Health Care, Third Parties and Transference (article)

Last October the Psychohistory Forum had an interesting session on the subjects of “Transference, Third Parties and Health Care.” The presenters were John Sonne, a psychiatrist/psychoanalyst in private practice who is also affiliated with Hahnemann Hospital and the New Jersey College of Medicine, and David Lotto, a psychologist/psychoanalyst in private practice in Pittsfield who is also affiliated with the University of Massachusetts.

The Forum’s goals in arranging for the lectures and discussion were threefold. One, to focus on a subject of considerable importance and interest to Forum members. Two, to explore some of the ways in which the presence of third-party insurers, health maintenance organizations, licensors and so forth influences therapy. Three, to understand the transference and countertransference feelings that we as practitioners, insurees and patients have and how these affect the course of treatment.

My special interest was how the countertransference feelings of practitioners affect the course of treatment since practitioners are ambivalent about having patients with insurance companies that are difficult or who have caused difficulties in the past. Recently, an insurance company official had made a special, and effective, effort to sabotage my treatment of an insured patient.

Both presenters raised a large variety of issues in addition to sharing some of their own experiences and countertransference issues. John Sonne thought that the transference of patients to insurers and health care organizations was to “mother” and wondered if the transference to the psychoanalyst was not to “father.” By implication he suggested that this was a more distant transference. He pointed out his own feelings that his insurance company should cover all of his bills during a recent procedure. David Lotto described being in a state of war, for a period of time, with health maintenance organizations in Massachusetts. This raised many questions in my mind because of his important work on the role of war and sacrifice and his determination to avert nuclear war.

By any number of measures the meeting was a success. First, there was a better­than­average turnout, especially in light of the fact that the meeting was held at a location that was inconvenient for most of our regular attendees. Second, people listened intently, raised numerous questions and continued the meeting longer than planned. But our success in understanding the role of transference and countertransference issues was limited. Though the priority of the need to understand transference was clearly stated as the central issue of this discussion the group preferred to devote most of its energies to concrete questions of the Clinton health proposal. Clearly, the perceived threat to our patients’ health care, our intellectual base (psychoanalysis) and our own economic base was and is too great for people to grapple at great length with the more amorphous transference issues.

Page 9