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Commentary
June 1998

The Role of PsychotherapyPsychiatry's Resistance to Managed Care

Arch Gen Psychiatry. 1998;55(6):564. doi:10.1001/archpsyc.55.6.564

MUCH OF the healing provided by medical treatment results from the physician-patient relationship, the emotionally charged personal tie that develops between a sick person and a caretaker, and particularly the thoughts and feelings that they exchange in the process. Dr Guze uses the term "psychotherapy" to describe this relationship. Others, myself included, would reserve the term for specific treatments that are based on a theoretical model of psychological functioning, its relation to pathologic condition and subjective distress, and the way in which relationships and communications can modify it. In Dr Guze's definition, psychotherapy is universal in all personal medical care. In mine, it is a class of therapies provided by some but not all psychiatrists (and some nonphysicians as well) to some patients but not to others. This second definition does not imply psychological causes. Rather it suggests that the treatment is based on a theory and has a strategy, and is not simply humanistic and compassionate care by a concerned physician. Psychotherapy may be indicated either for patients with "recognizable psychiatric disorders" or for persons with problems in living. Particularly relevant for Dr Guze's argument, it may be helpful in treating patients who experience problems in living and who also suffer from psychiatric disorders.

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