Dynamic psychotherapy: a 50-year perspective.

Dynamic psychotherapy is a method of treatment for psychiatric disorders and emotional problems that comprises a spectrum of approaches ranging between supportive and analytic peripheries. Although they are deployed in differing degrees and manners, all forms of dynamic psychotherapy derive their therapeutic powers from five components: support, hope, a certain kind of listening, insight, and guidance. Attentive listening is particularly important, while insight, although essential, is a complex phenomenon whose therapeutic value may be overestimated.

The changing role of dynamic psychotherapy in psychiatric practice.

The author reviews the range of accepted indications for dynamic psychotherapy when he first began practice after World War II and describes factors that have played a role in the current undervaluing of this treatment approach. He attributes much of the change to research that has produced a different understanding of many of the conditions treated by psychiatrists and has placed greater emphasis on their medical and biological aspects than on their psychological aspects. He also attributes many alterations in current practice to the change from a two-party to a three-party reimbursement system for psychiatric services.

Medical necessity and psychotherapy.

Managed care and, specifically, the need to conform to medical necessity requirements have had a dramatic effect on medical and psychiatric practice, especially on psychotherapy. The author describes the progression of the concept of medical necessity from a simple accounting of services reimbursable by insurance companies to an ambiguous term without definitional consensus. He describes its relationship to the medical model and discusses the incongruity between medical necessity and certain aspects of psychotherapy.