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.     

An account of a time-limited therapeutic group in an NHS setting for women with a history of incest

Group therapy may be a useful treatment modality for women who have been sexually abused as children. The group described here involved patients referred to the British NHS psychiatric service. This closed time-limited group was run by male and female cotherapists. Reasons are advanced for advocating a mixed-sex cotherapy team. The progress of the group is described. Issues of selection, preparatory individual therapy, further individual therapy following the group, and stress on the therapists are discussed. It is suggested that the mode of referral influences the severity of presenting problems and the level of additional support likely to be required by group members. The participants' views concerning the most helpful components of therapy are recorded and self-report measures are considered alongside the assessments of the therapists.     

General and contextualized emotion goals and its link with well-being across late,middle, and young adulthood

Prior research with young adults has shown how emotion goals (i.e., cognitive representations of preferred emotional states) can be instrumental (positive or negative) depending on the context and how this context sensitivity is linked to higher well-being. However, this research has overlooked older adults. We argue it is important looking at this age group as there is mixed evidence given that on one hand they have been described as exhibiting a positivity bias (hedonic orientation; preference for positive emotion goals), and on the other hand, being capable of suppressing this when it is adaptive to do so. Importantly, this bias towards positive emotion goals has been linked to better emotion regulation and higher well-being in older adults. In order to understand whether older adults can also exhibit instrumental emotion goals and whether this is linked to well-being, we conducted an exploratory study with older (N = 43, M_age = 68.33), middle (N = 47, M_age = 43.83), and young adults (N = 47; M_age = 21.98) who reported about their general and contextual emotion goals (in collaboration and confrontation), their well-being, and their current positive and negative affect. Although older adults reported lower negative affect than young adults, there were no age differences for general and contextualized emotion goals. Across the three age groups, a higher preference for happiness in general and in collaboration was linked to higher well-being. The obtained results highlight the need to study emotion goals longitudinally to better understand their possible changes throughout the lifespan and their influence on well-being.     

Self-referential schemas and attentional bias predict severity and naturalistic course of depression symptoms

Attentional bias and self-referential schemas have been observed in numerous cross-sectional studies of depressed adults and are theorised to maintain negative mood. However, few longitudinal studies have examined whether maladaptive cognition predicts the course of depressive symptoms. Fifty-seven adults with elevated depression symptoms were assessed for negative attentional bias using a dot-probe task with eye-tracking and self-referential schemas using a self-referent encoding task. Participants subsequently completed five weekly depression symptom assessments. Participants with more negative self-referential schemas had higher baseline depression symptoms (r?=?.55). However, participants who spent more time attending to negative words showed greater symptom worsening over time (r?=?.42). The findings for negative self-referential schemas replicate past research, while the findings for negative attention bias represent the first evidence showing that attentional biases predict naturalistic symptom course. This work suggests that negative attention biases maintain depression symptoms and represent an important treatment target for neurocognitive therapeutics.     

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.     

Outcome of psychoanalytically oriented group psychotherapy

A study of 100 consecutive persons who terminated, once a week, psychoanalytically oriented group psychotherapy shows that it is an effective treatment for neurotic persons with good ego strength who remain in therapy a year or longer. Analytically oriented group therapy was less effective in treating severely ego-impaired persons, and group members of all levels of ego strength often required augmentation of their group therapy by individual sessions and psychotropic medications. Early dropouts (less than 30 sessions) seemed related to lack of motivation and poor fit with the group. Later dropouts (sessions 30–60) seemed related to low ego strength.     

Introduction to Group-Analytic Psychotherapy by S. H. Foulkes

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she “understands” because of having also grown up in an alcoholic family); (b) the “will to restore,” which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a “rush to recovery” on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) “countertransference goodness and availability” as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

Premature termination: A clinical study

Ten patients who terminated prematurely from 10 different therapy groups were interviewed using a semistructured interview protocol. Half the subjects were patients in private therapy groups; the other half were patients in clinic therapy groups. Among the issues inquired about were subjects' initial attitudes about group treatment; the nature of the preparation process; subjects' experience of the group therapist, other group members, and the group process; their reasons for leaving their groups; and the nature of the termination process. The findings reported focus on patients' perceptions of therapists' motives; the importance of establishing appropriate treatment goals; the handling of negative feelings about the group and/or the group therapist; the issue of narcissistic injury; the experience of the balance between giving and receiving; the difficulties caused by unresolved conflicts within groups; and the problems posed by inadequate preparation for the group experience. Guidelines for practices aimed at minimizing premature terminations are offered.     

Latent Extinction in a Multiple-T Maze within Heterogeneous and Homogeneous Environments

This investigation found support for the general hypothesis that prior social experience influences current perception of historically relevant cues. Male college Ss, matched for quality of prior maternal evaluation, were separated into those (N = 40) who rated their fathers positive in their evaluations of them (HN) and those (N = 38) who rated their fathers as more negative (LN). These groups did not differ in their perception of maternal evaluative cues when presented alone. When paternal evaluative cues were presented as distractors, selective attention to maternal cues was more disrupted for the LN group. Deployment of attention to task-irrelevant paternal cues, as inferred from intrusions, did not differ for the HN and the LN groups. However, the LN subjects did demonstrate a negative qualitative bias in those intrusion errors which came from the task-irrelevant paternal set, whereas HN subjects showed a positive qualitative bias. Both biases were in keeping with paternal evaluative histories. Greater disruption of LN task performance may have been the result of responses, such as anxiety, associated with their negative bias.     

Affective flexibility: evaluative processing goals shape amygdala activity

ABSTRACT— Although early research implicated the amygdala in automatic processing of negative information, more recent research suggests that it plays a more general role in processing the motivational relevance of various stimuli, suggesting that the relation between valence and amygdala activation may depend on contextual goals. This study provides experimental evidence that the relation between valence and amygdala activity is dynamically modulated by evaluative goals. During functional magnetic resonance imaging, participants evaluated the positive, negative, or overall (positive plus negative) aspects of famous people. When participants were providing overall evaluations, both positive and negative names were associated with amygdala activation. When they were evaluating positivity, positive names were associated with amygdala activity, and when they were evaluating negativity, negative names were associated with amygdala activity. Evidence for a negativity bias was found; modulation was more pronounced for positive than for negative information. These data suggest that the amygdala flexibly processes motivationally relevant evaluative information in accordance with current processing goals, but processes negative information less flexibly than positive information.     

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.     

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.     

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.     

Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia

Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction.     

Perceived consequences underlying approach goals and avoidance goals in relation to anxiety

Numerous studies have examined anxiety from a cognitive and affective perspective but relatively little research has studied anxiety from a motivational perspective. There are theoretical grounds (e.g., Gray, 1982) for expecting anxiety to be characterised by heightened avoidance motivation, but this motivational bias is not thought to be accompanied by diminished approach motivation. A cross-sectional, mixed model design was used to investigate individuals’ response-variations on personal approach and avoidance goal systems. A convenience sample comprising an anxious group (n = 41) and non-anxious group (n = 33) completed tasks that measured number of self-generated approach goals and avoidance goals, and number of associated positive and negative consequence steps for goals. As predicted, anxious individuals, relative to non-anxious individuals, generated more avoidance goals and more negative consequence steps in response to goal non-attainment (irrespective of goal type) but did not differ on number of approach goals or positive consequence steps in response to goal attainment (irrespective of goal type). The present findings highlight the importance of personal goal systems in understanding the nature of anxiety.     

Effects of Implementation Intentions Linking Suppression of Alcohol Consumption to Socializing Goals on Alcohol‐Related Decisions

This article investigates the effects of implementation intentions that connect the suppression of alcohol consumption to socializing goals on the decision to accept an offer of a free alcoholic drink. Participants were university students (N = 48) who were randomly assigned to an implementation intention condition or a control condition. The results show that participants who formed implementation intentions were less likely to accept the offer of a free alcoholic drink than were participants who did not form implementation intentions. In addition, the results demonstrate that the implementation intention effect held among habitual alcohol drinkers. The results of the present study suggest that implementation exercises can successfully suppress habitual alcohol consumption.     

Treatment contracts in long-term groups with alcoholic outpatients: A group case study

This paper describes the process of treatment contracting in a long-term group with alcoholic outpatients — relating the contracting process to the dynamics of the group and to the total treatment context. The material presented highlights the ways in which the contracting process (in particular, grappling with the issue of who should set the terms of the contract) may serve as a model for helping group members better understand and cope with problems in assertiueness and limit setting.     

Differential outcomes of skill training,group counseling,and individual cognitive therapy for persons with acquired visual impairment

As part of the Living Skills Training Program, group counseling and individual cognitive therapy were implemented to decrease psychological distress for adults with acquired visual impairment. This quasi‐experimental design study compared the outcomes of a 6‐month skill training program combined with a group counseling program (n = 37), with (n = 9) or without (n = 10) individual cognitive therapy, and with a control group (n = 42). The outcome measures were the Profile of Mood States and the Nottingham Adjustment Scale Japanese Version. The results showed that participants with low psychological distress decreased anxiety and increased acceptance of disability, even when they did not participate in group counseling. However, among the participants with high distress, they did not show any improvement without group counseling or individual therapy. The participants with high distress who engaged in group counseling showed an improving trend in attitudes toward others. Moreover, the participants who chose to engage in individual therapy in addition to group counseling showed decreased tension‐anxiety, depression, and fatigue, and significantly improved acceptance of disability. These results suggest that group counseling, combined with individual cognitive therapy, can be an effective part of rehabilitation treatment for clients who have high psychological distress.     

Five Issues in Training Edited by Irving R. Weschler and Edgar H. Schein

This case study illustrates how combined therapy (individual, group, and marital) by the same therapist was used to resolve a woman's narcissistic transference. The author's position is that combined therapy creates a psychologically stimulating environment, which uniquely elicits a depth and range of transference feelings, thereby generating multiple therapeutic opportunities to experience and work through transference resistance in the here-and-now. Highlights of the treatment demonstrate how the synergy of three modalities is used to elicit, modulate, and resolve positive and negative aspects of the narcissistic transference. Four guidelines are suggested for treatment of patients in combined therapy.     

Stationäre Rehabilitation alkoholabhängiger Patienten

Systemic therapy concepts are widely used in therapy and rehabilitation of alcohol addictive patients. Although very useful in practice, evaluation studies are rare. Adequate evaluation strategies should be developed and implemented. This study was realized in a clinical rehabilitation centre (Hirtenstein, Allgäu/Germany), whose systemic concept is characterized by patient's wideranged possibilities of choice concerning therapy measures and therapy goals, the activation of social and personal resources, the development of an individually appropriate life-style, the training of desired competencies, and an offer for marital and family therapy. The evaluation is based on a repeated measures design without control group. The instruments and constructs of the evaluation are: F-SOZU (perceived social support), IIP (perceived interpersonal problems), MLDL (quality of life), SOC (sense of coherence), and an assessment sheet for personal resources (RI). Patients (n= 44) reported increased personal ressources as well as an increased level of quality of life. Perceived social support and the sense of coherence changed only moderately. Scaling of treatment satisfaction and goal attainment at the end of the rehabilitation program resulted in high positive scores. Patients reported only positive, no negative treatment side effects. The results indicate the usefulness of systemic and resource oriented concepts in the rehabilitation of alcohol addictive patients.