Counseling psychologists are often faced with ethical dilemmas when interacting with health maintenance organizations (HMOs). Client confidentiality can be threatened when extensive and detailed information is requested to authorize additional sessions. HMOs' preference for and emphasis on brief therapies could create undue pressure to select them instead of more appropriate choices. Should HMOs require these brief therapies when they are supported by research evidence, ethical dilemmas could occur.
Another major issue is that of prescription privileges for psychologists. In the June 1998 issue of Professional Psychology: Research and Practice, Drs. Peter Gutierrez and Kenneth Silk note that having the right to prescribe medication to clients would allow psychologists to deliver services to underserved populations, or those in rural areas; coordinate and monitor client treatment; and promote greater professional autonomy. However, this could also blur the lines between psychology and psychiatry, lengthen training, result in conflict between psychologists and medical professionals, and threaten counseling psychologists' unique identity.
Empirically Supported Treatments
Empirically supported treatments, or ESTs, are treatments that research supports as being effective in treating particular mental health disorders. Potential problems associated with establishing a list of ESTs include their misuse by HMOs, and assuming that other treatments do not work. Given that some treatments lend themselves more easily to research studies, those that do not, such as psychoanalysis, could be given short shrift. In addition, questions have been raised about whether these studies reflect the way therapy actually proceeds in the real world, calling the results into question when used to support a certain subset of treatments.
As technology increasingly pushes us toward being an online society, the question of Web or e-mail counseling has been raised. Psychologists specializing in certain areas could become more accessible, and those living in rural areas would not be obligated to travel long distances to receive assistance. However, confidentiality would be difficult to preserve, as e-mail and the Web are not secure means of communication. Accurate assessment and monitoring of the client may be more difficult because information gained through actual contact is lost. In addition, when clients reside in other states, the question of multi-state licensure is raised. Finally, should the client express suicidal or homicidal thoughts, the psychologist has less control over the situation.
Masters vs. Doctorate
HMOs may prefer their members to see therapists with master's degrees to lower cost. Psychologists could be forced to accept a lower rate of reimbursement, if they want to see these clients. Although the doctoral degree allows greater professional autonomy, including the freedom to practice without supervision, the pressure for lower-cost services may decrease the demand for psychologists in the future.
As with any profession, counseling psychology faces challenges and changes as time goes by. The increasing integration of technology into our lives, the advent of health maintenance organizations, the pressure to demonstrate treatment efficacy and effectiveness and the need for qualified individuals who can prescribe psychotropic medications in rural areas have given rise to a number of professional issues that counseling psychologists must face.