Acceleration of the therapeutic process with group

This paper deals with the impact of adding group to individual treatment of patients with neurotic character problems and attempts to illustrate the efficacy of this dual approach. The formidable task for the individual therapist is to make these patients see that their habitual ways of reacting are pathological and stem from repressed intrapsychic conflicts. This task is facilitated in a group in a number of ways since the group setting becomes an arena that affords wider therapeutic scrutiny. Having become aware that behavioral characteristics disguise anxiety, other group members initiate independent efforts to extract the underlying meanings for their fellow members. Their interventions are often more effective and acceptable because they are less likely than the therapist to be perceived in the projected image of the bad parent.Copyright, 1980, Washington Square Institute for Psychotherapy and Mental Health, which published this paper in No. 7 of the Group Psychotherapy Monograph Series, after the paper had been presented at the Seventh Annual Conference of the Group Psychotherapy Department.     

Training in group-analytic psychotherapy in Europe

Group-analytic psychotherapy focuses on the making and maintaining of close, emotionally fulfilling relationships. Its practitioners attempt to fuse an individual and a whole-group perspective, and seek to provide the enabling conditions for freer communication between group members. The group-analytic approach is widely used in the United Kingdom, and many experiential groups on psychotherapy training courses are conducted on group-analytic lines. The Institute of Group Psychotherapy in London recognizes eight one-year courses in England and Scotland specifically oriented to group-analytic theory and methods. These courses provide an introduction to group psychotherapy to over 300 professionals of varied backgrounds every year. There are also two courses in the United Kingdom that provide a full training in group-analysis and group-analytic psychotherapy, and 11 courses on the continent of Europe. The number of courses is growing and there is now a European Group-Analytic Training Network providing formal links between them. Results of a postal survey indicate that few (10%) attenders at a one-year course have a negative response and that many (85%) recommend the course to colleagues. The efficiency and therefore reduced cost of group teaching and the incorporation of a group experience may be contributing factors to the increasing demand for this type of training.This paper is based on a presentation at an Open Session on Training in Group Psychotherapy: The Quest for a Viable Model at the American Group Psychotherapy Association Annual Meeting, Boston, February 1990. This paper represents the author's own views and is not an official statement of the Institute of Group Analysis [London]. However, members and staff of the Institute have made helpful contributions to the author in preparing it. He is especially grateful for the assistance of Mrs. Liesel Hearst (Chairperson, Overseas Training Sub-Committee, Institute of Group Analysis, London), Dr. Keith Hyde (Convenor, Manchester Course in Group Psychotherapy), Fr. Jim Christie (Convenor, Glasgow Course in Group Psychotherapy), and Dr. Vivienne Cohen (Chairperson, Training Committee, Institute of Group Analysis, London, in preparing this paper. The questionnaire study was conducted with the assistance of the Training Section of the North-Western Regional Health Authority.     

Books

Why Marriage? . Edward E. Ford (with Robert L. Zorn) Basic Approaches to Group Psychotherapy and Group Counseling . George M. Gazda, editor. Charles C Thomas Writing Behavioral Contracts: A Case Simulation Practice Manual . William J. De Risi and George Butz A Handbook of Non-Verbal Group Exercises . Kenneth T. Morris and Kenneth M. Cinnamon. Charles C Thomas Student Power: Practice and Promise . Glorianne Wittes, Joan Chesler, and Dale Crowfoot Alternative Teaching Strategies: Helping Behaviorally Troubled Children Achieve . Marshall S. Swift and George Spivack     

Combining group psychotherapy and pharmacotherapy: a survey

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their "typical" outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication. Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.     

Comparing the effectiveness of behavioral treatment for chemotherapy-induced nausea and vomiting when administered by oncologists, oncology nurses, and clinical psychologists.

Adequate control of side effects during medical treatment of cancer increases patient compliance and quality of life. Antiemetic drugs are not an effective treatment for the one in three cancer patients on chemotherapy who experience anticipatory nausea and vomiting (ANV); the behavioral treatment of systematic desensitization has been found effective for ANV when delivered by clinical psychologists. This study examined the effectiveness of systematic desensitization when delivered by medical personnel versus clinical psychologists. Seventy-two consecutive cancer patients with ANV were randomly assigned to no-treatment control or to systematic desensitization from 5 behaviorally trained clinical psychologists, 6 clinical oncologists, or 10 oncology nurses. The treatment was found effective in reducing anticipatory nausea, anticipatory vomiting, posttreatment nausea, and posttreatment vomiting compared to control patients, with no significant differences in effectiveness found between clinical psychologists and oncology staff. Although medical personnel should not engage patients in psychotherapy or other interventions that cannot be completed successfully, they can treat patients effectively with systematic desensitization and should be encouraged to learn and use this and other behavioral intervention techniques to benefit total patient care.     

The effectiveness of university counselling for improving academic outcomes and well-being

The work discusses the effectiveness of the counselling treatment to enhance student academic success. The participants were randomly assigned to either an experimental group (66 students who had completed counselling treatment) or a wait-list comparison group (44 students). The Adult Self Report (ASR) by Achenbach and Rescorla [2003. Manual for the ASEBA adult forms & profiles. Burlington, VT: Research Center for Children, Youth, & Families, University of Vermont] and the Outcome Questionnaire 45 (OQ-45) by Lambert and Hill [1994. Assessing psychotherapy outcomes and processes. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 72–113). New York: John Wiley] were applied before and after the counselling sessions. Data show statistically significant decrease in the ASR clinical scales for both internalising and externalising problems after counselling as well as in the OQ-45 scores for distress symptoms and relationship difficulties. Compared with the control group, the students who received counselling exhibited a significant recovery regarding their progress with their studies.     

The capacity to join in the group process

This paper explores the difficulties certain individuals have in joining the interactional processes that make a group work. It explores the sequelea of traumatic early failures in need mediation, notably the encapsulation that renders them unresponsive to efforts by fellow group members to engage them. An uncanny similarity to holocaust victims is observed. Illustrative case examples are cited and suggestions for treatment offered.This paper was part of a symposium entitled Love and Hate in Group Therapy presented at The 11th International Congress of Group Psychotherapy, Montréal, Quebec, Canada, August 1992.     

Effects of Equine-Facilitated Psychotherapy on Post-Traumatic Stress Symptoms in Youth

Equine-assisted therapy has become an increasingly popular complementary mental health treatment approach, but there is limited empirical research assessing the effectiveness of this practice. In particular, equine-facilitated psychotherapy has many potential benefits for the treatment of trauma in youth. The purpose of the proposed study was to investigate changes in levels of post-traumatic stress symptomatology and levels of the human-animal bond in children and adolescents ages 10–18 over the course of a 10-week equine-facilitated psychotherapy (EFP) intervention. Youth in the treatment group (n?=?36) participated in 10 weekly two hour EFP sessions, and were compared on changes in post-traumatic stress symptoms with a control group of participants (n?=?32) who continued to receive the already existing traditional therapeutic services provided by their treatment facility or outpatient therapist. Findings suggested a significant decrease in post-traumatic stress symptoms across the intervention for both the treatment and control group, but the treatment group did not decrease significantly more than the control group. These findings suggest that EFP may be an effective additional treatment modality for post-traumatic stress symptoms, but there was no evidence from this initial study that EFP was significantly more effective than traditional office-based therapy. Further research and discussion of the relative benefits of EFP compared to traditional treatment modalities is warranted.     

Book reviews

Margaret Robinson, Family Transformation Through Divorce and Remarriage. A Systemic Approach
Froma Walsh and Monica McGoldrick (eds), Living Beyond Loss: Death in the Family
Rudi Dallos, Family Belief Systems, Therapy and Change
Lone Jacobsen and Peter Vesti, Torture Survivors – A New Group of Patients
W. Robert Beavers and Robert B. Hampson, Successful Families: Assessment and Intervention
Gregory Max Vogt and Stephen T. Sirridge, Like Son, Like Father: Healing the Father–Son Wound in Men's Lives
Douglas Hooper and Windy Dryden (eds), Couple Therapy: A Handbook. Open University Press Psychotherapy Handbook Series
Peter Stratton, Michael Preston-Shoot and Helga Hanks, Family Therapy: Training and Practice     

Researcher and clinician: Role conflict and resolution

Group therapy investigations are often conducted by researchers rather than by experienced clinicians who also possess research expertise. Given the fact that doctorally prepared clinicians must demonstrate research competence in their education programs, it is surprising that there is not more research on group therapy. The literature indicates that research and group psychotherapy practice are considered quite separate entities. However, there is much that both processes have in common. The principal investigator's experience during a group psychotherapy research project suggested that the conflict between the roles of researcher and clinician may not be due to differences in the external processes but rather to difficulties in trying to combine them within one person. The value of the researcher-clinician is elaborated, and recommendations are offered.This paper was supported by a grant from the Group Psychotherapy Foundation.     

Systems-centered training groups' process and outcome: a comparison with AGPA institute groups

In this quasi-experimental study we compared the process and outcome of six experiential Systems-Centered Training (SCT) groups to those of American Group Psychotherapy Association (AGPA) Institute groups from two prior studies (MacKenzie, Dies, Coche, Rutan, & Stone, 1987; Tschuschke & Greene, 2002). The SCT training compared well overall and the results provided preliminary, indirect support for the usefulness of "functional subgrouping" - SCT's conceptual and methodological bridge between the group-as-a-whole and the individual member. However, quasi-experimental design limitations make other interpretations equally plausible. Within-group change in the process variables for the SCT groups was also explored, as well as the relative contributions of these variables to post-training learning outcomes and anxious and depressive experience. The results partly corroborated prior studies, but also suggested that SCT may alter training group dynamics, learning, and emotional experience in ways consistent with SCT theory.     

Dynamically oriented group therapy with alcoholics: Making it work despite the prevailing bias

A bias exists in the psychiatric community against dynamically oriented group therapy with alcoholics. The basis for this bias lies primarily in negative experiences of practitioners who have attempted to use traditional therapy with alcoholic patients who continued to drink. At Appleton Outpatient Clinic, we have found that dynamically oriented group therapy is a highly suitable treatment modality for alcoholic patients when negative biases of treators can be addressed and when initial preparatory work is done with patients. This preparatory work includes: (a) building a working alliance around abstinence and providing adequate supports to make this possible; (b) explicit contracting that establishes clear treatment goals and consequences should the goals not be met; (c) preparatory short-termgroup experiences.This paper was presented at the 1988 annual meeting of the American Group Psychotherapy Association.     

Self-help groups at the turning point: Emerging egalitarian alliances with the formal health care system?

Review of the historical development and current status of mutual aid self-help groups (SHGs) in the U.S. The SHGs social movements received an impetus from the 1987 Surgeon General's Workshop. Some alliances forming to link SHGs with the health care system are described. The Workshop recommended principles to guide these alliances. What direction will linkages actually take? Professional or bureaucratic cooptation and control of SHGs? Professionals can take a stand to respect SHG autonomy and self-determination. Professionals need training about SHGs. Research is needed on usefulness of experiential knowledge created and disseminated in SHGs and their social movement aspects.     

Outcomes of specific interpersonal problems for binge eating disorder: comparing group psychodynamic interpersonal psychotherapy and group cognitive behavioral therapy

We assessed whether an attachment-based treatment, Group Psychodynamic Interpersonal Psychotherapy (GPIP) had a greater impact compared to Group Cognitive Behavioral Therapy (GCBT) on Cold/Distant and Intrusive/Needy interpersonal problems. Ninety-five individuals with Binge Eating Disorder (BED) were randomized to GPIP or GCBT and assessed at pre-, post-, and six months post-treatment. Both therapies resulted in a significant decrease in all eight interpersonal problem subscales except the Nonassertive subscale. GPIP resulted in a greater reduction in the Cold/Distant subscale compared to GCBT, but no differences were found for changes in the Intrusive/Needy subscale. GPIP may be most relevant for those with BED who have Cold/Distant interpersonal problems and attachment avoidance.     

Worksite Stress Management with High-Risk Maintenance Workers: A Controlled Study

This study evaluated effects of a worksite stress management/health promotion program with primarily minority blue-collar employees showing a number of high-risk health behaviors. In a biopsychosocial approach, participants were assessed with a standardized health risk appraisal that included physical and behavioral variables, plus measures of self-control, health attitudes/satisfaction, and other factors. A controlled group design was employed with pretreatment, treatment, posttreatment, and three-month follow-up. Participants were randomly assigned to a wait-listed control group (n = 26) and a health promotion intervention group (n = 24). The latter received a multimodal intervention including stress management training, educational workshops and counseling, and a self-directed behavior change program. Following posttreatment assessment, the control subjects were given treatment and their data were then added to that of the initial treatment group to comprise a total group of treatment finishers (n = 33). The results revealed a number of significant differences between the two groups at posttreatment and/or for the treatment finishers across time (pretreatment vs. posttreatment and/or follow-up), including certain of the physical and behavioral measures, self-efficacy, and some health attitudes, but no effects for job-related measures, such as absenteeism and job satisfaction.     

Patterns of coping with cancer.

We identified five patterns of coping in a sample of 603 cancer patients: "seeking or using social support," "focusing on the positive," "distancing," "cognitive escape-avoidance," and "behavioral escape-avoidance." Relationships of these coping patterns to sociodemographic characteristics, medical factors, stress appraisals, psychotherapeutic experience, and emotional distress were tested using correlational and regression techniques. Type of cancer, time since diagnosis, and whether a person was currently in treatment had few or no relationships to coping. The specific cancer-related problem (e.g., pain, fear of future) was also not associated with how individuals coped. Perceptions of its stressfulness, however, were related to significantly more coping through social support and more of both forms of escape-avoidance. Coping through social support, focusing on the positive, and distancing was associated with less emotional distress, whereas using cognitive and behavioral escape-avoidance was associated with more emotional distress. Implications of the results for understanding coping processes and intervention with cancer patients are discussed.     

An Introductory Course in Group Psychotherapy in The Netherlands: Use of a Knowledge-Sampling Test

Abstract

We offer comments regarding two articles in this issue, one titled “Bridging the Practitioner-Scientist Gap in Group Psychotherapy Research” and a complementary article providing the results of a survey, entitled “A Survey of Canadian Group Psychotherapist Association Members” Perceptions of Psychotherapy Research.’ We also make several recommendations for collaborative research between practitioners and scientists, such as the inclusion of clinicians on the research team, practice research networks, and improved approaches to communicating clinically relevant research findings. Also discussed are reflections and recommendations from the authors’ experience as scientist-practitioners.     

The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction

Insomniacs commonly complain that they are unable to get to sleep at night due to unwanted thoughts, worries and concerns. The present study investigated whether brief training in identifying and elaborating an interesting and engaging imagery task for use during the pre-sleep period can reduce unwanted pre-sleep cognitive activity and sleep onset latency. Forty one people with insomnia were given one of three instructional sets to follow on the experimental night; instructions to distract using imagery, general instructions to distract, or no instructions. Based on previous findings reported by Salkovskis & Campbell (1994) 'Behaviour Research and Therapy 32 (1994) 1' and ironic control theory (Wegner, 1994) 'Psychological Review 101 (1994) 34', it was predicted that (1) "imagery distraction" would be associated with shorter sleep onset latency and less frequent and distressing pre-sleep cognitive activity compared to the "no instruction" group and that (2) "general distraction" would be associated with longer sleep onset latency and more frequent and distressing pre-sleep cognitive activity compared to the "no instruction" group. Support was found for the first but not the second prediction. The success of the "imagery distraction" task is attributed to it occupying sufficient "cognitive space" to keep the individual from re-engaging with thoughts, worries, and concerns during the pre-sleep period. In addition, "imagery distraction" involved a very specific alternative cognitive task hence the operating process was given a feature positive search, conditions where mental control is likely to be achieved.     

A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

Modification of Hostile Interpretation Bias in Depression: A Randomized Controlled Trial

Interpretation Bias Modification (IBM) is gaining attention in the literature as an intervention that alters cognitive biases and reduces associated symptoms. Forty, primarily college-aged, non-treatment-seeking adults with major depressive disorder (MDD) were randomly assigned to receive either IBM targeting hostile interpretation bias (IBM-H) or a healthy video control (HVC) condition. Compared to those in HVC, participants in IBM-H reported more benign interpretations and fewer hostile interpretations at posttreatment. No difference in depressive interpretation bias was found between groups at posttreatment. IBM-H led to improved anger control at posttreatment and follow-up compared to HVC, though no effects of condition were found on trait anger or depressive symptoms. The IBM-H group perceived their treatment as less credible than the HVC group. For individuals with high expectancy of treatment success, IBM-H led to lower posttreatment depressive symptoms compared to HVC, while findings trended in the opposite direction for those with low expectancy of success. Overall, these preliminary findings point to boundary conditions for the efficacy of IBM protocols for anger and depression and potential improvements to be made to future IBM protocols.