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 settling was a university clinic providi ng treatment for an inner-city population. Health delivery and staff dynami cs made it difficult to conduct clinical research in this treatment-oriente d setting. The nonrandom design allowed for patient choice, with few client s attending more than two group sessions, thus decreasing its impact. Manag ed-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 use d to understand the failure to adequately test the effectiveness of waiting -list group therapy. Recommendations are offered to investigators who conte mplate conducting clinical research with limited resources.