Prologue

Making the case for extended dynamic psychotherapy is difficult, important, and possible. In these times of the “quick fix” and profit-driven managed care, the difficulty arises from the received wisdom that psychoanalysis and long-term dynamic treatment are “out” and medications and brief treatments are “in.” In many quarters, psychoanalytic thinking has fallen into disrepute while psychoanalytic treatments have suffered from a relative paucity of outcome research. Are psychoanalytic theory and practice destined for an early demise after one brief century of ascent and decline?

As the articles in this special supplemental issue attest, however, psychodynamic treatments have a unique value for certain patients, which is supported by a growing body of evidence. In particular:

1. There are significant groups of patients who will not improve without extended psychotherapy.

2. When information similar to that in this issue about the efficacy and cost effectiveness of psychotherapy was presented to policymakers during the health care reform initiative in 1993, virtual parity for outpatient psychotherapy benefits with all other medical care was provided both in the Democratic and Republican health care reform proposals. Similar data have led to the protection of psychotherapy benefits in laws in Virginia, Maryland, and the District of Columbia.

3. Most of the American public now support the idea of providing necessary mental health care.

4. Most Americans with psychiatric disorders, including those requiring extended dynamic psychotherapy, do not receive the care they need. This neglect leads to needless suffering and the loss of literally billions of dollars in lost wages, unnecessary medical and surgical services for psychosomatic complaints, and increased psychiatric hospital care. The enormous cost of

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   untreated psychiatric disorders also includes suicide attempts and completed suicides; increased medical, surgical, and hospital costs for medical patients with concomitant untre