Outpatient group psychotherapy following day treatment for patients with personality disorders

This prospective, naturalistic study evaluated the practice and effectiveness of an outpatient group therapy program following day treatment for patients with personality disorders (PDs). One hundred and eighty-seven patients (86% patients with PDs and 14% with no PDs), were treated in outpatient psychodynamic group therapy. Outcome was assessed by Global Assessment of Functioning, Symptom Check List 90-R, and Inventory of Interpersonal Problems-Circumplex, short version, at admission and discharge from day treatment, and at the end of outpatient group therapy. Average length of outpatient therapy was 24 months. Forty-three percent terminated in an irregular manner. Outcome of the continuation therapy was satisfactory for patients without PDs. For PD patients, the improvement from the day treatment was maintained during outpatient therapy, but further improvements were modest for symptoms and interpersonal distress, somewhat better for global functioning. Implications for further treatment development are discussed.     

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.     

Emotion-regulation skills as a treatment target in psychotherapy

Background

Deficits in emotion-regulation skills have been shown to be integral to the development and maintenance of a wide range of mental disorders.

Aim

To evaluate the importance of these skills as a treatment target in psychotherapeutic interventions.

Method

Nine specific emotion-regulation skills were assessed in a sample of 289 inpatients before and after cognitive-behavioural treatment. Self-reports of success in pretreatment skills application were first compared to those of 246 non-clinical controls. Pretreatment skills application and change in skills application during therapy were then related to a variety of outcome measures. Finally, the effects of integrating a brief training of general emotion-regulation skills into the CBT-based treatment were evaluated in a controlled trial.

Results

Uni- and multivariate analyses identified the skills of acceptance, tolerance, and active modification of negative emotions as particularly important for current mental health and treatment outcome. Replacing parts of the standard CBT treatment with the emotion-regulation training enhanced the effects of the CBT treatment on skills application and on other measures of mental health.

Conclusion

Incorporating interventions that directly target general emotion-regulation skills may improve the effectiveness of psychotherapeutic interventions.     

Keeping a group psychotherapy program alive and well within a psychiatric residency

A mandatory year of outpatient group therapy training is an accepted part of residency training in psychiatry. Residents need stable groups to lead in order to have a satisfactory training experience. A solid group program is integrated and cohesive. A group therapy coordinator has to consider the following factors in developing and maintaining the optimum program: sanction from the department of psychiatry; integration of the program into the system; transfer of groups from one class to another; personal screening and followup of all referrals; availability to professionals in the community; coordinator participation in relevant group therapy classes; a vehicle for supervisors to collaborate with each other and administrator; and a format for all members of the group program community to interact.This paper is an elaboration of a symposium presentation, Training in Group Psychotherapy: The Quest for a Viable Model, AGPA Annual meeting, 1990.     

Networking in a day treatment center for adolescents

Based on two years of clinical experience with eighty different client networks, the authors (1) offer a model of network orientation and assessment which has proven effective in lowering client resistance to a, network intervention; (2) present two strategies for clinical intervention with families using partial network assemblies; and (3) discuss the supportive relationship between family and network therapy with accompanying case illustrations.     

Significant treatment factors in short-term group psychotherapy

The author briefly describes an approach to short-term group psychotherapy based upon an adult developmental model. By means of a clinical case example significant treatment factors are examined. Such an approach to planned short-term group therapy may force group members to confront and deal with important existential issues.     

Threats of violence in group-oriented day treatment

Threats of violence in a group-oriented day treatment program are examined regarding the patient's motivation to make threats, and what occurs among patients and staff that fosters threats. Effects of threats on other patients, the program, and therapists are considered. Management of the threatening patient, the group, and staff reactions are described. Safety of group members is a sine qua non for the groups to function effectively.     

Organizational size and perceptions in a residential treatment program

Centralization of a residential mental health treatment program from three small houses to one large facility provided a naturally occurring opportunity to study the effect of organizational size on the perceptions held by clients and staff. Quantitative data were repeatedly collected on their perceptions of themselves, the organization as a whole, and subgroups within the organization during their involvement in both the small and large social contexts. Results of repeated measures analyses of variance provided considerable support for the theoretically derived hypotheses of heightened anxiety, self-impoverishment, more negative views of the psychosocial environment, and greater psychological distance in the large organizational context.     

Results of modifying the standard program of insight and relaxation psychotherapy

The inventory of methods used in insight and relaxation psychotherapy were taken as a basis for elaborating three additional psychotherapy programmes with the aim of better satisfying the needs of groups with different indications in respect of outpatient psychotherapy. The results obtained with these programmes were tested statistically, using groups of appropriate control subjects, by means of the pre- and post-test data of the MMPI, PAULI, d2 and a five-point self-estimation scale. The trend shown by the results achieved so far confirms that this differentiated therapeutic approach is correct. Further tests with large samples are necessary.