Group psychotherapy treatment of borderline personalities.

Borderline personalities have been treated in psychotherapy groups for over 40 years. This article elaborates some of the characteristics pertinent to the treatment of these patients. Combined treatment of group and individual therapy addresses the needs for object constancy, the integration of object and self representations, and the possibility of attachment to others. Collaboration with individual therapists in this process is essential and there are specific conditions that allow this to occur as well as guidelines to help them make referrals. Cotherapy can be especially beneficial if the cotherapy team is knowledgeable and experienced. The group therapist must have special training and supervision to conduct groups of such intensity and affectively laden content.     

A Critique of Group Therapy Research

In this randomized clinical trial, we compared time-limited group psychotherapy and time-limited individual psychotherapy. Ninety-eight nonpsychotic psychiatric outpatients participated. There were five therapists, all highly experienced with brief therapies. Significant improvement and maintenance of improvement occurred in both treatments. Although both treatments were quite beneficial on a number of our subjective measures, there was a clear preference by patients for the individual therapy. Recommendations are offered for improving the acceptability of group treatment approaches.     

A controlled study of effectiveness and patient suitability for short-term group psychotherapy

A controlled, clinical trial investigation of short-term psychoanalytically oriented group psychotherapy (STG) was conducted which included eight psychotherapy groups led by experienced therapists. Patient psychological mindedness (PM) was investigated as a selection criterion and prognostic variable. Seventy-nine psychiatric outpatients experiencing prolonged or delayed grief reactions were matched for level of PM and then randomly assigned to STG or a wait list. There was repeated measurement of several areas and sources of outcome. Results indicated a strong main effect for STG but not for PM on outcome, and minimal evidence for an interaction effect. Benefits were maintained at six-month follow-up. Psychological mindedness emerged as highly predictive of attrition. A clinical discussion is presented wherein the efficacy of STG is considered as reflecting a good patient-treatment match.     

Countertransference in Activity Group Therapy

A controlled, clinical trial investigation of short-term psychoanalytically oriented group psychotherapy (STG) was conducted which included eight psychotherapy groups led by experienced therapists. Patient psychological mindedness (PM) was investigated as a selection criterion and prognostic variable. Seventy-nine psychiatric outpatients experiencing prolonged or delayed grief reactions were matched for level of PM and then randomly assigned to STG or a wait list. There was repeated measurement of several areas and sources of outcome. Results indicated a strong main effect for STG but not for PM on outcome, and minimal evidence for an interaction effect. Benefits were maintained at six-month follow-up. Psychological mindedness emerged as highly predictive of attrition. A clinical discussion is presented wherein the efficacy of STG is considered as reflecting a good patient—treatment match.     

Die Therapie-Vorbereitungsgruppe

There are different kinds of pretraining for psychotherapeutic treatment. They have two objectives: to get future patients in the right frame of mind for the imminent psychotherapy by informing them about the treatment, and to support therapists while clarifying the indication and selecting patients. Pretherapy training for group psychotherapy is frequently offered in Anglo-American countries. So far empirical studies have only partly been able to prove the supposed positive effects of pretraining on process and outcome of psychotherapy treatment, particularly as the studies showed profound flaws with regard to methods and pretraining concepts. The “Therapie-Vorbereitungsgruppe” presented here is a pretherapy training group in the run-up to inpatient group psychotherapy at a German university clinic. In Germany, such groups are rarely offered. The “Therapie-Vorbereitungsgruppe” consists of weekly meetings of therapists of a psychotherapeutic ward and applicants for inpatient treatment. Ward members introduce the applicants into the concept of treatment and the treatment setting and they explore the psychological background of each of the applicants. Besides economical the concept has clinical and therapeutic advantages. Future inpatients get a realistic view of the treatment, they can build up a relationship to other inpatients and to therapists, and besides waiting for the admission to the clinic is made more bearable. Therapists are helped with their decision on the admission. The concept has proved itself in clinical practice for many years. The empirical proof of its effectiveness and a comparison with other, similar concepts fall due.     

Outcome in short-term group psychotherapy

This study examines the effectiveness of planned dynamic short-term group psychotherapy in a health maintenance organization setting. The groups, conducted by experienced short-term psychodynamically trained therapists, focused on common life-stage issues. A pretest/posttest design was employed; group participants completed a battery of self-report measures before, after, and 4–6 months after treatment. Group participants made statistically (and clinically) significant positive changes on the majority of change measures. They saw themselves as improved on target problems, became far less symptomatic, and reported considerable growth in interpersonal functioning.     

Where Is Group Treatment Going in the 21st Century?

The author contends that group psychotherapy can be a dynamic force for social change. He shows how group psychotherapists have developed tools that reach far beyond the limits of that particular profession; they deal with the basic interaction among all peoples everywhere in all societies. These tools can be demonstrated, taught, and experienced. In as much as they can be learned, group therapists have to start teaching them to people at the earliest levels of cognitive development. That means that it has to start in our school systems as part of the educational process. A particular kind of specialist has to be trained who can function within the system itself and yet think psychodynamically. The author maintains that this can be accomplished.     

Working with Racial Themes in Group Psychotherapy

Racial themes frequently emerge in group psychotherapy but are often unaddressed by therapists. Confusion about the relevance of race to the psychotherapeutic process, countertransferential responses, and a lack of training in how to address racial content contribute to therapists' reluctance. Approaches to addressing racial content in groups are examined. Case examples are used to demonstrate therapist characteristics and perspectives on the group process that create a climate where racial content can be explored. An exploration of the meaning of racial content provides an opportunity for deepened understanding of interpersonal relationships for patients and therapists.     

A group therapist perspective on self-help groups

The author provides an overview of self-help groups in terms of their origins, growth, scope, and effectiveness, and then compares these groups with professionally conducted psychotherapy groups. A framework for evaluating group helping systems is proposed which includes five principal dimensions: the helping group as a social microcosm; technological complexity/simplicity; psychological distance/closeness between helper and helpee; specificity/generality of help methods; and differentiation versus nondifferentiation among participants. The author concludes his article by recommending four strategies for how group therapists can contribute to self-help groups.     

Selbsthilfegruppen im Rahmen stationärer psychotherapeutischer Behandlungen

Psychosomatic in-patient treatment applies a combination of various methods in order to facilitate learning by insight and corrective emotional experiences in a therapeutic community. The establishment of a self-help group on the ward can be a useful complementary element in such a comprehensive approach. However, empirical research on this specific topic does not yet exist. Based on clinical experience, necessary preconditions as well as the pros and cons of integrating self-help into professional treatment are described. The assessment of 850 patients in a clinic for psychosomatic medicine and psychotherapy concerning a self-help group on the ward are presented. Relationships between patients’ evaluation of the self-help group and various other variables as well as the overall treatment effect were studied. Empirical data provide evidence of a differential effect of the self-help group on the ward: the majority of the patients experienced the self-help group as useful. Whether the patient is able to benefit from group therapy seems to be an intermediate variable and the therapists’ attitude towards self-help groups also seems to play an important role.     

Management of intense countertransference in group psychotherapy conducted in situations of civic conflict

Conducting group psychotherapy in a situation of intractable conflict such as Northern Ireland activates turbulent emotional dilemmas within psychotherapists and group members alike. Professional practice and therapeutic zeal must struggle daily to survive the stark encounter with the reality of a regressive and primitive psychology and on occasion may succumb to atavistic tendencies, dragging relationships down to primitive levels and leaving connections broken. In this article, three group therapists describe their countertransference struggles when leading such groups. They meet in a psychosocial setting in which the risk to one's psyche parallels the risk to one's life and limb. The countertransference experienced here is dark, indeed identified by one author as not unlike Dante's Inferno. They describe how understanding their personal countertransference enables them to survive emotionally even though it may not always lead to the survival of their groups. The effect of those struggles also troubled the act of writing itself making cooperation difficult on occasion, a mirror of the external social matrix.     

Small Groups: Studies in Social Interactions Edited by A. Paul Hare,F. Borgatta,and Robert F. Bales

Abstract

A large body of literature has supported the application of attachment theory to the understanding of psychotherapy. In addition, a more recent social psychological literature is exploring the application of attachment theory to the area of group dynamics and group process. The current study is designed to integrate these two distinct bodies of literature. In a preliminary fashion, we examined the relationship between group therapists’ group attachment styles and their assumptions and expectations of their patients’ attitudes about group psychotherapy. Seventy–six therapists completed the Smith, Murphy &; Coats (1999) measure of group attachment style. They also completed the Revised Group Therapy Survey (Carter, Mitchell, &; Krautheim, 2001) from the viewpoint of a typical patient they treat. As hypothesized, therapists with more group attachment anxiety assumed that patients would hold more negative myths and misconceptions about group treatment than therapists with less group attachment anxiety. The utility of a group attachment construct in future research and practice is discussed.     

A Systems Approach to Priority Setting of Interventions in Groups

The author provides an overview of self-help groups in terms of their origins, growth, scope, and effectiveness, and then compares these groups with professionally conducted psychotherapy groups. A framework for evaluating group helping systems is proposed which includes five principal dimensions: the helping group as a social microcosm; technological complexity/simplicity; psychological distance/closeness between helper and helpee; specificity/generality of help methods; and differentiation versus nondifferentiation among participants. The author concludes his article by recommending four strategies for how group therapists can contribute to self-help groups.     

Group Psychotherapy—The Psychoanalytic Approach by S. H. Foulkes and E. J. Anthony

Group therapists often lead consultation groups. For effective leadership it is important to distinguish between consultation groups and psychotherapy groups. A consultation group is one in which a leader serves as consultant to the members. Group process variables of task, contract, role of the leader, and effect of the larger system should be understood by the consultant. The process of defining, testing, and maintaining these variables encourages exploration of resistance and parallel process, and is an important aspect of the ongoing learning. Consultation group leaders should understand the importance of serving as group leader but not group therapist.     

Therapists' group attachments and their expectations of patients' attitudes about group therapy

A large body of literature has supported the application of attachment theory to the understanding of psychotherapy. In addition, a more recent social psychological literature is exploring the application of attachment theory to the area of group dynamics and group process. The current study is designed to integrate these two distinct bodies of literature. In a preliminary fashion, we examined the relationship between group therapists' group attachment styles and their assumptions and expectations of their patients' attitudes about group psychotherapy. Seventy-six therapists completed the Smith, Murphy & Coats (1999) measure of group attachment style. They also completed the Revised Group Therapy Survey (Carter, Mitchell, & Krautheim, 2001) from the viewpoint of a typical patient they treat. As hypothesized, therapists with more group attachment anxiety assumed that patients would hold more negative myths and misconceptions about group treatment than therapists with less group attachment anxiety. The utility of a group attachment construct in future research and practice is discussed.     

Leadership behavior,group climate and outcome in group psychotherapy: A study of outpatient psychotherapy groups

A recent clinical study of outpatient psychotherapy groups in a community mental health center explored the linkage between group leadership variables, group climate, and outcome. The study involved nine outpatient therapy groups, over 50 group clients, and several group therapists. A repeated measures design involving assessment of clients' outcome and level of functioning, group leadership style, and group climate was used to assess changes over a 6-month period. The findings suggest: 1) a reduction in symptoms and improved functioning for clients; 2) a similarity of perceptions by members and leaders of perceived leadership behaviors and group climate; 3) the presence of direct and indirect influences of group climate and leadership behavior on clients' outcome; and 4) a linkage between leadership behavior and group climate with the theoretical orientation of the group. The findings of the research are discussed in relation to the understanding of specific effects in group psychotherapy and the implications for construction of group psychotherapy theory.The authors would like to thank Robert Dies, Ph.D., for his helpful suggestions in the early phase of this study; Roy MacKenzie, M.D., for permission to use the Group Climate Questionnaire; Diane DePalma, Ph.D., for permission to use the Global Leadership Behavior Index; Chris Boltwood, B.A., for her untiring efforts in administering the instruments and coding and entering the data; and most importantly, the psychotherapy group members and the group therapists for their cooperation in this endeavor—without their help, this clinical study would not have been possible.A version of this paper was presented at the Annual Meeting of the American Group Psychotherapy Association, 1987, New Orleans, Louisiana. Lenore Phipps, R.N., M.S., C.S., was formerly Director, Group Psychotherapy Program at Park Ridge Mental Health Center, Rochester, now in private practice at Guild Medical Center, Norwood, MA 02062.     

Concurrent group and individual psychotherapy in a psychiatric day hospital for depressed elderly

Concurrent psychotherapy is used in various settings for patients of different diagnoses and ages. The concurrent group and individual psychotherapy of older adults with depressive disorders in a psychiatric day hospital is described, emphasizing phases of treatment and transference and countertransference themes uniquely relevant to working with depressed elderly patients in a day hospital. Case examples are offered to illustrate these issues. The special technical considerations that need to be utilized when multiple therapists and settings are present are described. The model employs the use of an integrative, interactive group therapy, along with various other group treatments and antidepressant medication, with individual therapy serving a subordinate but organizing role.     

Will the Mother-Group Have a Face? The Future of the Facilitating Environment

The author predicts that maintaining the responsible practice of group psychotherapy in the coming years will require attention to three areas of professional life. The training of group therapists must include group-as-a-whole, in addition to intrapsychic and interpersonal, theoretical constructs. A supportive network of professional colleagues must be available to provide consultation and continuing education. Finally, a culture that values the necessary components of group psychotherapy practice must be encouraged and supported.     

Antidepressants in group psychotherapy

This article alerts us to consider depression as a relatively frequent cause of impasse in the course of group psychotherapy. The authors recommend the combined use of antidepressant medication along with group psychotherapy when such depression is confirmed independently outside the group. Common obstacles and pitfalls preventing successful combined treatment are reviewed; the depressive logjam is differentiated from common resistance; and profiles of responders versus nonresponders are described. A rationale of the combined treatment, its results, and implications for group therapists are all delineated.