Small and unfilled psychotherapy groups: Understanding and using them effectively

Many open-ended psychotherapy groups have fewer than five members, and fewer than the number the therapist considers necessary for the group to be filled. This paper discusses the rationale for starting such groups and the special dynamics of running them. It then suggests strategies for the therapist to use in maximizing their therapeutic effectiveness. Suggestions are made for further research into the demographic and dynamic aspects of such groups.     

Sensory Deprivation: A Symposium Edited by Philip Solomon

In psychoanalytical psychotherapy interpretation is the main activity of the therapist. It is related to revealing the latent structure of meanings of phenomena. The phenomena of analytical therapy are presented as generated by the interaction of two structures: the therapeutic setting and the theoretical models of the therapist. The analytical group setting is contrasted with the individual setting through the elaboration of its central characteristic: the lack of intimacy. This is seen as generating specific regressive phenomena in groups which the therapist will attempt to interpret following an object relations theory. A discussion of interpretations in analytical group therapy focuses on three levels: the group itself, the interpersonal, and the intrapsychic. These are presented as complementary rather than mutually exclusive. Finally, the therapists' function in groups is discussed through the notion of the oscillatory nature of their participation, from a passive–receptive stance to an active–synthetic function which leads to the delivery of an interpretation.     

An investigation of various performance-based treatments with acrophobics

Five different performance-based treatments (participant modeling, participant modeling without therapist physical contact, modeling plus exposure, therapist-controlled exposure in vivo and rationale only) were compared to evaluate their relative effectiveness in the treatment of acrophobia. Ten subjects were assigned to each of the five groups. Avoidance behavior was assessed using a behavior test, self-report fear measures, heart-rate and self-efficacy expectation measures. Subjects were first submitted to two behavioral approach tests. These two pre-tests were administered 1 week apart, and no significant differences occurred between the evaluations. Analyses of variance for repeated measures at pre-test. post-test and follow-up revealed a significant improvement on all main outcome measures for the five groups. No significant differences among groups were observed. The total treatment time, which was also used as a dependent measure, did not yield any significant differences among treatment conditions. These findings have many implications. For instance, the need for induction aids, such as physical contact with the therapist and modeling, is questioned. Also, exposure per se whether therapist or self-controlled is shown to be effective in reducing avoidance behavior. Finally, the theoretical and clinical implications of these results are discussed.     

Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children

Parents of 43 conduct-problem children, aged 3-8 years, were randomly assigned to one of two treatments: an individually self-administered video-tape modeling treatment (IVM) and IVM treatment plus therapist consultation (IVMC). Randomization also included a waiting-list control group (CON). Compared with the control group, both treatment groups of mothers reported significantly fewer child behavior problems, reduced stress levels, and less use of spanking. Home visit data indicated that both treatment groups exhibited significant behavioral changes. There were relatively few differences between the two treatment conditions. However, the IVMC children were significantly less deviant than the IVM children, suggesting that the IVMC (with therapist consultation) treatment was superior to self-administered treatment with no therapist involvement. The added benefits of therapist involvement are discussed.     

Does Therapist–Rater Religious Match Predict Higher Therapist Ratings?

This study investigated whether therapist–rater religious match predicts better therapist ratings. Christian and Muslim Lebanese students (N = 187) were randomized into 3 conditions. A written vignette of the therapist was constant across conditions, but her picture was manipulated to include a veil, a cross pendant, or neither. Participants filled out a therapist rating form afterward. There were no significant differences in overall therapist ratings between groups.     

The Integration of Behavior,Vol. III by Thomas M. French

This article presents a model for understanding development within children's psychotherapy groups. It is proposed that two complementary cultures exist within children's groups, one, indigenous peer culture, strictly of the children's making and the other, therapeutic group culture, created by the therapist in collaboration with group members. The therapist is wise to approach indigenous peer culture as an ethnographer might a native culture, with an emphasis on observation and seeking understanding rather than on intervention. The therapist can use the indigenous peer culture to speak to the children in their own language and eventually to engage them in collaboratively building a meaning system that is uniquely designed to address their psychotherapeutic needs. The article defines these concepts, develops them theoretically, and illustrates them clinically.     

Therapeutic popularity and personality: Association between peer therapist nominations and the “Big Five” personality factors

The “Big Five” personality factors of three groups of psychology students differing in popularity as therapist among their peers were compared (n=33). In agreement with earlier research, popular therapists are “agreeable”, “conscientious” and “stable”. However, popular therapists are not “surgent/extravert” and especially not “dominant” and “talkative”. No support was found for the hypothesis that similarity in “agreeableness” or dissimilarity in “surgency” (the complementarily hypothesis derived from interpersonal theory) predicts therapist popularity. However, similarity between client and therapist in “stability” was predictive of nominations for therapist. On the assumption that therapist popularity predisposes good therapeutic alliances, the results indicate that therapists agreeableness, conscientiousness and emotional stability are relative to success in therapeutic interventions.     

Attitudes about psychotherapy: A qualitative study of introductory psychology students who have never been in psychotherapy and the influence of attachment style

Design: Interviews about attitudes about psychotherapy with 12 undergraduate students who had never been in psychotherapy were analysed using consensual qualitative research. Results: Participants believed that the client role is to disclose, be receptive, and be motivated; that the therapist role is to listen, support, and give advice; and that the therapeutic relationship should be close and personal. Participants had ideas about the benefits (a healing therapeutic relationship, personal and interpersonal changes) and the barriers (self‐stigma and public stigma, difficulty revealing, need to solve problems on own, cost) associated with seeking therapy, and they disliked the idea of being diagnosed. In contrast with participants who were securely attached, those who were insecurely attached more often wanted a professional therapeutic relationship, wanted the therapist to ask questions, mentioned fewer benefits to therapy, and thought that they would have difficulty disclosing to a therapist. Discussion: Implications for changing attitudes about psychotherapy and improving training programs for practitioners are discussed.     

Internet-based treatment of social phobia: a randomized controlled trial comparing unguided with two types of guided self-help

Internet-based self-help for social phobia with minimal therapist support via email have shown efficacy in several controlled trials by independent research teams. The role and necessity of therapist guidance is, however, still largely unclear. The present study compared the benefits of a 10-week web-based unguided self-help treatment for social phobia with the same intervention complemented with minimal, although weekly, therapist support via email. Further, a third treatment arm was included, in which the level of support was flexibly stepped up, from no support to email or telephone contact, on demand of the participants. Eighty-one individuals meeting diagnostic criteria for social phobia were randomly assigned to one of the three conditions. Primary outcome measures were self-report measures of symptoms of social phobia. Secondary outcome measures included symptoms of depression, interpersonal problems, and general symptomatology. Measures were taken at baseline, post-treatment, and at 6-month follow-up. Data from a telephone-administered diagnostic interview conducted at post-treatment were also included. Results showed significant symptom reductions in all three treatment groups with large effect sizes for primary social phobia measures (Cohen’s d = 1.47) and for secondary outcome measures (d = 1.16). No substantial and significant between-groups effects were found on any of the measures (Cohen’s d = 00–.36). Moreover, no difference between the three conditions was found regarding diagnosis-free status, clinically significant change, dropout rates, or adherence measures such as lessons or exercises completed. These findings indicate that Internet-delivered treatment for social phobia is a promising treatment option, whether no support is provided or with two different types of therapist guidance.     

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.     

The correlates of phone-in frequency, duration and the number of suggesdtions made in live supervision

The relationship between the parameters of live supervisory phone-ins and particular supervisory and therapy processes were examined in this study. The frequency of phone-ins and the number of suggestions made by supervisors were associated with specific therapist, supervisor and client behaviours. Less frequent phone-ins (five or fewer per session) were associated with greater client cooperation, greater supervisor collaboration and, surprisingly, less therapist collaboration with clients. There was also a trend for client cooperation to occur more frequently following phone-ins in which four or more suggestions were made. The duration of phone-in events was not significantly associated with the supervisory and therapy processes examined in this study.     

Intimacies: An Integrative Multicultural Framework for Couple Therapy

Implicitly or explicitly, our ideas about intimacy are the most fundamental notions giving direction to the process of couple therapy. Yet, as a field, we have spent little time conceptualizing intimacy and even less time considering the diversity of priorities and meanings couples bring to our offices. In Part One, Varieties of Intimacy, I describe a kaleidoscope of contexts—socio‐historical, cultural, gender, life cycle, and developmental—that inform our ideas and expectations for intimacy in couples’ relationships. I highlight different spheres in which intimacy may take place such as the emotional, sexual, intellectual, or familial. I propose a starting point in which the therapist, in a collaborative manner, helps the partners articulate their yearnings and priorities in order to negotiate a shared vision. In Part Two, Conceptualizing Intimacy, I suggest an experiential definition that gives room for each partner's subjective meanings, yet consider diverse relational processes that may need to be addressed for a resilient ebb and flow of intimate experiences. In Part Three , Sexual Intimacy, I outline conditions in which sex is more likely to be experienced as intimate rather than nonintimate. Finally, in Part Four, I describe Therapeutic Principles to guide the therapist in taking couples from reactivity to dialogue to negotiations of intimacy. The integrative framework proposed here discourages monolithic a priori notions of intimacy and highlights instead: nuanced meanings, relational processes to be considered differentially, present and past emotional blocks, and a flexible clinical approach to foster conditions for the creation and resilience of intimate experiences.     

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.     

Fertility Related Attitudes of Minority Mothers with Large and Small Families1

The relationship between certain attitudes and levels of fertility in five cultural groups–Blacks, Cubans, American Indians, migrant Chicanos, and white Protestants–was explored. Mothers, aged 35–45, with one or two children (small family, N= 253) or five children (large family, N= 196) were compared. Subjects responded to semantic differentials measuring attitudes toward pregnancy, family, abortion, sex, birth control, and parent. Large family mothers were generally more negative toward birth control, sex, and family. Cultures differed significantly on all six attitudes, with those toward abortion and pregnancy being the best discriminators. Significant interactions between cub ture and size were found on attitudes toward birth control and pregnancy. In general, large families wanted fewer children than they had and their negative attitudes toward birth control might be associated with their ineffective experiences; however, the trend was reversed in the migrant group where small family mothers were more negative toward birth control. Since small family mothers among migrant Chicanos were difficult to find and their estimates of ideal family size was large, it is likely that their negative attitudes toward birth mntrol reflected an aversion to its use.     

Utility of computerized case simulations in therapist training and evaluation

The present quasi-experimental study attempted to evaluate the utility of a set of three computer simulations for therapist training and evaluation by comparing psychology students from two universities at three training levels. The three groups consisted of junior and senior level undergraduates, first year graduate students, and third or fourth year graduate students. Analysis of outcome measures indicated subjects were generally accepting of computer simulation use for therapist training and evaluation and performance differences between the groups could be explained by group population differences. The results are discussed relative to the utility for computer simulations use for therapist training and evaluation.     

Fairy tales,landscapes and metaphor in supervision: An exploratory study

Objective: Supervision is an important requirement for most health professionals and finding innovative and creative forms of ensuring safe and ethical practice are helpful to practitioners. This paper explores the use of fairy tales, mental landscapes and metaphors to illuminate the therapeutic and supervisory relationship. A therapy case study was used as reference. Design: The design was based on a grounded theory methodology and qualitative‐based collaborative meetings between professionals. Both researchers/participants were from different therapeutic backgrounds; drama therapy and integrative counselling. Findings: Two main themes emerged relating to the therapeutic process: (1) Using Archetypal themes in fairy tales to enhance the clarity of the therapeutic landscape; and (2) The facilitation of the sense system through the use of small objects to reconceptualise the therapeutic dynamic. Conclusion: The use of metaphor and small objects to explore retrospective therapeutic encounters can enhance the role of supervision by broadening the cognitive landscape of the therapist. Implications for the therapist/client and supervisor relationships are considered.     

Effects of escalating and descending schedules of incentives on cigarette smoking in smokers without plans to quit

Contingent incentives can reduce substance abuse. Escalating payment schedules, which begin with a small incentive magnitude and progressively increase with meeting the contingency, increase smoking abstinence. Likewise, descending payment schedules can increase cocaine abstinence. The current experiment enrolled smokers without plans to quit in the next 6 months and compared escalating and descending payments schedules over 15 visits. In the larger incentive condition (LI, n = 39), the largest possible incentive was $100, and in the smaller incentive condition (SI, n = 18), the largest possible incentive was $32. In both conditions, more participants in the descending groups initiated abstinence. A higher proportion of participants in both the escalating and descending groups initiated abstinence in the LI than in the SI. Although participants in the descending groups had more abstinent visits during the first five contingent visits than those in the escalating groups, these differences were not maintained.     

Studying Personality Cross-Culturally Edited by Bert Kaplan

This article offers a theory about the evolution of small group systems through a seriesof stages It discusses the relationship of these stages to and their effect on the self-other and therapeutic mteruentive spheres m the long-term group treatment of children. The developmental unfolding is seen as universal to small groups and as operating on an interpersonal and collective level, distinguishable from individual psyches and close dyadic bonds but influenced by them. On an isomorphic level the group stages contain emotive, cognitive, and interactive themes and pr cesses that parallel and evoke those of the bonding and work processes. As such, the group dynamic provides an enabling matrix and a mirror for the other goings on in the member–therapist encounter. Its pacing and its progressions and regressions appear to correspond with those of the development of the transitional space and therapeutic culture of the group. Like the other articles in the symposium, this one offers specific examples in which the three spheres intersect and are integrated.     

The narcissistic therapist meets a narcissistic patient

The presence of narcissism in both therapist and patient results in a collusion that preserves the narcissistic integrity of the therapist and validates the narcissistic injury of the patient. Not only is the narcissistic behavior of the patient condoned, but narcissistic excesses in the therapist are tolerated. The unconscious identification on the part of the therapist with the patient produces anxiety in the therapist which results in treatment that intensifies the pathology of the patient.     

Putting down roots: the significance of technical adaptations in the therapeutic process with fostered and adopted children‡

Severely neglected and traumatised children have also suffered from a lack of the parental nurturing which is needed for ordinary emotional development to take place. Often their past experiences make them unable to utilise the nurturing that foster and adoptive families try to give them and they are delayed or stuck in their development. In therapy, when the early small signs of new emotional development start to emerge, they may be heralded by technical challenges to the therapist. Two examples are given in this paper, which are discussed in the context of Stern et al.’s ideas about moments of meeting, Winnicott’s concepts about transitional phenomena and playing, and Hurry and her colleagues’ thoughts about the therapist as a developmental object. It is argued that it is important for the therapist to be alert to the possible significance of these technical adaptations in terms of the child’s capacity for new emotional development. These often indicate that a watershed in the treatment has been reached and if positively responded to, that the patient is in the process of ‘putting down roots’ in the ground of the therapeutic relationship and starting to grow across a spectrum of developmental pathways.