In Psychoanalytic Therapy as Health Care, a timely and trenchant consideration of the clash of values between managed care and psychoanalysis, contributors elaborate a thoughtful defense of the therapeutic necessity and social importance of contemporary psychoanalytic and psychodynamic approaches in the provision of mental health care.
Part I begins with the question of where psychoanalytic treatments now stand in relation to health care; contributors offer explanations of the current state of affairs and consider possible directions of future developments. Part II looks directly at the conundrums that have resulted from the attempt to integrate psychotherapy and managed care, with contributors examining the ethical and legal dimensions of confidentiality, privacy, and reporting to third parties. Part III opens to wider consideration of the experiences of psychoanalysts under health care systems throughout the world. Finally, Part IV demonstrates the relevance of contemporary psychoanalytic approaches to a variety of contemporary patient populations, with contributors focusing on the applicability of analytically oriented treatment to AIDS patients, seriously disturbed young adults, and inner-city clinic patients.
Collectively, the contributors to Psychoanalytic Therapy as Health Care convincingly refute the claim that psychoanalytically informed therapy is an esoteric treatment suited only to the "worried well." Drawing on a wide range of clinical and empirical evidence, they forcefully argue that contemporary psychoanalytic approaches are applicable to seriously distressed persons in a variety of treatment contexts. Failure to include such long-term therapies within health care delivery systems, they conclude, will deprive many patients of help they need - and help from which they can benefit in enduring ways that far transcend the limited treatment goals of managed care.
"The editors have assembled a highly relevant and timely examination of the purgatorio where psychoanalytic psychotherapy and managed care meet. Although they focus on psychoanalytic therapy, they clearly believe that psychoanalysis operates as a bellwether for the key issue that has come to plague all humanistic psychotherapists, namely, the pressure for 'quick fix' treatments of diagnostically reified patients, with all its concomitant loss of dignity and privacy. The contributors carefully and even-handedly examine the issues, make a strong case for the contemporary relevance of psychoanalysis, and point out the directions it must move in to maintain that relevance in the future. This illuminating book should be of great interest both to health care professionals and to a lay audience-and not just of patients-who see in our current version of managed care the death knell of a humanistic approach to illness of any kind."
- Edgar Levenson, M.D., Training and Supervising Analyst, William Alanson White Institute
"Psychoanalytically oriented or informed psychotherapy is devoted to the optimization of human functioning, with cost considered only secondarily. Managed care is intent on containing the costs of delivering mental health services, with a return to previous functioning, rather than growth and change, considered an acceptable goal. The contributors to Psychoanalytic Therapy as Health Care examine the many consequences that follow from the collision of these two cultures. Any student of the contemporary health care delivery system will benefit by considering the many issues raised by this provocative and thoughtful volume."
- George Stricker, Ph.D., Distinguished Research Professor, Adelphi University
I. Psychoanalysis and Health Care: Present Problems and Future Prospects
1. Psychoanalysis in the Political Arena: The Reality Principle - Bryant L. Welch
2. Life After Health Care Reform: A Clinical Solution for Psychoanalysis - Toni Bernay
3. Managed Care and the Denial of Subjectivity - James W. Barron
4. Is Psychoanalysis Health Care? The Affirmative Position - Stanley Moldawsky
5. Why Psychoanalysis Is Not a Health Care Profession - Marvin Hyman
6. Psychoanalytic Education in the Age of Managed Care: Staying Alive in Shark-Infested Waters - Marylou Lionells
7. "There Is a Future for Professional Psychology" - Dorothy W. Cantor
II. Legal Issues: Privacy and Confidentiality
8. Restoring the Confessional: Reporting Laws and the Destruction of Confidentiality - David Sundelson
9. Psychoanalysis Under Managed Care: The Loss of Analytic Freedom - Robert R. Cummings
10. Privacy and Confidentiality: Issues in Psychoanalysis in the 90s - Russ Newman
III. International Perspectives
11. National Health Insurance Coverage of Psychoanalysis and Psychotherapy: An International Review Highlighting Some Current Problems - Brent Willock, Christa Balzert, Ahmed Fayek, and Juliam Abraham
12. Psychoanalysis and Health Care in Australia: Health Care Budget Cuts Affect Psychoanalysis - Ron Spielman
IV. Current Issues and Special Populations
13. Who Is in Psychoanalysis Now? Empirical Data and Reflections on Some Common Misperceptions - Norman Doidge
14. Psychoanalytic Approaches to the AIDS Epidemic - Mark J. Blechner
15. The Effectiveness of Long-Term, Intensive Inpatient Treatment of Seriously Disturbed, Treatment-Resistant Young Adults - Sydney J. Blatt and Richard Q. Ford
16. Managed Care Discovers the Talking Cure - Eric M. Plakun
17. Psychoanalytic Perspectcives on Clinical Work in the Inner City - Neil Altman
Epilogue: Look Toward the Future - The Editors