Process and Content in a Therapy Group for Bipolar Outpatients

Although the literature suggests that homogeneous therapy groups are useful for bipolar outpatients, little is known about the process in such groups. Using the GCQ-S and a content analysis of discussion topics, we evaluated group process during the first 31 sessions of an outpatient bipolar group. Compared with normative samples, our group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions and in the anxiety/tension scale. Furthermore, 81% of the discussion topics were related to the three group goals, and an additional 18% dealt with general group issues such as orienting new members and attendance. The results from this pilot study suggest that bipolar patients can discuss relevant issues in a homogeneous group environment that is cohesive, open, and safe.     

Process and content in a long-term PTSD therapy group for Vietnam veterans

Process and content were studied in four 16-session segments of a psychodynamically oriented therapy group for Vietnam veterans suffering from posttraumatic stress disorder (PTSD). On the Group Climate Questionnaire (GCQ-S), the group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions than contrasting samples of neurotic and psychotic groups. There was no evidence of group stages. Topics related to symptoms of PTSD were discussed most frequently (43.1%), followed by issues concerning relations with others (32.4%),general group therapy issues (13.7%), and other topics (10.8%). Clinical implications of these findings are discussed.The authors thank Tom Metzler, M.A., and Heidi Ronfeldt, B.S., for their assistance with the data analysis.Parts of this paper were presented at the American Group Psychotherapy Association Annual Meeting, February 15–20, 1993, San Diego, CA.     

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.     

Process and content in an outpatient schizophrenic group

Process and content issues were evaluated during the first six months of an outpatient schizophrenic group. Compared with groups composed of neurotic and characterological patients, the schizophrenic group scored higher in the Avoiding dimension of the Group Climate Questionnaire (GCQ-S). There was more cohesion and less interpersonal conflict as time went on. Although topics related to engagement and differentiation were discussed, there was no obvious GCQ-S evidence of these first two stages of group development. However, the data supported the presence of stage 3 (individuation) during sessions 20–26. Interpersonal topics dominated the group discussions, followed by issues involving reality-testing, expression of emotions, and advice-giving.The authors wish to thank Dr. K. Roy MacKenzie for his helpful comments on a draft of this paper.     

Group climate in a stress discussion group for medical interns

In order to better characterize group process, the short form of the Group Climate Questionnaire (GCQS) was used to study a stress discussion group for medical interns. This group was found to be significantly different from a normative psychotherapy group sample along three major dimensions: Engaged, Avoiding and Conflict. The group members were cohesive, involved and open, yet respectful of each other's privacy. These results are discussed with respect to the group's goals and leadership.The authors thank George Fein, Ph.D., for statistical assistance.     

Group therapy with schizophrenic patients: a short-term, homogeneous approach

The author presents a short-term, homogeneous model for treating schizophrenic patients in discussion-oriented therapy groups. Typically, patients attend nine sessions in the open inpatient groups and 12 sessions in the closed outpatient groups. The two goals of this co-therapy approach are to help patients cope with psychotic experiences and improve their interpersonal relationships. Discussions focus on hallucinations, delusions, loose associations, and maladaptive relationships, and anxiety-producing topics are avoided. The format is interaction-oriented and emphasizes the here and now. Empirical evidence supports the value of this short-term group therapy approach when it is used in conjunction with antipsychotic medications and long-term follow-up.     

Parent-perceived child behavior problems: Comparison of normative and clinical factors of the Adelaide-Conners Parent Rating Scale

The Adelaide-Conners Parent Rating Scale (APRS), an instrument developed by studying a large, representative group of schoolchildren, was used with a group of psychiatry attenders. Multimethod factor analysis found satisfactory agreement between the factor structures of the clinical and the normative groups. The patterns of scores on the 12 APRS scales were also compared. Two higher-order factors (Conflict with the Environment and Conflict within the Self) were identified in the clinical sample as previously found in the normative group. Comparison of the factor solutions with previous empirical efforts to identify parent-perceived patterns of child behavior disorder showed that the APRS compares well with other instruments and supports the strategy of proceeding from the study of normative populations to the study of clinically defined groups.This work was supported in part by a grant from the Department of Health, Canberra.     

Schizophrenic group process: A comparison and replication using the HIM-G

In order to test the robustness of our model for treating schizophrenic patients in group therapy, we replicated our previous study of an inpatient schizophrenic group and also explored process in an outpatient schizophrenic group using the Hill Interaction Matrix (HIM-G). In agreement with the prior study, the results showed the groups to have a uniquely high Confrontive score, representing the highest level of group work in the Hill system, and the rank order of HIM-G scores of the groups correlated significantly with each other. This suggests that our clinical approach can be taught to different therapists and has reliability across setting.Parts of this paper were presented in a poster session at the American Group Psychotherapy Association Annual Meeting in San Francisco, February 21–25, 1989.     

A comparative study of six different inpatient groups with respect to their basic assumption functioning

Seventy-five group therapy sessions of six different inpatient team groups in one short-term, one intermediate term, and one long-term psychiatric ward were studied with Group Focal Conflict Analysis and the Group Emotionality Rating System. The majority of the group sessions (41) functioned as fight-flight groups, twenty-four sessions functioned at a "pseudogroup" level, and ten sessions were dependency groups. The differences between the fight-flight groups and the dependency group on the variables aggression and dependency were highly significant statistically. A mixture of fight-flight groups and pseudogroups were found in the short-term ward with emergency obligations. The author discusses the assets and shortcomings of fight-flight and dependency cultures within psychiatric wards.     

Gender role conflict scale: validation for a sample of gay men and lesbian women

This study tested the oblique four-factor model of the Gender Role Conflict Scale for a sample of gay men and lesbian women residing in the United States. 400 gay men and 292 lesbian women recruited from university and college gay, lesbian, bisexual, and transgender LISTSERVs participated. The internal consistency reliability of the Gender Role Conflict Scale scores was high, but low means on the expressive dimension of gender role conflict were noted. The results of two separate sets of confirmatory factor analyses indicated that the four-factor model's fit to the data could be enhanced for both groups by applying item parceling to lower the number of indicators per factor, suggesting that the actual structural validity of the Gender Role Conflict Scale may be better than suggested by the reported fit indices.     

Characteristics of the Group Process in Long-Term Psychodynamic Group Psychotherapy for Patients with Psychosis

This study aimed to investigate the development of the group process through group climate parameter dynamics during long-term psychodynamic group psychotherapy for 30 outpatients with psychosis. The group process in four groups was monitored using MacKenzie’s Group Climate Questionnaire-Short Form (GCQ-S) that was completed by the therapist after each session over the two-year period. The trends of engagement, avoidance and conflict parameters differed between groups, and no clear indicators of the development phases were found. The results suggested that these groups remained in the first developmental phase during the observation period, and highlighted the characteristics of resistance and difficulties in establishing social relations in patients with psychosis.     

Clinical validation of the Chinese Personality Assessment Inventory

The clinical validity of the Chinese Personality Assessment Inventory (CPAI; F. M. Cheung, K. Leung, et al., 1996) was examined in 2 studies involving a group of 167 male prisoners in Hong Kong and a group of 339 psychiatric patients in China. Elevated scores on the clinical scales were obtained for the clinical samples. Logistic regression analyses confirmed that the CPAI scales were useful in differentiating between male prisoner and the Hong Kong male normative sample and between psychiatric patients and a random sample of normal adults in China. Multivariate analyses of variance results showed significant differences on the CPAI clinical scales and personality scales among subgroups of psychiatric patients with diagnoses of bipolar, schizophrenic, and neurotic disorders. The usefulness of an indigenous personality inventory 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.     

A categorical approach to infants’ individual differences during the Still-Face paradigm

Cluster analysis was used to create patterns of individual differences reflecting infant behaviors during the initial interaction episode of the Face-to-Face Still-Face (FFSF) paradigm. The clusters were used as the basic unit of analysis for studying infant and maternal behavior and dyadic coordination (i.e., matching and reparation) across FFSF. Seventy-five 4-month-old infants participated with their mothers. Cluster analysis identified three patterns: a Socially Engaged cluster (33%) exhibited high levels of social engagement with their mothers; a Disengaged cluster (60%) showed a tendency to be low in social interaction and a Negatively Engaged cluster (7%) showed high negative emotionality. During the Still-Face episode, the Socially Engaged cluster reacted by reducing focus on their mother and shifting their attention elsewhere, while infants in the Disengaged cluster reduced focus on the environment. Although both the Socially Engaged and Disengaged clusters increased in negative emotionality during the Still-Face, the Socially Engaged group largely recovered during the Reunion, whereas the Disengaged group displayed more negative emotion. The Negatively Engaged cluster demonstrated high levels of negative affect throughout the entire procedure. Mothers of Negatively Engaged infants showed less positive engagement and more social monitoring than mothers in other clusters during all episodes. Dyadic interaction differed between groups, with greater levels of matching and reparations in the engaged group, less in the Disengaged group, and very little coordination in the Negatively Engaged cluster. Findings highlight the role of distinctive patterns of infants’ individual differences in determining early dyadic functioning.     

Musik in der Medizin Edited by Hildebrand R. Teirich

Abstract

We compared differences in self-concept change across three years after short-(STG) and long-term (LTG) psychodynamic group psychotherapy, in a mixed sample of outpatients. Self-concept was assessed at baseline and three years later, using the Structural Analysis of Social Behavior Questionnaire. Vector scores Affiliation and Autonomy were primary, and the eight cluster scores–self-free, self-affirm, self-love, self-protect, self-control, self-blame, self-attack, and self-neglect–were secondary outcome measures. Within group univariate analyses showed change in LTG across three years on the vector scores Affiliation and Autonomy, while STG only changed on Autonomy. Comparisons between STG and LTG demonstrated a significantly larger improvement in Affiliation in LTG than in STG. This difference was explained by a higher improvement in the cluster scores of self-blame, self-attack, and self-neglect in LTG, dimensions that weight negatively on the Affiliation score. Patients with more serious self-neglect and harsh, punitive self-attack/self-blame may profit more in long-term than in short-term groups.     

Rorschach changes in long-term and short-term psychotherapy

Over a period of several years, repeat Korschach testing was done with two groups of patients receiving outpatient psychotherapy, a long-term group (n = 88) engaged in intensive, dynamically oriented psychotherapy and a short-term group (n = 88) involved in behavioral or gestalt therapy. Rorschach protocols were obtained at the beginning of the treatment and on three subsequent occasions, 1 year, 2 1/2 years, and 4 years later, when most of the long-term and all of the short-term patients had completed their therapy. The findings demonstrate generally beneficial effects of psychotherapy, greater change in long-term than in short-term therapy, and the validity of the Rorschach for measuring these effects and changes.     

Rorschach Changes in Long-Term Short-Term Psychotherapy

Over a period of several years, repeat Korschach testing was done with two groups of patients receiving outpatient psychotherapy, a long-term group (n = 88) engaged in intensive, dynamically oriented psychotherapy and a short-term group (n = 88) involved in behavioral or gestalt therapy. Rorschach protocols were obtained at the beginning of the treatment and on three subsequent occasions, 1 year, 21/2 years, and 4 years later, when most of the long-term and all of the short-term patients had completed their therapy. The findings demonstrate generally beneficial effects of psychotherapy, greater change in long-term than in short-term therapy, and the validity of the Rorschach for measuring these effects and changes.     

Children Who Hate by Fritz Redl and David Wineman

This paper describes a dynamically oriented group aftercare program for alcoholics and other substance abusers. The chronic nature of alcoholism and the need to insure that initial progress is not followed by regression point to the need for continuity of care, extending beyond the initial detoxification or initial crisis phase. The group-oriented aftercare program at Appleton Outpatient Clinic follows an intensive five-week program in either our outpatient clinic or Appleton's inpatient setting. The preparatory group and educational experiences that patients participate in prior to their entry into a long-term aftercare group are detailed. Finally, special issues that emerge in the long-term groups are discussed including (1) the group contract, (2) alcohol-related group defenses, and (3) management of the patient who drinks.     

Pilot study of hormone replacement therapy and menopausal symptoms, depression, and quality of life in Korean climacteric women

This cross-sectional survey compared scores on the Menopausal Symptoms Index, Depression, and the Quality of Life for 65 Korean climacteric women receiving regular hormone replacement therapy (M age=52.8 yr., SD=6.3) and 70 Korean climacteric patients not receiving such therapy (M age =51.6 yr., SD=7.1). Depression scores were positively correlated with the Menopausal Symptoms Index in both groups (r = .58 in the Therapy group and r = .50 in the Control group) and negatively correlated with scores for Quality of Life (r = -.48 in the Therapy group and r = -.68 in the Control group). Scores on the Menopausal Symptoms Index were negatively correlated with ratings of Quality of Life in both groups (r = -.53 in the Therapy group and r = -.45 in the Control group). These results suggest that hormone replacement therapy is associated with reduced Depression scores and higher Quality of Life scores in this sample of Korean climacteric women.