactive approach to meet the challenges of potential third party involvement. This proactive approach can promote a more trusting treatment alliance and avoid unnecessary breaches of privacy and confidentiality of the sort that we know adversely effect the psychoanalytic treatment process. This approach facilitates the psychoanalytic effort to seek truth. Truth about a third party's involvement may be hidden until the patient investigates and asks questions. Knowledge of the actual nature of involvement and the realistic amount of subsidy from the third party can inform the patient's decisions and promote a more viable treatment plan.
To date, we have developed six practice guidelines. They are not intended to serve as a standard of practice for mental health care. They are intended as guidelines only. They always recognize the primacy of the analyst's clinical judgment regarding a particular clinical decision or method of intervention or overall treatment plan.
“These practice guidelines are created to support the broad range of good psychoanalytic clinical work. Colleagues who use them demonstrate by example their commitment to quality patient care.”
Discusses benefits and risks that patients may consider in deciding whether or not to give consent for the analyst to create and release documents containing clinical information for third party review of psychoanalysis and modified psychoanalytic treatment. (This guideline is being revised. A draft revision is available from the National Office.)
Discusses the foundations for the recommendation that psychoanalysts not create and chart session-by-session progress notes for psychoanalysis and modified psychoanalytic treatment and clarifies the differences between progress notes, process notes, working notes, and research notes. (in JAPA, 1997, 45/2: 656–672.)
Discusses the foundations for the recommendation that psychoanalysis be pre-authorized by a method of review conducted by a psychoanalytic consultant who reports to the third party only whether or not psychoanalysis is warranted.
Discusses the recommendation that pre-authorized psychoanalytic treatment should not be subjected to ongoing review and presents reasons for this recommendation. (in TAP 34/2, 2000)
Clarifies the reasons why charting of progress notes, including the creation of check lists that constitute progress notes, is not recommended for psychoanalysis and modified psychoanalytic treatment. (in TAP 34/2, 2000)
Discusses how appointment and financial records, if kept, are considered to be part of a patient's medical record;
Discusses the customary practice of charging a fee for missed appointments, the need to clarify such policies with the patient, and the recommendation that the patient clarify these matters with the third party to reach agreement about who will be responsible to pay this fee. (in TAP 34/2, 2000)
A comprehensive document that emphasizes the technical necessity for establishing a safe, private, confidential treatment situation to conduct psychoanalysis and modified psychoanalytic treatment.
Presents 10 conditions that serve to create such a safe environment to conduct treatment in conjunction with third party authorization and subsidy;
Presents solutions to a variety of problems and dilemmas that members have encountered over the past two decades while conducting treatment that involved interaction with third parties. (See center insert, this issue of TAP.)
Robert R. Cummings, M.D., Ph.D. is Chair, Committee on Peer Review.