Description - Psychoanalytic Therapy as Health Care by Harriette Kaley
What are the prospects for psychoanalysis in an era of managed health care, preoccupied as it is with cost effectiveness and the notion of "medical necessity"? And what are the opportunities and dangers for psychoanalytic therapies in the emerging health-care delivery systems of the next century? In "Psychoanalytic Therapy as Health Care", a consideration of the clash of values between managed care and psychoanalysis, contributors elaborate a thoughtful defence of the therapeutic necessity and social importance of contemporary psychoanalytic and psychodynamic approaches in the provision of mental health care. Part 1 begins with the question of where psychoanalytic treatments now stand in relation to health care; contributors offer explanations of the current state of affairs and consider possible directions of future developments. Part 2 looks directly at the conundrums that have resulted from the attempt to integrate psychotherapy and managed care, with contributors examining the ethical and legal dimensions of confidentiality, privacy and reporting to third parties.
Part 3 opens wider considerations of the experiences of psychoanalysis under health care systems throughout the world. Here contributors bring a comparative perspective to bear on the current situation in the United States. Finally, part 4 demonstrates the relevance of contemporary psychoanalytic approaches to a variety of contemporary patient populations, with contributors focusing on the applicability of analytically oriented treatment to AIDS patients, seriously disturbed young adults and inner-city clinic patients. Collectively, the contributors to "Psychoanalytic Therapy as Health Care" refute the claim that psychoanalytically informed therapy is an esoteric treatment suited only to the "worried well". Drawing on a wide range of clinical and empirical evidence, they forcefully argue that contemporary psychoanalytic approaches are applicable to seriously distressed persons in a variety of treatment contexts. Failure to include such long-term therapies within health care delivery systems, they conclude, will deprive many patients of help they need - and help from which they can benefit in enduring ways that far transcend the limited treatment goals of managed care.
Psychodynamic clinicans owe a debt of gratitude to Harriet Kaley and her coeditors for this invigorating defence of insight and meaningful personality change in the face of a system increasingly content with criteria of serviceability, baseline functionality and other lesser gods.
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