In his letter in the November 15 issue, does Donald Douglas, M.D., actually mean to suggest that psychiatrists' fees would be justified if we all adapted the psychotherapeutic fad of the year, or some standardized manual-driven (or even computer-administered) version of the highly touted "cognitive-behavioral therapy"?

Criticisms of this type are imprecise. Diagnosis-specific analysis of psychotherapy remains to be examined carefully so that we can make intelligent choices between the emerging distillations of our fine heritage. Dismissing our psychoanalytic roots is a mistake. Any honest intellectual examination of the many psychotherapeutic strains that have developed must acknowledge that all have roots in the psychoanalytic tradition. Does Dr. Douglas actually believe that a psychiatrist's unique blend of skills, which allow us to blend psychotherapy and pharmacotherapy, is really so outmoded for so many of the major psychiatric disorders we treat day in and day out?

I believe he must be referring only to adjustment disorders and problems that respond to the (fallacious) one-to-three-session, "solution-focused" therapies that are proffered (or forced) by so many managed care organizations.

Finally, it is a mark of intellectual rigor mortis to suggest that anyone who might disagree with his point of view should perform independent research to validate the new therapeutic interventions he mentions. Peer review remains the cornerstone of scientific advancement, and although there are complex financial disincentives that limit the amount of psychotherapeutic research, surely we can agree that carefully designed studies are desirable.

David B. Robinson, M.D.
Juneau, Alaska

(Psychiatric News, March 7, 1997)