(Some time before Frank Froman’s doppelganger, Marve Plotnik, appeared on the scene, Marty Williams was regaling us with stories of Clem, the lovable sociopathic scamp. We welcome his return – I think. Ed.)

I ran into my old friend, Clem, the other day after not seeing him for years. Although he looked fit, and was nicely dressed, he was actually wearing an orange vest and picking up trash along the highway—punishment for his latest domestic violence arrest. We got to talking about his new job: He coaches psychologists on how to lie to their patients for managed care.

Clem said it was not surprising that he got the job. He has a good, solid track record for telling lies. He says every time he’s been arrested he’s lied under oath, he always lies to creditors, and he even lies to bartenders about how much alcohol he’s consumed. The last thing he wants is for the bar keep to cut him off. He noted that his lying has been quite successful, citing the fact that he’d previously picked up roadside trash as part of a driving-while-intoxicated sentence. “I never would have been allowed to get that drunk,” he asserted, “had I not been able to convince the bartender to keep giving me drinks. I can convince anyone of anything!” He said one of the largest managed care companies approached him and asked if he would help. Clem said yes. He’s been holding training sessions for up to 100 psychologists at a time, three times a week.

Taking the bait, I asked Clem why managed care psychologists need to learn to lie. Isn’t it enough for them simply to state honestly that the limited policy benefits restrict the kind and duration of therapy that can be provided, as well as what conditions are covered?

“No,” he replied, “in some cases the policy does not state a limit or restriction, so the therapist has to trick the patient into actually wanting the form of treatment that costs the least. No one wants the cheapest form of treatment, so psychologists have to make the mark—I mean “patient”—believe that cheapest is also best.” Then he paused and leaned close to me adding in a hushed voice, “You want to know something weird? Even though some psychologists won’t lie for managed care and opt out of the programs, many psychologists take to lying like a duck takes to water. You should see it; it’s beautiful.” Clem, at that moment got a little weepy, so I had to look away.

He explained the nuts and bolts to me. “Listen, in most managed care contracts, there is nothing that says a person is entitled to individual psychotherapy. Think about it, you can treat ten or 30 people in a group using the same single therapist who would use that same amount of time to do one or two individual sessions. The only problem is the damn patients: They keep demanding individual sessions, in part because they like their damn privacy.” I could see that Clem was getting worked up, so I went looking for some beer to help him stay calm. After I returned, with a six-pack of Corona, I asked Clem how he does it. “How do you convince someone with reasonable concerns about privacy to accept a referral to group therapy?” I wondered.

“Well the first thing,” he said, “is to get the psychologists to stop thinking about their damn ‘clinical decision making.’ You get these psychologists with their dumb ideas about what kind of treatment is best for what kind of patient. They’ll talk that way until they’re blue in the face, and it just makes me pity them. What do they think this is, 1968? Do they think JFK is in the White House and the world is just full of funding for human services? Next, they’ll be telling me about the Tooth Fairy. Give me a @#%^*& break! I tell them straight away, if you keep talking like that, you go and you get patients to pay you directly and stop feeding at the trough of managed care. And, if you want to keep scraping up your managed care scraps, you’ll do what I say.

“Then I tell them my method. I call it ‘Humiliation.’ What you want to do is make the patient feel bad about wanting individual psychotherapy, once the standard of care in psychological treatment. You might say something like, ‘Well, the research shows that Group Cognitive Behavior Therapy is the most effective treatment for your condition’—and you say this regardless of the condition—‘so that’s what we’re referring you to.’ If the patient asks for individual sessions, we move right into the Humiliation by saying something like, ‘Oh, you’re so special that you’re actually asking for one-on-one meetings despite the fact that the research says it isn’t necessary. I don’t know how you can live with yourself, being so selfish, like the whole world revolves around you and you get your special kind of treatment regardless of the research findings.’

“If you can’t shut them up with Humiliation, you move right into the ‘Pity Me’ method. In this approach, you try to get the damn patient to feel sorry for you and your limited resources. You say, ‘I’m really sorry but we’re not staffed to be able to see you individually each and every week. We can give you weekly group sessions, but, if you want individual sessions, it will have to be monthly or less. We just don’t have enough staff.’

“Ideally, you combine Humiliation with Pity Me, so the patient feels bad about asking and even worse about putting you out. Then, if nothing else works, you ease them completely out of any kind of therapy by giving them the old ‘Neurotransmitter’ schtick. You tell them that the whole thing is biochemical and, while they may get some enjoyment out of so-called ‘psychotherapy sessions,’ it won’t make a damn bit of difference in their outcome. You won’t believe the conditions I’ve pitched as biochemical: Borderline Personality, phobias, eating disorders, kleptomania, whatever! It’s actually a big win for the managed care company if you can do the Neurotransmitter pitch, because nothing is as cheap as putting someone on Prozac, especially if you can get the primary care doc to prescribe and save the expense of calling in a psychiatrist. One of the things I do is get the psychologist to call the primary care doc and talk the doc into prescribing some Prozac. The doc’s under pressure, too, and getting someone out of the office just by writing a prescription if a big win for them.

“Then, there’s the old ‘Delaying Trick,’ also called the ‘You Need Group-Skills Training Before You can Benefit from Individual therapy.’ I have the psychologist tell them they are in no condition to benefit from individual sessions until they go to a CBT group and get some skills under their belts. Of course, I known damn well that, after the group is over, they’ll forget that they ever wanted to be seen individually. Or—and get this, it’s a beaut—they feel so downcast about the group referral, they just slip away, vanish, gone. They feel so hopeless about getting the kind of treatment they wanted, they just fade out, getting no treatment at all. You can capitate a client base of a million lives, and if they never come for treatment, that pure gravy.”

As I left Clem at the side of the road, with this orange vest and six-pack of now empty Coronas, I had to give him credit. He may be crazy, but he sure isn’t stupid.

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