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.     

Impact of outpatient non-myeloablative haematopoietic stem cell transplantation in quality of life vs. conventional therapy

The role of outpatient hematopoietic stem cell transplantation (HSCT) as a therapeutic tool has been strengthened significantly because of the increasing number of patients undergoing this treatment. Due the very nature of this procedure, one of the aspects that should not be overlooked is the quality of life (QOL) of patients undergoing HSCT. Thus, one must consider not only health status after treatment, but also, the psychosocial implications for the patient. This is an observational, longitudinal, and prospective study to assess QOL in patients undergoing outpatient HSCT vs. similar patients receiving medical treatment (MxTx). By applying the COOP/WONKA charts on five occasions (pre-HSCT/initial, post-HSCT/first month, and at 3, 6, and 9 months), thirty-eight patients were analysed, 19 with HSCT and 19 with MxTx with no differences in age, gender or diagnosis. The initial survey found significant differences only in pain perception, which was higher in the HSCT group (p = .08); at the first month, there was a greater tendency for feelings of depression or anxiety in the HSCT group (p = .016), with more limitations in social (p = .003) and daily (p = .044) activities. From 3 months post-HSCT, the results were very similar. The differences persisted only in the area of social activities. Four patients developed graft-versus-host disease with no significant difference in the scores obtained compared to other transplant patients at 3, 6, and 9 months (p = .26) of follow-up.     

The Rat: A Study in Behavior by S. A. Barnett

This paper attempts to provide a helpful, “hands-on” guide to leaders of psychotherapy groups in a manner that is free of any one particular theoretical orientation. It focuses on characteristics that can be applied to groups emphasizing life skills, cognitive skills, or interpersonal skills in a variety of settings and types of groups—inpatient or outpatient, short or long term. Issues covered include the importance of structure as it relates to anxiety, group composition, skill requirements, resistance, and symbolic factors. The major theme is that leaders need to make choices and that these choices can be made easier with an awareness of the major factors involved in group psychotherapy.     

Clinical,Studies in Psychiatry by H. S. Sullivan

A structured group therapy approach for psychiatric inpatients is presented. After reviewing the literature indicating that insight-oriented approaches are not effective with severely disturbed patients, the data supporting an interpersonal, cognitive, problem-solving approach with such patients is reviewed. A rationale for combining this cognitive problem-solving approach and Yalom's interpersonal approach with psychiatric inpatients is then presented. This structured group therapy approach, called the problem-solving support group (PSSG) is discussed, defining the nature and composition, screening procedures, methods, and techniques of the PSSG. Its use with psychiatric patients is illustrated by therapy protocols depicting the nature of the therapeutic interactions during the group, while also demonstrating what the group appears to be accomplishing for its members.     

Training with computer-supported motor imagery in post-stroke rehabilitation.

Converging lines of evidence suggest that motor imagery (the mental simulation of a motor act within working memory) is associated with subliminal activation of the motor system. This observation has led to the hypothesis that cortical activation during motor imagery may affect the acquisition of specific motor skills and help the recovery of motor function. In this paper, we describe a clinical protocol in which we use interactive tools to stimulate motor imagery in hemiplegic stroke patients, thereby helping them to recover lost motor function. The protocol consists of an inpatient and an outpatient phase, combining physical and mental practice. In the inpatient phase, patients are trained in a laboratory setting, using a custom-made interactive workbench (VR Mirror). After discharge, patients use a portable device to guide mental and physical practice in a home setting. The proposed strategy is based on the hypotheses that: (a) combined physical and mental practice can make a cost-effective contribution to the rehabilitation of stroke patients, (b) effective mental practice is not possible without some form of support, from a therapist (as in our inpatient phase) or from technology (as in the outpatient phase), (c) the inclusion of an outpatient phase will allow the patient to practice more often than would otherwise be possible, therefore increasing the speed and/or effectiveness of learning, and (d) the use of interactive technology will reduce the patient's need for skilled support, therefore improving the cost-effectiveness of training.     

Developing the matrix representation grid (MRG): A method for observing group processes. Findings from time-limited group psychotherapy for alcohol-dependent patients

The MRG was published 1988 in order to support developments in group psychotherapy methods as one of the all too few process observation research methods for studying group-as-a-whole. After 9 years of what pilot studies have labeled successful clinical trials, this study aims at validating the MRG against the established SAVI: Structural Analysis of Verbal Interaction (Agazarian & Simon 1989). Videotaped group sessions from short-term groups for alcohol dependent patients conducted along two therapy methods, one behaviorally oriented and the other group analytic, are used as material. The MRG is validated in the study, confirmed to be clinically valuable, and some interesting comparisons between the two treatment modalities are also made.     

Five Issues in Training Edited by Irving R. Weschler and Edgar H. Schein

This case study illustrates how combined therapy (individual, group, and marital) by the same therapist was used to resolve a woman's narcissistic transference. The author's position is that combined therapy creates a psychologically stimulating environment, which uniquely elicits a depth and range of transference feelings, thereby generating multiple therapeutic opportunities to experience and work through transference resistance in the here-and-now. Highlights of the treatment demonstrate how the synergy of three modalities is used to elicit, modulate, and resolve positive and negative aspects of the narcissistic transference. Four guidelines are suggested for treatment of patients in combined therapy.     

Group process in short-term outpatient therapy groups for schizophrenics

The short form of the group climate questionnaire (GCQ-S) was used to evaluate process in three 12-session therapy groups for outpatient schizophrenics. Results showed no difference on the Engaged dimension between the short-term schizophrenic groups and either a normative sample of outpatient neurotic groups or the first 26 sessions of a long-term outpatient schizophrenic group. However, the short-term groups scored significantly lower (p<.001) on the Avoiding and Conflict dimensions as compared with either long-term sample. The session-to-session GCQ-S dimension pattern did not support the presence of sequential group stages, but there was a tendency for the Engaged scores to increase and the Avoiding and Conflict scores to decrease as time went on.The authors gratefully acknowledge K. Roy MacKenzie, M.D., and Don Brown, M.D., for their helpful comments regarding this paper. Parts of this paper were presented in a poster session at the American Group Psychotherapy Association Annual Meeting in New York, February 8–12, 1988.     

Family treatment approaches to drug abuse problems: a review.

This review covers the literature that has emerged specifically on the family treatment of drug abuse problems. Following a brief discussion of patterns and structures prevalent in drug-abusing families, 68 different studies or programs (discussed in 74 papers) are compared as to their techniques and results. These are categorized within the following modalities: marital treatment, group treatment for parents, concurrent parent and identified patient treatment, treatment with individual families (both inpatient and outpatient), sibling-oriented treatment, multiple family therapy, and social network therapy. A table presents the various studies, along with the types of results they provide. Outcomes are contrasted for the 14 studies that quantified their results. The final section presents implications for the following areas: treatment activities (clarification of technique, family recruitment, direction and effectiveness of treatment, confidentiality, and treatment delivery systems), training, prevention, and future research (outcome, technique and responsibility). It is concluded that family treatment for drug abuse is gaining widespread acceptance and shows considerable promise for dealing effectively with problems of this type.     

ENLISTED PERSONNEL SELECTION FOR THE U. S. NAVY1

Recently, over 33% of the new male enlistees were prematurely separated from the Navy (i.e., prior to the expiration of active duty obligation). The purpose of this study was to develop and evaluate a new screening tool, designed to estimate an applicant's chances of completing the first two years of service. Essentially all nonprior service males enlisting during 1973 were included in the study (N = 68,616). Predictors used were: (1) years school completed, (2) mental group, based upon aptitude level, (3) age, and (4) number of dependents. The dichotomous criterion was survival (72%) vs. loss (28%), after a median two years of service. The model developed on the total sample evidenced a multiple point-biserial validity of .31. Double cross-validation evidence showed that the model will produce reasonably accurate and stable predictions. Management-oriented information was prepared to illustrate the various consequences of employing alternative cutting scores. This permitted examination of the tradeoffs involved in raising or lowering standards in the light of the current supply and demand picture for nonprior service enlisted male applicants.     

The Emergence of Suicidal Ideation During the Post‐Hospital Treatment of Depressed Patients

There is a paucity of research on the emergence of suicidal ideation in recently hospitalized patients undergoing treatment for depression. As part of a larger clinical trial, patients (N = 103) with major depression without suicidal ideation at hospital discharge were followed for up to 6 months while receiving study‐related outpatient treatments. Fifty‐five percent reported the emergence of suicidal ideation during the outpatient period, with the vast majority (79%) exhibiting this problem within the first 2 months post‐discharge. Seventy percent of those reporting severe suicidality prior to hospitalization exhibited a reemergence of suicidal ideation post‐discharge. However, 29% without significant suicidality at the index hospitalization later developed suicidal ideation during the outpatient treatment period. A faster time to the emergence of suicidal ideation was predicted by both higher prehospitalization levels of suicidal ideation as well as greater depression severity at hospital discharge. Overall, rates of emergent suicidal ideation found in the current sample of recently hospitalized patients were higher than those reported in previous outpatient samples.     

Prelogical Experience by Edward S. Tauber and Maurice R. Green

Working as director of a group psychotherapy training program in a university medical center, the author has observed many groups in periods of decreased group stability. These situations tend to arise frequently in an academic setting where summer breaks and other school-related holidays may result in extended periods of irregular attendance. Such times appear to be quite stressful to group members and leaders and frequently result in a storm of transferential and/or countertransferential acting out. This may carry over into supervision sessions via the mechanism of the parallel process and these, too, may become stressful, unrewarding, and nonproductive. An attempt to understand such situations and to find better ways of helping trainees deal with them constructively has resulted in the following ideas about group instability. Although these times remain uncomfortable and stressful, they can be managed and used to generate valuable information for the participants that can further the therapeutic process.     

A Psychotherapy of Schizophrenia: Direct Analysis by Albert E. Scheflen

This article studies the impact of outpatient group therapy on medical care at a large city–county hospital. Of the 65 group therapy outpatients, 33 persons met the criterion of having attended at least 12 group sessions over the course of a year. We compared a control period (the year prior to initiating group therapy) with a study period (months 6–18 after starting group) and found a sharp decrease in the number of hospitalizations and in-hospital days. There was significantly increased use of neuroleptics and nonpsychotropics and increased attendance at nonpsychiatric clinics.     

Common barriers to healthcare for transgender people in the U.S. Southeast

Abstract

Background: Transgender and non-binary people are more likely to face barriers to healthcare than their cisgender counterparts. The majority of work in this area centers on the experiences of transgender people in northern cities and urban enclaves, yet over 500,000 transgender people live in the U.S. Southeast.

Aims: The purpose of this study is to explore barriers to healthcare among transgender people in the U.S. Southeast.

Methods: The research team conducted four 120-minute focus groups (eligibility criteria: 18?years or older, self-identify as transgender, live in the U.S. Southeast). Participants completed a demographic questionnaire prior to the start of the focus group. Each focus group explored access to and experiences of receiving basic healthcare as a transgender person in the U.S. Southeast. Established qualitative methods were used to conduct the focus groups and data analysis.

Results: Participants (n?=?48) ranged in age from 19 to 65, with the majority identifying as trans women (43.8%) and non-binary (33.3%). The sample was racially diverse: White (50%), Black (37.5%), and Latinx or Multiracial (12.5%). Multiple barriers to care were identified: (1) fear and mistrust of providers; (2) inconsistency in access to healthcare; (3) disrespect from providers; and, (4) mistreatment due to intersecting experiences of gender, race, class, and location.

Discussion: Transgender Southerners face barriers to care at the structural, cultural, and interpersonal levels. The study results have implications for researchers, as well as providers, practices, and health care systems throughout the region.     

Children Who Hate by Fritz Redl and David Wineman

This paper describes a dynamically oriented group aftercare program for alcoholics and other substance abusers. The chronic nature of alcoholism and the need to insure that initial progress is not followed by regression point to the need for continuity of care, extending beyond the initial detoxification or initial crisis phase. The group-oriented aftercare program at Appleton Outpatient Clinic follows an intensive five-week program in either our outpatient clinic or Appleton's inpatient setting. The preparatory group and educational experiences that patients participate in prior to their entry into a long-term aftercare group are detailed. Finally, special issues that emerge in the long-term groups are discussed including (1) the group contract, (2) alcohol-related group defenses, and (3) management of the patient who drinks.     

Process and content in an outpatient schizophrenic group

Process and content issues were evaluated during the first six months of an outpatient schizophrenic group. Compared with groups composed of neurotic and characterological patients, the schizophrenic group scored higher in the Avoiding dimension of the Group Climate Questionnaire (GCQ-S). There was more cohesion and less interpersonal conflict as time went on. Although topics related to engagement and differentiation were discussed, there was no obvious GCQ-S evidence of these first two stages of group development. However, the data supported the presence of stage 3 (individuation) during sessions 20–26. Interpersonal topics dominated the group discussions, followed by issues involving reality-testing, expression of emotions, and advice-giving.The authors wish to thank Dr. K. Roy MacKenzie for his helpful comments on a draft of this paper.     

Examining Autobiographical Memory Content in Patients with Depression and Anxiety Disorders

The purpose of this study was to move beyond the traditional specificity model of autobiographical memory (ABM) and to examine the content of memories with a focus on disorder and schema-relevant content. The sample (N = 82) included 25 patients with major depressive disorder (MDD), 24 with social phobia (SP), and 33 with panic disorder with agoraphobia (PDA) who were referred to a large outpatient clinic for group treatment of depression or anxiety. Participants completed the Autobiographical Memory Test (AMT) and Beck Depression Inventory–II as part of the clinical intake process. Responses to the AMT were coded for disorder-specific content based on diagnostic criteria for each disorder as well as for schema-relevant (sociotropy vs. autonomy) content. A repeated measures multiple analysis of variance demonstrated significant differences in disorder-specific content, with patients in the MDD group reporting more depressotypic ABMs than those in the PDA group but not the SP group. Similarly, in the analysis of schema-relevant content, significant differences were found between MDD and PDA regarding the presence of autonomy-based ABM ratings. Study results provide partial support for the cognitive specificity hypothesis with ABM content. The results are discussed in relation to the cognitive models of depression and anxiety.     

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.     

The Annual Survey of Psychoanalysis,Volume III Edited by John Frosch and Nathaniel Ross,Sidney Tarachow,Jacob A. Arlow

The effects of brief group psychotherapy in relapse prevention were tested. The groups focused on the clients' capacity to formulate their own treatment goals, including controlled drinking, programmed relapse, and total abstinence. Twelve months after completion of the eight-week outpatient group treatment, thirty-five clients were followed up. There appeared to be no harmful effects as a result of the treatment. Nobody in the follow-up group had a deteriorated drinking pattern as compared to pretreatment data. The follow-up results were significantly better than before treatment and also than in a comparison group of alcohol dependent patients. It seemed as if those patients who could benefit from the treatment had a shorter duration of abuse and had a later onset of uncontrolled drinking compared to those who continued with a negative drinking pattern and the dropouts. The clients assigned the positive treatment effects to course leaders' encouragement of personal decision making, increased awareness of risk situations, and improved coping skills. The group situation in itself seemed to be of special importance for this result. The degree of structure implemented by course leaders allowed a free and respectful opennes to develop between group members.