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.     

Group Psychotherapy—The Psychoanalytic Approach by S. H. Foulkes and E. J. Anthony

Group therapists often lead consultation groups. For effective leadership it is important to distinguish between consultation groups and psychotherapy groups. A consultation group is one in which a leader serves as consultant to the members. Group process variables of task, contract, role of the leader, and effect of the larger system should be understood by the consultant. The process of defining, testing, and maintaining these variables encourages exploration of resistance and parallel process, and is an important aspect of the ongoing learning. Consultation group leaders should understand the importance of serving as group leader but not group therapist.     

The Efficacy of an Integrated Theoretical Approach to Group Psychotherapy for Male Inmates

To assess the efficacy of an interpersonal process-oriented and cognitive-behavioral group psychotherapy program, 36 incarcerated male adults were assigned to either a treatment group (n = 20) or a no treatment control group (n = 16). Outcome measures consisted of paper-pencil self-report instruments, institutional behavioral data, and structured interviews with the group therapists (n = 3). Results indicated no significant changes in inmates' level of defensiveness, empathy, or institutional behavior; however, the inmates reported universally positive reactions to the treatment program. The group therapists also perceived the treatment program as efficacious, particularly in fostering a cohesive group atmosphere and increasing inmate responsibility for group leadership. Implications for practice and research are discussed.     

The Benefits of Group Therapy Observation for Therapists-in-Training

The authors contend, based on a survey of group therapy trainees, that observing an ongoing psychotherapy group in vivo provides an exceptional learning opportunity. Clinicians often experience resistance and anxiety regarding therapy group leadership, and group therapy is notoriously challenging to teach. Trainees consistently described the Group Observation course as one of the most effective training experiences that they have had. The observation group model mitigates many concerns that trainees have about group leadership and inspires enthusiasm and confidence for leading groups. Group observers learned vital group leadership skills, most notably: the ability to bear affect and trust the group process, the ability to follow and use group themes, metaphors, and underlying dynamics, and the ability to highlight attachment themes, work in the here and now, and promote immediacy.     

Group therapists' training: what predicts learning?

This field study represents the continuing effort to identify the determinants of learning within experiential small study groups. Thirty-seven training groups from the 1996 Institute of the American Group Psychotherapy Association were studied. Three process measures (Group Relationship Questionnaire [GRQ], Leader Adjective Measure [LAM], and Group Climate Questionnaire [GCQ]) were administered to 434 group members after the first two of four group sessions. Process variables were used to predict learning (measured by the Learning Evaluation Form [LEF]) at the end of the training groups. The factors derived from each of the measures showed good to excellent correspondence with previous studies employing the same instruments. Results suggest that perceptions of the leader and the group, rather than perceptions of one's own relationship to other group members, are more robust predictors of learning in these short-term training groups. Specifically, perceptions of an emotionally engaged group willing to confront conflict, and perceptions of a skillful leader, proved to be significant predictors of learning. Implications for the training of group therapists and group therapy research are discussed.     

Influence of Racial/Ethnic Membership and “Therapist Culture” on Therapists' Worldview

The authors investigated 2 competing hypotheses related to therapists' worldview and therapists' race/ethnicity: (a) whether therapists of different racial/ethnic groups differed on worldview reflecting group membership, and (b) whether therapists were similar to each other on worldview reflecting membership in a “therapist culture.” Results indicated that therapists shared similar worldviews regardless of group membership, and differences found between therapists based on racial/ethnic membership were minimal.     

Outcome in short-term group psychotherapy

This study examines the effectiveness of planned dynamic short-term group psychotherapy in a health maintenance organization setting. The groups, conducted by experienced short-term psychodynamically trained therapists, focused on common life-stage issues. A pretest/posttest design was employed; group participants completed a battery of self-report measures before, after, and 4–6 months after treatment. Group participants made statistically (and clinically) significant positive changes on the majority of change measures. They saw themselves as improved on target problems, became far less symptomatic, and reported considerable growth in interpersonal functioning.     

Therapist gender and the same-sex puberty age psychotherapy group

Puberty is considered to be the most difficult developmental period to conduct psychotherapy. Group psychotherapy has special appeal for pubescents because of the anxiety experienced in individual psychotherapy with adults, and the mutual identification and support experienced with groups of same-sex peers. Although pubescents readily form cohesive groups, the emotional stress for the group therapists is intense and many therapists are reluctant to take on such groups. Close attention to the principles of developmental ego psychology suggests that pubescent groups will be more effective if conducted by group therapists of the same sex as the patients.     

Some Relationships between Group Process and Mental Health Phenomena in Theory and Practice

Though the focus on interpersonal interaction is a powerful therapeutic factor in group therapy, traditional chemical dependency therapy groups generally fail to employ the interactional group orientation. An interactional approach can be effectively applied to alcoholics if the following guidelines are observed: (1) recovery is always accorded priority, (2) the patient accepts identification as an alcoholic, (3) anxiety is carefully modulated, (4) the proper distinction is made between what the alcoholic is and is not responsible for, (5) the therapist is thoroughly familiar with Alcoholics Anonymous language, steps, and traditions. It is important that therapists not permit misperceptions of A.A. to be used as therapy resistance and that they be able to harness the wisdom of A.A. for psychotherapeutic ends. Group therapists must also be prepared to deal with common themes arising in the treatment of the alcoholic patient: idealization, devaluation, externalization, defiance, grandiosity, conning, and avoidance.     

Schizophrenic group process: A comparison and replication using the HIM-G

In order to test the robustness of our model for treating schizophrenic patients in group therapy, we replicated our previous study of an inpatient schizophrenic group and also explored process in an outpatient schizophrenic group using the Hill Interaction Matrix (HIM-G). In agreement with the prior study, the results showed the groups to have a uniquely high Confrontive score, representing the highest level of group work in the Hill system, and the rank order of HIM-G scores of the groups correlated significantly with each other. This suggests that our clinical approach can be taught to different therapists and has reliability across setting.Parts of this paper were presented in a poster session at the American Group Psychotherapy Association Annual Meeting in San Francisco, February 21–25, 1989.     

Group therapy for eating disorders: A step-wise approach

Group therapy is emerging as a favored treatment for eating disorders. Open-ended psychodynamic group therapy is an effective treatment for the underlying conflicts in eating-disordered patients, yet these groups are difficult to form. The authors suggest a specific sequence using time-limited psychoeducational groups initially for symptom control, then offering an open-ended group for patients who are ready to address deeper issues in a group therapy setting.     

Sequential cotherapy of groups for training and clinical care

Cotherapy has often been used as the leadership model in group therapy. The literature is full of contradictory data and impressions as to the efficacy of this model. In this article a new form of cotherapy is presented which may offer some of the assets attributed to the cotherapy leadership model while at the same time reducing some of the liabilities. Sequential cotherapy refers to cotherapy when each of the therapists leads sequentially rather than at the same time. The pros and cons of such an approach are discussed from both the perspectives of training new group therapists and of service to patients in groups.Dr. Rutan and Mrs. Alonso are members of the faculty of Harvard University Medical School and share responsibility for training psychiatric residents in group therapy at Massachusetts General Hospital, Boston, Massachusetts.     

Sigmund Freud: Four Centenary Addresses by Ernest Jones

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their “typical” outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication.

Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.     

Procedures for Identifying Persons with Potential for Public School Administrative Positions by William C. Schutz

This investigation is based on over 400 American Group Psychotherapy Association members involved in 41 intensive, two-day training experiences for mental health professionals. The participants completed a questionnaire immediately after their group sessions to evaluate the process and leadership variables that contributed to a constructive learning experience. A similar questionnaire was mailed to participants three to four months later to explore the impact of training on group interventions within their clinical practices. One third of the trainees responded to the follow-up survey. Overall, the findings suggest that successful outcomes are related to a range of group processes, such as self-disclosure, feedback, and interpersonal support, as well as personal qualities and technical expertise modeled by the leaders of the training groups. Both the immediate and delayed assessments demonstrate that the groups were regarded as highly valuable learning opportunities.     

The Leader Ship Is Sinking: A Temporal Investigation of Narcissistic Leadership

Individuals higher in narcissism have leader emergent tendencies. The characteristics of their personality suggest, however, that their leadership qualities will decrease over time as a function of group acquaintance. We present data from two studies that provide the first empirical support for this theoretical position within a transformational leadership framework. In Study 1 (N = 112), we tested narcissistic leadership qualities in groups of unacquainted individuals over a 12‐week period. In Study 2 (N = 152), we adopted the same protocol with groups of acquainted individuals. In Study 1, narcissism was positively associated with peer‐rated leadership during initial group formation but not later. In Study 2, narcissism was not significantly associated with peer‐rated leadership during initial group formation and was negatively associated with peer‐rated leadership later. In Study 1, transformational leadership mediated the relationship between narcissism and leadership initially but not later on. In Study 2, transformational leadership failed to mediate the relationship between narcissism and leadership throughout the study. Despite enjoying a honeymoon period of leadership, the appeal and attractiveness of the narcissistic leader rapidly wane. This decline is explained in part by their changing transformational leadership qualities.     

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.     

Running: An adjunctive group therapy technique

Group therapists who work with severely disturbed patients know that group sessions are often characterized by verbal rambling, frequent and prolonged pauses and high levels of anxiety on the part of group members. This article focuses on the use of a group activity— namely, running—as an adjunct to group psychotherapy. A brief case report will illustrate the application of this innovative treatment technique; then issues that may arise when one leads a running group are dealt with in a question- and -answer format.The author wishes to express his appreciation to Mrs. Vera Kohn for editorial assistance in the preparation of this article.     

Popular or unpopular? Therapists' use of structured interviews and their estimation of patient acceptance

An accurate diagnosis is an important precondition for effective psychotherapeutic treatment. The use of structured interviews provides the gold standard for reliable diagnosis. Suppiger et al. (2009) showed that structured interviews have a high acceptance among patients. On a scale from 0 (not at all satisfied) to 100 (totally satisfied) patients rated overall satisfaction with a structured interview at M = 86.55. Nevertheless, therapists rarely seem to use structured interviews in clinical practice. The aim of this study was to assess how frequently therapists use structured interviews in daily practice. Secondly, we hypothesized that therapists underestimate patient acceptance of structured interviews. As a third goal, we explored further reasons why therapists choose not to use structured interviews. We conducted an online survey of 1,927 psychiatrists and psychotherapists in Switzerland and asked them how frequently they used structured interviews and how they estimated patient satisfaction with these interviews. Furthermore, we asked therapists why they chose to use or not use structured interviews. Therapists reported using structured interviews on average with about 15% of their patients. Furthermore, therapists estimated significantly lower patient acceptance than patients themselves indicated (M_therapist = 49.41, M_patient = 86.55). Our data suggest lack of familiarity with these instruments as well as an overestimation of the utility of open clinical interviews as further reasons for not using structured interviews.     

Effect of a Vocationally‐Focused Brief Cognitive Behavioural Intervention on Employment‐Related Outcomes for Individuals with Mood and Anxiety Disorders

Internet-delivered cognitive behavioural therapy (CBT) can be an effective method for treating major depression, but it often works best when therapist support is provided in the form of e-mail support or telephone calls. The authors investigated whether there were any intraclass correlations within therapists when delivering CBT for major depression via the Internet. They included data from two trials involving 10 therapists treating a total of 103 patients. The results of a nested one-way model in which participants were treated as raters for different therapists indicated that measures pertaining to symptom reductions (Beck Depression Inventory, Montgomery-Åsberg Depression Rating Scale–Self Report, and Beck Anxiety Inventory) did not support a clustering of data within therapists. However, the outcome on a secondary measure of life satisfaction (Quality of Life Inventory) yielded a significant intraclass correlation coefficient for therapists (r = .24, p = .001). The authors propose that text-based treatments are less sensitive to therapist effects when it comes to the primary symptom measures, but that treatment effects not directly targeted by the specific treatment program may be more dependent on the way the support is given and by whom (therapist effect). Limitations of the study are discussed.     

Therapeutic Multiple Family Groups

The therapeutic effects of interpretations by both therapists and other clients were recorded by observers in three cognitive–behavioral and three psychodynamic groups over a period of thirty one-and-one-half-hour group therapy sessions. There was no significant difference in the overall frequency of interpretations made in the two different therapy modalities; however, there was the expected difference in the types of interpretations made. Cognitive–behavior therapists and group members tended to interpret patterns of behavior or impact on others more frequently than did psychodynamic therapists and group members; while psychodynamic therapists and group members made more historical cause interpretations. However, contrary to expectations, both therapy modalities made more interpretations of patterns of present behavior than any other type. When these interpretations were converted into problem statements that were sent to outside raters after the termination of the groups, the outside raters judged that clients improved most when interpretations of a pattern of behavior were made; next most when interpretations of impact on others were made; and did not improve when interpretations of motive were employed in either modality.