Qualitative analysis of experiences of members of a psychoeducational assertiveness group

This study describes qualitatively a psychoeducational assertiveness intervention for 20 women's perceptions of positive and negative experiences, undertaken to identify whether therapeutic mechanisms operating in group therapy as described by Yalom might be inferred. There were 14 90-min. weekly sessions organized around educational material. Two groups were conducted with 10 university women each (M= 20.9 yr., SD= 1.9). Qualitative analysis of the 20 interviews identified five of Yalom's therapeutic mechanisms, namely, self-understanding, universality, acceptance, catharsis, and self-disclosure. The positive experiences were group cohesiveness, self-understanding, self-disclosure, positive views about the self and learning, and cognitive benefits. Self-disclosing at the early stages of group development was the most frequently reported negative experience or difficulty in the group. Although participants stated they improved interpersonal communication skills, analysis suggested the cultural context was an important mediator of assertive behavior.     

People in groups: Dynamic and therapeutic aspects

The author differentiates between a sociological-interactional (horizontal) axis and a psychological-motivational (vertical) axis in the group, and discusses the socio- and psychodynamics both of and in the group from each of these points of view. In group therapy, five phases are described: 1) exploratory contact; 2) regression; 3) catharsis; 4) insight; and 5) social learning. Group psychotherapy with large diagnostically heterogeneous groups in a hospital setting, small diagnostically homogeneous groups, and group discussions with patients' relatives are all described. In addition, attention is paid to experiential psychodynamic group process groups (analytic self-experience groups), which provide young psychotherapists with the opportunity to gain insight into both groups and the psychodynamics stimulated within this framework. The training of group therapists should include, after academic studies, clinical experience, individual psychotherapeutic training, an experiential group, cotherapy, group therapeutic work under expert supervision, and theoretical training.     

Perceptions of helpfulness and behavior in groups

Before, midway, and late in a 50-hour small group experience, 28 persons separately and subjectively appraised the helpfulness of 60 items representing Yalom's (1975) 12 curative factors of group psychotherapy. Items from the catharsis and interpersonal learning factors proved highly and increasingly helpful, despite their poor internal consistency. Item helpfulness also linked to members' ingroup behavior, as measured by peer ratings of acceptance-rejection of self and others. (Hurley, 1976). Persons more accepting of self and others regarded family reenactment items as more helpful, and advice and guidance items as less helpful, than did members who were more rejecting of self and others.     

Focused group therapy: An integrative approach

Focused Group Therapy (FGT) was developed within a research project on treatment for burned out patients on long-term sick leave. The core of FGT is to find and formulate an individual focus expressed in behavioural terms. This focus is then worked with in the here-and-now of the group therapy. It is argued that the use of common factors in group therapy, rather than a special technique, improves the clinical work. Thesupport factor in group therapy is understood in terms of cohesion, therapeutic alliance and goal-corrected empathic attunement. Thelearning factors that are stressed are the experience of being a part of a developing group, building on similarities instead of differences, affective communication and the implicit knowledge developed in new ways of dealing with interpersonal relations. Theaction factor is considered to consist of challenging interpersonal situations corresponding to the individual focus, which are mastered in the here-and-now of the group.     

Structural models of psychotherapy groups and their effect on inpatients with borderline personality disorders: Patients' perceptions

This research compares the way in which various group structural models affect self-understanding, interpersonal relationships and catharsis in hospitalized patients with borderline personality disorders. Each of the models is characterized by a different combination of group focus and leadership style. Three psychotherapy groups were chosen as paradigms: the dynamic psychotherapy group; the therapeutic games group, and psychodrama group. Sixty three inpatients with borderline personality disorders participated in the study. The one-way ANOVA yielded significant differences between the group models. Results of the post-hoc t-test showed that the dynamic and the games groups were perceived by the patients as more beneficial than psychodrama.     

The Couch and the Circle by Hyman Spotnitz

A qualitative study explored the therapeutic elements in psychodynamic group therapy for adolescents with learning disabilities and related psychosocial problems. Four boys and four girls, diagnosed with learning disabilities, were interviewed on completion of group therapy, to obtain their subjective experiences. Therapeutic factors were identified, grouped, and found to be operative through an interpersonal process, termed mutual recognition. Mutual recognition is defined as the adolescents realizing that they saw themselves in the others and that the others saw themselves in the participants. The subcategories were trust, connection, and group issues/process. The subcategories were interactive: they contributed to, and were influenced by, mutual recognition.     

Selbsthilfegruppen im Rahmen stationärer psychotherapeutischer Behandlungen

Psychosomatic in-patient treatment applies a combination of various methods in order to facilitate learning by insight and corrective emotional experiences in a therapeutic community. The establishment of a self-help group on the ward can be a useful complementary element in such a comprehensive approach. However, empirical research on this specific topic does not yet exist. Based on clinical experience, necessary preconditions as well as the pros and cons of integrating self-help into professional treatment are described. The assessment of 850 patients in a clinic for psychosomatic medicine and psychotherapy concerning a self-help group on the ward are presented. Relationships between patients’ evaluation of the self-help group and various other variables as well as the overall treatment effect were studied. Empirical data provide evidence of a differential effect of the self-help group on the ward: the majority of the patients experienced the self-help group as useful. Whether the patient is able to benefit from group therapy seems to be an intermediate variable and the therapists’ attitude towards self-help groups also seems to play an important role.     

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.     

Musiktherapie

Music therapeutic treatment targets the development of the perception, experience, symbolization and relationship abilities of an individual. The reception, production and reproduction of music induce intrapsychic and interpersonal processes. The processing of musical material provides a suitable means for reflective insight and recognition. With the help of music therapy resources are activated and individually significant associations of experiences are substantiated. Music therapy methods follow psychoodynamic, behavior therapeutic, learning theoretical, systemic, anthropological and holistic humanistic approaches. The scientific-based and evaluated special therapy focuses the expression of treatment diversity as well as theory formulation and immanent evaluation of treatment approaches.     

Must most psychotherapists remain as incompetent as they now are?

Although psychotherapy often is effective or helpful for groups of people, it is frequently inefficient and therefore is wasteful for many clients and actually contributes to harming a sizable minority of them. Some of the main aspects of therapeutic inefficiency are discussed in this paper, including: overemphasis on past experience; encouraging dependency and the dire need for love; overemphasis on modeling; the stressing of insight; the use of catharsis and abreaction; the use of cognitive distraction; self-efficacy suggestions; operant conditioning; gradual desensitization; and unselective eclecticism. Specific suggestions for increasing the efficiency of psychotherapy are given.     

The Benefits and Limitations of a Behavioral Intervention for Caregivers of Dementia Patients: A Qualitative Study

This study used qualitative methods to understand dementia caregivers’ experience of personal and therapeutic factors contributing to outcome following REACH VA, a behavioral intervention designed to alleviate caregiver burden and depressive symptoms. Caregivers and their interventionists were queried about their experiences of the treatment in semistructured interviews. Interviews were transcribed and analyzed using thematic analysis. The following themes emerged reflecting aspects of the intervention caregivers and interventionists found helpful: self-care, shared goals, psychoeducation, and stress-management skills. Some caregivers and interventionists found the provision of problem-solving skills to be helpful and others did not. Finally, some caregivers and interventionists reported that interpersonal support/bearing witness, insight, emotional transformation, and the discussion of interpersonal process were useful when part of the intervention or, when not included, would have been helpful. While behavioral interventions tend to be highly structured, interventionists’ ability to work flexibly within the protocol and tailor it to the caregiver’s needs was related to positive treatment response. The beneficial aspects of this treatment represent multiple theoretical orientations highlighting the importance of transtheoretical models of therapeutic action.     

Interpersonal predictors of onset of depression during the transition to adulthood

There is evidence that depression during adolescence and early adulthood is marked by deficits in interpersonal functioning. However, few studies have prospectively examined whether interpersonal difficulties are a risk factor for depression onset, so it is unclear whether these deficits in interpersonal functioning are products or predictors of depression. The present study aimed to clarify the direction of association between interpersonal factors and depression by examining whether social factors longitudinally predicted onset of depression in a diverse sample of young women with no history of depression. Hierarchical multiple regression analyses controlling for baseline depressive symptoms indicated that poorer family relationship quality and anxious attachment cognitions predicted onset of depressive episodes during the 2‐year period. Further, a wide variety of interpersonal factors predicted depressive symptoms over 6 months, including poor peer and family relationship quality, difficulty being close to others, and difficulty depending on others, controlling for baseline depressive symptoms and college attendance. The results provide evidence for the importance of an interpersonal perspective on vulnerability to depression.     

What do differences between own,admired, and attributed choices have to do with group induced shifts in choice

Two studies examined certain discrepancies which have been considered important evidence in support of interpersonal comparison (value-adherence) explanations of group induced shifts in choice. These are (a) the differences between a person's own choice and the choice he predicts others would make and (b) the difference between the former and the choice he admires. Findings from the first study indicate that own choices are more extreme than those a person predicts others would make because he is more certain and confident about the former than the latter, not because he wishes to appear to outdo others as interpersonal comparison theories of choice-shift effect would have it. The second study strongly suggests that extreme choices are admired not because they display maximal adherence to a social ideal but because they imply that the person's solution to a problem involving choice is well-founded, that he has persuasive reasons for the choice. On the whole the evidence bodes well for explanations of choice-shift effects based on persuasive argumentation and poorly for those relying on interpersonal comparison processes.     

The origins of empathic concern

Recent developments in research cast doubt on early conceptions of young children as primarily egocentric and uncaring of others' needs. Studies reviewed indicate a broad range of social competencies children bring to their interpersonal relationships. As early as 2 years of age, they show (a) the cognitive capacity to interpret, in simple ways, the physical and psychological states of others, (b) the emotional capacity to experience, affectively, the state of others, and (c) the behavioral repertoire that permits the possibility of attempts to alleviate discomfort in others. Both temperament and environment may contribute to individual differences in concern for others. Early socialization experiences that lead to adaptive and maladaptive patterns of responsiveness to others' needs are described. Examples of environmental risk conditions include parental depression, marital discord, parental maltreatment. Implications of this work for broadening existing conceptualizations of empathy and related prosocial orientations are addressed.     

Therapeutic factors in a systemic multi-family group treatment for major depression: patients' and partners' perspectives

This study investigated helpful and disturbing factors in multi-family groups with hospitalized, depressed patients and their family members. Both patients and their partners reported the occurrence of different therapeutic factors such as the cohesion of the group, different observational processes, and guidance from the therapist. The frequency of the therapeutic factors seemed to increase for both the patients and their partners as the group sessions progressed and several differences in reported therapeutic factors were found between the patients and their partners. A number of therapeutic factors such as modelling and guidance from the therapist were found to be related with improvement of depressive symptoms of the patient. The results help to provide some insight into which processes are important in multi-family group therapy for depression.     

A comparison of psychoanalytic and psychodramatic theory from a psychodramatist's perspective

A comparison of Freud's and Moreno's theories with regard to their implications for psychodrama therapy. Basic differences in the theories are discussed with special regard to therapist role, transference and tele, insight and catharsis, the time concept, the body, and developmental psychology. Other topics treated are concepts of drive or energy, psychic structure and role theory, psychic determinism contra the doctrine of spontaneity-creativity and differences between an intrapsychic and an interpersonal approach. An outline of the relationship of psychodrama and its philosophy and practice to other schools of psychotherapy is given.     

You don't know me, but I know you: the illusion of asymmetric insight

People, it is hypothesized, show an asymmetry in assessing their own interpersonal and intrapersonal knowledge relative to that of their peers. Six studies suggested that people perceive their knowledge of their peers to surpass their peers' knowledge of them. Several of the studies explored sources of this perceived asymmetry, especially the conviction that while observable behaviors (e.g., interpersonal revelations or idiosyncratic word completions) are more revealing of others than self, private thoughts and feelings are more revealing of self than others. Study 2 also found that college roommates believe they know themselves better than their peers know themselves. Study 6 showed that group members display a similar bias-they believe their groups know and understand relevant out-groups better than vice versa. The relevance of such illusions of asymmetric insight for interpersonal interaction and our understanding of "naive realism" is discussed.     

Coping efforts in daily life: role of big five traits and problem appraisals

The role of problem appraisal and Big Five traits in coping with bothersome daily events was investigated. Community-residing men completed diaries regarding stressful events and coping for eight consecutive days. Results of multi-level analyses indicated that lower perceived control over events was associated with greater reliance on distraction, catharsis, acceptance, seeking emotional social support, but less use of direct action. Stressor severity was positively associated with catharsis and religion, but negatively associated with acceptance. Neuroticism, Extraversion, Openness to experience, and Conscientiousness predicted coping strategy use. In addition, broad personality dimensions moderated relations between appraisals (perceived uncontrolability and severity) and coping strategy use. Although previous research implicated perceived control in coping, the present study suggests that both appraisals of stressor severity and individual differences in personality are also important determinants of coping strategy use at the daily level.     

The psychodynamics of forensic mental health nursing

Abstract

The aim of this paper is to clarify some important interpersonal dynamics that underpin forensic patients’ presentations within the clinical environment, in a way that is accessible to nurses. The world of forensic mental health nursing is often difficult to describe to those who have not experienced first hand prolonged clinical contact with patients at the therapeutic interface of secure services. Even then, the characteristic, intense emotional phenomena that tend to arise out of interpersonal relationships with patients and colleagues is not easy to articulate. Yet, for those of us who consider our professional identity to be one of “forensic mental health nurse,” it seems important to find a way to put words to what appears to occupy a large component of our working lives. More importantly, if we can develop a way to make sense of the way our work makes us feel and the way we can find ourselves relating to others within our professional roles, we will be in a better position to harness our energy and enthusiasm in the service of supporting forensic patients towards effective care and treatment pathways. Of course, forensic patients are supported through services with or without a framework for articulating emotional and interpersonal experiences. However, this frequently occurs in the context of significant struggle. For patients, this struggle is often characterized by difficulty communicating what their needs are, and for nurses this struggle is often characterized by feeling emotionally overwhelmed by their task of providing containing, therapeutic relationships for patients whose interpersonal needs are not clear to them. This article will use case examples to describe some of the complex interpersonal and emotional challenges faced by forensic nurses, and explain how a psychodynamic framework could support nursing practice in each of the case examples.