Psychoanalytically oriented short-term groups for outpatients: Unsettled issues

The psychoanalytic approach to short-term group therapy for outpatients has been less prevalent than other approaches. Unsettled issues associated with this approach concern the feasibility of carrying out psychoanalytic work on an ongoing basis, patient selection, group composition, patient preparation, therapist technique, and cotherapy. Recent literature relevant to a conceptual consideration of these issues is reviewed. A vignette from a recent therapy group is presented as part of a clinical consideration of the issues. In addition, practical suggestions for conducting such groups are provided.This article was derived from a paper presented at the Seventh Annual Meeting of the Canadian Group Psychotherapy Association, October 16, 1986, Mont Tremblant, Canada.     

Experience in Developing a Combined Activity and Verbal Group Therapy Program with Latency-Age Boys

Ten fundamental principles are outlined for the practice of brief, dynamic group therapy within a 10- to 20-session time limit. They include: group composition and screening; contracting for appropriate goals: facilitating rapid cohesiveness; stages of group development; building a work group atmosphere; leadership style; structural levels of focus; transference and countertransference considerations; the cotherapy relationship; and curative factors. This approach integrates recent formulations from the practice of short-term individual therapies as well as brief group approaches. Each brief group principle is contrasted with its long-term analytic group counterpart. Relevant research literature, historical roots, as well as other types of brief therapy groups are reviewed. The recent and experimental nature of these techniques is critically discussed.     

Insight-oriented group psychotherapy of latency-age children in an acute care setting

Traditional approaches to group therapy with latency-age children have stressed activity and nonverbal therapeutic interventions. These approaches originated in the 1940s with Slavson's activity aroup therapy. A review of the literature of the past 25 years reveals that many clinicians have increasingly employed verbal techniques with latencyage groups. Most such reports describe groups for latency-age out-patients. In this paper, a verbal, interpretive technique for group therapy with latency-age inpatients is described. Clinical vignettes are included to illustrate this technique. Our experience suggests that such a technique can become an integral part of the inpatient treatment program for the latency-age child.     

Significant treatment factors in short-term group psychotherapy

The author briefly describes an approach to short-term group psychotherapy based upon an adult developmental model. By means of a clinical case example significant treatment factors are examined. Such an approach to planned short-term group therapy may force group members to confront and deal with important existential issues.     

Short-term group psychotherapy: Who succeeds,who fails?

Group psychotherapy literature is unclear about what patient characteristics contribute to better and poorer outcome. This study examined pre-group therapy patient characteristics and their relationship to short-term group therapy outcome. A battery of outcome measurements was administered to 192 short-term group therapy patients before, after, and 4–6 months after their group experience. Three distinct outcome groups are defined: dropouts, low changers and high changers. Characteristics of each group are discussed. Aside from the traditionally important variables such as age and education, this study indicates that interpersonal variables (interpersonal sensitivity, distance/closeness to others, primary involvement with family) may be potentially important areas to pursue in screening and preparing patients for a group.     

Inpatient adolescent group therapy as a social system

This paper describes a method of group therapy that 1) utilizes open systems theory to describe the social structure of group therapy, and 2)presents interventions drawn from Masterson's ideas for treating borderline personality disorders. Illustrations from a group therapy program for chemically dependent adolescents in a short-term, inpatient treatment unit of a general hospital are offered. It is proposed that under constrained conditions of treatment, such as those described, group therapy can be effective if there is precision about the system boundaries of task, role, time and place, and if group interventions are based upon a theoretically and clinically consistent model such as Masterson's.     

T-Group Theory and Laboratory Method: Innovation in Re-Education Edited by Leland P. Bradford,Jack R. Gibb,and Kenneth D. Benne

The authors conducted a quantitative examination of parallels between milieu and therapy group dynamics on a short-term inpatient unit. The Ward Atmosphere Scale was used to assess the milieu, and the Group Climate Questionnaire-S to measure processes in key groups. Assessments were made by patients and staff once each week for 10 months. The authors found clear parallels between ward and therapy group processes. The parallels reflected the impact of patterns utilization of the unit, its treatment philosophy, and the emotional dynamics of its constituents. Examination of these associations also revealed limitations of the treatment setting, clarified the potential impact of particular staff interventions, and demonstrated biases in the rating methods. Study of parallel process on the psychiatric unit is a rich source of information on the nature of inpatient treatment.     

Psychodynamic group therapy for male survivors of sexual abuse

The group therapy literature on male sexual abuse is very preliminary and concerned solely with short-term support models. This paper describes a long-term psychodynamic therapy group for male survivors that has been running successfully in a clinic setting for almost three years. This combined group and individual treatment approach presupposes the selection of men who are capable of using group process to explore basic personality and relationship problems. With sexually abused men, certain treatment issues are paramount. These concern the safety of group boundaries, power and control, facilitating intimacy, handling shame and guilt, and the effects of trauma. Special attention is given to the gender-related dynamics and conflicts that occur in a group of male survivors with a male leader.     

Psychoanalytic Explorations in Art by Ernst Kris

A review of 43 controlled studies was conducted which evaluated the effectiveness of group therapy for schizophrenics. Group therapy was judged to be an effective modality of treatment for schizophrenics in 67 percent of the inpatient studies. It was especially useful in groups lasting more than three months. Therapy groups were effective for schizophrenics in 80 percent of the outpatient studies. Interaction-oriented approaches were more effective than insight-oriented approaches, which were found to be harmful for some schizophrenics.     

Bridging the gap between long- and short-term group psychotherapy: A viable treatment model

The purpose of this paper is to support the efficacy of short-term insight-oriented, process group psychotherapy and to present a unique treatment model. The format for a time-limited, dynamic group therapy model with the opportunity to recontract for additional segments will be discussed. Evidence will be presented that supports the effective use of this model for providing continuity of care for patients with both long- and short-term treatment goals. The referral process,contracting for appropriate goals, group development, the cotherapy relationship, and other specific treatment issues will be addressed.     

Group Therapy, 1976: An Overview

This article discusses short-term group psychotherapy with individuals suffering from an adjustment reaction or reactive depression precipitated by genital herpes. The authors describe their experience in conducting and supervising six such therapy groups and describe several therapeutic factors that emerged as central in the treatment of this population. Among these factors are relief from isolation, the exchange of information, a challenge to defensive denial, exposure to new ideas and behaviors, an opportunity to explore the developmental issues that typically emerge, and the discussion of ethical issues.     

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.     

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.     

Time-Limited Dynamic Psychotherapy as a Model for Short-Term Inpatient Groups

The present article proposes a method, practiced by the author, to adapt time-limited dynamic psychotherapy (TLDP), a short-term individual psychodynamic therapy, for use with inpatient psychotherapy groups. Characteristics of TLDP which suggest the usefulness of such an adaptation, including short-term duration, specific treatment focus, rapid conceptualizations and broad selection of patients, and emphasis on the here-and-now in therapy, are discussed. The general approach to treatment, a supportive stance that involves an identification of maladaptive interpersonal issues, and then working on these issues without directly confronting the patients, is described. Specific therapeutic techniques for common inpatient group situations are also discussed.     

An Evaluation of the Effects of Diagnostic Composition on Individual Treatment Outcome Within Transdiagnostic Cognitive–Behavioral Group Therapy for Anxiety

Recently, studies have supported the efficacy of treating anxiety disorders utilizing a transdiagnostic, or non-diagnosis-specific, framework (Erickson, D. H. (2003). Group cognitive behavioural therapy for heterogeneous anxiety disorders. Cognitive Behaviour Therapy, 32, 179–186; Garcia, M. S. (2004). Effectiveness of cognitive-behavioural group therapy in patients with anxiety disorders. Psychology in Spain, 8, 89–97; Norton, P. J., & Hope, D. A. (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36, 79–97). Transdiagnostic group treatment packages focus on the common aspects inherent across the anxiety disorders such as behavioral and cognitive avoidance, and faulty cognitive appraisals of threat potential or meaning (Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230). Although research supports the overall efficacy of transdiagnostic cognitive behavior therapy (CBT) for anxiety disorders (Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy: Theory, Research, Practice and Training, 45, 214–226), the effect of diagnostically mixed group composition on individual outcomes is less clear. This study investigated the relationship between group composition and treatment outcome within diagnostically heterogeneous groups with the purpose of determining if diagnostic heterogeneity differentially impacted treatment outcome for 84 individuals during a 12-week transdiagnostic cognitive–behavioral group anxiety treatment program (Norton, P. J. (2012a). Group cognitive-behavioral therapy of anxiety: A transdiagnostic treatment manual. New York: Guilford). The diagnostic makeup of the treatment group was examined at the beginning of treatment and at the end of treatment, and the results indicated that the diagnostic makeup of the treatment group had no significant impact on individual treatment outcome. These findings have direct implications for the delivery of transdiagnostic treatments, and are discussed in terms of their global implications for the transdiagnostic approach to the treatment of anxiety disorders.     

A.G.P.A. News

Clinical observations regarding themes and roles that are characteristic of short-term, psychoanalytically oriented therapy groups for loss patients are presented. They reflect aspects of both the therapy and the patients. Themes refer to the content of a recurrent conflict in the group. They include trust, survivor guilt, mortality, and termination. Roles refer to a set of patient behaviors that represent a shared conflict. They include the apparition, monk, professor, professional nurturer, emotional conductor, and cruise director. Challenges that the themes and roles present to the therapist and clinical guidelines for addressing them are offered. Awareness of characteristic themes and roles and possible therapist responses are regarded as important parts of the preparation and training of therapists who plan to conduct short-term loss groups.     

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.     

Patterns and determinants of attitudes of psychiatric residents toward group therapy

The nature and origins of psychiatric residents' attitudes toward group psychotherapy were assessed by means of a semistructured interview. Subjects were 10 PGY-4 residents from five different residency training programs. Questions focused on subjects' perceptions of the possibilities and limitations of group therapy as a treatment modality, the efficacy and dangers of combined and conjoint treatment, the nature and extent of their training experiences in group approaches, the salient characteristics of their group therapy teachers and supervisors, and the attitudes of faculty about group psychotherapy that they were able to infer. Results suggest enormous variability of residents' attitudes. Hypotheses about the reasons for such variability are offered.     

Spontaneous Personality Synthesis in Group Therapy

Combined therapy is defined as concurrent dyadic and group therapy with the same therapist. This paper focuses on a neglected aspect of combined therapy: broaching and exploring this question with one's individual, patient. The author shows how raising this question: (1) alters the therapeutic field whether or not the patient joins; (2) can sharpen the therapist's understanding of the indications and contraindications for group membership; (3) offers untapped therapeutic approaches and opportunities to clarify issues in the individual treatment; and (4) stirs up countertransference issues related to issues of profitability, the transference of the patient in individual treatment, and the transference of the group-as-a-whole. Several case examples are provided.