Managed care demands in psychotherapy are too easily treated in a surface fashion and without regard for their potential of holding unconscious derivative importance and meaning. There is internal and external pressure on the therapist to abandon psychodynamic psychotherapeutic skills in managed care psychotherapy. When the managed care benefit becomes the primary focus of clinical attention, it supersedes the client's needs, and negative transference and resistance are externalized and not handled clinically. This paper illustrates the contribution psychodynamic understanding and method can make to managed care psychotherapies by demonstrating the clinical phenomenon and handling of the client's and therapist's transferences to managed care and client's defensive use of managed care recommendations.