Managed care and mental health: the silencing of a profession.

Rapid change in the organization and financing of health care has created a bewildering and threatening climate for psychotherapists. Fearful of exclusion from preferred provider and health maintenance organizations, and aware that patient advocacy is interpreted as antagonism to these organizations' goals, many therapists have fallen silent, acquiescing to practices they do not support. Crystallization of these practices into policy and law is now imminent. It is crucial that therapists reclaim their authority, speaking out on behalf of current and future patients as well as the concealed constituency of historically disenfranchised persons for whom psychotherapy has provided a voice.