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These are hard times for psychoanalysis in places where this field of study and clinical applications once flourished. As Ryan has noted in another context: 'Most American universities face a financially troubled future; public universities are affected by the tax problems of the states that finance them, while private universities find that … their usual sources of research funds all have shallower pockets in the current recession' ('Some cause for anxiety', Times Literary Supplement, 10 January 1992, p. 22).
Health care, a high priority in the United States, is due for a major change. Outcome studies, economic targets and goals, and managed care are but a few of the major challenges that impact upon the practice of psychoanalytic treatment, the recruitment of candidates for education, and the availability of patients who can afford psychoanalytic therapy. The excitement and enthusiasm that drove students and patients into psychoanalysis almost half a century ago are now much diminished. Newer 'cost-effective' treatments, an ever increasing number of 'spin-off' theories and approaches confuse the 'public', especially when new or innovative ideas are advanced and then 'attacked or demeaned' by fellow psychoanalysts. Differences in theory and approach can and should be discussed, debated, and tested—but without the acrimony and politicisation