Effective Use of Group Therapy in Managed Care

Effective Use of Group Therapy in Managed Care

K. Roy MacKenzie

Washington DC: American Psychiatric Press, 182 pp., 1994.

Managed care is clearly an area of current and growing concern for psychiatrists. Even in jurisdictions where managed care itself is not currently part of the practice climate, the containment of cost and measurement of efficacy of treatments are central to health care planning. In some ways it is surprising that a book like this has not appeared earlier, as the face validity of group therapy as a cost containment measure seems obvious.

This book is one of the American Psychiatric Press’ Clinical Practice Series and, hence, is a relatively succinct outline of both the potential role of group therapy in managed care systems, and some of the possible forms that such treatment systems may take. Thus, the book includes chapters on the rationale for group psychotherapy in managed care and an overview of managed care and competition. It also includes several chapters on various forms of group therapy systems that have been devised for such varying clinical populations as the seriously mentally ill, personality disordered patients, depressed patients and individuals who have experienced loss. There is, however, nothing dealing specifically with patients at either end of the age spectrum — children and adolescents, or the elderly.

The book draws on contributions from an impressive group of authors, and is, therefore, able to reflect in many ways the state of the art in group therapy systems. The editor, Dr. Roy MacKenzie, is an experienced and well-known group therapist who has worked in both Canada and the United States, giving him a useful perspective on managed care. The other authors include such highly respected names as Dr. William Piper, Dr. Howard Kibel and Dr. Walter Stone.

The strength of the book and its greatest value lies in its ability to challenge the reader to think creatively about service delivery in psychiatry and psychotherapy. Anyone who is looking at the issue of providing effective and efficient psychotherapeutic interventions for a patient population would be well-advised to consult this book, both for its usefulness in presenting what has been done and, hence, stimulating one to think creatively about service delivery, and for the ways that several of the authors have attempted to measure the effectiveness of their work. If one is thinking of setting up a new treatment system or trying to assess the effectiveness of an ongoing psychotherapy service, the chapters in this book provide useful models.

Despite its claim on the cover to “provide a solid understanding of how group programs work,” this book is not a textbook of group therapy. It will not help someone learn how to provide effective group therapy. It will instead help an experienced therapist expand his or her horizons. It is not an extensive examination of the technique, but rather an excellent overview of the possibilities of group therapy.

Group psychotherapy is frequently treated as the poor cousin of individual psychotherapy. MacKenzie’s book goes some way to show that group therapy may, in fact, have an extremely important role to play in the future, as we are increasingly forced to examine the efficiency and effectiveness of our treatments in psychiatry.