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January 1, 1997

Lying on the Couch

Author Affiliations

Sheppard Pratt Health System Baltimore, Md

JAMA. 1997;277(1):83-84. doi:10.1001/jama.1997.03540250091047

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


Psychiatry is a vital part of medicine. As healing professionals, psychiatrists face many challenges. Managed care has intruded on the privacy of the doctorpatient relationship and disrupted continuing care. Modern psychopharmacology has brought into question the need and efficacy of the talking treatment, that is, psychotherapy. The many therapeutic schools foster bitter competition among practitioners, both medical and nonmedical. Highly publicized cases of therapist-patient sex, recovered memory suits, and unethical behavior tarnish the literally thousands of hours of work of diligent, honest therapists and patients. Psychotherapy, 100 years after the invention of psychoanalysis, is as controversial today as it was in late 19th century Vienna. How much is science? How much is art? How much is invention? How much is chicanery and manipulation? All are issues in today's popular imagination. Perhaps the biggest challenge comes from our patients and how we provide therapy for their suffering.

And what do we