Psychoanalytic Therapy as Health Care: Effectiveness and Economics in the Twenty-First Century: Harriette Kaley, Morris N. Eagle, and David L. Wolitzky. Hillsdale, NJ: The Analytic Press, 1999, 312 pp., $49.95.

Psychoanalytic values, including confidentiality, neutrality, autonomy and self-determination of the patient, and especially the central importance of the treatment relationship, are dramatically opposed to managed care's focus on the quick fix and the profit margin for the next quarter. The editors of this book offer a timely, multifaceted approach to the problems stemming from this polarity, in all forms of psychoanalytically informed treatment.

The book is organized into four sections. The first presents an overview of the problems, with suggestions for the future, most chapters having been written for the 1994 American Psychological Association meetings with the theme “Psychoanalysis as Health Care.” A chapter by Bryan Welch describes the belated political awakening of psychologists and psychoanalysts, the gradual public awareness of managed care abuses, and the subsequent legal challenges that are beginning to hold managed care companies more accountable. Dorothy Cantor (mistakenly identified under “Contributors” as a former president of the American Psychoanalytic Association) gives a rousing call for psychologists to become politically active. One need only look at the figures in the Hay Group Study showing that mental health dollars paid by insurance have decreased 54 percent since 1988, while general health dollars declined 7.4 percent (National Association of Psychiatric Health Systems 1998). James Barron, in his chapter, makes the important point that managed care has been able to use the positivistic, antisubjective viewpoint in psychology as an ally in the denial of subjectivity and the unconscious, focusing on target symptoms and excluding underlying characterological or causative issues. While the chapters in this section all present important aspects of the history of managed care, why we got where we are, and where we may be going, the word “psychologist” should have been replaced by “analyst” or “therapist” when these chapters were rewritten for