ABSTRACT
As noted in the section dealing with clinical formulation and treatment planning, today it is imperative that theresources available to support the treatment be recognized as a reality factor affecting what treatment is and is not feasible. Just as the constitutional and biologic substratum and the family support network influence treatment, so do the financial resources and their accessibility. In cases where treatment is dependent upon resources provided by a third party payor and managed by a fourth party utilization manager, alliances with these parties are virtually as important as those with the patient and family. Indeed, these participants in the treatment team, who often wish to be "invisible," still need to share clinical responsibility commensurate with their authority in the treatment decision-making processes. In the increasingly complex network of relationships bearing upon a child's treatment, the child therapist may find him-or herself in a nexus of competing and conflicting interests (Larson, 1996). In such a context, the child who might otherwise be treated in intensive, longer term, psychoanalytic psychotherapy may instead be treated with supportive or cognitive behavioral therapy having a shorter term orientation and more focused, less ambitious goals. It may
be difficult for some clinicians to accept that such factors have so much influence over critical treatment decisions. Indeed, the child's therapist in a managed care environment may spearhead some important negotiations between the factions involved. He or she may feel like a "double agent," at times serving as vigorous advocate with the managed care company for the child's treatment needs, and in other instances helping the child and family appreciate the need to manage the resources available for treatment.
