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.