ABSTRACT
Despite considerable professional activity by therapists and consultants over the years, and despite the quite unique conditions for mental health work in this important area, surprisingly little has been written about psychotherapy in the special setting of boarding schools. Although only 6 years have passed since I first wrote about the requirements and rewards of boarding-school work (Gottlieb, 1991), a near-revolution has occurred, profoundly although silently affecting these schools, students, therapists, and families alike. These often invidious changes have for the most part followed in the choppy wake of the transition of our national health care system toward a managed-care model. Along with effecting changes in the financial organization of health and mental health, managed care has brought complementary changes in the kinds of treatments available and, perhaps most significantly, in the prevailing models of emotional illnesses on which professionals rely. Furthermore, in pursuit of reductions in mental health care costs, managed-care monitors have turned to less qualified (at times to unqualified or under-qualified, and undersupervised) practitioners. Not only has quality of care suffered as a result, but the very concept of expertise itself (experience, qualification) has been undermined.
