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Gunderson and Gabbard raise an impassioned cri de coeur about the very survival of psychoanalytic psychotherapy as an integral part of the psychiatric armamentarium within the current health care scene. They assert, and I agree fully, that where once (in the halcyon days of the 1950s and 1960s) it took center stage as the principal psychiatric therapeutic, it has in recent decades become progressively “marginalized,” as they put it, within psychiatry. In an invited address in 1990 to the California Psychiatric Association on the future of psychotherapy (Wallerstein 1991), I called our psychotherapeutic enterprise an “endangered species” within psychiatry. In the decade since, the situation has certainly worsened.
In that 1990 address I outlined, even more elaborately than Gunderson and Gabbard do here, the variety of political, socioeconomic, scientific, and professional pressures that have together led us to this progressively unhappy state of affairs. I offered there my own guardedly optimistic statement of the conditions under which we might survive as psychoanalytic therapists, without, however, making the vital growth of our research structure as central to the prognosis for our future well-being as Gunderson and Gabbard very properly have. Nonetheless, I do offer some demurral to their statements on the way in which the pressures under which we work have brought about this decline. Certainly, I agree completely with the centrality in this regard of the