This chapter identifies and examines the many layered concerns about managed mental health care concentrating on the problems that are unique to manage mental health care and how they affect the field of psychotherapeutic practice. The term managed health care does not necessarily conjure up an image of a healthy robust human being. Spurred by the enactment of the US Health Maintenance Organization Act of 1973, managed care for mental health services has now become a predominant feature in the United States. The notion that psychotherapy is designed for the intellectually endowed and privileged wealthy fosters the idea that it is a luxury and not a necessity for mental health. The claim of managed care services is that it enhances access to care and does so in a more timely and appropriate manner than financially restrictive, traditional fee-for-services. Managed mental health care organizations are run as businesses that provide services.