Working with bilingual patients in psychotherapy presents many unique problems. One such problem is a "here and now" split between both affective experiences and developmental issues that took place in the mother tongue and their availability for exploration in psychotherapy conducted in a second language. Previous theoretical material is reviewed and two additional models, one psychodynamic and one psycholinguistic, explaining this phenomenon are offered. Case material is presented to highlight both the affective split and the nonavailability of developmental issues in psychotherapy. Regression is discussed as an additional concept in approaching the language switching phenomena. Techniques to overcome these problems are offered.

Records of 52 Medicaid managed care psychiatric patients engaged in a home intervention program (HIP) were analyzed to determine (a) if home-based intervention reduced a participant's readmission rates to an inpatient behavioral health facility and (b) if a negative relationship existed between total HIP sessions and readmissions following the implementation of home-based services. A paired t test comparing admissions 6 months prior to HIP with admissions 6 months after HIP demonstrated an average decrease of readmissions by 2.5 (p < .0001), or 86%. These results supported the hypothesis that HIP reduces participants' readmission rates.

This article examines the issues associated with the current managed care delivery system for certification of mental health services, including pain management. Inconsistencies in dispositions having impacts upon patient care appear to be inherent in the current peer review certification system. Issues related to public assistance clients will be given particular attention. After introducing the issues, this article reviews the literature to survey what facets have been the subjects of academic research and reflection. It then presents case examples of inconsistencies, followed by recommendations for a model with checks and balances. In conclusion, creation of an independent monitor group is recommended.

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