Developing the matrix representation grid (MRG): A method for observing group processes. Findings from time-limited group psychotherapy for alcohol-dependent patients

The MRG was published 1988 in order to support developments in group psychotherapy methods as one of the all too few process observation research methods for studying group-as-a-whole. After 9 years of what pilot studies have labeled successful clinical trials, this study aims at validating the MRG against the established SAVI: Structural Analysis of Verbal Interaction (Agazarian & Simon 1989). Videotaped group sessions from short-term groups for alcohol dependent patients conducted along two therapy methods, one behaviorally oriented and the other group analytic, are used as material. The MRG is validated in the study, confirmed to be clinically valuable, and some interesting comparisons between the two treatment modalities are also made.     

Psychological support needs of patients with head and neck cancer and their caregivers: A qualitative study

Objective: The aim of this study was to explore the psychological support needs of patients with head and neck cancer (HNC) and their caregivers. The appropriate timing, length, format and content of sessions were also investigated.

Design: Eighty-three patients with HNC and 73 of their caregivers completed questionnaires at diagnosis. Follow-up questionnaires were mailed to patients six months later.

Main outcome measures: Free text-comments to open-ended questions in the questionnaires were analysed using an inductive thematic approach with coding and theme development directed by the content of responses. This was used to determine psychological support needs both at diagnosis and at six month follow-up.

Results: Patients described ‘just being there’, empathy, maintaining normality and practical support as helpful from family/friends. They desired information, honesty, positivity and empathy from clinical staff. Formal psychological support was desired by approximately 40% of patients and caregivers, particularly early after diagnosis and during treatment. Most participants desired face to face sessions, providing individualised information and coping strategies.

Conclusion: The results of this study suggest that psychological interventions for patients with HNC and their caregivers should be delivered early after diagnosis in face to face sessions, presenting honest and factual information about the disease and coping strategies.     

Process and Content in a Therapy Group for Bipolar Outpatients

Although the literature suggests that homogeneous therapy groups are useful for bipolar outpatients, little is known about the process in such groups. Using the GCQ-S and a content analysis of discussion topics, we evaluated group process during the first 31 sessions of an outpatient bipolar group. Compared with normative samples, our group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions and in the anxiety/tension scale. Furthermore, 81% of the discussion topics were related to the three group goals, and an additional 18% dealt with general group issues such as orienting new members and attendance. The results from this pilot study suggest that bipolar patients can discuss relevant issues in a homogeneous group environment that is cohesive, open, and safe.     

Group process in short-term outpatient therapy groups for schizophrenics

The short form of the group climate questionnaire (GCQ-S) was used to evaluate process in three 12-session therapy groups for outpatient schizophrenics. Results showed no difference on the Engaged dimension between the short-term schizophrenic groups and either a normative sample of outpatient neurotic groups or the first 26 sessions of a long-term outpatient schizophrenic group. However, the short-term groups scored significantly lower (p<.001) on the Avoiding and Conflict dimensions as compared with either long-term sample. The session-to-session GCQ-S dimension pattern did not support the presence of sequential group stages, but there was a tendency for the Engaged scores to increase and the Avoiding and Conflict scores to decrease as time went on.The authors gratefully acknowledge K. Roy MacKenzie, M.D., and Don Brown, M.D., for their helpful comments regarding this paper. Parts of this paper were presented in a poster session at the American Group Psychotherapy Association Annual Meeting in New York, February 8–12, 1988.     

Effect of Short-Term Training on Reaching Behavior in Infants: A Randomized Controlled Clinical Trial

The purpose of this study was to test the effect of short-term training on reaching behavior in infants at the onset of reaching. The study was a single-blind, parallel group design, randomized controlled clinical trial. Thirty healthy infants were randomly assigned to a social control group (n = 15) or a reaching training group (n = 15). Infants began the study up to 3 days after the onset of reaching and were assessed three times across 2 days: pretraining (before training), posttraining 1 (after 1 session of training), and posttraining 2 (after 3 sessions of training). The reaching training group received 3 sessions of training by a physical therapist while the control group received a similar amount of time sitting in the therapist's lap. The data were analyzed using repeated-measures analyses of variance, and independent-samples tests with Bonferroni adjustments. Short-term training resulted in increased frequency of object contacts, shorter and smoother reaches, and improved hand positioning. The few short training sessions likely provided opportunities for infants to explore and learn to select movements from their existing movement repertoire. These results demonstrate that adaptive changes in infants' novel behaviors can emerge rapidly, and highlight the need for increased understanding of how to most effectively time early interventions.     

Play Therapy in Elementary Schools: A Best Practice for Improving Academic Achievement

This pilot study of 1st graders who are academically at risk examined the effectiveness of child‐centered play therapy (CCPT). The experimental group received biweekly, 30‐minute play therapy sessions for 8 weeks. Findings indicated that these 1st graders participating in CCPT (n = 21) demonstrated a statistically significant increase on the Early Achievement Composite of the Young Children's Achievement Test (Hresko, Peak, Herron, & Bridges, 2000) when compared with children in the control group (n = 20). Results support using CCPT as an intervention for academic achievement.     

Feasibility and impact of a school-based intervention for families of urban adolescents with asthma: results from a randomized pilot trial

The purpose of this study was to test the feasibility and short-term outcomes of Asthma: It's a Family Affair!, a school-based intervention for adolescents with asthma and their caregivers. Twenty-four ethnic minority families with a middle school student with asthma were randomized to immediate intervention or no-treatment control. Intervention students received six group sessions on prevention and management of asthma. Caregivers received five group sessions teaching child-rearing skills to support the youth's autonomy and asthma self-management. All students attended all sessions; caregivers attended an average of three. Two months post-intervention, relative to controls, intervention caregivers reported better problem-solving with children. Intervention students were more responsible for carrying medication, took more prevention steps, and woke fewer nights from asthma. The intervention resulted in positive short-term changes in family relations, asthma management by students, and health status.     

Effects of Group Activity Play Therapy on Problem Behaviors of Preadolescent Ugandan Orphans

This randomized controlled study examined the effectiveness of group activity play therapy (GAPT) with 60 displaced Ugandan orphans, ages 10 to 12 years, exhibiting clinical levels of behavior problems. Teachers and housemothers reported that experimental group children demonstrated statistically significant reductions (p < .025) in behavior problems compared with children in the active control condition and that GAPT demonstrated moderate to large treatment effects. Results support GAPT as an effective intervention for troubled Ugandan orphans.     

Group Session Rating Scale: Preliminary psychometrics in substance abuse group interventions

Background: Although ultra‐brief outcome and process measures have been developed for individual therapy, currently there are no ultra‐brief alliance measures for group therapy. Method: The current study examined 105 clients in group therapy for issues related to substance abuse or with issues related to the substance abuse of a significant other. We tested whether a newly developed group therapy alliance measure – the Group Session Rating Scale would be related to other commonly used group process measures (Working Alliance Inventory, Group Cohesion, Group Climate) and early change (change over the first four sessions of group therapy). Results: The findings provided support for reliability based on Cronbach alphas and test‐retest coefficients. Additionally, the GSRS was a one‐factor measure that was related to other group process measures as well as predicted early change. Discussion: Clinical implications for how to utilise ultra‐brief outcome and alliance measures are provided.     

The Prophylactic Mastectomy Dilemma: A Support Group for Women at High Genetic Risk for Breast Cancer

The goal of this pilot study was to test the usefulness of a six session psychoeducational support group for women at high genetic risk for breast cancer who were considering prophylactic mastectomy. The themes of the group sessions included overestimation of and anxiety about risk; desire for hard data; the emotional impact of watching a mother die of breast cancer; concerns about spouse reactions; self- and body image; the decision-making process; and confusion over whom to trust in decision making. Both the participants and the multidisciplinary leaders concluded that as a supplement to individual counseling, a support group is a beneficial and cost-effective treatment modality. Recommendations for the optimal format for such a group are described.     

Small and unfilled psychotherapy groups: Understanding and using them effectively

Many open-ended psychotherapy groups have fewer than five members, and fewer than the number the therapist considers necessary for the group to be filled. This paper discusses the rationale for starting such groups and the special dynamics of running them. It then suggests strategies for the therapist to use in maximizing their therapeutic effectiveness. Suggestions are made for further research into the demographic and dynamic aspects of such groups.     

Evaluation of a Peer-Led Mutual Support Group for Chinese Families of People with Schizophrenia

Family interventions in schizophrenia have shown positive effects on patients but little attention has been paid to their effects on family members, particularly those in non-Western countries. This randomized controlled trial evaluated the effectiveness of a bi-weekly, 12-session, family-led mutual support group for Chinese caregivers of schizophrenia sufferers over 6 months compared with standard psychiatric care. It was conducted with 76 families of outpatients with schizophrenia in Hong Kong of whom 38 were assigned randomly to either a mutual support group or standard care. Families' psychosocial health status and patients' symptom severity and length of re-hospitalizations at recruitment, one-week and 12-month post-intervention were compared between groups. Results of repeated-measures mixed model indicated that the mutual support group experienced significantly greater improvements in families' burden, functioning and number of support persons and length of patients' re-hospitalizations at two post-tests. The findings provide evidence that mutual support groups can be an effective family-initiated, community-based intervention for Chinese schizophrenia sufferers.     

Evaluation of a psychosocial intervention on social support, perceived control, coping strategies, emotional distress, and quality of life of breast cancer patients

The purpose of this research was to demonstrate that a specific psychosocial intervention changes reactions to cancer and quality of life. This study was carried out on 66 patients with a first breast cancer. Patients were randomly divided into two groups: a specific intervention group (G1, 8 sessions) or a support group (G2, 8 sessions). A control group (G3) was composed of patients who refused to participate in psychological intervention. Social support, perceived control, repression of emotions, coping strategies, emotional distress, and quality of life were assessed one week before (T1) and at the end (T2) of the psychological intervention. Results showed that G1 did not have significantly modified quality of life or psychological scores. Patients of G2 had poorer emotional quality of life, use of internal causal attributions, and minimized their illness at T1 as compared to patients of G3. At Time 2 these differences were not observed.     

Kurz- und Langzeitbehandlung in der Verhaltenstherapie

In Germany, short and long-term psychotherapy are the two established forms for providing basic outpatient cognitive behavior therapy. The goal of the current study is to describe and discuss empirical evidence for these two structural forms; therefore, results from randomized controlled trials are presented and their implications related to the optimal number of therapy sessions are described. Furthermore, important results of naturalistic process outcome research are outlined. Additionally, the individual needs of patients for specific numbers of sessions are described based on data from the Association of Statutory Health Insurance Physicians. The results of randomized controlled trials generally showed strong empirical evidence for the efficacy of short-term cognitive behavior therapy of 7–20 sessions in patients with simple diagnoses; however, there is less empirical evidence in relation to the general efficacy and differential indications for long-term behavior therapy. These study results are supported by data from 200,000 patients receiving outpatient treatment in the German healthcare system. In two thirds of these patients, less than 25 sessions were sufficient to achieve subjectively adequate clinical improvement; however, approximately 10?% of the patients needed more than 60 therapy sessions. Empirical evidence concerning outcomes of long-term therapy with such a high number of sessions is scarce. Future research should address this research gap in order to identify empirically-based individual adaptation rules concerning the optimal number of treatment sessions in long-term therapy.     

Group therapy with schizophrenic patients: a short-term, homogeneous approach

The author presents a short-term, homogeneous model for treating schizophrenic patients in discussion-oriented therapy groups. Typically, patients attend nine sessions in the open inpatient groups and 12 sessions in the closed outpatient groups. The two goals of this co-therapy approach are to help patients cope with psychotic experiences and improve their interpersonal relationships. Discussions focus on hallucinations, delusions, loose associations, and maladaptive relationships, and anxiety-producing topics are avoided. The format is interaction-oriented and emphasizes the here and now. Empirical evidence supports the value of this short-term group therapy approach when it is used in conjunction with antipsychotic medications and long-term follow-up.     

“Social Separation” Among Women Under 40 Years of Age Diagnosed with Breast Cancer and Carrying a BRCA1 or BRCA2 Mutation

We conducted an exploratory, qualitative study investigating experiences of women who had developed breast cancer under the age of 40 and who were identified as BRCA1 or BRCA2 mutation carriers. These germline mutation carriers face an increased lifetime risk of a second primary breast cancer and an increased risk for a primary ovarian cancer. Thirteen women who fit this criteria participated in three focus groups conducted at a major cancer center in the UK during Spring 2003. We asked broad, open-ended questions that allowed for a wide range of responses about their cancer and genetic testing experiences, physical and psycho-social concerns, family and partner reactions and their need for social support. The women expressed feelings of devastation, loneliness, feeling different and isolation, ambivalence about having to support family members, worries about partner’s anxiety and depression, and anxiety about talking to family members, especially children. These feelings were stronger after the cancer diagnosis and compounded by the genetic test results that occurred at a later time. We also found that, at least temporarily, the women experienced what we call “social separation”—emotional distance from, or dissonance with groups they interact with or are part of, e.g., family and friends, frequently leading to a reduction in communication or a change in previously unstated, but accepted normal interaction. We concentrate on a few characteristics of social separation—feelings of aloneness, isolation and separation, use of silence and verbal discretion, the relationship between estrangement and kinship interaction and norm disruption, and are looking at social patterns of interpersonal relationships that may occur when risk and illness statuses are new and framing and feeling rules have not as yet been clearly developed due to a cultural lag.     

‘Them’ and ‘us’: The experiences of women with metastatic disease in mixed-stage versus stage-specific breast cancer support groups

The objective of this study was to explore the experiences of women with metastatic breast cancer (MBC) in mixed-stage and stage-specific groups. Interpretative phenomenological analysis (IPA) was used to examine 15 interviews from eight women with MBC. The interviewees felt that their experiences were very much different from those of women with primary breast cancer (BC), because of their different prognoses. In mixed-stage groups, the interviewees described feeling silenced, marginalised and helpless. They did not receive support in these groups because survivors of primary BC are often afraid to face the idea of metastasis. In stage-specific MBC groups, on the other hand, women were able to talk openly and were understood by others with whom they identified. They became more informed about issues related to their illness. Seeing others living well despite MBC made them feel more hopeful. Although there are some disadvantages of participating in stage-specific groups, the findings suggest that, overall, stage-specific groups are more helpful to women with MBC than mixed-stage groups. These findings have implications for the provision of group support for this population.     

Group therapy for eating disorders: A step-wise approach

Group therapy is emerging as a favored treatment for eating disorders. Open-ended psychodynamic group therapy is an effective treatment for the underlying conflicts in eating-disordered patients, yet these groups are difficult to form. The authors suggest a specific sequence using time-limited psychoeducational groups initially for symptom control, then offering an open-ended group for patients who are ready to address deeper issues in a group therapy setting.