Some Observations on Group Therapy with the Blind

This study integrates the theoretical assumptions underlying member preparation for group into a series of pregroup interview guidelines, which are then field tested for reliability and validity using a Solomon Four-Group design. Findings indicate a significant relationship exists between those individuals having the pregroup interview and a realistic perception of group membership and understanding of group purpose. The third dimension, which tested congruence between member goals and group purpose due to having the pregroup interview, was not significant. Implications of the study and suggestions for further research are discussed.     

Therapist Interventions Associated with Productive Emotional Processing in the Context of Attachment-Based Family Therapy for Depressed and Suicidal Adolescents

Productive emotional processing is considered a key change mechanism in attachment-based family therapy (ABFT). This study examined the impact of attachment-based family therapy therapist interventions aimed to promote productive emotional processing of primary adaptive emotions in a sample of 30 depressed and suicidal adolescents who had participated in a larger randomized clinical trial. Results of sequential analyses revealed that relational reframes and therapists’ focus on primary adaptive emotions were associated with the subsequent initiation of adolescents’ productive emotional processing of primary adaptive emotions. In contrast, interpretations, reassurances, and therapists’ focus on adolescents’ rejecting anger toward their parents were all followed by the discontinuation of adolescents’ emotional processing that had already begun. Finally, therapists’ general encouragement of affect and focus on adolescents’ unmet attachment/identity needs were associated with both the initiation of adolescents’ productive emotional processing, and with the discontinuation of such processing once it had already begun. Theoretical and clinical implications are discussed.     

Peer Victimization and Suicidal Thoughts and Behaviors in Depressed Adolescents

Suicide is a leading cause of death among youth worldwide, and depressed adolescents are at a significantly elevated risk to report suicidal ideation, planning, and attempts. Peer victimization is a robust predictor of adolescent suicidal thoughts and behaviors (STBs), but little research has focused on why bullying leads to suicidal thoughts and behaviors. To address this empirical gap, we recruited 340 (246 female) depressed adolescents ages 13–19 (M = 15.59, SD = 1.41) within 48 h of admission for acute psychiatric treatment. At the initial assessment, participants were administered clinical interviews characterizing psychopathology, nonsuicidal self-injury, and STBs (ideation, plans, and attempts). Further, they completed questionnaires assessing 3 forms of victimization (overt, relational, and reputational), recent risky behavior engagement, and psychiatric symptom severity. Controlling for internalizing symptoms and age, overt and reputational bullying were associated with more frequent past month suicide attempts, but not suicide ideation. Past month risky behavior engagement, but not NSSI, mediated the relation between victimization and attempts. However, sex differences revealed that this effect only held for males whereas bullying was directly associated with suicide attempts among females. In contrast, overt and relational bullying were non-linearly associated with suicide plans, and these relations were not mediated by risky behaviors or NSSI. Results highlight the complex network of factors that lead victimized adolescents to engage in STBs and may inform targeted suicide prevention and intervention programs.     

Group Therapy with Terror-Injured Persons in Israel: Societal Impediments to Successful Working Through

This paper describes a group intervention with terror-injured people in Israel to show the parallels between developments in the group and Israeli society's difficulties in working through and mourning its experiences of terror. Despite the development of group cohesion and a sense of empowerment, the group members remained unable to deal with the powerful emotions stemming from the experience of terror and continued to cling to their shared identity as terror victims, irrevocably helpless and isolated from others. Without excluding other explanations, we suggest that these difficulties reflect the defense mechanisms employed by Israeli society in dealing with the threat to its survival that is implicit in the terror to which it is exposed.     

Therapeutic Factors Contributing to Change in Cognitive-Behavioral Group Therapy for Older Persons with Schizophrenia

The contributions of homework, therapy participation, cognitive insight, and skills acquisition to treatment outcomes in group CBT for schizophrenia were examined. Increased cognitive insight was associated with reduced positive, negative and total symptoms, but not improved psychosocial functioning. Greater participation was associated with increased cognitive insight, reduction in total and negative symptoms, and a trend was found for positive symptoms. Greater homework adherence was associated with greater skill acquisition, but skill acquisition was not significantly associated with change in any outcome. The therapeutic factors contributing to change in CBT for schizophrenia appear different for symptom and psychosocial functioning outcomes.     

Long-Term Outpatient Treatment in Alcoholics with Previous Suicidal Behavior

The importance of previous suicidal behavior for the treatment of alcoholics was analyzed in a long-term outpatient treatment study. In a series of 72 patients, 21 patients, (29%), 17 men and 4 women, had previously made at least one suicide attempt or had seriously threatened to kill themselves (3 cases). In comparison with the other alcoholics, those with previous suicidal behavior had a similar attrition rate, they were not more troublesome in treatment, and they had the same rate of favorable outcome during the third year after start of treatment. They differed from the other alcoholics in having a more severe abuse and a less favorable outcome during the initial part of the treatment. In conclusion, our results support the possibility of a long-term outpatient treatment strategy in alcoholics with previous suicide attempts.     

Effect of Problem‐Solving Therapy on Depressed Low‐Income Homebound Older Adults' Death/Suicidal Ideation and Hopelessness

Previous study findings of psychotherapy's effect on suicide prevention have been inconsistent. This study reports the results of secondary analyses of outcome data from a short‐term depression treatment on reducing death/suicidal ideation among 158 low‐income homebound adults aged 50+. The treatment, in‐person or telehealth problem‐solving therapy (PST), compared with telephone support call, has been found effective in reducing depressive symptoms and disability among participants. Compared with support call participants, tele‐PST participants, but not in‐person PST participants, exhibited lower ideation ratings across the follow‐up period. Effect sizes at 36 weeks were 0.31 for tele‐PST and 0.17 for in‐person PST. Hopelessness mediated the effect of tele‐PST but not in‐person PST; however, in‐person PST also alleviated hopelessness, which led to lower ideation. Clinical implications of the findings are discussed.     

Attitudes Toward the Body in Suicidal,Depressed, and Normal Adolescents

Our purpose was to investigate the hypothesis that suicidal adolescents, compared with depressed nonsuicidal and nonsuicidal normal adolescents, display a more negative attitude toward their bodies. Scales for suicidal tendencies, dissociative tendencies, perception of actual versus ideal body features, and feelings toward the body were administered to the subjects. The suicidal subjects showed a larger perceived discrepancy between actual versus ideal body features and a more negative feeling toward the body, and scored higher on some aspects of dissociation than the normal group. The suicidal group also displayed more negative feelings toward the body and scored higher on some aspects of dissociation than the depressed group. A series of correlations showed that the higher the suicidal tendency, the higher the dissociation, the larger the discrepancy, and the stronger the negative feelings toward the body. The findings were explained as reflecting unique characteristics of suicidal individuals that develop from early trauma and sadomasochistic relationships. These characteristics may facilitate suicidal behavior.     

Collaboration and a Self-Help Orientation in Therapy with Suicidal Clients

Working with suicidal clients historically has placed a heavy burden of responsibility on the therapist for a successful outcome. This orientation generally has left clinicians feeling stressed and in need of controlling their clients' behavior; clients, in turn, often have developed unrealistic expectations of therapy or resistance of the therapist's interventions. In this context, the chance for a potentially valuable collaboration between client and therapist is often lost. This paper builds on previous work that has introduced the notion of a collaborative working relationship with suicidal clients. It is argued that the therapeutic process ideally should not only utilize the therapist's knowledge and skills in treating suicidal clients, but also cultivate self-efficacy by encouraging the client to adopt a self-help orientation to therapy. Several general principles of a collaborative/self-help orientation to working with suicidal clients are discussed and a variety of specific therapeutic strategies consistent with this orientation are described.     

Group Orientation for Persons on Probation or Parole

The group orientation program described in this article is a systematic attempt to transmit information and initiate a counseling relationship with persons newly placed on probation or parole. The group orientation process reduced tension and allowed reluctant clients to be guided into a helping relationship. Following the group sessions, individual meetings are designed to capitalize on those gains. During one 7-month period, 130 persons went through the group orientation, and 81 of these were subsequently transferred to reduced supervision.     

The Relations of Temperament and Emotion Self-regulation with Suicidal Behaviors in a Clinical Sample of Depressed Children in Hungary

Although major depressive disorder (MDD) is associated with suicidal behaviors, some depressed individuals are not suicidal and others evidence various forms of suicidality. We thus investigated whether aspects of temperament and self-regulation of dysphoria represent risk factors for DSM-IV suicidality (recurrent thoughts of death, recurrent suicidal ideation, suicidal plan, and suicide attempt) in depressed youths. Using a sample of children with MDD (N = 407; ages 7-14 years), recruited from clinical sites across Hungary, we tested the hypotheses that: (a) suicidality is related to higher levels of trait negative emotionality as well as more maladaptive and fewer adaptive regulatory responses to dysphoria and (b) as the severity of suicidal behavior increases, levels of trait negative emotionality and dysfunctional emotion regulation also increase. We also explored if other aspects of temperament relate to suicidality. Children's DSM-IV diagnoses were based on semi-structured interviews and best-estimate psychiatric consensus. Parents independently provided ratings of their children's temperament, and children separately completed an inventory of emotion regulation (ER). Using multivariate models, we failed to confirm the hypothesized relations of negative trait emotionality and suicidality, but confirmed that high maladaptive and low adaptive ER response tendencies increase the odds of suicidal behaviors, above and beyond the risk posed by depressive illness severity. Unplanned interaction terms between temperament dimensions (other than negative emotionality) and ER suggested that at some high-extremes of temperament, ER has no impact on suicidality but in their absence, adaptive ER lowers the risk of suicidality. The practical implications of the findings are discussed.