Archipelago- I forget where you said you live, but in Boston, NYC and much of the northeast, insurance seems to dictate how psychiatrists can run their practice. Even if it doesn't fit with their own preferences, if a psychiatrist wants to be accessible to a large population and make a good living, they need to follow the insurance company guidelines. I too believe that it makes more sense to receive your whole treatment from one provider- if you take psych meds but need therapy I'd prefer to get it from the same person, and I'm sure many others would too. I think thats why psychiatric nursing has picked up as a profession in my area, because that is precisely what they do- meds and therapy. And its cheaper for the insurace co's...

I think everyone's success in therapy will depend on what they want to get out of therapy and what is a good fit for them. I think oftentimes the practical issues of time, cost and provider availability make psychoanalysis less appealing to some people (especially today when everyone wants such fast results). I don't think people doubt the effectiveness, but with the other factors I mentioned, many patients and providers just don't have the time or patience to really commit to intense analysis. With the availability of therapies like CBT and DBT that work for so many people, then it seems natural to go with it. It makes even more sense with all the demand we have on us with work, family, social obligations, etc.,.

I also think many T's, analysts or psychiatrists, whatever we want to call them, combine approaches according to their clients needs and wants. So unless there is a pathology that responds very strongly to one approach- such as DBT for borderlines, I think many practitioners are flexible in their approach. I realize true psychoanalysis is intense and therapists/doctors need training in it. But for the most part, I think many in the field don't want to commit to just one style of therapy since their client's needs can vary so widely.