Group Treatment with French-Speaking African Survivors of Torture and Its Effects on Clinical Engagement: Can Hope Be Operationalized?

This study examines the clinical engagement of French-speaking African survivors of torture by measuring how often they utilize adjunctive programmatic services (i.e., mental health, social, and legal services) in relation to their involvement with the Francophone support group. Thirty-two clients who attended at least five Francophone group therapy sessions were identified and matched with their counterparts who never attended the Francophone group. We compared the number of services the clients in the Francophone group and the control group utilized, controlling for the number of services the clients utilized before attending the Francophone group. We found that the Francophone group showed significantly greater overall programmatic engagement. For the types of services utilized, the Francophone group sought out more mental health services, but there was no significant difference in social and legal services. These findings suggest that involvement with the Francophone group can be linked to increased levels of programmatic engagement.     

Introducing humanistic group counselling for somatisation in a primary care practice: Preliminary findings

Can group counselling help patients who present with symptoms that cannot be explained medically? Preliminary results of working with one such group are reported. Six patients in a primary care practice were offered weekly sessions for half a year. The findings suggest that the patients attended all group sessions. The patients reported experiences known to be related to group counselling, and when the group ended, patient reports show that the severity of their problems was reduced significantly (p<.001). Furthermore, during the six months after the group ended patients significantly (p<.025) reduced their visits to their general practitioners. These results seem to call for wider use of humanistic group counselling with somatising patients and further research into the impact of such form of counselling.     

Inadequate Response to Therapy as a Predictor of Suicide

The role of response to cognitive therapy as a predictor of suicide was investigated by comparing 17 outpatients with mood disorders who committed suicide with 17 matched patients who did not commit suicide. The suiciders attended significantly fewer sessions of cognitive therapy and dropped out of therapy more frequently: 88% of the suiciders, compared to 53% of the controls, were rated by their therapists as requiring more treatment at termination. They also had higher levels of hopelessness at the termination of therapy. The results suggest that premature termination of therapy and inadequate response to treatment have unfavorable prognostic significance for eventual suicide.     

Amelioration of transference resistance: substitute therapists in milieu group psychotherapy

Building upon Wolf's (1949) notion of the use of an alternate session in group psychotherapy, this paper suggests that an alternate therapist substituting for an absent regular therapist in milieu group psychotherapy can facilitate similar therapeutic benefits. The mechanism of this process of overcoming transference resistance is seen as twofold: (1) sessions with a substitute therapist allow patients to confront the infantilization often present in a milieu setting and experiment with more autonomous ego functioning. (2) Sessions with a substitute therapist create conditions which are apart from the ongoing process of the therapy group, thereby allowing for a therapeutic splitting process to develop wherein transference feelings about the regular therapist can be expressed to his or her "alter ego." Several case vignettes are presented in order to illustrate the clinical utility of a substitute therapist.     

Development and maintenance of choice in a dynamic environment

Four pigeons were exposed to a concurrent procedure similar to that used by Davison, Baum, and colleagues (e.g., Davison & Baum, 2000, 2006) in which seven components were arranged in a mixed schedule, and each programmed a different left∶right reinforcer ratio (1∶27, 1∶9, 1∶3, 1∶1, 3∶1, 9∶1, 27∶1). Components within each session were presented randomly, lasted for 10 reinforcers each, and were separated by 10-s blackouts. These conditions were in effect for 100 sessions. When data were aggregated over Sessions 16-50, the present results were similar to those reported by Davison, Baum, and colleagues: (a) preference adjusted rapidly (i.e., sensitivity to reinforcement increased) within components; (b) preference for a given alternative increased with successive reinforcers delivered via that alternative (continuations), but was substantially attenuated following a reinforcer on the other alternative (a discontinuation); and (c) food deliveries produced preference pulses (immediate, local, increases in preference for the just-reinforced alternative). The same analyses were conducted across 10-session blocks for Sessions 1-100. In general, the basic structure of choice revealed by analyses of data from Sessions 16-50 was preserved at a smaller level of aggregation (10 sessions), and it developed rapidly (within the first 10 sessions). Some characteristics of choice, however, changed systematically across sessions. For example, effects of successive reinforcers within a component tended to increase across sessions, as did the magnitude and length of the preference pulses. Thus, models of choice under these conditions may need to take into account variations in behavior allocation that are not captured completely when data are aggregated over large numbers of sessions.     

A comparison of attachment outcomes in enactment-based versus therapist-centered therapy process modalities in couple therapy

Attachment issues are viewed by many therapists as lying at the heart of couple distress. It is critical to empirically validate therapy processes that facilitate couples in responding to each other's attachment needs. This study examined enactments as a therapy process and change mechanism to promote secure attachment in couple therapy. Sixteen couples were randomly assigned to 1 of 2 experimental groups--1 group received 3 therapist-centered sessions followed by 3 enactment-based sessions, and a second group received 3 enactment-based sessions followed by 3 therapist-centered sessions. To measure between-session and within-session change, each spouse completed presession and postsession measures of attachment security each week. Results showed that couples who received enactment-based sessions first reported greater increases in attachment security than those receiving therapist-centered sessions first. These same couples continued to show improvement after switching to the therapist-centered sessions. Conversely, couples who received therapist-centered sessions first did not increase attachment after switching to enactment-based sessions. For wives, enactment-based sessions produced the greatest improvement in attachment, yet both therapy process modalities led to some improvement. Conversely, for husbands, attachment improved only when they received enactment-based sessions first. Enactment-based sessions may therefore be more important for husbands than wives. Overall, with some qualification it appears that enactment-based therapy process may improve attachment more than a therapist-centered process. These observed trends and findings are generally consistent with previous research supporting use of enactments in couple therapy.     

Child and parental outcomes of a group parenting intervention for Latino families: A pilot study of the CANNE program

Criando a Nuestros Ni?os hacia el éxito (CANNE) is the Spanish adaptation of Parenting Our Children to Excellence (PACE). A pilot study conducted with 124 parents of preschoolers (mostly recent Mexican immigrants) provides preliminary evidence for the community acceptability and efficacy of CANNE. Eighty-eight of the 124 parents who enrolled in the program attended one or more of the 8 sessions (17% attended 1 session, 11% attended 2-4 sessions, and 72% attended 5 or more sessions), participated actively in sessions, and expressed high degrees of program satisfaction. Over time, parents improved on measures of harsh-inconsistent discipline, and children improved on social competence and social-communication skills. When high-versus-low attenders were compared, high attenders (parents who attended 4 sessions or more) reported greater increases than low attenders in their appropriate-positive parenting practices and clear expectations, and in their children's social competence and communication skills, and they reported greater decreases in their harsh-inconsistent discipline and in their children's aggressiveness and hyperactivity. Some of these changes were evident by the end of the program, whereas others became apparent (or stronger) over a 3-month follow-up period. These encouraging results point to the need for an efficacy study that assesses how well CANNE can help larger numbers of Latino parents in the important task of bringing up their young children in the United States.     

Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.     

The Love and Fear of Flying by Douglas D. Bond

A study of over 700 referrals for group therapy within a large university hospital setting revealed that such services were primarily provided for moderately to severely disturbed patients, mostly single white females from working and middle class backgrounds, university students, and unemployed, poorly educated minority group members. However, 41 percent of the patients initially referred never actually attended a therapy group. Among those who did begin group therapy, drop-outs occurred most frequently during early sessions. Over half the treated patients were seen for a total of twelve or fewer sessions. Data are interpreted as highlighting the importance of implementing careful referral and preparation procedures, and as underscoring the necessity for developing effective short-term group therapy approaches.     

The “WTL” model of cancer care

Family conference and oncology tutoring programs have been attended by 1,000 patients, family members, and support persons. Patients are taught to become active participants in their therapy, and families learn communication skills. Evaluation questionnaires reveal that ninety-four percent felt a significant improvement in family-patient communication. Ninety-three percent felt that personal needs related to the disease of cancer were accurately addressed. And ninety-seven percent indicated they would be referring others to the service.     

Level of alliance, pattern of alliance, and outcome in short-term group therapy

This study investigated the relationships between initial level of alliance, pattern of alliance over sessions, and outcome in a sample of 107 patients who completed short-term group therapy for complicated grief. Both patient-rated alliance and therapist-rated alliance were studied. For patient-rated alliance, both the initial level of alliance and the linear pattern of alliance were directly and significantly related to favorable outcome. For therapist-rated alliance, no significant direct relationships with outcome were found. Instead, significant interaction effects were found. For patients with relatively high initial alliance, the greater the increase in alliance over sessions, the better the outcome. For patients with relatively low initial alliance, the greater the decrease in alliance over sessions, the better the outcome. Explanations for the findings are considered as well as possible clinical implications.     

Subjective and reinforcing effects of smoking during negative mood induction

Two notions strongly held by many smokers are that negative mood increases smoking behavior and that this increase is due to the ability of smoking to alleviate negative affect. This study used a modified mood induction procedure to examine both the impact of smoking on induced mood, as well as the effect of induced mood on actual smoking behavior. Forty-eight smokers were randomly assigned to a smoking or a water-drinking comparison group. Each participant attended 3 sessions during which 1 of 3 mood states (positive, negative, or neutral) was induced. Contrary to expectation, smoking did not attenuate negative affect. However, negative mood induction subsequently quickened latency to smoke and increased number of puffs consumed ad lib.     

Assistance with learning competence and decision-making in schools and further education

721 first-year university students were asked about the amount of help they had received or might have received at their pre-tertiary institutions in developing their learning competence and in course/university/career decision-making. Over all items, nearly 30% felt they had been helped minimally, 40-45% slightly to moderately, and nearly 30% moderately to very much. They felt they had been helped most with learning competence concerns, less with their career and educational decision-making, and least of all with handling distracting personal worries. There were no significant differences by sex or by type of institution previously attended. The correlation between perceived amount of help and A-level scores was not significant. The implications of the findings are discussed in terms of the possible contribution of learning competence to attainment and the need for realistic educational and career decision-making.     

Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy

Premature termination from group psychotherapy continues to be a serious problem in the treatment of patients with borderline personality disorder (BPD). Qualitative research is regarded as an important means to shed light upon the complex dynamics leading to dropout. We conducted an interview study with patients having a diagnosis of BPD (n = 8) who dropped out from long-term group psychotherapy as a continuation therapy following intensive day treatment. The group therapists for these patients were interviewed as well (n = 12). The findings suggest the operation of many processes that contribute to dropout. Most significant appeared to be experiences of separation and loss of the day hospital that were not worked through and a failure of the group to regulate and contain the patients' affects. To integrate patients at risk of premature termination it seems necessary to pay attention to the strong negative emotions that they experience in the group. A higher treatment intensity than weekly group sessions may help to promote more beneficial group processes.     

An Investigation of the Rate and Predictors of Initiating and Attending Group Cognitive Behavioral Therapy for Insomnia After Referral

Although group Cognitive Behavioral Therapy for Insomnia (CBT-I) is an efficacious and well-studied treatment, relatively less is known about its clinical effectiveness in community outpatient settings. Prior research has suggested that dropout from CBT-I may be high in treatment settings vs. clinical trials. The current study therefore investigated the rates and predictors of initiating and attending CBT-I group within an outpatient psychiatry clinic. Participants were 75 consecutive outpatients presenting for treatment at a specialty sleep and anxiety clinic who completed an evaluation and were referred to CBT-I group. Participants completed self-report measures at initial evaluation, and their attendance throughout treatment was tracked. The majority of patients attended ≥1 session, with a mean of 3/5 sessions completed for initiators. Those with poorer global sleep quality and longer sleep onset latency were less likely to attend group and attended fewer sessions. Those with more severe anxiety and depression were less likely to initiate attendance and attended fewer sessions. The majority of patients referred to CBT-I initiated group and attended at least half of the sessions. Further, demographics do not seem to impact these rates. Unfortunately, those with the most severe symptoms, and thus in most need for treatment, are least likely to initiate and attend. This may be due to comorbid anxiety or depression symptoms. Future research should replicate these findings, as well as explore how to encourage those most in need of treatment to initiate and attend CBT-I.     

Mood acknowledgment and correction for the mood-congruency bias in social judgment

Past research has revealed a mood-congruency bias wherein people evaluate other individuals more positively when they are experiencing good moods than when they are experiencing bad moods. At times, however, people may attempt to prevent their transient mood states from biasing their evaluations of other people. It was proposed that the capacity to attend openly to one’s moods is an important precursor to such mood correction efforts. Two studies supported this hypothesis. People who were encouraged to attend to their feelings (Study 1), as well as people who are naturally inclined to acknowledge their feelings (Study 2), were more likely than their counterparts to prevent their positive and negative moods from biasing their judgments of a target person.     

Short‐term psychodynamic infant–parent interventions at Child health centers: Outcomes on parental depression and infant social–emotional functioning

Randomized controlled trials (RCTs) demonstrate efficacy of parent–infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short‐term Psychodynamic Infant–Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social–Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers’ questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect‐sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.