Providing therapy in the context of third party determined time limits: A mixed methods study of psychologists' experiences of working in pre-set timeframes

Abstract

Psychological services in Australia are frequently provided in the context of third party payers who impose time limits based on reasons other than particular client (or therapist) characteristics. Time limits may function as a useful clinical factor in the provision of therapy, for example through accelerating treatment. Less is known about the third party imposition of time limits and the impact they may have on psychotherapy from the perspective of psychologists. The present study investigates the impact of time limits imposed in this manner from the viewpoint of practising psychologists. Practising psychologists took part in a mixed methods study. Twenty seven participated in a semi-structured interview, and eighty-five completed a mailed questionnaire. Interviews were analysed thematically, while both qualitative content analysis and statistical analyses were applied to questionnaires. The interview and questionnaire findings were congruent, both showing that a time limit makes a difference to psychologists. Psychologists are less satisfied with treatment that can be provided in the time limited as opposed to time unlimited context. However, they also perceived benefit in terms of improved client access to psychologists and improvements in the efficiency of therapy. Participants reported that the system of third party referrals had an impact on them that was over and above the impact that a time limit itself had, for example, the fact they were externally managed. The broader context therefore reportedly brought with it the need for psychologists to adapt their treatment to the context of the service. Psychologists reported that, in response to time limits, they often changed their treatment type, for example, from a psychodynamic to cognitive behavioural approach. They also made more general changes, such as moving quicker through the process of therapy and becoming more directive and less client-centred. Perceived outcomes were also affected by the time-limited context. How psychologists conceive of, report, and achieve outcomes is different in this context, and overall outcomes were perceived as weaker. In conclusion, this study has demonstrated that time limits impact upon psychologists in important ways with regard to the process and outcomes of psychotherapy. The broader system of third party referrals has implications for the delivery of psychological services in Australia, which clinical understandings of time limitation have not accounted for. Previous research has shown that the number of sessions available makes a difference, but the present research shows that a time limit cannot be separated from the system under which it is imposed, because once it is imposed, it has implications throughout the whole process.