A Comparative Study of Factors Outside the Therapy Room Influencing Therapeutic Practice in The United States and Norway

Abstract

Objective. The goal of this thesis is to describe the experiences of psychotherapists in the United States and in Norway in dealing with the outside influencers, namely managed care organizations (MCO) in the United States and governmental bureaucracy in Norway. Research on managed care and the therapeutic process in the United States has not been given much attention since the turn of the century, and due to the recent arrival of governmental influence on psychotherapeutic practice in Norway, a matching research picture does not exist. Therefore, this thesis represents a pilot research project seeking to bring to light the experiences of Norwegian psychotherapists, and re-open the discussion of the effects of managed care in the United States. Methods. Interviewees were selected through word-of-mouth and “cold-call” emails. Semi-structured interviews were conducted with seven mental health practitioners, three from the United States, and four from Norway. All of the interviewees, from both countries, have been in practice on average for more than 20 years. Thematic analyses were conducted to discover the underlying themes, and great care was taken to ensure the interviewee’s anonymity through the use of pseudonyms. Results. Interview analyses revealed a number of themes. American psychotherapists discussed issues with joining a managed care panel and maintaining membership, adjusting their practices to fit managed care requirements, qualifying and advocating for their clients’ treatment, and working around the managed health care system. Norwegian psychotherapists discussed governmental control and their new rules for practice, efficiency standards, the government’s power to support and limit their practices, pressure from the outside, and the strong voice of the therapist. Interviewees from both countries similarly mentioned the distinction between public and private care, paperwork, and justification and opposition for their respective systems. Conclusion. The results of this study revealed a major distinction between American and Norwegian psychotherapists. Because American psychotherapists adjust their practices to fit the demands of the MCO, they have given up much of their autonomy, and have become “robots.” Conversely, because Norwegian psychotherapists use the power of their voices to speak out against the new governmental practices, they retain greater control, and act as “pilots” navigating in their therapy rooms.