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Recent developments in health care management have had a traumatic impact on psychoanalysis. The emphasis on time-limited, symptom-focused treatments is contrary to the longer-term wide-ranging goals of psychoanalytic treatment. The intrusions on the psychoanalytic frame have been broad based and at times overwhelming. It is essential to the future of psychoanalysis for its practitioners to develop an understanding of these issues, with the goal of responding to them in the most effective manner. Psychoanalytic Therapy as Health Care: Effectiveness and Economics in the 21st Century, is highly uneven in addressing these issues.
The book's chapters are grouped into four sections: the impact of managed care on psychoanalytic practice, issues of privacy and confidentiality in part engendered by the advent of managed care, health care systems in other countries, and the variety of patient populations that can be treated with psychoanalytic approaches.
In their introduction, the editors note two broad issues weakening the case for psychoanalytic treatment in the era of managed care. One is the lack of research on psychodynamic treatments in general and long-term treatments in particular. This concern, however, is not a major focus of the book, which has only one chapter (Chapter 15) devoted to a psychoanalytic research project. The second problem is that psychoanalysis has tended to be viewed as an esoteric treatment suitable only for a highly limited group of patients. This particular issue is dealt with more effectively in the fourth section of the book, which delineates how psychoanalytically based treatments are not just for the ‘worried well’.
The first section, which focuses on the impact of managed care on psychoanalytic practice, is the most problematic and least illuminating. The chapters were primarily drawn from papers delivered at the 1994 annual convention of the Division of Psychoanalysis (Division 39) of the American Psychological Association on the theme of ‘