Integrating interpersonal neurobiology with group psychotherapy

An understanding of the principles of neuroscience that illuminate how interpersonal relationships shape the brain, especially as articulated by interpersonal neurobiology (IPNB) (Siegel, 1999), may help group therapists 1) increase their holding capacity, 2) offer patients a framework that can decrease shame and increase regulation, and 3) identify methods of group interaction that can foster neuroplasticity, support neural integration, and lead to greater well-being and more fulfilling relationships. This paper introduces several aspects of neuroscience and discusses how therapist awareness and sharing of this knowledge with group participants at the right empathic moment can be both a psychoeducational support and a promoter of neural integration. While numerous neuroscience topics may be of help, here we will suggest three: early brain development, including the nature of implicit, explicit, and autobiographical memory; group as a source of regulation (with a brief mention of mirror neurons); and four domains of neural integration that are particularly useful in the setting of group therapy.     

A process recording for evaluating group psychotherapy training methods

This paper discusses an exploratory investigation concerned with the long range questions: How does group psychotherapy help patients? and How can psychiatry residency programs best train residents to treat patients in therapeutic groups? Group psychotherapy has come to be accepted in its own right as a decisive contribution to the study of and relief of emotional disorders. As a component of comprehensive psychiatric services it is indispensable. However, while its clinical value has been demonstrated, its scientific validity has not. A Group Process Inventory has been developed by the author and has been utilized for the past two years by psychiatric residents in recording the process of their therapeutic groups in a teaching hospital mental hygiene clinic. The preliminary use of this recording as a clinical-teaching instrument has proven effective. This inventory is being revised to serve as a research instrument.     

Outcomes of specific interpersonal problems for binge eating disorder: comparing group psychodynamic interpersonal psychotherapy and group cognitive behavioral therapy

We assessed whether an attachment-based treatment, Group Psychodynamic Interpersonal Psychotherapy (GPIP) had a greater impact compared to Group Cognitive Behavioral Therapy (GCBT) on Cold/Distant and Intrusive/Needy interpersonal problems. Ninety-five individuals with Binge Eating Disorder (BED) were randomized to GPIP or GCBT and assessed at pre-, post-, and six months post-treatment. Both therapies resulted in a significant decrease in all eight interpersonal problem subscales except the Nonassertive subscale. GPIP resulted in a greater reduction in the Cold/Distant subscale compared to GCBT, but no differences were found for changes in the Intrusive/Needy subscale. GPIP may be most relevant for those with BED who have Cold/Distant interpersonal problems and attachment avoidance.     

The development and content of an interpersonal psychotherapy group for postnatal depression

Postnatal depression (PND) usually causes distressing symptoms for sufferers and significant impairments in relationships. Group Interpersonal Psychotherapy (IPT-G) provides the experienced therapist with a brief, focused, and manualized approach to helping women recover from the debilitating effects of PND. This paper describes the background and development of IPT-G for PND. The evidence for the effectiveness of individual and group IPT formats with this population is summarized. The triad of theories underpinning IPT are discussed with an emphasis on the important role of attachment styles during the transition to parenthood. Its strengths, which include its unique package of targets, tactics, and techniques, are highlighted. The benefits and challenges of IPT-G are also explored, and the results of a randomized controlled trial are summarized. Finally, a case study illustrates how IPT-G specifically addresses the social role transitions, conflicts, losses, and social isolation that mothers commonly experience.     

Sudden gains in interpersonal psychotherapy for depression

Sudden, precipitous improvements in depressive symptom severity have been identified as occurring among unipolar depressed individuals. These "sudden gains" have been associated with superior acute treatment outcome in several treatment modalities, including cognitive therapy. A better understanding of sudden gains may provide insight into the mechanisms of action in these and other psychotherapies. One efficacious therapy that has been overlooked in sudden gains research is interpersonal psychotherapy (IPT; Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books). The present research examined the rates and concomitant features of sudden, precipitous improvements in depressive symptomotology among 185 women receiving IPT for recurrent depression. Sudden gains, defined using extant criteria for the Beck Depression Inventory, were assessed over 12 weeks of acute IPT treatment for depression and occurred for 33.5% of the sample. Sudden gains were not associated with diagnostic and demographic characteristics or with differential likelihood of achieving depression remission with IPT monotherapy during active treatment. Further, those with sudden gains were no more likely to maintain their recovery through maintenance treatment. The lack of impact of sudden gains on eventual outcome is discussed in terms of potentially disparate emphases and mechanisms of change between IPT and cognitive-behavioral therapy (CBT).     

Countertransference in group psychotherapy

This paper attempts to up-date our understanding of countertransference in the therapy group setting. After a brief review of some of the psychoanalytic and the group psychotherapy literature dealing with countertransference, the paper points out the vulnerability of the group therapist and presents examples of possible countertransferential situations, such as stereotyped roles, reactions to external aspects of patients, and therapists' insecurities. It concludes by suggesting ways in which group therapists can become more sensitive to their countertransferences.     

Hostility in group psychotherapy

To run a psychodynamic group therapeutically, the leader must understand the meanings and functions of hostility. Fundamental to this task is the leader's awareness of his or her bias toward hostility as a constructive or destructive feeling and willingness to serve as a lightening rod for it. This paper discusses the sources of hostility during different stages of group development. The therapeutic handling of hostility is discussed under the following topics: theoretical considerations, defensive functions, and communicative functions. Case examples illustrate the proper handling of contractual violations, scapegoating, and narcissistic injury. Countertransference reactions to anger and rage in the group are discussed.     

Referral to group psychotherapy: a retrospective study on patients' personality features associated with clinicians' judgments

This study was designed to explore selected personality features of patients that are associated with clinicians' judgments about whom to refer to dynamic group psychotherapy versus individual therapy. Results suggested that an aspect of patients' adult attachment style, namely level of confidence and level of hostility, may have influenced the clinicians' judgments and decision making about treatment referrals.     

Resistance in group psychotherapy

The authors view resistance generally as healthy and a sign of a more or less intact ego. A brief review of the psychoanalytic literature and the group therapy literature presents resistance as a mechanism that closes off aspects of the internal and external world seen as potentially dangerous. Patient resistances are identified as coming from cultural values, fear of strangers, fear of regression, and resentment toward the therapist. Clinical vignettes of group patients and group interaction are presented. Finally, resistance of therapists and indications of such resistance are also explored.     

Scapegoating in group psychotherapy

The purpose of this paper is to describe and illuminate the phenomenon of scapegoating in group psychotherapy. Specifically, the role of projective identification - on both individual and group-wide bases - in the evolution of the deviant is delineated. Individual, interpersonal, and whole-group interventions are presented along with the technique of functional subgrouping, a relatively new and particularly potent group intervention. Several case vignettes are detailed for illustration.     

Antidepressants in group psychotherapy

This article alerts us to consider depression as a relatively frequent cause of impasse in the course of group psychotherapy. The authors recommend the combined use of antidepressant medication along with group psychotherapy when such depression is confirmed independently outside the group. Common obstacles and pitfalls preventing successful combined treatment are reviewed; the depressive logjam is differentiated from common resistance; and profiles of responders versus nonresponders are described. A rationale of the combined treatment, its results, and implications for group therapists are all delineated.