This paper compares the conceptual base of psychoanalytically-informed psychotherapy with that of managed care. It is proposed that each is rooted in a discrete and incompatible system of thought and professional culture-one in psychoanalysis and the other in business. Differences exist between these cultures in the meaning of time, therapeutic goal, and clinical role. Case material illustrates the impact of managed care culture on the development of transference in both patient and therapist. The transitional space of treatment is expanded to a five party object relational system-patient, therapist, case manager, insurance company, and employer-that manifests culture clash.