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This paper gives an overview of group psychotherapy in Norway: the history, approaches in use, programs for systematic training, how group services are financed, and finally how practice and research are integrated in the public mental health system.

The purpose of the study was to compare the effectiveness of 4-day versus 5-day day hospital (DH) treatment and to document effectiveness based on a large sample size. Participants were 801 patients, diagnosed with an eating disorder, who participated in DH treatment from 1985 to 2009. The study followed a sequential cohort ABA design. Higher intensity DH was associated with higher rates of abstinence from bingeing and vomiting and larger improvements in depression and body dissatisfaction. Higher intensity DH provided no consistent advantage in rates of weight restoration or improvement on other indices of psychological functioning. These findings suggest that the optimal intensity of treatment may vary depending on treatment goals, but 5-day DH is recommended for eating disorders.

Developmental concerns and sociocultural expectations may keep female patients and therapists from addressing financial issues openly in group psychotherapy. Interpersonal theory provides a different view of nurturing that may help women leaders deal better with financial discussions in group. This paper includes a review of the literature on group psychotherapy and fees; feminist literature relevant to leadership; money management in group therapy; countertransference; and case examples.

Managed Care has had a significant impact on delivery systems for mental health services. Direct and indirect persuasion to provide more cost-effective treatments has been one consequence. The cost-saving qualities and the effectiveness of group interventions have produced clear expectations for an increased use of therapy groups. This study compared perceptions and uses of group treatments on a national sample of managed care organizations and mental health providers. Because group psychotherapy encompasses such a broad definition, five specific types of group interventions were defined: problem-focused homogenous, process-oriented heterogeneous, psycho-educational, self-help, and short-term groups. Implications of differences and similarities between directors of managed care organizations and treatment providers are examined and discussed across five response categories (familiarity/training, perceived effectiveness, likelihood of reimbursement/referral, daily use, and expectation for future use).

The changes in health-care financing that have taken place over the last decade have spurred interest in finding innovative ways of delivering services at manageable cost levels. It comes as no surprise that increased interest and research have focused on group therapies as a major vehicle for reaching large numbers of people in need of psychological care that is brief, effective, and cost-efficient. More specifically, practitioners in the field of substance abuse have long recognized the value of group experiences as an integral part of the recovery and rehabilitative process. The influence of managed care to contain costs has added new incentives to expand the existing knowledge base in group treatment of addictions to comply with reduced funding and time constraints.

Group psychotherapy has proven effective in treating an impressive array of specific problems. Clinical experience has also shown its utility in alleviating the more general, and very costly, alienation and pain with which the human condition is often fraught. Recent changes in health care delivery reflect a marketplace that emphasizes cost containment, brevity and specificity of treatment, and a narrowed focus of training. Techniques are often valued above relationships. In this climate, we are in danger of losing sight of group therapy's deeper promise; the experiential lesson that human beings must move toward each other with involvement and a commitment to understanding in response to the inevitable difficulties that arise as we share time, space, and resources.

This Presidential Address examines the current health-care situation, focusing on group therapists and patients. Psychodynamically inclined practitioners emphasize that group treatment effectiveness is related to the quality and strength of the "therapeutic alliance". But the empowerment of provider-administrators to determine treatment availability can undermine the treatment bond, so vitally needed for effective and efficient therapy! Although health-care costs have increased rapidly and need realistic containment, the importance of the group-therapist bond must be enhanced rather than minimized since it contributes to favorable therapeutic results. The final section addresses some possible approaches to protecting treatment.

There is increasing interest in the application of brief group psychotherapy to treat a wide variety of patient conditions. This paper reviews a selected set of controlled and comparison studies of brief, outpatient group treatment with adults, and considers findings that support the effectiveness of this approach. Authors discuss barriers to the use of brief group interventions and make recommendations regarding increased utilization of this approach in managed mental health settings.

The structure of health care delivery is in a period of rapid change. An understanding of psychotherapy service use patterns indicates the importance of time categories as well as the relevance of group techniques. Traditional interpersonal and psychodynamic group techniques may be modified for time-limited use without sacrificing basic values and with demonstrated effectiveness. Adapting to a more fiscally stringent practice environment requires the clinician to undertake a difficult process of transition. As professionals our task is to prepare ourselves for this challenge and to let the health care system know that proper practice guidelines are necessary to achieve effective treatment for our patients.

This article responds to K. Roy MacKenzie's Presidential Address, which concerns the challenge of mental health reform as it effects group psychotherapy. Issues of the time-effective use of groups for specific patient populations are explored. The need for practice guidelines that benefit from outcome studies is emphasized. In addition, the efforts of the National Registry of Certified Group Psychotherapists to support group therapy within the current managed care environment are explicated.

This article reviews some of the health care issues raised by K. Roy MacKenzie. The author identifies additional contributors to spiralling costs and offers a slightly different perspective on the issue of the efficacy of short-term time-limited psychotherapy. In particular, the author raises questions regarding the cost-driven aspect of today's health care delivery system versus quality of care. He also challenges some of the research findings used in support of MacKenzie's argument that short-term time-limited group therapy is as cost-effective as long-term individual psychotherapy. More specifically, he considers how resistance and the sense of hopefulness might influence the favorable outcomes of the studies cited in MacKenzie's article. In addition, the relationship between short-term psychotherapy and managed care abuse is addressed and a partial solution to preventing such abuse by legislating public accountability is offered.

Money may be the most upsetting and therefore the most avoided topic in group psychotherapy. To overcome this resistance, the leader must secure prospective members' willingness to speak openly about financial matters. Financial issues particular to group therapy emerge when money is normalized as a topic for discussion. These include lowering or not raising fees, rescheduling, leaves of absence, combined and conjoint therapy, and nonverbal behaviors. Several case examples are provided. Members' strong feelings toward the leader around financial transactions often find expression in angry accusations. Suggestions for dealing therapeutically with countertransference reactions to these accusations are offered.