Special section: Health services research: Opportunities and challenges for psychotherapy researchers the promise and problems of psychotherapy research in a managed care setting

Psychotherapy research in managed health-care settings is discussed. Investigations of the relationships between amount of therapy and subsequent outcome adjusted by such patient characteristics as diagnosis, indicators of illness chronicity and severity, and social support markers are well suited to these settings. In addition, research on the effectiveness of treatment guidelines, treatment manuals, alternative therapies, and alternatives to therapy, is likely to be conducted in these companies resulting in potentially important applied results. Finally, investigations dealing with the selection and training of therapists and care managers would seem to be particularly relevant in managed care. Problems associated with the conduct of research in these settings are presented including lack of experimental control, demand characteristics, and the effects of business decisions on the collection and dissemination of data. On balance we conclude that managed healthcare organizations will be an important future source of naturalistic studies on the effects of psychotherapy.