Transference in Gerontologic Group Psychotherapy: Studies in Gerontologic Human Relations IV

For a number of reasons, we decided to bring three long-term, open-ended psychodynamic therapy groups to termination. We examine the process that began with the announcement of the change to a time-limited format, and concluded with the termination of the group. The transition had a powerful impact on the members and the group-as-a-whole. The therapists used supervision to deal with the intensity of the group process and the countertransference demands posed by the transition. Groups facing a similar change due to economic pressures may benefit from these observations.     

Time-Limited Brief Therapy with Families: A One-Year Follow-Up Study

Families from a previously reported study of time-limited brief treatment were followed up one year after termination. Results based on questionnaires completed by the parents provide no evidence for deterioration after termination for families that had received six-session time-limited therapy, twelve-session time-limited therapy, or treatment without time limits. At one year, there were no significant differences in outcome between time-limited and unlimited approaches, between six-session and twelve-session treatment, or between treated families and a waiting list control group (most of whom had entered therapy by this time). As in the original study, the results do not support claims of increased therapeutic effectiveness for time and session limits. However, time limits did succeed in shortening treatment without significantly reducing its effectiveness or the durability of outcome.     

Manipulation of Verbal Behavior of Chronic Hospitalized Schizophrenics in a Group Therapy Situation

This paper describes a semistructured, time-limited model of group treatment for latency age children. The members, all of whom came from reconstituted families, had a variety of reactive, somatoform, and characterological problems. With help from the therapists, each member constructed his or her own genogram which was then discussed by the group as a whole. Because this format incorporated a technique for mapping family structure into a traditional model of children's group therapy, it focused the group's manifest communication on changing family roles and relationships, both as they had occurred in reality and as they were symbolically reenacted within the group process. Feelings of shame, guilt, anger, and loss were markedly ameliorated as the group members studied the structure of their extended families within an environment which encouraged normative peer interaction and progressive emotional development. A brief review of the recent literature on time-limited, theme centered groups for children is included to provide a context for understanding the group.     

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.     

Time-limited group psychotherapy: Has cinderella found her prince?

The time-limited group psychotherapy treatment format is in demand in a healthcare delivery system that is increasingly concerned with effective and efficient methods for treating acute mental health problems and maintaining patients in the community. The empirical literature provides strong support for the positive outcome of relatively brief treatment. A larger service delivery system ensures a flow of patients who can be managed in a variety of types of groups. This will require the group clinician to become comfortable working in conjunction with a larger system and knowledgably delivering different types of treatment while continuing to use the group itself as a major source of therapeutic power.     

Special Aspects of Countertransference in Analytic Group Psychotherapy

The structure of health care delivery is in a period of rapid change. An understanding of psychotherapy service use patterns indicates the importance of time categories as well as the relevance of group techniques. Traditional interpersonal and psychodynamic group techniques may be modified for time-limited use without sacrificing basic values and with demonstrated effectiveness. Adapting to a more fiscally stringent practice environment requires the clinician to undertake a difficult process of transition. As professionals our task is to prepare ourselves for this challenge and to let the health care system know that proper practice guidelines are necessary to achieve effective treatment for our patients.     

Two models of brief group psychotherapy for herpes sufferers

The psychological consequences that often follow from contracting genital herpes fall into four general categories: sexual functioning, interpersonal relations, emotional life, and self-esteem. After detailing these, a rationale for treating genital herpes sufferers in group is offered, and then two models for the time-limited group treatment of this population are described. The first is a cognitive behavioral stress management program which has three component parts: relaxation training, rational-emotive training, and assertiveness training. The second is a dynamically oriented group in which the group focus shifts over time from the difficulties associated with the disease itself to general exploration of interpersonal styles and themes. Some comparisons between the two models are drawn.     

A time-limited dynamic approach to adolescent inpatient group psychotherapy

In response to sharply curtailed lengths of stay of adolescents in an inpatient psychiatric program, new therapeutic modalities need to be implemented. A time-limited dynamic approach to adolescent inpatient group psychotherapy is presented. The model integrates psychoanalytic and crisis theory into a group format. The primary focus in this model is upon resolution of problematic interpersonal interactions as they are related to the current crisis state. The group process, as related to the adolescent, involves three phases. These include an initial intake phase, which incorporates an ego-functioning assessment; a second or middle phase which focuses on making actions ego-alien; and the termination phase, which incorporates the learning experience and how it relates to the resolution of precipitators of the admission.     

A time-limited group for patients with HIV infection and their partners

This paper presents the authors' experience coleading a time-limited group treatment for HIV-positive patients and their partners. Because of the impact of this disease not only on the infected person, but also on his or her partner, a couples group format was used. This 12-week group consisted of four couples, heterosexual and homosexual, of diverse ethnic and socioeconomic backgrounds. While the group focused primarily on couples' issues, individual concerns, conflicts, and experiences relating to the HIV diagnosis were also explored. Clinical vignettes demonstrate the process and benefits of this group experience.     

Group-based problem-solving therapy in self-poisoning females: A pilot study

Aims: The treatment of suicidal behaviour remains limited in efficacy. This pilot study assessed the effectiveness of a time-limited, group-based problem-solving therapy intervention compared with a treatment as usual control group, in females who self-poison. Method: A total of 18 clients were equally randomised to treatment or control groups. All clients were assessed using standardised questionnaires for depression, hopelessness, suicidal ideation and social problem-solving skills, at pre-treatment, post-treatment and two months follow-up. Results: The treatment group experienced significant reductions in levels of depression, hopelessness, suicidal ideation and improvements in self-assessed social problem-solving skills. Improvements in mental health and aspects of self-assessed problem-solving skills for the treatment group continued to be evident at two months follow-up. The control group did not change significantly over time on mental health measures or social problem solving abilities. Conclusion: Although limited by small sample size, the results suggest that group-based problem-solving therapy is effective in the management of deliberate self-poisoning. This paper is a unique contribution in that it examines the implementation of problem solving therapy with a homogenous population and in a group format. Methodological concerns and directions for future research are discussed.     

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.     

Attitudes Towards Prenatal Genetic Counseling,Prenatal Genetic Testing,and Termination of Pregnancy among Southeast and East Asian Women in the United States

Recognizing the heterogeneity of the Asian population with regards to acculturation, education, health awareness, and cultural values is vital for tailoring culturally sensitive and appropriate care. Prior studies show that cultural values influence perceptions of genetics within Asian populations. The reputation of the family unit factors into decisions such as pregnancy termination and disclosure of family medical history, and the nondirective model of American genetic counseling may conflict with the historical Asian model of paternalistic health care. Previous studies also provide conflicting evidence regarding correlations between education, acculturation, age, and awareness and perceptions of genetic testing. The aims of this study were to describe attitudes towards prenatal genetics among Southeast and East Asian women living in the United States for varying amounts of time and to explore sociocultural factors influencing those attitudes. Twenty-three Asian women who were members of Asian cultural organizations in the United States were interviewed via telephone about their attitudes towards prenatal genetic counseling, prenatal genetic testing, and termination of pregnancy. Responses were transcribed and coded for common themes using a thematic analysis approach. Four major themes emerged. In general, participants: (1) had diverse expectations for genetic counselors; (2) tended to weigh risks and benefits with regards to genetic testing decisions; (3) had mixed views on termination for lethal and non-lethal genetic conditions; and (4) identified cultural factors which influenced testing and termination such as lack of available resources, societal shame and stigma, and family pressure. These findings may allow prenatal genetic counselors to gain a richer, more nuanced understanding of their Asian patients and to offer culturally tailored prenatal genetic counseling.     

Group intervention with children of parents with aids

This paper describes a format for group intervention with children of parents with AIDS. Therapeutic factors specific to group work with these children and special issues regarding AIDS are discussed. The stages of development of such groups are outlined, with particular attention paid to themes of grief and loss. Suggestions for future work in this area are given.     

Co-leader termination in an outpatient alcohol treatment group

The termination of a co-leader from a long-term therapy group for alcoholic outpatients is described over a seven-week period from the initial termination announcement to the first week following the co-leader's departure. The authors highlight salient themes and defensive maneuvers that appear as the group struggles with the difficult task of termination. Attempting initially to flee from the impending loss, the group defends with pseudomature responses and veiled hostility. These are followed by themes of abandonment and loss. The group leaders' initial collusion with the group's denial of loss is described, along with leader tactics to facilitate the group's termination work. Finally, the meaning of a group farewell gift is discussed in terms of both its implicit communications and as a form of resistance.     

The Development,Process, and Evaluation of Group Psychotherapy With Sexually Abused Preschool Girls

The development, process, and evolution of group psychotherapy specifically designed for sexually abused preschool aged females is presented. Utilization of male and female cotherapists, group structure, individual and family dynamics, the role of children's mothers in treatment, and process of treatment are examined. Issues regarding countertransference phenomena, cotherapy relations, in-depth involvement of the children's mothers, and specifics related to structuring of a time-limited group are beyond the initial intent and scope of this paper, and are not discussed here.

The cotherapists conclude that group psychotherapy for children of this age group is both clearly valuable and highly indicated as an adjunct treatment modality. In future group psychotherapy with sexually abused preschool aged children, based upon clinical experience and evaluation, the cotherapists advocate a time-limited approach whereby each session would focus upon specific issues as illustrated in Table 1, and include structured and purposeful involvement of the girls' caretakers.     

The Present Status of Group Therapy in United States Correctional Institutions

A time-limited group treatment program focusing on mothers of toddlers with a borderline personality disorder is reported. The project involved two intersecting groups—the toddler group and the mother group. The focus of the work with the children was to promote their social interests and skills to an expanded world beyond the maternal dyad. The focus of the work with the mothers was on their difficulties with emotional separation-individuation and on strengthening their ego functioning, particularly in the area of mothering so that they could participate positively in their child's separation-individuation phase.

Representative group process is presented as it organized around three distinct phases. The initial phase was marked by intense resistance, and ambivalence. During the middle phase, group cohesion developed around shared feelings and issues. The termination phase focused insistently on issues of separation. Conclusions drawn from the project include the utility of a group approach in influencing maternal behavior.     

Introducing Mindfulness to Clinical Psychologists in Training: An Experiential Course of Brief Exercises

A 14 session, structured, mindfulness skills group utilizing short (10 min) practices was undertaken by clinical psychologists in training as a voluntary lunchtime activity. The present study was a preliminary investigation into whether a short course of brief mindfulness exercises could facilitate the development of personal understandings of mindfulness without requiring a significant time commitment that might impinge upon participants’ ability to take part. Quantitative and qualitative evaluations suggested that the course could be a useful experiential introduction to mindfulness for clinicians. The results also suggested that the format of frequent, brief exercises could have utility for conducting mindfulness-based training in time-limited environments but further research is required to examine the effects of frequency and duration of practice on the development of mindfulness skills.     

El Sexo Oculto Del Dinero (The Hidden Sex in Money)

This paper identifies common themes evident in the six preceding contributions to this special issue of the Journal, and provides an overview of the rapidly burgeoning literature on short-term groups. The primary focus is on leadership style and on the conflicts that many clinicians experience about the manipulative implications of their more active therapeutic interventions in time-limited groups. Three leadership style dimensions, introduction of structure, support/confrontation, and openness/deception, are examined to differentiate the pejorative and potentially harmful aspects of manipulation from the positive and constructive aspects of more active interventions, which might best be called “directive facilitation.”     

Reading Plays to Enhance Professional Development

Writing in a narrative style, the authors describe the continuing education model of the Red Well Theater Group. The model combines a study group format with a play reading performance module to enhance the professional development of the Group’s members and their audiences of colleagues. The educational goals are to: 1) didactically study the principles and practice of group therapy; 2) theatrically illuminate concepts, relational themes, and small group dynamics relevant to group therapy; 3) experientially deepen therapist empathy for the challenge of being in a group; and 4) provide a vitalizing experience in support of therapist well-being. As an example of this model in action, the authors elaborate their experience preparing The Great God Pan, by Amy Herzog, for presentation at the 2014 American Group Psychotherapy Association (AGPA) Annual Meeting.     

Screening for Psychotherapy by an Open-Ended Group

A developmental model of conducting a time-limited, short-term inpatient psychotherapy group is described. The therapist's primary goal in this model is to promote members' awareness of their dysfunctional interpersonal behaviors and the conflicts underlying these behaviors. The therapist pursues this goal by facilitating the group in resolving the conflicts of the four phases through which the group passes. In Phase I, the group addresses conflicts related to the establishment of trust. In Phase II, issues related to dependency wishes focused upon authority figures occupy the group's attention. In Phase III, conflicts within peer relation-ships become focal. In Phase IV as the group approaches termination, group members explore feelings related to the acceptance of loss. For each phase, optimal therapist interventions are described.