Psyche. XXXV, 1981: The Presence of the Third Party in Psychoanalysis: The Problem of Payment by Others. Johannes Cremerius. Pp. 1-41.

For several years a conflict has been smoldering between those who favor psychoanalytic treatment financed by medical insurance plans and those who oppose this arrangement on the ground that it is incompatible with the therapeutic goals of psychoanalysis. In discussing this conflict, the author comes to the conclusion that "pure" analysis, as conceived by Freud, is a normative concept which is continually negated by the reality of psychoanalytic treatment. The

steady presence of third parties in analysis—the presence of society and of social norms for analyst and patient—is a fact in the light of which the confrontation around third party payments seems disproportionate. Instead, the author urges that this problem be approached on the technical level. Only in this way can it be addressed realistically and with a hope for solutions. Without attempting to ignore the difficulties and contradictions arising from insurance financing, the author concludes that psychoanalysis can dispense with third party financing only at the price of social isolation and therapeutic stagnation, citing the situation of psychoanalysis in the United States as an example.