Gunderson and Gabbard provide us a lucid and compelling evaluation of the dire straits we navigate in this era of third-party payment. In my opinion, people will have to pay for either their own or someone else's psychoanalysis. I do not think a quick fix, organized by any DSM-IV category, will show that insurance companies, managed care organizations, or governments should pay for psychoanalyses because they are cost-effective. Clinical trials at this time are better directed to dynamic and integrative psychotherapies.

The meager resources for scientific study within psychoanalysis should be devoted to doing what is scientifically best—that is, to continue to revise our theory of conscious and unconscious mental processes and how they are involved in symptom formation, character psychopathology, and character growth.