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.     

Short-term psychodynamic intervention in an urban health clinic: A case report

This paper describes the application of short-term dynamic therapeutic techniques to treat both symptom disturbance and character pathology in an urban mental health clinic. Short-Term dynamic psychotherapy focuses extensively on the subjectivity and inner life of the patient with emphasis on repressed anger, sadness and desire. Methods to overcome patient ambivalence and resistance to psychotherapy are presented. The clinical psychodynamics associated with early life trauma are illustrated with a case of an African-American patient.Acknowledgments for support & critical feedback are expressed to Christine Baker, Ph.D., John Swanson, ACSW, Duncan Walton, Ph.D., and Isabelle Beveridge (Graphics).     

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.     

The making of a group psychotherapist: Needs and goals for graduate and postgraduate training

Group therapy is a widely practiced, effective, but underrated specialty. Unfortunately, group therapy seems to be taught more haphazardly, with less attention to quality, than is individual therapy. Group therapy has a technique, history, and literature of its own and should be taught independently from individual psychotherapy. The training of psychiatric residents is particularly crucial for group therapy to prosper and be seen as more prestigious. A common core of experience is vital for training in group therapy, whether the trainee's background is psychiatry, psychology, social work, pastoral counseling, or nursing. This core consists of: 1) clinical experience doing group therapy; 2) supervision; 3) a professional training group experience; 4) observation of experienced group therapists; 5) exposure to current thinking in the field; 6) personal group therapy; and 7) a didactic course in theory and technique. Clinical experiences involving cotherapy and combined individual and group treatments are especially useful, both as training and as treatment modalities.He is on sabbatical leave from John Jay College of Criminal Justice where he is Professor of Psychology and was founding Chairman of the Psychology Department.The authors wish to thank Arnold Rachman, Ph.D., Michael Lapidus, M.D., Fayek Nakhla, M.D., Nyapati R. Rao, M.D., and Dorothy Gartner, Ph.D., for their helpful comments on earlier versions of this paper, and Ms. Deloris J. Johnson for her typing and editorial assistance.     

Group psychology in the totalitarian system: A psychoanalytic view

The author discusses the ideas of three important psychoanalytic thinkers about group processes in large social groups: Sigmund Freud, Wilfred Bion, and Erich Fromm. Their ideas are developed and applied to analysis of group processes in totalitarian systems, as they were known to the author in Czechoslovakia and the Soviet Union. In conclusion, treatment considerations as they apply to patients who grew up in these regimes are developed and illustrated by clinical cases.This paper is dedicated to Dr. Alexander Wolf, who made his groups growth-promoting, free and holding environments.The author wants to thank Valerie Angel, M.S.W., Eva Papiasvili, Ph.D., Susan Kavaler, Ph.D., Maria Luisa Bastos, Ph.D., and Nancy Smith for their support, critical commentary, and helpful suggestions.     

The shattered mirror: Treatment of a group of narcissistic patients

Increasingly, group psychotherapy takes its place as a valid treatment model for patients with severe character pathology. This paper explores the impact of group treatment on a homogeneous group of patients with narcissistic character problems. The clinical example serves to illustrate the particular dynamics of this patient population; addresses the challenges inherent in treating these patients in a homogeneous, long-term therapy group; and, finally, underscores the countertransference pitfalls in such a clinical situation. Nonetheless, the successful working through of some of these patients' terrifying pathology supports the important of continuing experience and research into this arena.The author wishes to acknowledge with gratitude the invaluable assistance of J. Scott Rutan, Ph.D., in the planning and preparation of this clinical report.     

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.     

Modified group psychotherapy with chronic renal dialysis patients

Renal dialysis is a life saving, chronic medical procedure for those patients whose kidneys no longer function. However, the psychological reactions to this procedure, which necessitates a state of passivity for several hours, often overshadow the medical implications, and, in some instances, are decisive in terms of the patient's adjustment to treatment. Frequently, patients are unable to utilize individual psychotherapy to its maximum because of their need to perceive their illness as only medical. Group therapy however provides a less threatening psychological milieu and tends to give rise to peer support and mutual interaction.Barbara Halin Willinger, M.S.W., A.C.S.W., was the social work supervisor of the Renal Dialysis Unit at Metropolitan Hospital at the writing of this paper. She is a private psychotherapist and is affiliated with a mental health clinic where she also practices individual and group psychotherapy.The author wishes to thank Martin Saltzman, M.D. and Haley Glazer, M.S.W. for their suggestions.     

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.     

Potentiating group psychotherapy for bulimia with ancillary rational-emotive-hypnotherapy

A rational-emotive-hypnotherapy (REH) treatment was administered to five bulimic females who were concurrently participating in electic group psychotherapy. A within-group time series analysis design was employed to examine subjects' binge and purge symptoms. The combined treatments produced a declining frequency in symptoms for four subjects across three phases of the study. REH was responsible for 4 out of 8 possible treatment effects and appeared to potentiate the group psychotherapy. A theoretical explanation is offered for the REH effects along with recommendations for future REH with bulimics. This study was presented as a paper to the annual meeting of the American Psychological Association, 1982, Washington, DC. Appreciation is extended to Don W. Ball, Ph.D. for editorial and technical assistance in the preparation of this article.     

Living with diabetes

Management of diabetes can be affected by emotional distress in two ways: directly, via the effect of stress on glycemic control, and indirectly via effects on self-care routines. Rational-emotive therapy, along with a number of other cognitive, emotive, and behavioral tools, is an important intervention for patients who have diabetes-related distress. The authors describe personal and professional examples of the application of these tools to living rationally with diabetes.Richard R. Rubin, Ph.D. is a staff member of the Diabetes Center and the Pediatric Diabetes Clinic at the Johns Hopkins Hospital. In addition, he has a private psychotherapy practice, substantially devoted to counseling and coping skills training for people with diabetes.Susan R. Walen, Ph.D. is an Associate Professor in the Department of Psychology, Towson State University and Director of the Baltimore Center for Cognitive Therapy. She is the coauthor ofA Practitioner's Guide to Rational-Emotive Therapy.Albert Ellis, Ph.D. is the founder of Rational Emotive Therapy and president of the Institute for RET in New York City. He is the author of more than 50 books and 600 journal articles on psychotherapy topics.     

Borderline personality disorder level predicts change in depressiveness after short‐term group psychotherapy: A study in a daily psychiatric clinic

The project examined the comorbidity between depression symptoms and the level of borderline personality organisation among patients admitted for group psychotherapy (Study 1). It also aimed to analyse how the level of borderline personality organisation relates to the reduction in depression symptoms after short‐term psychotherapy (Study 2). The study was conducted in a day clinic where patients were receiving psychotherapy for emotional problems affecting their functioning (N = 57). The study used the Borderline Personality Inventory (BPI) and the Patient Health Questionnaire. The analysis showed that BPI was positively related to depression symptoms. The higher borderline personality organisation patients presented when entering group psychotherapy, the greater was the decrease in depression symptoms after 3 months of psychotherapy. We discuss the results in relation to the notion that the presence of depression could be a positive prognostic indicator for patients with borderline personality.     

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.     

Outcomes of inpatient group psychotherapy associated with dispositional and situational affiliativeness

Before and after participating in an intensive three-week program of group psychotherapy, 33 recently rehospitalized male veterans (mean age=42) completed the Symptom Check List-90R and the Profile of Mood States. Prior to this program they also completed a trait affiliativeness measure and later rated their subsequent group therapy sessions for situational affiliativeness. The outcome measures indicated medium to large effect size benefits, which consistently associated positively with both separate and joint measures of trait and situational affiliativeness. The results encourage greater clinical attention to affiliativeness, a construct central to interpersonal theories of personality.This article is based upon a dissertation submitted to the Department of Psychology, Michigan State University, in partial fulfillment of the requirements for the Ph.D. by the senior author.The authors express appreciation for the interest and cooperation of Drs. Bruce Vreeland, Larry Schwartz, Robert Munley, and Hope Conte and the patients of the Veterans Administration Medical Center, Battle Creek, Michigan.     

From the private I to the public ear: Effective learning groups for college-age students

This paper addresses the problem of organizing and conducting groups at a college counseling center. It focuses on the importance of a therapist learning from his/her errors, of appropriately matching a client with a particular group and of preparing clients and group leaders for work with a group. The concept of boundary management is used as a way to understand group events and to make sense of group leader errors. Throughout the paper, attention is given to how best to develop groups within the unique framework of a college community.This paper was presented at Brandeis University's Conference on Psychological Work with College Students, November 6, 1982. It was written in the memory of Eugenia Hanfmann, Ph.D., who as Director of the Brandeis University Counseling Center encouraged the author to appreciate the value of learning from his errors! In writing this paper the author is grateful for the support and for the suggestions offered by his colleagues, Bruce Weiss, Ph.D., and E. Martin Schotz, M.D.     

Psychoanalytic Psychotherapy for Severely Disturbed Borderline Patients: Observations on the Supervision Group of Psychotherapists

The authors describe the role of a supervision group of psychotherapists within a wider therapeutic field for severely disturbed borderline patients. The group concentrates on the transference and countertransference, seen according to Racker’s distinction between concordant and complementary identifications. The implications of the prevalence of the complementary identifications over the concordant identifications of the therapists to their patients and the resulting regression to primitive defense mechanisms can be counterbalanced by the group’s integrative functioning as receiver (1) of a variety of information about the patient, (2) of the therapist’s attempt to understand and synthesize, and (3) of the therapist’s countertransference reactions to his patient. The major discrepancies between the various conceptions of the borderline patients’ psychic world and the appropriate therapeutic technique to be applied are also discussed, as well as the way the group filters the information and integrates the therapeutic thought. It might be said, therefore, that, in the “inpatient” phase of the individual psychotherapy, the group of psychotherapists functions, for the patient and the treatment, in a synthesizing context, as it provides the therapist with a space of integration for his split-off part of self and object representations, which the therapist makes use of for his patient.*Members of the Athens University Project for Borderline Patients’ research team consisting of psychoanalysts and psychotherapists, Eginition Hospital, 74 Vas Sophias Avenue, Athens 11528, Greece.Maria Chatziandreou, M.D., is a member of the Hellenic Psychoanalytical Society.Haris Tsani, M.D., is a candidate of the Hellenic Psychoanalytical Society.Nikos Lamnidis, M.D., is a candidate of the Hellenic Psychoanalytical Society.Claire Synodinou, Ph.D., is a member of the Paris Psychoanalytical Society and an associate professor at Panteion University, Athens.Grigoris Vaslamatzis, M.D., is a training analyst of the Hellenic Society of Psychoanalytic Psychotherapy and an associate professor of psychiatry at Athens University.Address correspondence to: Maria Chatziandreou, M.D., 1-3, Skippi Street, 11525 Athens, Greece.     

The problem of reinterpretive distortions in group psychotherapy with borderline patients

Group psychotherapy with borderline patients is challenging work. A group in which the core of patients falls within this nosological category is described. The phrase reinterpretive distortion is used to characterize an aspect of these patients' communication style which makes their effective treatment quite difficult. Examples of the phenomenon are offered, as is an explanation of the dynamics which give rise to it and the functions it seems to serve. Effective ways to deal with reinterpretive distortions in the group psychotherapy context are suggested.     

Gender-specific common nouns: Sex differences in self-use

Males and females completed questionnaires on self-esteem and on their use, applied to themselves, of (a) girl/boy, (b) gal/guy, (c) lady/gentleman, and (d) woman/man in 10 situations. Terms chosen did not vary with self-esteem or with psychiatric vs nonpsychiatric status. Older subjects preferred lady/gentleman and woman/man. Females seldom chose gal, and used it less often than males used guy. Both sexes chose girl/boy most in negative situations. Females used girl more than males used boy in self-praise situations. Females preferred both sexes to think of them as ladies. Males preferred females to think of them as gentlemen and thought that term most complimentary, but preferred males to think of them as men. These results are discussed in terms of societal sex roles.The authors wish to thank Gary Leonardson, Ph.D., and Nancy Henley, Ph.D., for their aid in completing this study.