Abstract
The author surveys the many forces of change that will have an impact on the practice of psychotherapy in coming years. These include parity, health care reform, federal and state deficits, electronic health records, evidence-based medicine, pay-for-performance, reimbursement issues, and attacks on fee-for-service medicine. Vulnerable aspects of psychotherapy are privacy and confidentiality, individualization and choice of therapy, access to therapy, therapist's choice about participation, denial of coverage based on diagnosis, and sufficient payments to sustain practice. Psychiatric workforce issues may compound the effects. The author identifies some issues calling for vigilance, advocacy, and defense of the key values of psychotherapy and the environment for providing it. (Journal of Psychiatric Practice 2009;15:408-414).
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