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.     

Attachment to groups: Relationships with group esteem,self-esteem,and investment in ingroups

We apply a model of interpersonal attachment style to the group domain, examining how attachment to ingroups relates to self-views, group esteem, and ingroup investment. In Study 1 (N = 306), participants completed measures of self-esteem, group esteem, group attachment insecurity, and investment. Study 2 (N = 316) implemented a within-subjects experimental design in which participants completed the same measures as in Study 1 with regard to ingroups they held in high versus low esteem. In both studies, the negative relationship between group esteem and group attachment avoidance was stronger among participants with higher self-esteem, and the negative relationship between self-esteem and group attachment anxiety was stronger for more esteemed ingroups. Over and above group esteem, group attachment anxiety was positively and avoidance negatively related to investment in ingroups. We integrated frameworks spanning group dynamics and close relationships to contribute to a more comprehensive understanding of how individuals perceive their relationships with ingroups.     

Attachment anxiety,intra‐group (dis)respect,actual efforts,and group donation

The current study examines attachment‐style differences in responses to inductions of group respect and disrespect. Participants completed a scale assessing attachment anxiety and avoidance, performed group tasks, and received high, average, or low respect feedback from group members. Then we assessed commitment to this group, actual effort expenditure on behalf of the group, and money donation to the group. For participants scoring relatively high on attachment anxiety, high group respect heightened group commitment and effort expenditure on behalf of the group, whereas group disrespect led to lower group commitment but to more money donation to the group and higher effort expenditure. Participants who scored relatively low on attachment anxiety were not significantly affected by group respect or disrespect. The implications of attachment theory for group dynamics were discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Therapist gender and the same-sex puberty age psychotherapy group

Puberty is considered to be the most difficult developmental period to conduct psychotherapy. Group psychotherapy has special appeal for pubescents because of the anxiety experienced in individual psychotherapy with adults, and the mutual identification and support experienced with groups of same-sex peers. Although pubescents readily form cohesive groups, the emotional stress for the group therapists is intense and many therapists are reluctant to take on such groups. Close attention to the principles of developmental ego psychology suggests that pubescent groups will be more effective if conducted by group therapists of the same sex as the patients.     

Women, money, and psychodynamic group psychotherapy.

Developmental concerns and sociocultural expectations may keep female patients and therapists from addressing financial issues openly in group psychotherapy. Interpersonal theory provides a different view of nurturing that may help women leaders deal better with financial discussions in group. This paper includes a review of the literature on group psychotherapy and fees; feminist literature relevant to leadership; money management in group therapy; countertransference; and case examples.     

Running: An adjunctive group therapy technique

Group therapists who work with severely disturbed patients know that group sessions are often characterized by verbal rambling, frequent and prolonged pauses and high levels of anxiety on the part of group members. This article focuses on the use of a group activity— namely, running—as an adjunct to group psychotherapy. A brief case report will illustrate the application of this innovative treatment technique; then issues that may arise when one leads a running group are dealt with in a question- and -answer format.The author wishes to express his appreciation to Mrs. Vera Kohn for editorial assistance in the preparation of this article.     

The influence of individual attachment styles on group members' experience of therapist transitions

Attachment theory has recently been applied to clinical practice in an effort to improve understanding and treatment of the maladaptive relational patterns clients bring to therapy. While most of this research has focused on individual therapy, interest in the application of attachment theory to group psychotherapy is growing. This paper will explore the impact of clients' attachment styles on their experiences of co-therapist transition in an ongoing psychodynamic therapy group. This discussion will elucidate how knowledge of attachment theory and an understanding of clients' individual attachment styles can be useful in predicting responses to therapist-initiated terminations and transitions.     

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.     

Attachment theory and group processes: the association between attachment style and group-related representations,goals, memories,and functioning

Four studies examined attachment-style differences in group-related cognitions and behaviors. In Studies 1-2, participants completed scales on group-related cognitions and emotions. In Studies 3-4, participants were divided into small groups, and their performance in group tasks as well as the cohesion of their group were assessed. Both attachment anxiety and avoidance in close relationships were associated with negative group-related cognitions and emotions. Anxiety was also related to the pursuit of closeness goals and impaired instrumental performance in group tasks. Avoidance was related to the pursuit of distance goals and deficits in socioemotional and instrumental performance. Group cohesion significantly moderated the effects of attachment anxiety. The discussion emphasizes the relevance of attachment theory within group contexts.     

Practice-based evidence: patients who did not respond to group analysis

Evidence-based psychotherapy is typically based on treatment outcome for the "average" patient in aggregate designs; reports on individual non-responders are rarely published. In this observational study, we explored factors that might have contributed to non-response in long-term dynamic group psychotherapy. Eight patients (14%) who did not change were compared with 48 treatment responders on clinical variables, and their case stories were retrospectively scrutinized for explanatory factors. The non-responders had less initial distress, stayed for shorter durations in therapy, and were more dissatisfied with their group and therapists. Based on detailed case stories, attempts are made to tease out idiographic hypotheses why each patient did not change during group analysis.     

Development of anxiety arousal in group psychotherapy

37 patients taken from three psychotherapy groups had completed a course of communication training as preparation for dynamic group psychotherapy. Two anxiety tests were performed at different times before, during and after the therapy. After completion of the communication training, the anxiety diminished as a result of general factors that had come into effect. After completion of the dynamic group psychotherapy they diminished owing to a genuine improvement in social competence. The different modes of action of two psychotherapeutic methods are clearly shown.     

Counseling Older Adults with Dementia: A Survey of Therapists in Massachusetts

Although much has been written about therapeutic interventions with caregivers, little is known about the counseling services that are available for victims of dementia. The present study was designed to explore community mental health center (CMHC) services and therapists' experiences in providing psychotherapy to this population in Massachusetts. Only 27 of the 36 CMHCs in the state reported providing mental health services to older adults with a dementing illness. A survey of therapists who specialized in working with older adults found that the percentage of older adult clients estimated to have dementia averaged about half of their caseload. Older persons in the early phase of a dementing illness were most frequently referred for depression and anxiety, whereas those with moderate decline were most frequently referred for management of disruptive behavior. The most common services provided to clients with dementia consisted of assessment and individual counseling. The latter finding indicates a discrepancy between what is practiced and the professional literature. Most of the psychotherapy described in the literature concerns group interventions, which were rarely provided by the mental health centers in Massachusetts. The centers tended to offer individual counseling; however, little information on how to provide this form of treatment can be found.     

Managing Anxiety: A Therapist Common Factor

In this paper, we propose that therapist anxiety in the therapy room, especially anxiety stirred up by difficult or triggering clients, represents a challenge to effective therapy, and that effective management of this anxiety be considered as a necessary therapist skill for conducting quality couple and family therapy (CFT). We propose that effective therapists need to be able to manage their emotions, especially their anxiety, in order to truly help their clients. The failure to do this can lead to break downs in the alliance and the flow of therapy, and these deleterious effects can be prevented when therapists actively navigate their internal states through self-awareness and ongoing introspection. Bridging psychotherapy literature, we discuss specific strategies to this end, and make clinical recommendations for CFTs and CFT training programs.     

Training Soviet immigrant therapists in the field of group psychotherapy

Between 1970 and 1990 about one-half million Jews immigrated to Israel, most of them from the former Soviet Union, including many mental health therapists who had trained and worked in the Soviet Union. This article addresses the special characteristics of this population, in general, and of the mental health therapists, in particular. It relates these characteristics to training for group psychotherapy. Key issues include their unique experience of the inner world as a source of danger, the specific defensive modes connected with this experience, their perception of authority as an agent of ideology, and their representation of the group as a persecutory entity and as a vehicle of indoctrination.     

Therapists' judgments of mentally healthy beliefs for women and men

Clinical and counseling literature indicates that practicing psychologists often observe different mental health standards for women and men. Most of this research has examined mental health in terms of personality attributes, and as such there is a noticeable lack of research concerned with mentally healthybeliefs. The present research was concerned with the investigation of a possible gender bias in therapists' mental health standards, defined in terms of personal beliefs. For this purpose, the Irrational Beliefs Test (IBT; Jones, 1969) was completed three different times by a group of licensed psychologists in private practice, measuring their beliefs of how (1) a mentally healthy sex-unspecified adult, (2) a mentally healthy male adult, and (3) a mentally healthy female adult would respond to the IBT. The results indicated that both women and men therapists associated unique beliefs with women's and men's mental health.The late Dr. Frank B. Lambert studied the philosophical foundations of psychotherapy theory and was concerned about value issues in the practice of psychotherapy. He was pursuing his Ph.D. in counseling psychology at the time of his untimely death.Portions of these data were presented at the 1985 annual meeting of the American Psychological Association, Los Angeles, California. Graditude is extended to Lucia Gilbert and Mark R. Leary for their helpful comments on an earlier version of this article.     

Feminism and group psychotherapy: an ethical responsibility.

In response to Martin Lakin's (1991) IJGP article, "Some Ethical Issues in Feminist-Oriented Therapy Groups for Women," this article examines recent developments in feminist theory and proposes that a feminist perspective is both ethical and can make significant contributions to the practice of group psychotherapy. The overview of feminist theory focuses on (1) the importance of the social context, (2) contributions and challenges to psychoanalytic and developmental theory, (3) attention to power relations, (4) the connection between the personal and political, and (5) recognition and integration of diversity and difference. Clinical examples illustrate ways in which male and female group therapists can take a feminist perspective and become "ethical advocates."     

Relational dynamics between psychotherapy clients and clinic administrative staff: A pilot study

Extensive empirical research has established therapeutic alliance as one of the most stable predictors of psychotherapy outcomes. Nearly all the contemporary empirical literature on therapeutic alliance focuses on the therapist-client dyad without attending to the relational experiences many clients in outpatient clinics have with administrative staff. Literatures from the fields of social work, psychiatric nursing and milieu therapy suggest there are more systemic relational and environmental dynamics that impact treatment beyond the therapist-client dyad, although these issues have been considered primarily in inpatient settings. A relational ecology framework has been developed drawing upon relational psychoanalysis, attachment theory and symbolic anthropology to help conceptualise the broader relational dynamics beyond the therapist-client dyad that may impact a more systemic therapeutic alliance in certain outpatient contexts. In an initial cross-sectional pilot study with a sample of clients (N = 107) receiving psychotherapy at a community mental health clinic in the Northeastern United States, the present study found client ratings of both (a) the therapeutic alliance with their therapists and (b) their alliance with administrative staff each significantly positively predicted client ratings of treatment. Thus, ratings of administrative alliance predicted client ratings of treatment over and above the effects of the therapist-client therapeutic alliance. These findings provide preliminary support for further investigation of the relational ecology of outpatient psychotherapy and suggest that client experiences of relational and environmental dynamics with administrative staff may be important contributors to psychotherapy outcomes. Limitations of the present study and implications for future research and practice are discussed.     

Suicide in group therapy: trauma and possibility

Abstract This paper compares and contrasts the experiences of two different long term psychodynamic psychotherapy groups in which a patient suicided. The acute reactions and longer term process of each group is described in detail and discussed. The reactions of the two leaders, married to each other and in a shared supervisory group with the late Anne Alonso, and their own working through of the traumatic losses are explored. Their experiences highlight the importance of open discussion of the suicides in the groups, consultation with senior colleagues, and continual processing of their own reactions as a means of fostering posttraumatic growth. The authors discuss their experience in light of the literature on trauma in groups and the emerging literature on posttraumatic growth and they reflect on implications for the community of group therapists.     

Integrating clients' moment‐to‐moment ratings into psychotherapy research: A novel approach

Counselling and psychotherapy researchers have considerably advanced the field's understanding of psychotherapy processes and how they relate to treatment outcomes. Despite these advances, little is known about the client's perspective of changes in psychotherapy processes that occur throughout a given session (i.e. micro‐processes). To address this gap, this article describes the novel application of methods that assess participants' moment‐to‐moment ratings to psychotherapy research. This method entails recording psychotherapy session content that clients and other potential raters (e.g. therapists, researchers) later review while simultaneously providing continuous ratings of psychotherapy processes (e.g. helpfulness, alliance). In addition, moment‐to‐moment ratings can facilitate significant events research by prompting researchers to elicit client feedback about the moments that are rated the most and least positively. However, few studies have used these methods in the context of psychotherapy research. Studies incorporating these methods may yield findings that advance psychotherapy research, training efforts and clinical practice. For example, studies may examine how the magnitude and timing of clients' moment‐to‐moment ratings of psychotherapy processes are associated with treatment outcomes, therapist ratings and physiological processes (e.g. heart rate variability). Trainee therapists and their supervisors may also use clients' moment‐to‐moment ratings to facilitate attunement to verbal and non‐verbal indicators of moments perceived more positively and negatively. Last, these methods can produce findings that are highly relevant to clinical practice, where therapists routinely navigate fluctuations in psychotherapy processes (e.g. alliance ruptures) that can be assessed using moment‐to‐moment ratings.     

The written summary in group psychotherapy revisited

This paper addresses the use of the weekly written summary with patients in group psychotherapy. In an effort to stimulate group process and effect cotherapist communication, the authors instituted this group recording in an ongoing psychodynamically oriented mixed adult group. While the utilization of this device did, in fact, stimulate the group process and became an important part of the group's life, the therapists additionally saw significant effects upon their working alliance. These included increased focused dialogue upon group dynamics, more purposeful planning for group interventions, and heightened awareness of the significance of interventions in the group.Ms. Bosman-Clark is formerly Clinical Instructor, Department of Psychiatry, Baylor College of Medicine.