Her interests include the study of cultural and personality factors as they influence psychotherapeutic processes and results.

Dose-effect and duration comparability studies provide direction for effective time guidelines for outpatient psychotherapy. Current managed care approaches appear inappropriate in emphasizing usage rather than effectiveness curves. Guidelines are suggested for basic, intermediate, and extended treatment with different goals, dosages, and managed care policies.Probably the most controversial feature of managed mental health care is limiting the duration of outpatient psychotherapy (Herron, 1992;Lowman, 1992). The advantages and disadvantages of this policy have been described by Haas & Cummings (1991). This article reviews the empirical evidence that can be used to provide time guidelines for effective outpatient treatment.Although there are a limited number of studies, and they are restricted in their comparability by differences in methodology, they do provide direction for establishing more effective policy than currently exists. Essentially they suggest that a variety of results can be accomplished with different dosages (duration) of psychotherapy. Thus the most effective policy would be a function of the desired goals that in turn are endorsed by the society in its establishment of funding plans for outpatient psychotherapy.

Studied 12 measures of process-reactive schizophrenia to determine their relative effedveness in predicting outcome defined as symptomatic improvement. Each patient ( N = 144) was rated on the process-reactive measures and a t 3-and 6-month intervals on the Present State Examination to evaluate symptom change. Major findings were that the Ego-Strength, St.age of Illness, Kantor, Langfeldt, paranoid and chronicity criteria failed to predict outcome successfully. The first four criteria do not appear to be suitable processreactive measures when the distinction is based on symptom change. However, paranoid-nonparanoid and chronic-acute criteria merit further invest.& gation. The Ullmann-Giovannoni, Social Competence, Phillips scales, and marital status predicted outcome accurately a t both 3and 6-manth evaluations. The Phillips scale was the single best predictor of outcome at 3 months, while marital status was the best at 6 months. Overall, the Phillips scale waq the most powerful and useful predictor of outcome.

Divided schizophrenics into reactive and process groups (20 males and 20 females in each group) on the basis of three criteria: Premorbid adjustment, role orientation, and paranoid‐nonparanoid status. All were administered the Defense Mechanism Inventory, which measures five clusters of defenses. Reactives had significantly higher scores than process patients on Turning against Self and Projection. Process patients had significantly higher scores on Reversal. No significant differences between groups were found on Turning against Object and Principalization, nor were there significant sex differences. The results support the probability of different defensive preferences for the reactive and process syndromes.

This article examines the relationship between psychotherapy funding policies and concepts of mental health. Three levels of mental health-necessity, improvement, and potentiality-are proposed. Necessity represents basic adaptation, the current dominant level illustrated by brief psychotherapy funded through managed mental health care. Improvement is the phase beyond necessity aimed at prevention and heightened quality of life, and potentiality is the ideal. The latter two now receive limited funding and emphasis. At question are both economic and social policies that endorse a narrow rather than a broad conception of mental health.