Roy MacKenzie has made another important contribution to the group treatment literature in support of time-effective and diagnosis-related group treatment models. His previous books entitled Introduction to Time-Limited Group Psychotherapy and Effective Use of Group Therapy in Managed Care helped those of us working in and consulting to diverse clinical settings rethink the way we provided our services.

These earlier works gave us some direction on how the health care landscape was changing in regard to managed care, and they summarized the rationale and clinical justification for time-limited and diagnosis-related groups in a variety of settings. Now that a solid research base supports the efficacy of group treatment, including time-limited models, MacKenzie's current book builds nicely on his previous writings, addressing theory, clinical applications, and program development issues.

MacKenzie thoughtfully describes a generic model of psychotherapy applicable to group treatment that transcends any one theoretical focus and that recognizes the therapeutic forces at work in group treatment. It draws from interpersonal, dynamic, cognitive, and behavioral schools of thought. Most clinicians who have led groups in a variety of settings will quickly relate to the importance of this integrative approach in meeting the needs of diverse populations and clinical presentations.

Much of the book is devoted to a review of the theory and practice of time-managed group psychotherapy. Both experienced and novice group clinicians will appreciate the attention to detail and the specific suggestions about tailoring style and technique to the different stages of a group's life and members' behavior. It is refreshing to read about the importance of a continuum of leadership activity and the emphasis on the value of support and education. MacKenzie asserts that structure and a relatively higher level of leader activity can lessen group members' anxiety, make self-disclosure easier, and accelerate members' involvement. These are all critical issues in time-limited group experiences, where the opportunity for the gradual development of group process does not always exist.

The author supports massaging the interactional process and holding session debriefings to increase the likelihood of personal understanding and cognitive integration of the group experience. He encourages the use of homework, such as journal writing, to take learning outside the session. Depending on the group focus, a variety of cognitive-behavioral interventions are employed, such as training to challenge negative thinking patterns.

The final third of the book addresses systems issues in developing group programs. Included are a helpful readiness checklist, a review of several models of group therapy, and an appendix with useful forms, scales, and information sheets. The group therapy models apply the principles of the generic model to a range of purposes or topics, such as crisis intervention, eating disorders, and substance abuse. These sections are not how-to manuals, but rather helpful guidelines for experienced clinicians or novice clinicians receiving supervision.

Time-Managed Group Psychotherapy: Effective Clinical Applications is a valuable text for group clinicians and for those wishing to develop their group leadership skills. It presents an integrative model of thinking about groups and embraces the importance of diverse and flexible applications of group leadership skills. I also appreciate MacKenzie's acknowledgment of the importance of skill development, support, and outside-of-therapy activity, such as homework, to improve patient-client outcomes—issues all too often neglected in more traditional behavioral health care practice.

Dr. Villapiano is director of training and consultation for Innovative Training Systems in Newton, Massachusetts, and is in private practice in Newton.