Transference and Countertransference in a Third-Party Payment System (HMO)

The authors discuss the transference and countertransference reactions characteristic of a mental health service in a health maintenance organization. Among the transference issues considered of greatest interest are responses to payment premium rather than fee-for-service; attitudes toward the limited duration of treatment and the circumscribed return-to-function goals; reactions to the therapist and to the HMO as authorities; and the effects of being a clinic patient on one's self-image. The countertransference issues considered most significant include reactions by the therapist to being salaried rather than receiving fees for service; responses to self-exposure, peer review, and quality control; and alterations of the therapist's self-image related to such factors as his value system, cultural milieu, and therapeutic orientation.