The impact of managed care insurance coverage on the psychoanalytic situation is explored, using case material to show the particular ways transference and resistance may differ or not differ under this special circumstance. Managed care shapes typical areas of anxiety such as fees, schedules, frequency, and termination into riper opportunities for transference and resistance exploration. However, the so-called reality factor of an external influence easily disguises these potentialities. The analyst may unwittingly act out countertransference feelings using this “reality factor” as a rationale. While managed care does shift the nature of the therapeutic relationship, the emphasis on interpretation of transference and resistance remains at the forefront of technique.