The revolution in the delivery of and payment for medical care in the United States is dramatically transforming the theory and practice of psychotherapy. Psychotherapists, like their physician counterparts, are being asked to become cost-effective, and therefore time-efficient, in the delivery of their services. In addition, they are being asked to generate outcome data to substantiate their clinical effectiveness. There is little doubt that many physicians, health-care personnel, and psychotherapists will find economic survival more difficult, if not impossible, in their current roles. Training programs must respond to these changing demands on practitioners in order to increase the likelihood of their surviving in these tumultuous times.

For much of this century of psychotherapy, psychotherapists have enjoyed the luxury theoretical debate. In what has been amusingly described as a "dogma eats dogma" environment, various therapist have proclaimed the superiority of their theoretical approaches. Although meta-analytic studies have demonstrated the relative equivalence of several approaches (Lambert & Bergin, 1994), and
well-designed comparisons of several schools in the treatment of depression (Klerman, Weissman, Markowitz, Glick, Wilner, Mason, & Shear, 1994) have yielded little difference in the aggregate, psychotherapy debates continue, but with lessening fervor.

Over the past quarter-century, the movement to integrate the psychotherapies has accelerated (Norcross & Goldfried, 1992). Clinicians drawn more by patient needs than by theoretical allegiance have attempted to assimilate potential concepts and techniques from a variety of different schools in order to provide efficient treatment for their patients. Eclecticism has given way to several different integrative approaches, which hold the promise of providing a practical framework of decision points associated with a limited number of potentially effective strategies and techniques applicable to varying patient needs.

Among psychotherapy researchers debates abound between those who support experientially validated therapies (EVTs) and those who emphasize process variables, particularly those variables that the patient brings to therapy. This training program builds upon the process research paradigm by emphasizing the capabilities of the trainees as they proceed through the learning curve. Instead of claiming trainees are trained or indoctrinated into a specific orientation, this approach tires to build on trainee strengths and experiences by evoking and sharpening already present psychotherapeutic skills and knowledge. Like their patients, trainees vary in the critical process related to being successful in therapy , such as readiness to change, social network strengths, and ability to form therapeutic alliance.

There are currently three existing categories of training in psychotherapy. Most training programs fall in the first category. These programs appear to be rather disorganized in their conceptual presentation of psychotherapy, allowing different teachers and professors to present their own perspectives on psychotherapy through supervision and didactic seminars, and implicitly suggesting that trainees should put the ideas and techniques together in a way that suits them personally.