Progress report

Life has lately gotten more interesting than ever, as I've been fucked over by Anthem Blue Cross / Blue Shield. As described in an earlier post, Anthem has decided to hold onto more dollars by requiring the kinds of nonsense dream descriptions of "measurable" progress that have heretofore distinguished Medicaid as the arse end of therapy quality assurance. Imagine working with a person whose identity is empty and false owing to childhood catastrophe, who therefore has depression, absence of self-esteem, the anxiety of no existential safety net, suicidal resignation, and having to fabricate minutiae of "progress" at each and every session over the course of several months to a year or more, or different reasons for the lack of it.

My most recent paycheck was less than one-half of the typical amount. It doesn't matter to Anthem that I may be homeless if this happens two more times. The remedy would be to dumb down the essence and nuance of therapy – and for that matter, of the client – and create long- and short-term measurable objectives and goals that turn the client into a sixth-grade math word problem. What is so awfully undermining is that I don't know that I can do it, despite real effort. I don't know how to have a terrible imagination and to write the meaningless stupid. And I will admit: I can't stomach asking clients to digitize their distress.

In the meantime, I continue to see thirty-five to forty clients per week, always giving my all, even if half of them turn out to be pro bono. I am very lucky that the presence of a client on the couch is one part of the two parts of my sense of motivation, what wakes my heart from its long dysthymic nap. The other part is the existence of my wife. As new pay periods come and go, I will keep my readers abreast of developments, which I fear may be inevitable atrophy.

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Addendum two weeks on: Next check, again less than one-half the earned amount. Anthem sends me clients, I do my job, write peer review-quality progress notes, and am refused payment. I am told that the owner of the group practice is working with lawyers, calling officials, confronting jackasses who wield power. Next Addendum may be more interesting.