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.     

Process and content in a long-term PTSD therapy group for Vietnam veterans

Process and content were studied in four 16-session segments of a psychodynamically oriented therapy group for Vietnam veterans suffering from posttraumatic stress disorder (PTSD). On the Group Climate Questionnaire (GCQ-S), the group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions than contrasting samples of neurotic and psychotic groups. There was no evidence of group stages. Topics related to symptoms of PTSD were discussed most frequently (43.1%), followed by issues concerning relations with others (32.4%),general group therapy issues (13.7%), and other topics (10.8%). Clinical implications of these findings are discussed.The authors thank Tom Metzler, M.A., and Heidi Ronfeldt, B.S., for their assistance with the data analysis.Parts of this paper were presented at the American Group Psychotherapy Association Annual Meeting, February 15–20, 1993, San Diego, CA.     

Abstracts

The demand for therapy groups for child sexual assault victims has risen as detection of abuse has increased, but little has been published about conducting and evaluating such groups. The authors present a comprehensive review of the literature and describe their sixteen-week therapy group with seven eleven- and twelve-year-old girls. Treatment themes, activities, group process issues, and psychometric findings on the Piers-Harris Children's Self Concept Scale and the Child Behavior Checklist are discussed. Suggestions for future groups and research are offered.     

The Life and Work of Sigmund Freud. Vol. III: The Last Phase by Ernest Jones

This paper describes the ward group, a modified version of group psychotherapy, designed for use in conjunction with comprehensive long-term treatment for severely disturbed adolescents and young adults. The authors examine the structural features of the ward group and discuss the group in relation to the unit and the hospital regarding such issues as membership, confidentiality, space, time, and ward group identity. The complex issues of task boundaries, the ward group as both an administrative unit and as a therapy group, are given special attention. The ward group transmits unit and hospital values and expectations, maintains behavioral controls over patients, exercises administrative decision-making authority, operates as a reflective–explorational therapy group, and represents an important means through which patients can achieve a sense of significance within the institutional setting.     

Living and dying with aids: Report of a three-year psychotherapy group

Group therapy is used to help patients deal with the painful emotional responses to Acquired Immune Deficiency Syndrome. This paper describes an ongoing group for persons with AIDS conducted for three years by the authors. Educative, supportive, and intensive psychodynamic models were combined in the group. Population characteristics, psychological issues, problems, and advantages of this group are discussed. This multi-modal approach has been found to be a useful and effective approach to the emotional problems of AIDS.     

Recent Developments in Psychoanalytic Child Therapy Edited by Joseph Weinreb

This article provides an annotated summary of 26 different procedures potentially useful in analyzing group therapy process, and includes an overview of therapeutic themes, research issues and clinical implications. The goal is to familiarize clinicians and researchers with the range of standardized and semistandardized procedures available for studying group interactions that have appeared in the literature during the past several decades. The authors concentrate on observer rating systems and do not systematically review self-report instruments. It is argued that the application of objective rating systems may foster greater understanding of group therapeutic interactions than is generally possible through normal clinical observations.     

Group Therapy, 1976: An Overview

This article discusses short-term group psychotherapy with individuals suffering from an adjustment reaction or reactive depression precipitated by genital herpes. The authors describe their experience in conducting and supervising six such therapy groups and describe several therapeutic factors that emerged as central in the treatment of this population. Among these factors are relief from isolation, the exchange of information, a challenge to defensive denial, exposure to new ideas and behaviors, an opportunity to explore the developmental issues that typically emerge, and the discussion of ethical issues.     

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.     

Control of the Mind Edited by Seymour M. Farber and Roger H. L. Wilson

Abstract

This article describes an innovative model of couples therapy designed to mitigate marital instability. The authors suggest that combining ongoing couples therapy with a separate relationship-focused group for each partner favorably impacts each person’s neuropsychophysiological regulation and their ability to participate in a stable intimate marriage.

The neurobiology of attachment theory is seen as providing understanding of the affect regulation issues operational in many couple relationships. The safe and secure attachments worked out in the relationship-focused group therapy are seen as improving neuropsychophysiological integration and regulation.     

Spontaneous Personality Synthesis in Group Therapy

Combined therapy is defined as concurrent dyadic and group therapy with the same therapist. This paper focuses on a neglected aspect of combined therapy: broaching and exploring this question with one's individual, patient. The author shows how raising this question: (1) alters the therapeutic field whether or not the patient joins; (2) can sharpen the therapist's understanding of the indications and contraindications for group membership; (3) offers untapped therapeutic approaches and opportunities to clarify issues in the individual treatment; and (4) stirs up countertransference issues related to issues of profitability, the transference of the patient in individual treatment, and the transference of the group-as-a-whole. Several case examples are provided.     

Feminist Issues in Couple Therapy

Abstract

The authors reviewed the feminist couple therapy literature from 1995 to 2006. They summarized this large body of work into several key themes. The first revealed that feminist couples therapists are continuing to discuss and deconstruct gender issues in couple therapy. The second showed that feminists believe that therapists should be educated both academically and personally about culture and diversity so as to support couples in their therapy around their own issues of diversity as well as learning to deal with issues of social justice as a couple. In the third theme, the authors introduced readers to feminists' emphasis on connection and empathy within couple and sex therapy. And, in the fourth, the authors explored feminists' work with power in couple therapy as they applied to couple therapy in general as well as around the specific topics of: balancing family and work and therapy for familial violence.     

Psychoanalytically oriented short-term groups for outpatients: Unsettled issues

The psychoanalytic approach to short-term group therapy for outpatients has been less prevalent than other approaches. Unsettled issues associated with this approach concern the feasibility of carrying out psychoanalytic work on an ongoing basis, patient selection, group composition, patient preparation, therapist technique, and cotherapy. Recent literature relevant to a conceptual consideration of these issues is reviewed. A vignette from a recent therapy group is presented as part of a clinical consideration of the issues. In addition, practical suggestions for conducting such groups are provided.This article was derived from a paper presented at the Seventh Annual Meeting of the Canadian Group Psychotherapy Association, October 16, 1986, Mont Tremblant, Canada.     

Three post-Vietnam “rap/therapy” groups: An analysis

An analysis is presented of the content and process over a one year's period of time of 81 sessions with three therapy groups of help-seeking Vietnam theater veterans. Data were collected concerning the frequency and content of the symptoms and issues that were discussed, the frequency and relationship of the discussion of current life issues versus Vietnam and pre- and post-Vietnam life issues, the predominant therapeutic themes that emerged in the groups, and the kinds of therapy interventions provided. Implications are discussed regarding the DSM-III inclusionary symptom criteria for post-traumatic stress disorder, and the structure and format to facilitate a combined rap and therapy group process with Vietnam veterans.The opinions of the authors do not reflect official Veterans Administration policy and should not be so construed.     

Reframing DSM-IV: Positive Strategies From Developmental Counseling and Therapy

Professional counselors in educational and mental health settings all must deal with so-called psychopathology. At issue is how can they work with “disorder” from a positive, developmental perspective? Developmental counseling and therapy (DCT) offers an approach to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994) classification systems that enables the reframing of severe client distress as a logical response to developmental history. Included are specific suggestions for positive case management and practice. Special attention is given to the interface of multicultural issues, etiology, and treatment. The authors maintain that if professional counselors take a developmental approach to a so-called disorder, the positive theoretical and psychoeducational integrity of the American Counseling Association can be maintained while working with the most difficult issues.     

Gender: A critical factor in a couples group

Couples group therapy should be considered as a primary treatment for marital couples whose dysfunctional interaction is rigidified and chronic. A gender-linked perspective for treatment is developed which expands a psychodynamic approach underscoring power as one of the central issues in marital conflict. Clinical vignettes from couples groups illustrate this model. A gender orientation facilitates the psychodynamic group process, decreases unrealistic expectations of the spouse, and encourages greater acceptance of male/female and individual differences. In this setting, individuals are able to develop new and more functional modes of interaction with their spouses, which generate an increased sense of empowerment.Excerpts from this paper were presented at the American Family Therapy Association meeting in Montreal, 1988.The authors gratefully acknowledge the helpful comments of Henry Grunebaum, M.D., and Fred Sander, M.D.     

Holding in mind: Theory and practice of seeing children in groups

ABSTRACT The authors will describe their therapy group for children in a Child and Family Consultation Centre. They will discuss the rationale for this treatment. An account will be given of the group processes with special reference to different feelings as they emerge in the transference relationships. Issues concerning the dynamics of co-therapy will be addressed. The work on the ‘reflective function’ by Fonagy and Target, which the authors think is an important contribution to understanding the therapeutic process in the group, will be discussed.

What literature there is on group therapy for children suggests that it is an effective form of treatment. This article describes the way in which the children's issues come alive in group therapy and in this way can be addressed quickly, in comparison with individual therapy where the process is sometimes slower. It will be emphasized that structure and boundaries are essential for containment of children so that psychoanalytic reflectiveness can take place. This reflectiveness includes understanding of the group process as well as the inner world of the child.     

Problems in Integrating Traditional Group Therapies with New Group Forms

The authors describe a range of critical issues that are common within homogeneously composed groups for patients suffering from Acquired Immunodeficiency Syndrome (AIDS) and AIDS Related Complex (ARC). They examine the need for these patients to understand their physical symptomatology, to reconsider life's priorities, and to confront their ethical and moral dilemmas. The authors also highlight special affects, unique group atmosphere and process, and the nature of the group contract that is essential for these patients.     

Trauma, Shame, and Group Psychotherapy: A Self Psychology Perspective

This paper attempts to define trauma from a self psychology/intersubjective perspective and explores shame as a basic aspect of trauma. Self psychologically oriented group therapy is examined as an effective treatment modality for dealing with issues of shame as well as the after effects of trauma.     

Group Therapy for Latency Age Black Males: Unplanned Interventions,Setting, and Racial Transferences as Catalysts for Change

This paper focuses on the special problems and processes encountered in organizing and running a group therapy program for black, latency age, male children within an urban school setting. The group chosen for presentation consisted of five boys (average age 11.8 years, range 11–13) and was run by two white clinical psychology interns (a male and female).

In the course of the group several important issues emerged which acted as catalysts for change. These included unplanned interventions, setting effects, cotherapy issues, and racial transferences. The findings and follow-up suggested that a modified expressive group psychotherapy approach can be successful in treating inner city black children.     

The issue of sexuality in group psychotherapy

Sexuality is an underlying, but often unspoken and ignored issue in group psychotherapy. Within the context of how a group reacts to and uses sexuality, the authors focus on three relationship areas: client/client, client/therapist, and therapist/therapist. Some of the hazards of failing to deal with sexually laden conflicts and intimacy issues in these relationships are explored. Some of the advantages of an open and honest approach to uncovering sexrole related stereotypes and behaviors are proposed. The authors attempt to demonstrate that recognition of therapists' and group members' sexuality must be appreciated as an important element in the therapeutic process.