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From the Editor

Rationalization therapy: Feel-good psychiatry

Vol. 4, No. 2 / February 2005

For some years, I have been considering giving up traditional psychotherapy and concentrating on “rationalization therapy.” Patients will tell me what they want to do, and I will help them rationalize it.

Much of what passes for psychotherapy is, in fact, rationalization therapy in disguise. What’s different about my idea is that accurately labeling this new therapy will make the transaction more honest. We will abandon any talk about “making patients well” and concentrate on making them feel good about getting what they want.

Rationalization therapy can also rescue us from time-based billing. One reason surgeons make more money than we do is that they can bill on codes related to a procedure’s difficulty. We, on the other hand, are trapped into billing for the minutes we spend with a patient, regardless of how difficult our psychotherapeutic goals may be.

For rationalization therapy, I propose that we bill on how difficult it is to rationalize the patient’s wish, regardless of how long it takes us to help him or her rationalize it. For example, rationalizing taking an extra sick day from work when not really sick would be a Level-1 code with low reimbursement. Rationalizing murder would be a Level-3 code, resulting in much higher reimbursement.

For rationalizing murder, we also would be entitled to a higher relative value unit (RVU) reimbursement. This RVU would take into account not just our “physicians work” component but also a cost-of-practice component for higher professional liability costs we might incur.

Rationalization therapy thus would be win-win for us and our patients. My only hesitation in making this practice change has to do with another idea I’m considering, called “procrastination therapy.” But I’ll get to that another day.

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