To the Wall Street Journal. My hat is off to you for taking a hard look at the hollow promises of mental-health managed care, especially as we have endured it here in Ohio (Psychobattle, WSJ, July 13, 1965). Typical of the glib, misinformed, and short-sighted thinking of some managed mental-health-care advocates is the quote form Michael Freeman, president of the Institute for Behavioral Health Care: “Who needs psychoanalysis for eight years when you can get your needs met in 20 sessions?”
In fact, 20 sessions would greatly benefit many people, but just try to get anything close to that much treatment authorized by most managed care firms! And some people simply do not “get” their “needs met” in 20 sessions, so must undertake the more intensive, arduous work of psychoanalysis in order to overcome their impairment and suffering. A study of psychoanalytic patients in Ontario (Doidge, N. et al., American Journal of Psychiatry, 151:586, 1994) showed that 82% had come to psychoanalysis after failing to respond sufficiently to other forms of treatment.
Freeman also exaggerated the length of psychoanalysis, since the average length of completed analyses is 5.3 years in the United States, where many patients must pay the cost themselves (American Psychoanalytic Association survey, 1990)—and 4.9 years in Ontario, where it is covered by provincial health insurance .
Norman A. Clemens, M.D.
Cleveland