This paper examines the relationship between clinical psychology and the health care system. The first part reviews the empirical Axis I disorders with patients who also have a comorbid DSM-IV diagnosed personality disorder. While the understanding and treatment of AI disorders have improved, severe limitations exist when patients use the health care system to pay for any other psychological treatment. The second section uses findings from the first section to discuss the status of clinical psychology's relationship with the health care system. Three perspectives on this relationship are offered. An important focus of this section is the observation that clinical psychologists are not powerless against managed care. Because many psychologists cannot see their own value they allow themselves to be controlled by the health care system. This can lead to an inability to treat patients in a health conscious, ethical, and legal manner. This managed care psychotherapy mindset is also prevalent in graduate programs today. This mindset could be changed if practitioners and students will take a stand for themselves and the integrity of the profession, and not accept the substandard limitations placed on them by the health care system. (Contains 46 references.) (JDM)