*  Privacy and confidentiality means sharing sensitive, personal information with a single, trusted professional chosen by the patient. Managed care usually requires sharing private information with several people who are not chosen by the patient, such as gatekeepers and utilization reviewers, and storing it in files accessible to hundreds of employees.

* Managed care sometimes claims to provide all mental health services when it offers only brief therapy -- a short-term treatment not effective for many concerns.

* A utilization reviewer's decisions may overrule the decision of the professional who is conducting the treatment. The reviewer's decision often is based upon limited information and/or a too-brief discussion of a case with the treating therapist.

* Medical ethical codes require that health professionals avoid and minimize conflicts of interest regarding their primary obligation to the patient's welfare. Managed care, on the other hand, does just the opposite. Professionals may avoid dealing with important long-term issues or cut therapy short because managed care prefers to refer new patients to therapists with a record of short-term (less expensive) treatment.

* Many Managed Care Companies still use what they call "managed care unfriendly" behavior ratings which perform much the same function as gag clauses. For example, if a therapist commits an "unfriendly behavior," it shows up as a low rating. The forbidden "unfriendly behavior" may include telling patients when they may benefit from a treatment not paid by the managed care company.  

* Managed care often fails to inform patients of treatment alternatives outside of the plan. This failure to inform serves the purposes of the managed care company because patients who do not know other treatment is possible, are more likely to report satisfaction with the managed care treatment. Unfortunately, this failure to inform also undermines the patients' control, because the patient loses the choice to self-pay for the preferred treatment.

* Medication is frequently presented as complete treatment. In fact, psychotherapy, either instead of or in combination with medication, is a better treatment than medications alone.

* Patients who are sent to psychotherapy are usually told that ultra brief therapy is the treatment of choice, and if they don't improve, they are told that there are no realistic alternatives. The reality is that long-term psychotherapy is a more effective treatment for many presenting problems. Many people find it so helpful that they will decide to self-pay for long-term, in-depth psychotherapy.