Needed: professional ethics for working with groups

The present apga Ethical Standards statement is deficient in several respects regarding group work. It leaves judgment and responsibility entirely in the practitioner's hands. This article discusses the issues that arise from the properties and dynamics of groups themselves and ethical concerns that occur in the formation of groups in personnel and guidance work. It also offers suggestions for interpreting and extending the Ethical Standards in working with groups and examines the need for apga to seize leadership in developing appropriate new standards.     

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.     

Lifestyle effects of group health education for patients with coronary heart disease

Abstract

In the present study, effects of a health education (INFO) and a PsychoEducational Prevention (INFO + PEP) Programme were Investigated in three hospitals. These programmes were offered to groups of coronary heart disease (CHD) patients and their partners alter discharge from hospital. The INFO was offered to 127 CHD patients in addition to FIT (i.e. standard medical care and physical training). The PEP was offered to 90 Patients in, addition to the INFO and FIT. A control group of 122 patients received only FIT. The INFO and the PEP consisted of four weekly two-hour group sessions each. In addition, the PEP was followed by seven telephone follow-up contacts.

On average, patients improved their lifestyles during the first three months. Between three and twelve months an extra improvement was found for eating habits, whereas there was a relapse for smoking and a sedentary lifestyle. In the short term, angina pectoris and a longer period of heart complaints were parallelled with a decrease in the risk of maintaining unhealthy eating habits, whereas in the long term a longer period of heart complaints a younger age and unemployment predicted a lower risk of maintaining unhealthy eating habits In the short term living with a partner and in the long term female gender were predictive of continued smoking behaviour In the short term, older age, a first CABG and a specific hospital setting decreased the risk of a continued sedentary lifestyle.

The FIT + INFO + PEP had a favourable short-term effect on eating habits. For smoking and a sedentary lifestyle, however, there were negative effects. In the short term patients in the FIT +INFO and those in the FIT +INFO+PEP had significantly more problems in quitting a sedentary lifestyle than those in the FIT intervention in the long term, patients in the FIT + INFO had significantly more problems in stopping smoking compared to these in the FIT.     

HIV prevention with persons with mental health problems

The HIV seroprevalence rate among persons with mental health problems (PMHP) is substantially higher than that of the general population in the United States. This study examines the efficacy over 12 months of an HIV prevention program with 99 individuals attending outpatient mental health clinics who were randomly assigned to receive either: (a) a seven-session, small-group intervention of Project LIGHT (Living in Good Health Together); or (b) a one-session video intervention. Regression analyses of data from 87% of the sample interviewed at 1-year follow-up revealed that intervention group membership was associated with significantly fewer sexual risk acts. A significant intervention effect for condom use was found for 72% of the sample who were African American, but not for Latino or Caucasian participants. Results from this study suggest that HIV risk reduction groups such as Project LIGHT may have utility in public mental health care settings.     

Othering,blame and shame when working with people living with HIV

Significant advances in HIV treatment has meant that for the majority of patients with HIV, they are able to live a normal lifespan. However, HIV remains a highly stigmatizing disease with the potential to significantly impact on one’s social identity and sense of self. This paper draws on data from a qualitative study of interviews with five gay men, to explore the experiences of shame in relation to living with HIV. The paper adopts a psychoanalytic lens to highlight the mechanisms of splitting that may be involved at both a social and individual level, and the experience of shame among the participants. The paper aims to use this research data to supplement our understanding of what may be occurring ‘on the couch’ with patients who are living with HIV.     

Effects of verbal working memory deficits on metaphor comprehension in patients with Parkinson's disease

This research studied one aspect of pragmatic language processing, the ability to understand metaphorical language, to determine whether patients with Parkinson disease (PD) are impaired for these abilities, and whether cognitive resource limitations/fronto-striatal dysfunction contributes to these deficits. Seventeen PD participants and healthy controls (HC) completed a series of neuropsychological tests and performed a metaphor comprehension task following the methods of Gernsbacher and colleagues [Gernsbacher, M. A., Keysar, B., Robertson, R. R. W., & Werner, N. K. (2001). The role of suppression and enhancement in understanding metaphors. Journal of Memory and Language, 45, 433-450.] When participants in the PD group were identified as "impaired" or "unimpaired" relative to the control group on a measure of verbal working memory span, we found that only PD participants with impaired working memory were simultaneously impaired in the processing of metaphorical language. Based on our findings we argue that certain "complex" forms of language processing such as metaphor interpretation are highly dependent on intact fronto-striatal systems for working memory which are frequently, although not always, compromised during the early course of PD.     

Effects of a post-hospitalization group health education programme for patients with coronary heart disease

Abstract

Effects of a post-hospitolization group health education programme for patients with coronary heart disease. A health education programme was offered to groups of coronary heart patients and their partners after discharge from hospital. A randomized pre-test post-test control group design was used to evaluate the effects of this experimental intervention. The health education programme was offered to 109 coronary heart patients in groups of between five and eight patients together with their partners in addition to standard medical care and physical training. A control group of 108 patients received only standard medical care and physical training.

The intervention consisted of eight weekly two-hour group health education sessions and one follow-up session. All sessions focused on the promotion of healthy habits and the reduction of adverse psychosocial consequences of the incident.

In the short term (about four months after the incident) the health education programme showed statistically significant intervention effects on knowledge about coronary heart diseases, smoking cessation, healthy eating habits and the number of consultations with the family physician, but no effects on emotional distress. In the long term (one year after the incident) there was only a significant intervention effect on smoking cessation.

These results suggest that the effects of the programme are modest, especially in terms of maintenance of behavioural change. As a consequence, it is suggested that the programme should not be offered to all coronary patients during cardiac rehabilitation, but only to those who can be expected to profit most from it.     

Application of a family systems approach to working with people affected by HIV disease – two case studies

HIV infection, with its particular modes of transmission, affects relationships, interrupts the normal life-cycle and brings different challenges to patients and their contacts as they pass through the asymptomatic and symptomatic phases to the terminal stages of illness. This paper describes a family systems approach to therapy with people affected by HIV disease, illustrated by two case examples.     

Group interventions for patients with cancer and HIV disease: part IV. Clinical and policy recommendations

Group interventions have assumed a growing role in primary prevention and supportive care for cancer and HIV disease. Earlier sections of this Special Report examined empirical findings for these interventions and provided recommendations for future research. The current section offers brief recommendations for service providers, policymakers, and stakeholders. Group services now occupy an increasingly prominent place in primary prevention programs and medical settings. In previous sections of this Special Report (Sherman, Leszcz et al., 2004; Sherman, Mosier et al., 2004a, 2004b) we examined the efficacy of different group interventions at different phases of cancer or HIV disease, considered characteristics of the intervention and the participants that might influence outcomes, and discussed mechanisms of action. Methodological challenges and priorities for future research were highlighted. In this, the final section, we offer brief recommendations for service providers, policymakers, and other stakeholders. We consider some of the barriers that constrain use of empirically-based group interventions and note how these programs might be implemented more widely and effectively.     

HIV/AIDS and health care workers: contact with patients and attitudes towards them

Data on a range of variables associated with contact with patients with HIV/AIDS and attitudes towards them were collected from 174 Scottish health care workers. Measures of attitudes and contact (overall, social and physical) were derived from the scales devised by Pleck et al. (1988). The measure of overall contact was not significantly related to attitudes, but those with predominantly social contact with patients with HIV/AIDS had more positive attitudes towards them. This relationship was moderated by occupational characteristics, concern about working with people of unknown HIV status and neuroticism. With all these variables controlled, including social contact, those who had not received in-service training relating to HIV/AIDS had more negative attitudes. The results are discussed with regard to the measurement of social contact with patients, salient beliefs, the occupational characteristics associated with attitudes, and in-service education.     

Stress and Burnout among health-care staff working with people affected by HIV

The nature, causes, consequences and symptoms of stress and burnout among healthcare staff working with people affected by HIV are identified. The extent to which these characteristics are specific to HIV/AIDS workers is discussed. Some options for prevention and management of burnout are presented.     

The Significance of Ferenczi's clinical contributions for working with psychotic patients

This paper tries to show that Ferenczi's contributions in “The Development of Psychoanalysis” (with Otto Rank) and in his “Clinical Diary” are pivotal for the development of modern psychotherapy with severely disturbed patients. In addition, the question of whether a psychotherapeutic technique should or could be communicated to others is discussed.     

Outpatient groups for chronic psychiatric patients

Long-term support groups have been utilized at the University of Alberta Hospitals since 1977 in order to meet the needs of chronic psychiatric patients who are unwilling or unable to commit to insight-oriented therapy. These groups meet once weekly for one hour and are intended to be drop-in groups, which patients can use regularly or only while in crisis. It is hypothesized that the institution or style of therapy practiced at an institution, rather than the specific therapists, provides a source of stability and support to these patients. Our experience suggests these groups are beneficial and cost-efficient, but research is necesssary to evaluate them to determine components of therapeutic effectiveness.Linda McAuley, M.A., was a staff therapist at the Psychiatric Walk-in Clinic and is currently in private practice.An earlier version of this paper was presented at a meeting of the Canadian Group Psychotherapy Association in Banff, Alberta, October, 1987.     

Self-rated emotional health in adults with and without HIV

Affect is an important indicator of quality of life; unfortunately, many people with Human Immunodeficiency Virus (HIV) disease are vulnerable to depression and negative affect. In a secondary data analysis, 50 HIV-positive and 50 HIV-negative adults between 30 and 65 years old completed several affective measures and rated their emotional health. The HIV-positive adults reported more negative affect than the HIV-negative adults. Older age, loneliness, and HIV stigma were associated with such negative affect.     

Group interventions for patients with cancer and HIV disease: Part III. Moderating variables and mechanisms of action

Growing evidence supports the value of group interventions for individuals who are at risk for or have developed cancer or HIV disease. However, information is more limited concerning how these services can be delivered in an optimal manner, and what processes contribute to their benefits. Parts I and II of this review examined the efficacy of different interventions for individuals at different phases of illness, ranging from primary prevention to late-stage disease, in both psychosocial and biological domains. The current paper examines some of the factors other than phase of illness that might influence group treatment effects (e.g., intervention parameters, participant characteristics), and explores mechanisms of action.