Lying On The Couch

by Irvin D. Yalom

But deep therapy was losing the battle: the barbarian hordes of expediency were everywhere. Marching to the starched new banners of managed care, the battalions of brief therapy darkened the landscape and hammered at the gates of the analytic institutes, the last armed enclaves of wisdom, truth, and reason in psychotherapy. The enemy was close enough for Marshal to see its many faces: biofeedback and muscular relaxation for anxiety disorders; implosion or desensitization for phobias; drugs for dysthymia and obsessive/compulsive disorders; cognitive group therapy for eating disorders; assertiveness training for the timid; diaphragmatic breathing groups for panicked patients; social skills training for the socially avoidant; one-session hypnotic interventions for smoking; and those goddamned twelve-step groups for everything else! The economic juggernaut of managed care had overwhelmed medical defenses in many parts of the country. Therapists in subjugated states were forced, if they wished to stay in practice, to genuflect to the conqueror, who paid them a fraction of their customary fee and assigned them patients to treat for five or maybe six sessions when, in actuality, fifty or sixty sessions were needed. When therapists used up their meager allotted rations, the charade began in earnest and they were forced to beg their case manager for additional sessions to continue treatment. And, of course, they had to document their request with mountains of phony, time-consuming ...