The Archaic Personality Structure of Alcoholics and Its Implications for Group Therapy

The purpose of this investigation was to obtain a better understanding of the nature of expectations about group psychotherapy, given a consistent body of research pointing to the relationship between specific treatment expectancies and premature termination. The Group Therapy Survey was developed and utilized to assess the predominant beliefs, attitudes, and expectations of 206 clinical and nonclinical subjects toward group therapy. The results of the investigation reflected three major categories of expectations: (1) Group therapy is unpredictable, (2) group therapy is not as effective as individual therapy, and (3) group therapy can be detrimental to participants. Possible explanations for the origin and development of such expectations are entertained, including the publicizing of the more radical aspects of the encounter group movement and other negative portrayals of group therapy in the media and the film industry. Recommendations are offered concerning the use of the survey prior to intake or a pregroup orientation interview in order to tailor a discussion to the prospective client's personality, expectations, and problems.     

Group Therapy in Israel

This paper is an analysis of the group therapy and the group work phenomena in Israel as a microcosm of the Israeli society and culture. We discuss the structure of Israeli society and its features, identify the key norms and myths that express the social unconscious, and pinpoint events that mark critical points of change. Drawing on these, the paper then describes some examples of the influence of Israeli identity on participants' and group therapists' behavior, and on current training programs.     

Group Therapy Abroad

Abstract

Writing in a narrative tradition, the authors report on the 14th and final convening of the Boston-Threshold Group–sponsored annual Northern Ireland Group Psychotherapy Conference. “It Can Be Done: The Power of the Group to Bear the Unbearable.” They provide context and leadership perspectives on the history of the conference and the planning of its final meeting. Associations to the opening plenary presentation of the play Rounding Third, by Richard Dresser, as performed by the Red Well Theater Group, link themes of power sharing, trauma, containment, and hope to the here-and-now experience of the conference participants. Personal meanings attributed to the conference tradition and its ending are shared.     

Leadership among Patients in Group Therapy

Despite the nearly universally shared agreement among group therapists about the importance of group norms, empirical studies have rarely demonstrated a positive relationship between specific norms in psychotherapy groups and patient benefit. The study explored this relationship by examining the linkages between norms, a specific therapeutic process, and patient outcome. Examined were seventy-two spousal bereavement groups. Subjects' responses to a thirty-one item behavioral inventory were used to define norms; outcomes were based upon Time 1/Time 2 differences on a series of eleven measures indexing depression, anxiety, somatic symptoms, abuse of psychotropic medication, coping mastery, well-being, self-esteem, target problem rating, several measures of role stress and strain, and stigma. The findings suggest that normative characteristics were linked to a process, reciprocal social exchange, that influences positive outcomes. The results are preliminary, since they only serve to demonstrate such a relationship can exit.     

Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current treatment (ACT + TAU; N = 21) or to continue with treatment as usual alone (TAU; N = 20). There was significantly more improvement from baseline for the ACT + TAU condition than the TAU condition on the primary outcome variable—self-rated BPD symptoms. The ACT + TAU gain was both clinically and statistically significant. The ACT + TAU condition also had significantly more positive change on anxiety and hopelessness, and on the following ACT consistent process variables: psychological flexibility, emotion regulation skills, mindfulness, and fear of emotions. For all but anxiety, the improvements for the ACT + TAU condition were significant, while the TAU condition had no significant changes on any measure. Follow-up was possible for only a small number of participants. The improvements gained by the ACT + TAU participants were maintained except for fear of emotions. Anxiety continued to improve, becoming significantly different from baseline at follow-up. Examination of mediators found that psychological flexibility, emotion regulation skills and mindfulness, but not less fear of emotions, mediated BPD symptoms. Psychological flexibility and emotion regulation skills also mediated hopelessness. There is a need for a larger trial, for comparison with other established treatments for BPD, and for conducting a trial of a longer intervention. Nonetheless, this pilot study suggests that a brief group-based ACT intervention may be a valuable addition to TAU for people with BPD symptoms in the public sector.     

Simultaneous Group and Insulin Therapy

Abstract

The concept of focus can provide a meaningful bridge between theory and practice. The authors’ aim in this paper is to demonstrate that for theory to be clinically useful, it should provide a sense of focus and organization for clinical work. They illustrate how their particular use of a self–psychological/intersubjective model leads to an emphasis on what they refer to as “sustained empathic focus.” The authors’ choice of concepts leads them consistently to stress the patient’s subjective experience and emerging vulnerability.