Counselors, therapists, and peers should be authentic. But what does that really mean in the context of ‘systems of care’ and practicing psychotherapy?
Authenticity is commonly defined as true to one’s own beliefs or without pretensions. My question is, how can someone be authentic in a system that pushes its values, ethics, and prescribed regulations for your treatment?
How can a consumer of services ever hope to treated without bias or judgment in a system that categorizes, assesses & diagnoses you with prescribed manuals?
I am now suggesting that if there are authentic therapists or peers, then the empathy and the connection made with you during your treatment is really a negotiated form of the word authenticity. This negotiated word is far from the platonic, pure definition of authentic. I would hazard to say; this word has been commoditized for reimbursement from insurance companies & non-profit (but really, for-profit) agencies.
Inside the Clinic: The local one-stop-shop for consumers of mental health treatment
There are rules for participation in treatment on the level of common Article 31 clinic regulations for practices operated by the New York State Office of Mental Health and other states with state regulatory commissions for mental health treatment. Please wait a minute, and I’ve never heard of rules in an authentic relationship. If it espouses authentic values, the relationship will inherently take its course given the input and energy invested in connection.
Well, this is not how treatment plays out in the modern clinic. It is prescribed, very much based on funding streams & “anchors of care,” which denote which practices take privilege over others & which interventions are “in,” and which are “out.”
When you enter the first enter the clinic and come under its gaze, you, the consumer, are immediately assessed for risk of immediate harm & safety and given a diagnosis that supposedly helps practitioners map out a pathway and strategy for your treatment. Hold on that doesn’t sound very authentic! Why are consumers of mental health treatment assessed, marked, and essentially ticketed for retail value for insurance companies’ reimbursement?
This is because, if we are to be completely honest here, when you are given a diagnosis for insurance purposes, the clinic is basically forwarding your projected cost given the “medical necessity” of your diagnostic label. This means, if you are given a diagnosis of acute anxiety, most managed care insurance companies will want to know your progress towards your “goals” or readiness for discharge.
On the other hand, if you are lucky enough to be diagnosed with chronic schizophrenia, you are eligible for Medicaid and other catastrophic coverages that pay for long-term care. That is your value & worth in systems of care.
So, wherein all of this is the authentic relationships? I would hazard to say it rests in the negotiated “back-and-forth” dialogue between you, the consumer & your practitioner’s willingness to drive treatment forward and justify your continuing care at the clinic.
This means, depending on various factors, such as 1) weighing out your needs as a consumer, 2) the cost to keep you in treatment, 3) pressures of a rising caseload, 4) risk of harm as a level-of-care issue, 5) participation in treatment; you, the consumer can rest comfortably that your mental health psychotherapy will not terminate your treatment without a complex & systematic formula justifying your discharge.
There is no space for authenticity when the system determines your medical value, but it does hold space in the consumers’ active participation. To keep driving moving forward, you, the consumer, will need to participate in justifying your ongoing treatment by your willingness to be active in your care. The rules for Article 31 clinics are clear as day. State regulatory bodies want to know if you are involved and vested in your treatment. The consumer is not worth the cost of your state and insurance psychiatric rehabilitation.
Peer to Peer: Considering Authenticity in systems of care landscapes
Unless you are a freelance, privately contracted peer or consultant, you are apart of a larger system of care. Understanding the peer’s authentic value to the consumer is even more problematic in this context. But it is a value. I am suggesting that the peer, too, in the wake of care systems justifying peer work; the peer has been assigned a rate for their services & an identified need has been filled with peer services to the consumer’s treatment in the system. The integrity of peers aside, consumers of services are duped into thinking their voice is heard by their peer advocate. Whatever problem they are having moving through the system and recovery process will be righted by the peer.
This is fallacious thinking and should be addressed by peers working in all systems of care. Peers are traded among agencies like commodities & packaged under the disguise of mutual support. This is extremely problematic for consumers that are truly disorganized in their thinking & actively delusional or psychotic.
In most cases, the peer’s voice is silenced, and the legal system goes to work. This means, if you are so sick that you cannot differentiate “right” from “wrong” and become an acute risk of harm, it isn’t your peer’s voice that will be heard by the treatment team when you are unhappy with your care. Instead, it will make the lawyer’s voice, above all, that either justifies your continuing care voluntarily or, conversely, the consumer’s commitment to forced treatment & change of legal status to involuntary.
I have not been a peer forever. I did not rise through the ranks of the movement. However, I’ve done my research & don’t know of too many courtroom peers challenging judges to convert a consumer’s legal status to voluntary. So why aren’t peers advocates in the courtroom? To find why peers haven’t made it to the law level in mental health treatment, follow the money.
As a commodity to be traded for essentially peer support, peer work has no trade value in the legal system when it intersects a consumer’s treatment within systems of care. This means, essentially, it is the voice of the lawyer, psychiatrist, & perhaps therapist that has primacy over the peer because of his or her legal worth on a level that satisfied the court’s concern over risk & harm to others.
I am not suggesting that peers should be assessing for risk or making legal decisions regarding their clients. I am also not saying clinicians should fly by the seat of their pants and forgo prescribed treatment practices because it doesn’t satisfy the definition of authentic treatment on a philosophical level.
Instead, I am trying to signal to the mental health community that we have a long way to go before consumers will begin to perceive their therapist’s advice as truly empathetic and the peer’s voice as their equal in care systems. With this said, we can continue to evaluate funding streams and question insurance companies’ reimbursement practices that assign consumers of care treatment based more on money and worth than our society’s drive to end disparities in treatment practices.