Potential of Group Practices in Mental Hospitals

This paper reviews the burgeoning literature on short-term group therapy, primarily focusing on outpatient groups, and formulates a set of general principles for conducting such groups. Short-term group therapy is defined, and technical characteristics shared by most short-term treatment approaches are summarized. Clinical applications and common group goals are identified. Although few empirical studies have been reported, the efficacy of short-term approaches is shown to be comparable to that of longer-term treatment interventions. The implications of a short-term format are highlighted with regard to patient selection and preparation, group composition, and the nature of the contract. Detailed consideration is given to the therapist's role, and a comprehensive, supportively oriented approach is described.     

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.     

Multiple-family group counseling

This article describes the innovative, short-term approach of multiple-family group counseling in which the counselor applies the principles and dynamics found in family and group counseling to the treatment of the student—in this case, the “identified client” and his family. In an attempt to provide an effective and economical therapeutic experience of practical value to the school system, several family units meet together to discuss some of the personal-social problems that adversely affect the adolescent and result in the acquisition of maladaptive behaviors within the school setting.     

Short-term homogeneous group therapy for schizophrenic inpatients: A questionnaire evaluation

Traditional, insightoriented group therapy with a heterogeneous patient population has not been effective in the short-term inpatient setting. We have experimented with a homogeneous group therapy format where all of the patients have been acutely psychotic schizophrenics. Clinically, this approach has been found to be useful. Questionnaires filled out by the patients at the time of discharge have supported this conclusion. The patients valued the group more as a place to express their feelings and learn ways of interacting with others than as a place to test reality or receive advice on practical issues.     

Experience in Developing a Combined Activity and Verbal Group Therapy Program with Latency-Age Boys

Ten fundamental principles are outlined for the practice of brief, dynamic group therapy within a 10- to 20-session time limit. They include: group composition and screening; contracting for appropriate goals: facilitating rapid cohesiveness; stages of group development; building a work group atmosphere; leadership style; structural levels of focus; transference and countertransference considerations; the cotherapy relationship; and curative factors. This approach integrates recent formulations from the practice of short-term individual therapies as well as brief group approaches. Each brief group principle is contrasted with its long-term analytic group counterpart. Relevant research literature, historical roots, as well as other types of brief therapy groups are reviewed. The recent and experimental nature of these techniques is critically discussed.     

Psychodynamic group therapy for male survivors of sexual abuse

The group therapy literature on male sexual abuse is very preliminary and concerned solely with short-term support models. This paper describes a long-term psychodynamic therapy group for male survivors that has been running successfully in a clinic setting for almost three years. This combined group and individual treatment approach presupposes the selection of men who are capable of using group process to explore basic personality and relationship problems. With sexually abused men, certain treatment issues are paramount. These concern the safety of group boundaries, power and control, facilitating intimacy, handling shame and guilt, and the effects of trauma. Special attention is given to the gender-related dynamics and conflicts that occur in a group of male survivors with a male leader.     

A Model for Communication Skills Group Using Structured Exercises and Audiovisual Equipment

Long-term psychiatric patients who are transitioning out of the hospital often lack the social skills necessary to adapt to work and leisure situations. The behaviors that are appropriate in a hospital environment are radically different from behaviors expected in the community. This paper describes a short-term, 12-session, audio-visual group developed for an inpatient psychiatric population. The group's purpose is to provide a laboratory for members to look at their interactional styles and to develop improved social skills. Focused feedback and videotaped exercises allow group members to do this within a supportive atmosphere. The tasks introduced are designed to coincide with the developmental states of the short-term group. As the sessions proceeded, we utilized sequential exercises that would help members to feel safe, to problem solve as a group, and to practice communication skills.     

Increased training complexity reduces the effectiveness of brief working memory training: evidence from short-term single and dual n-back training interventions

N-back training has recently come under intense scientific scrutiny due to reports of training-related improvements in general fluid intelligence. As of yet, relatively little is known about the effects of short-term n-back training interventions, however. In a pretest-training-posttest design, we compared brief dual and single n-back training regimen in terms of training gains and transfer effects relative to a passive control group. Transfer effects indicated that, in the short-term, single n-back training may be the more effective training task: At the short training duration we employed, neither training group showed far transfer to specific task switch costs, Stroop inhibition costs or matrix reasoning indexing fluid intelligence. Yet, both types of training resulted in a reduction of general task switch costs indicating improved cognitive control during the sustained maintenance of competing task sets. Single but not dual n-back training additionally yielded near transfer to an untrained working memory updating task.     

Bridging the gap between long- and short-term group psychotherapy: A viable treatment model

The purpose of this paper is to support the efficacy of short-term insight-oriented, process group psychotherapy and to present a unique treatment model. The format for a time-limited, dynamic group therapy model with the opportunity to recontract for additional segments will be discussed. Evidence will be presented that supports the effective use of this model for providing continuity of care for patients with both long- and short-term treatment goals. The referral process,contracting for appropriate goals, group development, the cotherapy relationship, and other specific treatment issues will be addressed.     

Transference and Countertransference: New Horizons

In this exploratory study one set of patients (n – 50) was randomly assigned to either short-term group therapy or short-term individual therapy. Another set of patients was randomly assigned to either long-term group therapy or long-term individual therapy. All patients were rated prior to therapy on fifteen variables which were believed to be important for psychoanalytically oriented therapy. A comprehensive battery of outcome measures was administered both before and after therapy. Univariate and multivariate analyses were conducted in an effort to discover differential predictors of improvement for group therapy and individual therapy. None of the variables was found to be a significant predictor of improvement in one type of therapy and of nonimprovement in the other type. However, a number of variables were found to be significant predictors of improvement for one type of therapy but not for the other. It is suggested that for a given patient, a pattern of scoring on a number of such variables might tend to favor one type of therapy over another. The authors hope that the present study will serve to encourage further research work on the issue of assisting clinicians in their decisions concerning general and differential prediction of therapy outcome.     

Short-term group psychotherapy: Who succeeds,who fails?

Group psychotherapy literature is unclear about what patient characteristics contribute to better and poorer outcome. This study examined pre-group therapy patient characteristics and their relationship to short-term group therapy outcome. A battery of outcome measurements was administered to 192 short-term group therapy patients before, after, and 4–6 months after their group experience. Three distinct outcome groups are defined: dropouts, low changers and high changers. Characteristics of each group are discussed. Aside from the traditionally important variables such as age and education, this study indicates that interpersonal variables (interpersonal sensitivity, distance/closeness to others, primary involvement with family) may be potentially important areas to pursue in screening and preparing patients for a group.     

The Chestnut Lodge Kiosk: Observations on a Psychiatric Hospital's Work Project Part Two

This article reviews some of the health care issues raised by K. Roy MacKenzie. The author identifies additional contributors to spiralling costs and offers a slightly different perspective on the issue of the efficacy of short-term time-limited psychotherapy. In particular, the author raises questions regarding the cost-driven aspect of today's health care delivery system versus quality of care. He also challenges some of the research findings used in support of MacKenzie's argument that short-term time-limited group therapy is as cost-effective as long-term individual psychotherapy. More specifically, he considers how resistance and the sense of hopefulness might influence the favorable outcomes of the studies cited in MacKenzie's article. In addition, the relationship between short-term psychotherapy and managed care abuse is addressed and a partial solution to preventing such abuse by legislating public accountability is offered.     

Managed Care and Pastoral Counseling: An Opportunity for Spiritual Growth

Managed care has forced changes on pastoral care. Among these changes are increased demand for and volume of clients. An appropriate response to this demand is for pastoral counselors to adopt a more short-term oriented treatment approach. While this approach has historically been at odds with the pastoral counseling movement, the authors argue that a combination of the therapies of Albert Adler and Albert Ellis provides a framework for addressing the needs of clients. Social Work at the     

Recognition of facial expression and identity in part reflects a common ability,independent of general intelligence and visual short-term memory

Recognising identity and emotion conveyed by the face is important for successful social interactions and has thus been the focus of considerable research. Debate has surrounded the extent to which the mechanisms underpinning face emotion and face identity recognition are distinct or share common processes. Here we use an individual differences approach to address this issue. In a well-powered (N?=?605) and age-diverse sample we used structural equation modelling to assess the association between face emotion recognition and face identity recognition ability. We also sought to assess whether this association (if present) reflected visual short-term memory and/or general intelligence (g). We observed a strong positive correlation (r?=?.52) between face emotion recognition ability and face identity recognition ability. This association was reduced in magnitude but still moderate in size (r?=?.28) and highly significant when controlling for measures of g and visual short-term memory. These results indicate that face emotion and face identity recognition abilities in part share a common processing mechanism. We suggest that face processing ability involves multiple functional components and that modelling the sources of individual differences can offer an important perspective on the relationship between these components.     

Brief group psychotherapy at retirement

Brief group psychotherapy as a method of treating psychological aftereffects of retirement is still in its infancy. It is therefore still possible to outline the whole field in overview. This paper examines the dynamics of aging and the relevant literature, discusses the conceptual issues involved, and describes techniques employed with this specific population. The typical cluster of complaints is portrayed, the psychological stressors associated with retirement are analyzed, and the various group-therapeutic modalities developed to counteract them are described. Furthermore, the rationale, process and characteristics of short-term group psychotherapy in the treatment of adjustment difficulties to retirement are reviewed. The clinical application of this approach, the therapist's particular roles and the therapeutic impact of this method are delineated.He would like to thank his co-therapist, Mrs. Sophie Bielawski, Reg. O.T., for her support and helpful observations and Drs. J. Regan and E. Sunday for their advice on methodolody.     

Effectiveness of the intensive group process-retreat model in the treatment of bulimia

The present study examined the effectiveness of a short-term, intensive, group process-retreat treatment model for bulimia. The multicomponent, two-day treatment and follow-up booster session focused primarily on the interpersonal deficits associated with the disorder. A sample of 24 subjects who met the DSM-III criteria for bulimia and who binged-purged at least one time per week participated in the study. Compared to a control group (N=12), the women who received the group treatment (N=12) evidenced significant improvements in self-esteem and severity of binge eating. The frequency of binge-purge episodes and dysfunctional eating attitudes were also significantly reduced. The results of this study suggest that the intensive group-process retreat model is an effective adjunct in the treatment of bulimia.     

Group climate in an open-ended cancer support group

A number of well-described, controlled studies assessing cancer support group intervention support their effectiveness. All of these experimental groups have been close-ended and typically involve six to eight weekly sessions. Because many cancer patients are unable or unwilling to participate in closed, extended-session groups, there is particular need for analysis of the effectiveness of short-term, open-ended groups. Additionally, objective measures are needed to delineate the factors contributing to a successful outcome in cancer support groups. We used the Short Form of the Group Climate Questionnaire (GCQ-S) to characterize 23 sessions in an open-ended, short-term, Veterans Hospital based cancer support group. The cancer group scored significantly lower on the Avoiding and Conflict dimensions (p<.001) compared to a normative psychotherapy group sample. There was no difference on the Engaged dimension. This pilot study suggests that a cancer support group in this setting can create an environment where members are cohesive and take responsibility for their own change process, while keeping interpersonal conflict to a minimum. Based on these preliminary findings, we encourage controlled clinical trials examining the efficacy of open-ended cancer support groups.At the time of this study, Dr. Daroff was a resident in Psychiatry, University of California, San Francisco.     

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.     

Confrontation and support in group therapy in the residential treatment of severely disturbed adolescents

This paper focuses on the use of various forms of group therapy for severely emotionally and behaviorally disturbed adolescents. Group therapy is considered to be subordinate to a total systemic approach which includes individual, family, group, and milieu therapy. The author uses an eclectic theoretical frame of reference which includes some elements of psychodynamic, object relations, and structural and strategic family therapy theory. Precedents for the confrontational-supportive approach include encounter group and residential drug addiction programs, psychodynamic short-term individual therapy, and dynamic group therapy.     

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.