For the first time in history, behavioral health providers are expected to understand and participate in activities intended to access and improve the quality of services they provide. This handbook is designed as a general resource in the field of behavioral health quality management for a very diverse group of readers, including graduate and undergraduate students, payors, purchasers and administrators within managed care organizations, public sector service system planners and managers, applied health services researchers and program evaluators. This volume provides a comprehensive context for the development of quality management (QM) in health services - behavioral health in particular - as well as an overview of tools, techniques, and programs reflecting QM in practice. It also offers perspectives on both internally- and externally-based QM activities.

The editors of the present volume were also privileged to collaborate on an earlier book, Intimacy, also published by Plenum Press. In our pref ace to that volume, we described the importance and essence of inti macy and its centrality in the domain of human relationships. After reading the contributions to that volume, a number of issues emerged and pressed for elaboration. These questions concerned the nature and parameters of intimacy. The natural extension of these con cerns can be found in the current work, Self-Disclosure in the Therapeutic Relationship. The editors, after careful consideration of the theoretical, philo sophical, and technical literature, are impressed by the relationship between intimacy and appropriate self-disclosure. Self-disclosure, in this context, refers to those behaviors that allow oneself to be suffi ciently revealing so as to become available for an intimate relationship. Levenson has referred to psychotherapy as the demystification of expe rience wherein intimacy emerges during the time that interpersonal vigilance diminishes through growing feelings of safety. Interpersonal experience can be demystified and detoxified by disclosure, openness, and authentic relatedness. This is not an easy process. Before one can be open, make contact, or reach out with authenticity, one must be available to oneself. This means making contact with-and accepting-the dark, fearful, and of ten untouched areas within the person that are often hidden even from oneself. The process of therapy enables those areas to gain conscious ness, be tolerated, and be shared with trusted others."

professional-standards-review organizations (PSRO) in defining quality of care for the Medicare program; it is a "shared responsibility of health professionals and government to provide a reasonable basis for confidence that action will be taken, both to assess whether services meet professionally recognized standards and to correct any deficiencies that may be found" (p. 14). Similar pronouncements have been made for the quality assurance activities of the Department of Defense's CHAMPUS program and of the 1980s successor to the PSROs, the federally designated peer-review organizations (PROs), established to ensure quality and utilization-efficient care for Medicare. Links between the federal and state gov ernments and between professional associations and private review entities have been developed to make this "shared responsibility" manifest in the delivery and reimbursement of health services. This responsibility is seen in light of both pro fessional and legal accountability, a view noted by Gibson and Singhas (1978) and Alger (1980). Accountability, then, becomes a concentric concept that elaborates on the pure view of quality and reflects the federal government's consumer protection activities during the 1970s. The Joint Commission on Accreditation of Hospitals (JCAH), which has pro vided another primary historical leadership role in defining quality assurance, has promoted the evolution of the concept of resource limitations as a part of the defini tion of quality assurance.

The editors of the present volume were also privileged to collaborate on an earlier book, Intimacy, also published by Plenum Press. In our pref ace to that volume, we described the importance and essence of inti macy and its centrality in the domain of human relationships. After reading the contributions to that volume, a number of issues emerged and pressed for elaboration. These questions concerned the nature and parameters of intimacy. The natural extension of these con cerns can be found in the current work, Self-Disclosure in the Therapeutic Relationship. The editors, after careful consideration of the theoretical, philo sophical, and technical literature, are impressed by the relationship between intimacy and appropriate self-disclosure. Self-disclosure, in this context, refers to those behaviors that allow oneself to be suffi ciently revealing so as to become available for an intimate relationship. Levenson has referred to psychotherapy as the demystification of expe rience wherein intimacy emerges during the time that interpersonal vigilance diminishes through growing feelings of safety. Interpersonal experience can be demystified and detoxified by disclosure, openness, and authentic relatedness. This is not an easy process. Before one can be open, make contact, or reach out with authenticity, one must be available to oneself. This means making contact with-and accepting-the dark, fearful, and of ten untouched areas within the person that are often hidden even from oneself. The process of therapy enables those areas to gain conscious ness, be tolerated, and be shared with trusted others.

For the first time in history, behavioral health providers are expected to understand and participate in activities intended to access and improve the quality of services they provide. This handbook is designed as a general resource in the field of behavioral health quality management for a very diverse group of readers, including graduate and undergraduate students, payors, purchasers and administrators within managed care organizations, public sector service system planners and managers, applied health services researchers and program evaluators. This volume provides a comprehensive context for the development of quality management (QM) in health services - behavioral health in particular - as well as an overview of tools, techniques, and programs reflecting QM in practice. It also offers perspectives on both internally- and externally-based QM activities.

Family and marital therapies are rapidly becoming highly used methods of treatment of mental disorders and are no longer ancillary methods to individual psychotherapy. The last few decades have brought about an increasing awareness of the fact that, excluding organic etiology, practically all mental disorders are caused, fostered, and/or related to faulty interpersonal relations. As a rule, the .earlier in life one is exposed to noxious factors, the more severe is the damage. Thus, early child-parents' and child-siblings' interactions are highly relevant determinants of mental health and mental disorder. Moreover, parents themselves do not live in a vacuum. Their marital interaction significantly contributes to their own mental health or to its decline, and parent-child relationships are greatly influenced by the nature of intraparental relationships. Parental discord, conflicts, and abandonment affect the child's personality development. Thus, family and marital therapy is more than therapy; it is an important contribution to the prevention of mental disorder. The present volume is comprised of three parts. The first, primarily theoretical, analyzes the fundamental aspects of marital and family therapy. The second part describes the various therapeutic techniques and the last deals with several specific issues. It gives me great pleasure to acknowledge my gratitude to my coeditor, Dr. George Stricker. Without his thorough and devoted efforts, this volume could not have come into being. I am also profoundly indebted to our consulting editors, Dr. James Framo, Dr.