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It is an irony of our times that at the point when psychotherapy has al­ 
most completely lost its stigma, at least in the middle classes, and at the 
point when a respectable literature on its effectiveness has accumulated 
(NAME_1, NAME_2, & NAME_1, 1975; NAME_3 NAME_4, & NAME_5, 1980; 
NAME_6 NAME_7, & NAME_8, 1986; VandenBos, 1986, 1996; Lipsey & 
NAME_9, 1993; NAME_10 NAME_8, 1994; NAME_11 NAME_12, 1995; NAME_13 
& Fonagy, 1995; Seligman, 1995, 1996; Howard, Moras, NAME_14, NAME_15­ 
ovich, & NAME_16, 1996; NAME_17, 1996), we are experiencing political and 
economic pressures that are demoralizing practitioners, discouraging 
clients from seeking help, punishing clinicians who are able to inspire 
patients' willingness to stay in treatment long enough to accomplish 
something enduring, and redefining as "therapy" a nonconfidential re­ 
lationship that may be summarily stopped at any point (cf. NAME_18 & 
NAME_19, 1996).
    Becoming a good therapist is inherently arduous and time consuming, 
but lately, the task has been complicated by anxieties among aspiring 
clinicians that they will not be able to practice the difficult art they have 
made so many sacrifices to master. As a teacher of therapists, I have 
seen evidence that these anxieties have been rising steadily in recent 
years. For example, in my introductory survey of psychoanalytic theory 
at Rutgers, I typically assign a paper asking students to analyze one of 
their dreams in classical Freudian fashion. Occasionally a kind of "class 
theme" emerges in the papers, often involving separation (students usu­ 
ally take this course in their first graduate semester) or self esteem (not 
easy to maintain in graduate school). In a recent semester, almost half 
the analyzed dreams contained images of an intrusive, arbitrary, unem­ 
pathic authority hostile police officers, angry school principals, auto­ 
cratic nuns, and the like. When I reported this pattern and asked class 
members how they understood its meaning, they associated immedi­ 
ately to their apprehensions about practice in a "managed care world" 
where some bureaucratic directive would suddenly override their clini­ 
cal judgment.
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