Large-group psychotherapy in a day treatment program

The potential for psychotherapy in a large-group format has been discussed since the 1960s. Day treatment programs provide optimal support for such groups. One program type, which has maintained large-group psychotherapy as a central feature for over twenty years, is described. Essential features include an integrated therapeutic team, with clearly defined leadership, that is open to examination of its own process. Such groups may not only provide effective therapy, but are also readily amenable for teaching and research in psychotherapy.     

Schools of Psychoanalytic Thought by Ruth L. Munroe

This paper assesses the impact of large-group processes and dynamics upon the patient-staff community meeting in hospital treatment. It focuses upon the therapeutic values and limitations of the large-group format by examining, from an integrated general systems and object relations perspective, how size, structure, patient population, staff training, and leadership variables reciprocally affect the process and content of the community meeting. The special problems associated with selecting an appropriate format for the meeting and the intense pull of regressive group forces upon the large-group leader are discussed.     

Supervising Integrative Psychotherapy in the 21st Century: Pressing Needs,Impressing Possibilities

Supervisors and teachers who are interested in advancing integrative psychotherapy in the 21st century have the dual task of surveying the range of treatment approaches that have been developed and distilling these approaches down to a manageable number of influences that have been found to have the greatest impact on clinical practice over time. It has been proposed that there are four bona fide schools of psychotherapy that would be most useful for comprehensive training and supervision that would contribute to either (a) case conceptualization or (b) the process of clinical interviewing: psychodynamic psychotherapy; cognitive-behavioral psychotherapy; family systems therapy; and, humanistic/client-centered therapy. The goal for such broadly based clinical instruction would be for students, trainees, and interns to have an ability to provide a multi-level case conceptualization for any of the psychotherapy cases for which they are providing treatment. Thorough instruction in clinical reasoning and decision-making in this type of multi-level case formulation can provide some of the most valuable tools for novice and experienced clinicians alike.     

Succession and survival in psychotherapy organizations

Abstract: This paper examines the world of psychotherapy by applying a systemic and psychodynamic understanding of the family business as a way of understanding the dilemmas and challenges of leadership succession. Oedipal factors are explored as an important theme within the succession process. This exploration is set within the context of what function psychotherapy has performed in society over the last thirty years. The hypothesis is that the first generation of leaders aimed to provide containment for the individual citizen at a time of failed dependency in society. The suggestion is that this gave way to the primary task for the second generation, which has been to focus on the therapist in training. The challenge for the third generation is to develop a meaningful role for psychotherapy today and to ensure survival at a time when other shorter therapies such as CBT are gaining ascendancy over longer term psychoanalytic psychotherapy.     

Shame in pastoral psychotherapy

This essay contends that pastoral psychotherapy is an arena of shame for clients and therapists. If unacknowledged, shame can undermine therapy and injure all participants. The approach is to provide a succinct typology of shame, to describe how shame is woven into the structure and process of psychotherapy, and to offer seven ways therapists can work creatively with shame in psychotherapy and turn it into a healing resource.     

Process parallels in related groups

The theoretical basis for the repetition of themes in related groups is addressed by describing similar processes in four systems: inpatient psychiatric ward, inpatient psychotherapy group, supervisory group, and group psychotherapy division. The principles of general system theory help explain process parallels in allied groups and illuminate group process.     

A training outline for conducting psychotherapy process ratings: An example using therapist technique

Aims: This study addresses the effects of structured training on the development of coding skills used in psychotherapy process research. Method: Participants included graduate trainees enrolled in an APA approved Clinical PhD programme. A course outline for training is reviewed and examined in relation to ratings of therapist techniques used during psychotherapy sessions. Results: The effects of this structured training protocol for raters resulted in good to excellent levels of interrater reliability. Different groups of raters were compared along multiple factors such as level of graduate training, training received on a particular measure, and psychotherapy experience. Discussion: The implications of these findings for rater training in psychotherapy process research are discussed.     

Group Leader-Recorder Relationship in a State Hospital: A Learning Tool

The process group for staff and trainees in institutional settings has become increasingly unpopular as a resource, although ironically, the need for such a group has grown. The author presents the idea that the process group is not used more often because of a general lack of understanding of the nature of such groups as well as a failure to clearly distinguish process groups from traditional psychotherapy groups. The author goes on to give a clear definition of the task and the boundaries of a process group and, using knowledge of systems thinking, discusses special techniques for running such groups with illustrative examples.     

Modifications of Yalom's interactional group therapy model as a mode of treatment for alcoholism

As a result of a review of the literature and especially Brown and Yalom's (1977) clinical report, it is suggested that the preferred mode of treatment for alcoholism is group psychotherapy. The group's ability to provide support, structure and reinforcement for abstinence make it a powerful catalyst in the recovery process. In measures of time, efficacy and recovery, group psychotherapy generally succeeds where other treatment modalities frequently fail.     

Perceptions of psychotherapy trainees of psychotherapy research

Aims: The research‐practice gap and lack of engagement with research by trainees and qualified therapists is a widely discussed issue amongst psychotherapy researchers. The present study investigates the perceptions of psychotherapy trainees of psychotherapy research and explores what would encourage them to participate in research. Method: Two focus groups of 16 trainees in total were conducted at two separate psychotherapy training institutes to explore trainees’ attitudes and perceptions. Data was analysed using Braun and Clarke's (2006) thematic analysis. Results: Three superordinate themes emerged: negative perception of research; recognition of the importance of research; and what would be needed to facilitate engagement in research. Discussion: The results suggest that interest in and willingness to participate in research exists, however it is necessary for negative perceptions about research to be addressed and for researchers to design projects which are supportive of participants.     

Group psychotherapy with alcoholics: Interface with self-help groups

This paper addresses recovering alcoholics' concurrent involvement in psychotherapy groups and self-help groups. A developmental model of alcoholism group psychotherapy is presented, differentiating between early and advanced sobriety. Psychotherapy and self-help groups are compared and contrasted. Multiple group membership entails various areas of compatibility. Divergence and conflict result from differences in underlying conceptual framework and approach. Clinical implications of members' involvement in partially discrepant group settings are explored with an emphasis on transference and countertransference reactions. Multiple group membership is identified as a salient factor in alcoholism group psychotherapy at all levels of recovery.She is also in private practice.This paper was presented at the American Group Psychotherapy Association Annual Conference, Boston, February 1990.     

Introduction to Psychiatry by O. Spurgeon English and Stuart M. Finch

Multiple group psychotherapy was employed as the primary treatment modality in a day-treatment program as an innovative multifaceted approach to treating adolescents comorbid for psychiatric and substance abuse diagnoses. The concurrent educational program included a high school on site. The groups included Substance Abuse Group, which promoted the 12-step model; Health Group; Psychotherapy Group; Leisure Time Group; Self-Awareness Group; and Multiple Family Group. The effect of the multiple groups was to provide a variety of experiences focusing on varied aspects of normal and dysfunctional adolescent development. Together the combination of groups served to strengthen the participants' cohesiveness, communicating skills, and hopefulness.     

Lifelong Mild Bad Feelings: A Review and Solution to a Psychotherapeutic Enigma

A review indicates that (a) comparatively little is known about the common phenomenon of lifelong mild bad feelings, and (b) psychotherapy has generally overlooked an effective focus on this enigmatic feeling state. As an invitation for clinicians to provide more attention to this feeling state, a proposal is suggested toward one way of freeing a patient of lifelong mild bad feelings in the course of a session.     

Considering methodological integrity in counselling and psychotherapy research

Within the field of counselling and psychotherapy research, qualitative methods have been a longstanding tradition of inquiry due to the mutual interest of therapists and researchers in both internal experiences and intersubjective processes. Methodological integrity is a conceptual framework that has been advanced to increase the rigor of these methods. In this paper, we consider the value of this concept for counselling and psychotherapy researchers and reviewers. This framework guides investigators and reviewers to consider how procedures can be adapted to meet the goals of specific studies, given their characteristics and approach to inquiry. In this brief article, we exemplify the relevance and application of this concept to this field by describing the decision‐making process within the designing of a qualitative research project to investigate clients' needs within rape crisis counselling. Through this exemplar, we also provide guidance to counselling and psychotherapy researchers on considerations during the process of research review and reporting.     

Report to the World Federation for Mental Health Editor's Note

The effects of written, cognitive pretraining on self-reported self-disclosure and cohesion in group psychotherapy were studied. Subjects were members of time-limited psychotherapy groups that focused on incest-related issues. The experimental groups were given written cognitive pretraining designed to increase self-reported self-disclosure and cohesion. The control groups received general group information. Subjects in the pretrained groups reported higher levels of self-perceived self-disclosure than the control groups after sessions 4 (p = .003) and 8 (p = .003). Self-reported self-disclosure did not increase over time for pretrained or nonpretrained subjects. Cohesion did not differ across groups, but increased over time for experimental subjects (p = .008), and not for control subjects.     

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.     

Benchmarking Community-Based Couple Therapy: Considering Measurement Reactivity

Couple therapy has been shown to be effective in randomized clinical trials; however, results from naturalistic couple therapy have been less consistent. This study utilized a benchmarking approach to compare the effectiveness of couple therapy in a community-based setting with findings from efficacy treatments, such as treatment within randomized clinical trials. The current study is the largest couple therapy sample published to date (N = 3,347 couples). Clients in couple therapy were asked to provide initial and weekly ratings of symptomology on the Outcome Questionnaire (OQ-45.2). We found that treatment effect sizes found at community clinics were smaller than efficacy studies (i.e., the benchmark). However, when taking into account measurement reactivity, the effect sizes were comparable. This is the first benchmarking study for community-based couple therapy, allowing for meaningful comparisons and understanding of outcomes in real-world couple therapy. Implications for the field are offered in terms of evaluating community-based psychotherapy studies with benchmarking for couple therapy. Results of this study provide clinicians and researchers a way to meaningfully compare couple therapy outcomes, accounting for differences in community-based practices and randomized clinical trials. This benchmark also underscores the impact of measurement sensitivity, an issue commonly overlooked in psychotherapy research and practice.     

Support Groups: A Conceptualization

A conceptualization of support groups, differentiating them from counseling and psychotherapy groups, is offered, and its implications for group formation, membership;, and format are discussed.