Transcription
The real problem with borderline personality disorder is there's no one who's going to dispute the fact that this is a group of people with severe disorders, complex disorders, and multiple diagnosis. Okay, that's very different than having a person who walks in with one disorder that you've got a evidence-based treatment for that takes eight weeks that works.
Okay, believe me, I've had it. I've had people come in, they say, "I've got this disorder." I say, "Great. We've got this treatment." But they say, "Great." I say, "Okay, do this." They say, "Okay." They do it that week. Come back, they say, "Okay, that worked. What next?" I say, "Do this." They do that. And then, you know, at 10 weeks later, they're fine. They call me a year later and say, "I'm fabulous. Thanks." Da da da. Okay.
This is not that. This is difficult multiple diagnosis complex disorders where when they're highly suicidal, you're at high risk or you think you're at high risk. So, a lot of people don't want to treat suicidal people. For one, they feel they might get sued if the person kills themselves. And unfortunately, they might. They think I'll have to take phone calls at home. I have two little kids. I don't want to do this or I, you know, why would I do that? Because you don't get any more money for treating a client that's difficult, that takes a lot more time, where you do take a lot of phone calls. You get no more money for that than you do for that previous client I was telling you about. That's really easy. The only difference is one's long term and one's short term. Okay? So, you get paid longer for the long term and not as long for the other.
But the point is is that there's no incentive in the field to treat highly difficult clients. So therefore, you often find your most talented therapists can choose the clients they want. So they choose easy clients and other cl other therapists who don't have that kind of choice often end up treating the very severe. Sooner or later there has to be some system where for difficult clients who take up much more time you get paid more. But that's probably going to depend on having really effective treatments. And that's going to depend on being able to show that an effective treatment saves the insurance company money.