Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42California Biofeedback — Fall 2016 7 might transpire that the client expresses an interest in seeing the information as well, so that it isn’t simply being conveyed in- directly. Matters unfolding on the screen would be explained, and it would become clear which way warmer and colder lies. If the proffered signal turns out to be engag- ing to the client, then so much the better. Of course all of this is being done in the interest of more effective psychotherapy. The client expands his level of awareness to non-cognitive aspects of his experience as the therapy proceeds. This approach might pass muster be- cause physiological regulation is never set as an explicit therapeutic objective. No claim is being made that exposure to the physiological measures may effect resolu- tion of the particular clinical complaint— not to the client and not to the insurance company. The focus ever and always re- mains on the psychotherapy. There is support for our position even ‘on the other side.’ For years we have heard of informal arrangements in which insurance representatives have urged prac- titioners simply to go ahead and code for psychotherapy and get on with it. The practitioner asks to have this in writing, and then that doesn’t happen. It’s a famil- iar story. But what if the practitioner puts this in writing instead, and then sends the document along with each bill? Then if the insurance company accepts the claim, it cannot later claim to have been de- frauded—particularly if the initial impe- tus came from an agent of the insurance company. Every submittal of a bill is an implicit contractual negotiation with the compa- ny, one in which the practitioner applies for reimbursement and the company ap- praises the validity of the claim. It is said the the burden of proper coding is a legal requirement for the practitioner. But the essence of that requirement is that the third-party payer not be misinformed. In complex situations, words are needed that go beyond procedure codes. What has shifted over the years is that practitioners increasingly regard the bio- feedback/neurofeedback as an essential part of psychotherapy rather than as an adjunct of some kind. We live daily with the reality that bottlenecks in therapy are broken through biofeedback and neuro- feedback. Sometimes productive psycho- therapy really only begins after such bot- tlenecks are broken. Perhaps the time has arrived when we should pursue a collective solution to this issue rather than leaving individual prac- titioners at the mercy of the system. What form might this take? If the WABN took an official position in this matter, then ap- peals could be made to the other regional organizations and the AAPB to join in the campaign. Appeals could also be made to Division 42, the Practice Directorate of the American Psychological Association. From there it would go to the national Board. Even in the absence of support at the level of the APA, however, the biofeed- back community constitutes a “respect- able minority” within the field of psy- chology, one with particular expertise that conveys authority. Any formal position by a group such as ours would also provide backing to any practitioner who is explor- ing innovative remedies to our present bureaucratic dilemma. u Siegfried Othmer