Insurance

THE USE OF MEDICAL INSURANCE FOR the payment of at least some portion of the cost of analysis is now a common and ever-increasing occurrence. Despite this, the literature on the use and meanings of insurance is relatively sparse. I have observed that protection against castration and depletion of body contents, as well as the need for control are central unconscious fantasies that accompany the use of insurance to pay for analysis (Halpert, 1972). I also postulated that when the entire fee is paid by insurance and where obsessive anal factors are prominent in the analysand's psychology, resistance might be intensified to the point of unanalyzability. I reported on a psychotherapy case in which there was a transference to the insurance company, pointing out:

The anonymous third party, the insurance company, becomes like the anonymous therapist—a transference figure. But the insurance company, unlike the therapist, gratifies transference wishes; it takes care of and protects the patient [Halpert, 1973, p. 67].

Gray (1973) indicates the importance of analyzing patients' decisions to use or not use their insurance. She also feels that, "major medical insurance coverage per se has little adverse effect on the conduct of otherwise adequate analyses in a situation in which the contract remains exclusively between doctor and patient" (p. 110). According to Langs (1976), however, the violation of confidentiality inherent in third-party payment is too disruptive of the bipersonal field to allow analysis to proceed