Protecting the therapeutic alliance in this time of changing health-care delivery systems.

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.