Psychotherapy in the managed care health market

The author considers the future of psychotherapy in the managed care health market. He focuses on two interrelated questions. How can the efficacy of psychotherapy be scientifically demonstrated? Can psychotherapy meet the standards of cost-effectiveness set by health plans? He notes that efficacy is not enough in the managed care market, in which health plans also focus on the rational allocation of resources and economies of scale. The author then turns to the question of whether the doctor-patient relationship, which was central to American medicine throughout much of the 20th century, can survive in the current healthcare climate. He reviews the literature on the efficacy of psychotherapy and discusses the criteria for empirically validated treatments proposed by the American Psychological Association. He concludes that there is considerable support for the premise that the personal qualities of the individual therapist that contribute to the formation of the therapeutic alliance are at least as important, if not more important, than the specific method of psychotherapy used. The author concludes that medicine and psychiatry may be neglecting an important and uniquely curative element-the doctor-patient relationship, the human encounter that is the foundation of the art and science of medicine.