Abstract
This four part article is concerned with how health care delivery settings (private sector versus managed health care), affect psychotherapists' practice style. Following general comments about the revolution in the American health care delivery system and its effects upon psychotherapy, individual clinicians from the disciplines of nursing and counseling psychology compare their personal experiences of working in both HMOs and private practice. In the final section, data from interviews with 43 HMO psychotherapists are summarized. Those with private practice experience reported that some of the ways in which their practice styles differed between the two settings were as follows: flexibility and limitations of treatment parameters; financial incentives, dealing with therapeutic dependency; therapist's awareness of time; freedom of patient selection; messages of health; therapist's activity level in the transference; collaboration of mental health professionals; and history taking. The authors conclude that in order to be fully understood, psychotherapy must be studied within its environmental context, or "ecological niche." Defining appropriate treatment parameters (the quality, quantity, and cost effectiveness) of psychotherapy as well as consideration of the positive effects of managed health care upon the evolution of psychotherapy should be considered.