Use of didactic training and feedback to improve quality and acceptability of progress notes written by direct-care staff on a psychiatric inpatient unit

Writing progress notes represent a critical activity of practicing clinicians in a variety of settings. They provide a way for medical practitioners, insurance companies, and others to communicate in a timely fashion regarding ongoing clinical care. Previous research showed that intervention components like didactic training, using note templates, and feedback improved the quality of progress notes. At least two questions remain despite several studies already addressing progress note writing. First, previous research most often used multiple intervention components to improve progress notes. Thus, the relative impact of two common components of interventions, such as didactic training and feedback, is unclear. Second, previous research has not evaluated the acceptability of improved progress notes for the practitioners that actually utilize them. Thus, the purpose of the current study evaluated the components of didactic training and feedback on improved progress note writing for four direct staff employed by a psychiatric inpatient unit. A second purpose of this study was to evaluate the acceptability of the training procedures by both (a) the direct-care staff participating in this study and (b) four members of the psychiatric treatment team that used direct-care staff progress notes to inform their clinical care. Results showed that feedback was necessary to improve the accuracy of progress notes for three of four participants. The direct-care staff reported the training procedures as acceptable and the treatment team noted improvements in the quality of the progress notes after intervention. These data will be discussed in terms of ways to arrange effective training programs to improve direct-care staff's progress notes.     

Too close for comfort: the impact of dual relationships on group therapy and group therapy training

The healing power of psychodynamically oriented therapy and training groups rests, to a large degree, upon the quality of the here and now interactions. For the work to be effective, the basic principles of analytic group work need to be followed, including the observance of no extra-group contact. Simply said, nothing leaves the room. This principle has both ethical and clinical implications. It is my premise that while some forms of outside contact between members are relatively benign, other types are not. Outside contact that is built into the fabric and context of the group may pose a risk, as may be the case where dual relationships exist between members. The impact of dual relationships between group members in the particular instance of analytic training institutes is the focus of this article. What happens to the transference in this context when members reveal too much of their personal lives to each other through dual relationships is explored. It is suggested that extra-group contact can disrupt the balance between reality and transference distortion in group interactions in at least three ways: (a) "The Emperor's New Clothes" effect, (b) looping, and (c) gaslighting. Vignettes are presented to illustrate these phenomena and suggestions for reform are offered.     

Using presence to improve a virtual training environment.

In the rail industry, drivers must be trained to operate complex heavy machinery while responding appropriately to rapidly unfolding events in environments that are expensive and often dangerous to replicate in the real world. Virtual training environments (VTEs) can deliver stress exposure training to improve the decision-making skills of train drivers. Higher levels of recallable knowledge in the real world have been linked directly to the degree to which trainees have been engrossed in their VTE, an experience often measured through the concept of "presence." This paper reports on the use of presence to guide improvements to a VTE developed to deliver driver training in degraded track conditions. Two surveys were used to collect data on train drivers' introspective feedback on the level of presence created by the virtual rail environment and the simulator's effectiveness in generating immersion across a range of presence causal factors. Results indicate that using presence to investigate VTEs has practical significance. Outcomes provide direct information on where future improvements and modifications to the VTE can be made.     

Management of a dying patient in group therapy

In the last few years there has been an increased interest in the psychosocial aspect as well as in the therapeutic needs of the dying patient. Although much has been written about the treatment of the dying patient, most of these works were done in the individual setting, either with out-patients or with hospitalized patients. However, relatively little attention has been paid to the treatment and management of the dying patient in a group therapy setting. In this paper the authors describe their experience in working with a dying patient in an ongoing therapy group. The effect on the group, on the individual patient and on the therapist are discussed. Moreover, the conflicting needs of the individual patients versus those of the remaining group members are discussed and compared to similar reports from the group therapy literature.     

Joining with resistance: addressing reluctance to engage in group therapy training

Although research has documented the effectiveness of group psychotherapy, trainees are often reluctant to embrace this modality. This reluctance may reflect an informed choice based on knowledge, interest, and skill. Alternatively, reluctance may reflect misinformation or resistance due to conflicted feelings that arise from group dynamics. The latter are a major obstacle to the success of group therapy training and treatment programs. Understanding the origins of this reluctance and the developmental challenges of group therapy for trainees better equips supervisors to address this difficulty. This article uses case examples to illustrate how trainee reluctance emerges. It also provides strategies for working with hesitant trainees. The success of group therapy programs rests on the supervisor's ability to manage trainees' inhibitions to group therapy.     

Process variables mediating change in intensive group therapy training

This investigation is based on over 400 American Group Psychotherapy Association members involved in 41 intensive, two-day training experiences for mental health professionals. The participants completed a questionnaire immediately after their group sessions to evaluate the process and leadership variables that contributed to a constructive learning experience. A similar questionnaire was mailed to participants three to four months later to explore the impact of training on group interventions within their clinical practices. One third of the trainees responded to the follow-up survey. Overall, the findings suggest that successful outcomes are related to a range of group processes, such as self-disclosure, feedback, and interpersonal support, as well as personal qualities and technical expertise modeled by the leaders of the training groups. Both the immediate and delayed assessments demonstrate that the groups were regarded as highly valuable learning opportunities.     

Effects of individualized video feedback combined with group parent training on inappropriate maternal behavior

The effects of adding individualized video feedback (IVF) to Webster-Stratton's (2000, 2001) group-based parent training program (GT) were evaluated using a multiple baseline design across four mother-child dyads. During all phases of the study, inappropriate maternal behavior was recorded from videotapes of playtime with their preschoolers with developmental disabilities. Results suggested that GT+IVF reduced inappropriate maternal behavior to levels below GT alone.     

Optimizing group collaboration to improve later retention

In educational settings, collaborative learning and recall are often encouraged and sometimes required. Yet, we know very little about the cognitive processes that operate during collaboration, and how they can be optimized to improve later individual retention. The current study aimed to address this gap by testing how the operations of three cognitive processes during collaboration: (1) retrieval disruption, (2) re-exposure and (3) cross-cuing, influence the formation of individual and group recall strategies. Across two experiments, 252 undergraduates studied a word list and recalled it in a Collaborative–Collaborative–Individual–Individual (CCII), an Individual–Collaborative–Individual–Individual (ICII), or an Individual–Individual–Individual–Individual (IIII) sequence. A 40-min delay was inserted early (CC-delay-II, IC-delay-II and II-delay-II; Experiment 1) or later in the recall sequence (CCI-delay-I, ICI-delay-I and III-delay-I; Experiment 2) to assess the differential benefits of different recall sequences. Regardless of where the delay occurred in the recall sequence, both collaboration conditions (CC and IC) benefited later individual recall to a greater extent than the individual recall condition (CCII > III and ICII > IIII). Repeated collaboration (CC) generated greater post-collaborative recall benefits than single collaboration (IC) when the delay was inserted early in the recall sequence (CC-delay-II > IC-delay-II), but the benefits were equivalent when the delay was inserted later in the recall sequence (CCI-delay-I–ICI-delay-I). Implications for future research and educational applications are discussed.     

Listening to the adolescent therapy group

This article reviews traditional psychodynamic views of listening to the manifest and latent content of the patient's communication. It then reviews the literature on the application of such listening in group treatment. The particular application of such listening and intervention in groups for adolescents with significant ego deficits is explored.     

Individual differences in response to unfavorable group feedback

The purpose of this study was to examine how individual differences in repression—sensitization moderate the effects of negative feedback in task groups. Seventy-eight research participants, organized into 26 simulated task groups, were asked to work as a team on a series of anagram problems. Participants received either unfavorable individual or team feedback concerning performance. It was predicted that the direct threat associated with individual feedback would increase defensiveness among repressors. This hypothesis was supported; that is, repressors, in comparison to sensitizers, denied the group task as a measure of ability and effort and reported lower attraction to the task and group. It was predicted further that the indirect threat of team level feedback would increase defensiveness among sensitizers. This hypothesis was also supported. Here sensitizers, in comparison to repressors, denied the task as a measure of ability and effort and indicated lower attraction to the task and group. Additional analyses of covariance revealed that the cognitive processes associated with self-attributions (i.e., ability and effort) mediated the reports of task and group attraction. Theoretical and practical implications of these findings and directions for future study are also discussed.     

An evaluation of group therapy for adolescents using social skills training

The present study investigated the hypothesis that social skills training is more effective in increasing socially acceptable behaviour in adolescents than is a generalized or non-specific form of group therapy. Forty-two subjects were selected to participate in the study from among adolescents referred for group therapy at two youth guidance clinics in Brisbane, Australia. The 23 males and 19 females were randomly assigned to one of three treatment conditions: a social skills training group, a non-specific therapy group and a waiting-list-for-therapy (control) condition. All subjects were assessed before and after treatment on five measures of social skills. Subjects in the social skills training group showed significant improvements on three of these measures while the non-specific therapy and waiting-list control groups showed no specific changes on any of the measures.