A systems analysis of a failure to test the effectiveness of waiting-list group therapy

This nonexperimental effectiveness study attempted to evaluate the utility of a brief waiting-list group. The setting was a university clinic providing treatment for an inner-city population. Health delivery and staff dynamics made it difficult to conduct clinical research in this treatment-oriented setting. The nonrandom design allowed for patient choice, with few clients attending more than two group sessions, thus decreasing its impact. Managed-care pressures decreased staff cooperation with our research objectives, resulting in very low return rates in testing and follow-up data. A social systems analysis, highlighting staff and institutional ambivalence, is used to understand the failure to adequately test the effectiveness of waiting-list group therapy. Recommendations are offered to investigators who contemplate conducting clinical research with limited resources.