Sharon is 27 years old. She doesn't plan to be 28. She is lonely, and hurting and desperate. She’s decided as a final attempt to seek counseling; however, the few counselors covered by her insurance company all have waiting lists. She also understands that her sessions might be limited to as few as three sessions. The soonest she can be seen is three weeks from now. She isn't sure how she will make it through the day. She contacted a crisis line only to find that the line had been disconnected.

Robert is 34. He is divorced with 3 children to support. After child support is taken from his check, and rent and other essential living expenses are paid for, he only has $21.00 a week left over. Therapy would cost him a minimum of $50.00 per session. He has a $200.00 deductible, and once this is met he will still be responsible for $25.00 a visit. Robert's anxiety is growing by leaps and bounds. He hardly sleeps, has lost his appetite, and has begun experiencing sharp pains in his chest. Twice last week, he has had to leave work early because he thought he was having a heart attack. His doctor informed him that he was experiencing panic attacks and suggested counseling. He has no idea how he can afford it, however he feels as though he's running out of time faster than he's running out of money.

Both of these individuals are feeling out of control. Both seek counseling, yet it is unlikely that the traditional once per week therapy session offered indefinitely will be available to them. While this is unfortunately the reality, there are other realities as well: (1) they need help soon; (2) they are not alone; there are many Americans in similar positions; and (3) we who live in this "kinder, more gentle nation" have some responsibility ("the ability to respond") to offer assistance.

The days of close knit families and communities that provided ready-made support for just about every American are over for many of us. Instead, the average adult today must often find his or her own way, constructing a safety net piece by piece. Children are often required to fend for themselves as their parents frantically struggle to keep the family intact, the bills paid, and maintain the necessities. In this mobile and fast-moving society where we have grown dependent upon grocery stores, electric companies, etc., we are required to develop a new kind of self-reliance these days. Often we must deal with the complexities of parenting, relationships and life crisis's without the loving concern of family, mentors, and old friends nearby. More and more, individuals who used to turn to built-in support systems now seek the assistance of a stranger, a trained therapist during difficult times. It sadly seems that while a growing number of people are more amenable to utilizing such services; many individuals who are in need of psychotherapy cannot afford it. Those who are in a position to seek therapy all too often do so with the expectation that the therapist will somehow administer a cure while the recipient remains relatively passive. For some it's as if the therapist need only to hear their prayer in order for the answers to be provided. Others are prepared to work hard within the comfort of the therapist's office and then resume their normal activities once the session is concluded. Few recognize that healing requires as much and often more effort outside of the therapist's domain. Most who utilize the services of a psychotherapist are being forced to recognize the limits of psychotherapy, as (ready or not) the number of sessions available to those who rely on insurance to subsidize the cost are often dramatically reduced.

It is commonly believed that therapy occurs once per week. This is not necessarily so, and for some it is not even financially possible. Therapy can provide significant benefits without the old constraints of a 50-minute weekly session, particularly when utilized in conjunction with other resources. If the needs of individuals such as Sharon and Robert are to be responded to whole heartedly: (1) we, as therapists, must offer alternatives to the traditional psychotherapy format; (2) Robert and Sharon must assume more responsibility than traditional psychotherapy clients have in the past; and (3) a growing awareness must evolve within our society regarding the necessity of mutual support while assuming ("taking upon oneself") more fully that which is required of us to become more accountable ("liable to be called to account") for our own health and well-being.

As usual, times are changing. One of the changes that will be occurring more frequently due to the crisis in health care costs is the alterations in medical benefits increasingly overseen by managed care companies. In my own little corner of the Universe, this is most dramatically represented by the wide spread adoption of Brief Treatment methods. While the transition has created a number of challenges, like all transformations that are spawned by crisis, this shift also offers opportunities. We are clearly not the only ones suffering the aches and pains brought on by the transformation of the health care system. Our clients are sustaining tremendous losses as well, and they should not be ignored. I have tried to minimize my clients’ losses while ignoring the losses of the population at large for the most part. I busily redesigned my practice to some extent and repaired my lifeboat, so to speak, in order to survive the incoming tide of managed care. The truth of the matter is that my practice has grown as a result of my successful attempts to figure out the politics and win the favor of managed care companies. They really like me, and I am grateful. Perhaps too grateful! I have heard of the frustration of clients who were working with someone they cared about and trusted only to be informed that the therapist was not covered by their new and "improved" insurance policy. I have witnessed the anguish of a severely depressed woman who's therapist informed her that weekly sessions would need to be reduced to monthly in order to ensure that her sessions would be covered by her insurance. I am aware of the many in need of services being placed on lengthy waiting lists. I have tried for the most part to not think about them too much. My own little lifeboat is solid and sea worthy, and I have places to go, people to see. I have tried, until now, to direct my energy elsewhere. Now I am forcing myself to look and see. During this health care crisis, we, as providers, are all preoccupied with saving our own practices and that is understandable; however, the dust has begun to settle, and it is time that we examine how we can individually and cooperatively create the most beneficial environment to our clients. The good old days may be over but the new ones hold great promise as well if we actively commit to exploring the possibilities.