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(1998). Psychoanalytic Inquiry, 18:730-745

Therapeutic Triangles: Some Complex Clinical Issues

Edith Gould, B.C.D. and Fredric N. Busch, M.D.

Diverse scientific, socioeconomic, and cultural developments have converged and altered the face of contemporary psychiatry and the practice of psychoanalysis and psychotherapy. The 1990s, referred to as the “era of the brain,” has been a period of intense focus on understanding the neurophysiological underpinnings of mental health disorders. The impressive efficacy of Selective Serotonin Reuptake Inhibitors (SSRIs) such as Fluoxitene and Sertraline in ameliorating severe symptoms associated with depression, anxiety, and obsessive-compulsive disorders has, unfortunately, in some sectors, stirred up questions about the validity and usefulness of long-term psychotherapy. Nowhere is this skepticism more apparent than in the policies of health maintenance organizations (HMOs) regarding reimbursement for outpatient psychotherapy. Operating under a mandate to cut costs, “Managed care companies make no bones about their preference for treating mental health problems wi

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