Self psychology and group therapy

This paper illustrates how the theories of Heinz Kohut elucidate the curative aspects of group treatment. Group therapy is an ideal milieu in which mirroring, idealizing and alterego transferences can be experienced and worked through. Transmuting internalizations, or psychic structure building, occur when optimal frustration of these needs can be provided by available selfobjects. In group therapy a patient can use the group-as-a-whole, the individual members as well as the leader as potential selfobjects. With the help of individual sessions to reflect on group encounters, a patient can gain a more fully integrated therapeutic experience.The author wishes to acknowledge Susan Sands, Ph.D., Jane Jordan, M.S.W., and Ruth White, Ph.D., for their help.     

An Evaluation of the Effects of Diagnostic Composition on Individual Treatment Outcome Within Transdiagnostic Cognitive–Behavioral Group Therapy for Anxiety

Recently, studies have supported the efficacy of treating anxiety disorders utilizing a transdiagnostic, or non-diagnosis-specific, framework (Erickson, D. H. (2003). Group cognitive behavioural therapy for heterogeneous anxiety disorders. Cognitive Behaviour Therapy, 32, 179–186; Garcia, M. S. (2004). Effectiveness of cognitive-behavioural group therapy in patients with anxiety disorders. Psychology in Spain, 8, 89–97; Norton, P. J., & Hope, D. A. (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36, 79–97). Transdiagnostic group treatment packages focus on the common aspects inherent across the anxiety disorders such as behavioral and cognitive avoidance, and faulty cognitive appraisals of threat potential or meaning (Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230). Although research supports the overall efficacy of transdiagnostic cognitive behavior therapy (CBT) for anxiety disorders (Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy: Theory, Research, Practice and Training, 45, 214–226), the effect of diagnostically mixed group composition on individual outcomes is less clear. This study investigated the relationship between group composition and treatment outcome within diagnostically heterogeneous groups with the purpose of determining if diagnostic heterogeneity differentially impacted treatment outcome for 84 individuals during a 12-week transdiagnostic cognitive–behavioral group anxiety treatment program (Norton, P. J. (2012a). Group cognitive-behavioral therapy of anxiety: A transdiagnostic treatment manual. New York: Guilford). The diagnostic makeup of the treatment group was examined at the beginning of treatment and at the end of treatment, and the results indicated that the diagnostic makeup of the treatment group had no significant impact on individual treatment outcome. These findings have direct implications for the delivery of transdiagnostic treatments, and are discussed in terms of their global implications for the transdiagnostic approach to the treatment of anxiety disorders.     

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.     

Self-efficacy and depressive affect in college students

In an attempt to extend Bandura's theory of self-efficacy, we investigated the hypothesis that increases in self-efficacy, based on mastery experiences, would lead to improvements in mood and problem solving among dysphoric subjects.College students (N=79), classified as dysphoric or nondysphoric by the Beck Depression Inventory, were randomly assigned to anagram training groups that received bogus bar graphs suggesting either task ease or difficulty. Before and after training, subjects rated themselves on depressive affect (DACL) and self-efficacy. A difficult anagram task and a final DACL rating completed the procedure.Anagram training conditions did not lead to differential self-efficacy. However, multiple regression analyses showed that self-efficacy was related to depressive symptoms. Greater DACL decreases after training were seen in dysphoric subjects who reported higher posttraining self-efficacy. This improved mood is consistent with Bandura's theory. An unexpected finding among dysphoric subjects was that the higher their self-efficacy was, the lower was their final anagram performance. It appears that dysphoric/high self-efficacy subjects may have become more demoralized than dysphoric/low self-efficacy subjects when they encountered a need for much greater effort expenditure on the difficult anagram task.The findings suggest that skills training interventions which raise self-efficacy may be most effective in reducing depressive symptoms. The relevance of effort expenditure to the development of competine in depressed undiriduals appears to merit further investigation.where he served previously as Director of Clinical Psychology and as Chairperson of the Department of Psychology.Jeffrey Schwartz, Ph.D., a clinical psychologist, has been a staff member at the Cliffwood Mental Health Center in Englewood, New Jersey for the past five years. He is also engaged in private practice in New York City.Jefferson M. Fish, Ph.D., is Professor of Psychology at St. John's University in New York City, where he served previously as Director of Clinical Psychology and as Chairperson of the Department of Psychology.This paper is based on the first author's Ph.D. dissertation in Clinical Psychology at St. John's University under the direction of the second author. Both authors wish to thank Jeffrey Nevid and John Hogan for their support and contributions as committee members, and Marc Garcia for his invaluable assistance with data analysis. Requests for reprints should be addressed to the second author, Department of Psychology, St. John's University, Jamaica, New York 11439. All other correspondence should be directed to the first author at the same address.     

Internment and ministry: A dialogue with Joseph Kitagawa

This dialogue presents a profile of the late Joseph Kitagawa—a renowned scholar of the history of religions (Religionswissenschaft). It focuses on comparative religion and philosophy, as well as several other important issues related to his distinguished career as an Episcopal priest and dean of the Divinity School of the University of Chicago. They are: his experience of American concentration camps during World War II; Christian atheism and new theological models; concepts of time in Oriental and Occidental faiths; depth-psychology and contemporary ministry; and Paul Tillich's significance for the pastoral counseling movement.David M. Moss, Ph.D., Th.D., is the Book Review Editor of thisjournal and the Past President of the Georgia Chapter of the American Association's Division of Psychoanalysis. The interview is part of a series that will be published in a volume entitledDialogues in Depth Psychology and Religion.     

A model for police officer burnout

This article presents an empirically derived model of police officer burnout based on 199 male police officers. A brief review of research on police officer stress is also provided.This chapter is a summary of research conducted by Dr. Alan M. Goodman for his doctoral dissertation entitledA Model for Police Officer Burnout, June 1983, California School of Professional Psychology, San Diego.Alan M. Goodman, Ph.D. obtained his Ph.D. in Clinical Psychology from the California School of Professional Psychology in San Diego, California. In addition, Dr. Goodman is a School Psychologist and is a consultant to several school districts in Southern California. Dr. Goodman has been employed in both inpatient and outpatient mental health settings. Most recently, Dr. Goodman has been a Registered Psychologist at Catholic Community Services in San Diego where he conducted individual, conjoint and family therapy sessions for a varied socioeconomic population, including city service personnel.Dr. Goodman has conducted extensive observations of police officers on the job through the Ride-A-Long program in which non-police personnel may accompany police officers on a particular shift of duty. In addition, he has consulted with numerous police chiefs regarding the various high-risk factors for those police officers who may be experiencing burnout and stress. In addition, intervention strategies in order to alleviate these feelings were discussed with these officials.     

Treatment of alcoholic couples in outpatient group therapy

This paper summarizes special issues that group leaders are likely to encounter when adapting their skills to outpatient group therapy with alcoholic couples. More specifically, the paper: (a) discusses the advantages of treating alcoholic couples in a group as opposed to individual couple's therapy; (b) outlines the parameters of a couples group with alcoholic members that differentiate it from working with other kinds of couples in group; and (c) provides guidelines and techniques for tackling some of the specific kinds of problems and situations that arise.This paper was presented at the Annual Meeting of the American Group Psychotherapy Association, New York City, February, 1985.The author wishes to acknowledge the contribution of Geraldine Alpert, Ph.D., whose thoughtful comments and discussion helped to crystallize the concepts presented.     

BOOK REVIEWS

Book reviewed in this article: Frustration and Aggression: By John Dollard and others. Child Psychology: By Skinner and Harriman . The Psychology of Women: By Helene Deutsch , M.D. Rorschach's Test 1.—Basic Processes: By Samuel J. Beck , Ph.D. The Nature and Treatment of Mental Disorders: By Dom Thomas Verner Moore , O.S.B., Ph.D., M.D. Education for Democracy: By J. D. G. Medley . A Plan for Australia. The American Character: By Margaret Mead . Widening Horizons: By P. R. Morris and others.     

Evaluation of self-administered rational emotive therapy programs for interpersonal anxiety

Self-administered rational emotive therapy (RET), withA New Guide to Rational Living (Ellis & Harper, 1975), as the treatment manual, was evaluated by comparing three groups which varied in terms of therapist contact (therapist administered, minimal contact, self-administered). University students who volunteered for the research program involving the treatment of interpersonal anxiety were randomly assigned to one of these treatments or to a wait-list control group. The results for 72 subjects who completed the 5-week program indicated the three treatment groups made significant gains over untreated controls on some of the self-report measures. No between-group differences appeared on ratings by significant others. A four- to five-month follow-up, which obtained data from 41 (58%) of the subjects, provided some support for the maintenance of treatment effects for the therapist administered and minimal contact groups. Correlations of assessed irrational beliefs with outcome measures provided some support for the RET model.Norris D. Vestre, Ph.D., is a Professor in the Department of Psychology, Arizona State University. Terrence J. Judge, M.C., R.N.C., is a nurse therapist at Camelback Vista Treatment Center, Scottsdale, Arizona.     

Focused group therapy: An integrative approach

Focused Group Therapy (FGT) was developed within a research project on treatment for burned out patients on long-term sick leave. The core of FGT is to find and formulate an individual focus expressed in behavioural terms. This focus is then worked with in the here-and-now of the group therapy. It is argued that the use of common factors in group therapy, rather than a special technique, improves the clinical work. Thesupport factor in group therapy is understood in terms of cohesion, therapeutic alliance and goal-corrected empathic attunement. Thelearning factors that are stressed are the experience of being a part of a developing group, building on similarities instead of differences, affective communication and the implicit knowledge developed in new ways of dealing with interpersonal relations. Theaction factor is considered to consist of challenging interpersonal situations corresponding to the individual focus, which are mastered in the here-and-now of the group.     

Handling Spirituality/Religion in Professional Training: Experiences of a Sample of Muslim Psychology Students

With increasing research interest in the relationship between spirituality/religion and mental health, the present study uses semi-structured interviews on a select group of Muslim students to explore their understanding and handling of spirituality in a secular training programme. Their understanding of spirituality, its perceived role in therapy and their training experiences are subjected to qualitative analysis using the framework approach (Ritchie & Spencer, 1994. In A. Bryman & R.G. Burgess (Eds), Analysing Qualitative Data. London: Routledge). All five participants perceived spirituality as central to human functioning. Probes into their training experience uncovered issues of bias against religious applicants, apprehension about demonstrating religious commitment, fear of punishment for compromising religious integrity, better rapport with Muslim patients but general uncertainty about handling spiritual issues in therapy, and a strong desire for the integration of spirituality/religion in the program.Cynthia Joan Patel, M.A., is a Lecturer in the School of Psychology at the University of Kwazulu-Natal, Westville Campus, Durban, South Africa. She is a Registered Counselling and Research Psychologist with the Health Professions Council of South Africa). Her research interests include women and religion, attitudes toward abortion, and the meaning of work in women’s lives. Armas E. E. Shikongo, M.A., is a Lecturer in the Department of Psychology at the University of Namibia. His research area is the psychology of spirituality.     

Sex role identification and young women's irrational beliefs

The present study was designed to examine the relationship between young women's beliefs about approval, frustration, and dependency and their sex-role identification. Sixty-six college women responded to a questionnaire which contained the Irrational Beliefs Test (Jones, 1969) and the Multidimensional Sex Role Inventory (MSRI; Bernard, 1981). As predicted, women who score high in irrational beliefs concerning approval, frustration, and dependency also scored higher on the MSRI scale pertaining to anxiety and neuroticism than did their more rational counterparts. Also, the high irrational group scored lower than did the low irrational group on the MSRI scale measuring instrumental-agentic traits. These results have two implications for feminist RET psychotherapists. First, they clarify the value of using instruments to assess both irrational beliefs and sex role identification in treatment planning. Secondly, they sensitize the psychotherapist to the impact of sex-role socialization and identification on the psychological adjustment of young women.This article is based in part on a master's thesis completed by Tracy L. Vining, M.A.The authors thank William Tooke, Ph.D., for his helpful advice.Tracy L. Vining, M.A., is a School Psychologist at the Wayne Finger Lakes BOCES in Rushville, N.Y. William P. Gaeddert, Ph.D., is an Associate Professor in the Psychology Department at SUNY-Plattsburgh, and Naomi B. McCormick is a Professor in the Psychology Department at SUNY-Plattsburgh and a Fellow of the Institute for Rational-Emotive Therapy.     

The use of the Core Conflictual Relationship Theme method in describing and comparing gestalt and rational emotive behavior therapy with adolescents

The Core Conflitual Relationship Theme (CCRT) method (Luborsky, 1977) is used to study recurrent relationship patterns in therapy and may be employed as a measure of transference as well. We found only one article in the literature in which it was applied to a mode of psychotherapy, other than psychodynamic (Turner, 1992). In addition, there are only a few articles in the literature that refer to the CCRT method with children and adolescents. In this paper, we applied the CCRT method to two videotaped individual sessions of young adolescent boys, one in gestalt therapy and the other in rational emotive behavior therapy. Results showed that both boys revealed similar core relational theme profiles, but that their respective therapists each dealt differently with these relationship conflicts. In this pilot use of the CCRT with adolescent therapy, we were able to describe relationship patterns and delineate key differences between the two treatment modalities.Stacey Agin, a gradduate student in School Psychology at New York University, submitted this paper for partial fulfillment of the requirements for the Doctorate of Psychology. Iris E. Fodor is a professor of Applied Psychology at New York University and is director of the School Psychology program. She is known for her work on integrating cognitive and gestalt therapies. We gratefully acknowledge the cooperation of Raymond DiGiuseppe, Ph.D. Violet Oaklander, Ph.D. and Michael Bernard, Ph.D. in allowing us to utilize their videotaped psychotherapy sessions for the purposes of this study.     

Mind, Body, and Spirit: Family Physicians’ Beliefs, Attitudes, and Practices Regarding the Integration of Patient Spirituality into Medical Care

This study used a qualitative approach to explore family physicians’ beliefs, attitudes, and practices regarding the integration of patient spirituality into clinical care. Participants included family medicine residents completing training in the Southwest USA. The qualitative approach drew upon phenomenology and elements of grounded-theory. In-depth interviews were conducted with each participant. Interviews were recorded, transcribed and coded using grounded-theory techniques. Four main themes regarding physicians’ attitudes, beliefs, and practices were apparent from the analyses; (1) nature of spiritual assessment in practice, (2) experience connecting spirituality and medicine, (3) personal barriers to clinical practice, and (4) reflected strengths of an integrated approach. There was an almost unanimous conviction among respondents that openness to discussing spirituality contributes to better health and physician–patient relationships and addressing spiritual issues requires sensitivity, patience, tolerance for ambiguity, dealing with time constraints, and sensitivity to ones “own spiritual place.” The residents’ voices in this study reflect an awareness of religious diversity, a sensitivity to the degree to which their beliefs differ from those of their patients, and a deep respect for the individual beliefs of their patients. Implications for practice and education are discussed.Michael M. Olson, Ph.D., is a member of the Department of Family Medicine, University of Texas Medical Branch in Galveston.M. Kay Sandor, Ph.D., R.N., is in the School of Nursing.Victor Sierpina, M.D., is in the Department of Family Medicine.Harold Vanderpool, Ph.D., Th.M., represents the Institute for Medical Humanities at the university and Patricia Dayao, M.A., is a graduate student there.Funding for this study provided in part by the John G. and Marie Stella Kenedy Foundation and the George Washington Institute for Spirituality and Health/John Templeton Foundation. Correspondence to Michael M. Olson, mmolson@utmb.edu.     

Reflections on using group therapy as a treatment modality—Why,how, for whom,and when: A guide to clinicians,supervisors, and instructors

This paper emphasizes the potential of group forces for benefit or harm in group therapy as well as human development. Clinical, experimental-historical, and experiential evidence is cited in order to assess methods for harnessing group forces effectively. Ways in which group therapy is particularly valuable for enabling individuals to develop interpersonal skills, resist group pressure, improve communicative skills, deal with problems of inferiority and pessimism, be responsive to feedback, deal with resistance and transference, and manage problems in the working through phase of therapy are focused on. Another emphasis is on how group therapy technique differs from, supplements, and improves on the effectiveness of individual therapy alone. Crucial problems of patient selection and placement are explored, as is the idea that doing group therapy helps the therapist deal with countertransference problems and increases overall effectiveness and personal growth.Dr. Fenster is Professor of Psychology and was founding Chairman of the Psychology Department at John Jay College of Criminal Justice. This paper was written while he was on sabbatical leave and serving as Coordinator of Group Therapy in the Psychiatry Department at Brookdale Hospital Medical Center.     

Using group therapy to foster the psychosexual development of patients with eating disorders

When eating-disordered patients participate in long-term eating-dis-order groups, they move through phases of group development that parallel phases of psychosexual development. In the trust (oral) phase, members have an opportunity to experience a positive symbiosis, a suitable holding environment, and optimal frustration. In the control (anal) phase, members learn to identify and express anger constructively. In the intimacy (oedipal) phase, members learn to compete and be intimate. Individual and group movement is facilitated by the group leader being able to identify stages of group development and being able to utilize phase-related techniques.Many thanks to Anne Alonso, Ph.D., Robert Dies, Ph.D., and Geraldine Alpert, Ph.D., for their critiques of the first draft of this paper.     

Judeo-Christian Clergy and Personal Crisis: Religion,Posttraumatic Growth and Well Being

This study investigated the psychological impact of personal traumatic events in a sample of 30 Judeo-Christian clergy. Use of religion-based coping strategies following a difficult life event was expected to facilitate posttraumatic growth, and posttraumatic growth was, in turn, expected to result in greater current well being. Both predictions were supported. In addition, higher levels of rumination soon after the event were associated with greater posttraumatic growth. The results indicated that clergy benefited from both positive and negative styles of religious coping, and that posttraumatic growth was not associated with greater well being for this sample. Deborah Proffitt, M.A., is in private practice in Charlotte, North Carolina. Arnie Cann, Ph.D., is a Professor in the Psychology Department at the University of North Carolina Charlotte. A social psychologist, he is involved in research on posttraumatic growth and interpersonal relationships. Lawrence G. Calhoun, Ph.D., is a Professor in the Psychology Department at the University of North Carolina Charlotte. A clinical psychologist, he has studied posttraumatic growth and responses to crises. Richard G. Tedeschi, Ph.D., is a Professor in the Psychology Department at the University of North Carolina Charlotte. A clinical psychologist, he has studied posttraumatic growth and bereavement issues.     

Totemic therapy

Totemic therapists, those recognized as healers because of their identification with an ethnic subculture, religious group, or social cause, are a factor in modern society often overlooked or underestimated as a mental health resource. Whatever the advantages and disadvantages of totemic therapy, such therapists will be in increasing demand as pluralistic social trends continue. It is therefore realistic to ask how their skills may be increased and their services better utilized.Ronald R. Lee, Ph.D., was born in Melbourne, Australia, and received his Ph.D. in Pastoral Psychology from Northwestern University/Garrett Evangelical Theological Seminary in 1965. He is Professor of Pastoral Psychology and Counseling at Garrett-Evangelical Theological Seminary and is a Diplomate in the American Association of Pastoral Counselors.     

Clinical approaches to the near-death experiencer

The literature on near-death experiences (NDEs) and their aftereffects has focused on the positive personality transformations and spiritual development that often follow an NDE, while it has neglected the emotional and interpersonal problems sometimes precipitated by the experience. We report general guidelines and specific interventions, developed at an interdisciplinary conference, to assist NDErs in coping with psychological difficulties following their experiences.This report was based on a conference on Clinical Approaches to the Near-Death Experience, sponsored by the International Association for Near-Death Studies, February 5–9, 1984, in Pembroke Pines, FL, and funded in part by a grant from the Institute of Noetic Sciences. The authors gratefully acknowledge the contributions of the other participants in that conference: Patricia Bahr, Boyce Batey, Sharon Batey, Nancy Bush, Kimberly Clark, M.S.W., Diane Corcoran, R.N., Ph.D., Elaine Durham, Linda Fleishman, Charles Flynn, Ph.D., Margaret Huddleston, Joan Kaye, Esther Knecht, Carolyn Lewis-Stone, M.S.W., Jean Marr, Ph.D., John McDonagh, Ph.D., Anne-Marie Meagher, M.D., John Migliaccio, M.Ed., Judith Miller, Ph.D., Raymond Moody, Jr., M.D., Ph.D., Leslee Morabito, Annalee Oaks, R.N., M.A., Ruth Orner, Ph.D., Carol Parrish-Harra, Madelaine Podurgiel, R.N., Ph.D., Laurie Schwartz, Joyce Strom-Paikin, R.N., M.S., Robert Sullivan, Nina Thornburg, M.S.N., Israel Topel, M.D., and Kate Wyatt, Ph.D.     

Support groups for medical caregivers of people with HIV diseases

As we enter the second decade of AIDS, medical caregivers are experiencing stress and burnout as a result of their work with people with HIV diseases. There are common themes to the stress, as well as differences in the experience of stress according to the characteristics of the healthcare setting. Caregiver support groups are a means of reducing this stress by helping medical caregivers cope better, manage difficult cases, normalize their feelings, put understanding and context to their experiences, decrease isolation, and instill meaning in their work. The use of support groups across various medical settings is presented.The author wishes to acknowledge the assistance of Nicholas Covino, Ph.D., Peter Kassel, Psy.D., Randall Paulsen, M.D., Veronica Rempusheski, Ph.D., Dan Silverman, M.D., and Susan Burns Tisdale, R.N., in ongoing research regarding caregiver support groups. The author also wishes to express gratitude to Genya Bernstein, Psy.D., for many editorial contributions.