Effects of the new economic climate on psychotherapeutic practice

Psychotherapy, especially the intensive variety, has been put under considerable adverse pressure by changes in the economics of medicine and psychiatry. The dominance of third-party rather than out-of-pocket payment for services raises questions about the "medicality," and thus the eligibility for coverage, of some disorders treated with psychotherapy. Trends toward the "industrialization" of psychiatry threaten to curtail the independent, fee-for-service conditions that may be necessary for psychotherapeutic practice. Efforts to reassert the medicality of psychotherapeutic psychiatry are essential, even though this will be difficult to accomplish and may have some limiting effects on coverage.