The self-help group: The mental health professional's role

The self-help group has become an increasingly important vehicle for providing mental health services for populations that have been otherwise therapeutically disenfranchised. The article discusses the role of the mental health professional in organizing self-help groups and in facilitating their fulfilling their goals. Transference, countertransference, and group dynamic issues are discussed in detail. These issues are illustrated with particular reference to a self-help group for the parents of cult members.The author would like to extend his appreciation and thanks to the Division of Group Psychotherapy of the Department of Psychiatry of the Mount Sinai Hospital, where this paper was first presented. He would also like to express his appreciation to Arnold Markowitz, A.C.S.W., of the Cult Hotline and Clinic of the Jewish Board of Family and Community Services for his help and to the staff of Westchester Jewish Community Services for their support.     

Response Expectancies and Irrational Beliefs Predict Exam-Related Distress

Individual differences in cognitive factors such as response expectancies and irrational beliefs (IBs) have been shown to contribute to variability in distress associated with stressful situations. However, their independent influence on distress when examined within the same study has not been established, nor has the potential of mediational relationships. The purpose of this study was to investigate the contribution of response expectancies and IBs (both general and exam-specific) to exam-related distress in a prospective study. Results revealed that both response expectancies and general IBs separately predicted exam-related distress (p’s<.05; N=105). Observed effects of general IBs were perfectly mediated by, and observed effects of exam-specific IBs were partially mediated by, response expectancies using the Baron and Kenny approach. These data support the view that cognitive factors contribute to psychological distress and are consistent with response expectancy and rational emotive behavior theories. The results suggest that interventions focused on response expectancies and IBs might be an effective means to reduce psychological distress associated with real life stressors such as exams. Future research is needed to determine whether this effect generalizes to other stressful situations. Dr. Montgomery is Director of the Integrative Behavioral Medicine Program at the Mount Sinai School of Medicine. Dr. David is an associate professor at Babes-Bolyai University, in Romania. Dr. DiLorenzo is an assistant professor in the Psychology Department of Stern College. Dr. Schnur is a postdoctoral fellow in the Department of Oncological Sciences at Mount Sinai School of Medicine. This work was supported by the National Cancer Institute (CA81137) and the American Cancer Society (PF-05-098-01-CPPB).     

Issues in the supervision of group psychotherapy: Countertransference and the group supervisor's agenda

Countertransference issues are of particular importance to the beginning group therapist. This paper describes the role of supervision in helping the beginning group therapist deal with counter-transference issues as they effect the formation of a group and the role that the group leader plays in facilitating therapeutic activity within the group. Particular problem areas and the countertransference they evoke and the role of supervision in working through are described.The author wishes to acknowledge the suggestions and support of Aaron Stein, M.D., and other members of the Division of Group Psychotherapy of the Department of Psychiatry of the Mt. Sinai School of Medicine.     

The establishment of the department of psychiatry in the Mount Sinai Hospital: a conflict between neurology and psychiatry

A conflict between neurology and psychiatry and controversies about psychoanalysis played an important role in the establishment of psychiatry in the general hospital. This article reviews the impact of this conflict on the establishment of an independent Department of Psychiatry in the Mount Sinai Hospital in New York during the first half of the twentieth century. A unique opportunity is provided to consider the relationships and personalities of the individuals involved, as well as economic, social, and scientific factors, including the introduction of psychoanalysis as a major psychiatric treatment.     

Congregational intervention when the pastor has committed sexual misconduct

When a pastor has committed sexual misconduct, the congregation is impacted profoundly. Viewed as one of the pastor's primary systems, the congregation may have played a significant part in precipitating a crisis, yet also become secondary victims. Intervention with the congregation is, therefore, as crucial as with the primary victims, the pastor, and his family. The Parish Consultation Service is developing a strategy for intervention with congregations. Some preliminary research highlights many of the issues involved, and indicates the direction such intervention should take.Additional training in Family Therapy. Currently coordinator of the Parish Consultation Service; Consultant to Episcopal Church Clergy Family Project; Intake family therapist, Ministerial Health Services, Metropolitan Mount Sinai Hospital; occasional work with husband in Office of Pastoral Development for the Episcopal House of Bishops; Free-lance writer.     

A personality profile of Mount Everest climbers

The Eysenck Personality Questionnaire-Revised was administered to a group of climbers (N=39) who were attempting to summit Mount Everest. The personality profiles for these climbers were characterized by higher scores on the Extraversion (sociability) and Psychoticism (toughmindedness) scales and lower scores on the Neuroticism (anxiety) scales than for the normative sample. This profile is consistent with the pattern typically observed for athletes and notably for higher achieving athletes.     

Resistance in group psychotherapy

The authors view resistance generally as healthy and a sign of a more or less intact ego. A brief review of the psychoanalytic literature and the group therapy literature presents resistance as a mechanism that closes off aspects of the internal and external world seen as potentially dangerous. Patient resistances are identified as coming from cultural values, fear of strangers, fear of regression, and resentment toward the therapist. Clinical vignettes of group patients and group interaction are presented. Finally, resistance of therapists and indications of such resistance are also explored.     

Leadership behavior,group climate and outcome in group psychotherapy: A study of outpatient psychotherapy groups

A recent clinical study of outpatient psychotherapy groups in a community mental health center explored the linkage between group leadership variables, group climate, and outcome. The study involved nine outpatient therapy groups, over 50 group clients, and several group therapists. A repeated measures design involving assessment of clients' outcome and level of functioning, group leadership style, and group climate was used to assess changes over a 6-month period. The findings suggest: 1) a reduction in symptoms and improved functioning for clients; 2) a similarity of perceptions by members and leaders of perceived leadership behaviors and group climate; 3) the presence of direct and indirect influences of group climate and leadership behavior on clients' outcome; and 4) a linkage between leadership behavior and group climate with the theoretical orientation of the group. The findings of the research are discussed in relation to the understanding of specific effects in group psychotherapy and the implications for construction of group psychotherapy theory.The authors would like to thank Robert Dies, Ph.D., for his helpful suggestions in the early phase of this study; Roy MacKenzie, M.D., for permission to use the Group Climate Questionnaire; Diane DePalma, Ph.D., for permission to use the Global Leadership Behavior Index; Chris Boltwood, B.A., for her untiring efforts in administering the instruments and coding and entering the data; and most importantly, the psychotherapy group members and the group therapists for their cooperation in this endeavor—without their help, this clinical study would not have been possible.A version of this paper was presented at the Annual Meeting of the American Group Psychotherapy Association, 1987, New Orleans, Louisiana. Lenore Phipps, R.N., M.S., C.S., was formerly Director, Group Psychotherapy Program at Park Ridge Mental Health Center, Rochester, now in private practice at Guild Medical Center, Norwood, MA 02062.     

Posttraumatic stress disorder in posttransplant children: creating a clinical program to address their needs

Posttraumatic stress symptoms have been shown to occur in pediatric and adult solid-organ transplant recipients. The presence of these symptoms is associated with non-adherence to medications, increased distress, and poor outcome. Because posttraumatic stress disorder is treatable and because a transplant operation usually is an "anticipated trauma," it is possible to address posttraumatic stress disorder symptoms in transplant recipients and attempt to prevent their development. Under my direction, the pediatric liver transplant program at Mount Sinai Medical Center in New York City created research and clinical programs to address posttraumatic stress symptoms and their consequences. Specifically, the focus on non-adherence to immunosuppressive medications in transplant recipients who are distressed and their parents. This article begins with a review of the data that led to the decision to start these programs. I then present the basic elements that are in place, in this particular program, to address patients' needs. I end this review with preliminary outcome data that illustrate the potential impact of such an integrated approach to patient care on medical outcomes.     

The medical student experience with disasters and disaster response

Medical students from New York City were integrally involved in the response by health professionals to aid the families of victims of the September 11, 2001, attacks on the World Trade Center. The present study was performed to investigate the emotional impact of this involvement on medical students from the Mount Sinai School of Medicine in New York City. One hundred fifty-seven students responded to a mail survey that explored their personal and professional involvement in the disaster as well as their psychiatric symptoms in the week after the event and at the time of the survey (3.5 months after the event). Findings suggested a differential emotional impact on female students and on students involved in less supervised and more emotionally intense activities. However, involvement in the relief effort, per se, did not contribute to psychiatric symptomatology. It may have been associated with enhanced professional self-esteem among the students. These findings have implications for future planning of psychiatric response to disasters.     

A Synopsis of Rational-Emotive Behavior Therapy (REBT); Fundamental and Applied Research

The article presents a synopsis on rational-emotive behavior therapy (REBT), its fundamental theoretical framework, its applications, and future directions. The paper is organized according to the following structure: in part one, REBT fundamental/basic research is discussed; in the second part clinical/applied research in REBT is presented, including aspects of efficacy and effectiveness, discrimination of disorders for which REBT works most effectively, and its relations to other therapies. Uses and misuses of REBT and their impact on research and future developments are presented as well. While it is true that REBT research has many shortcomings, the overgeneralization and/or magnification of the negative, and the minimization of the positive are dysfunctional beliefs that maintain the false idea in the field that REBT has few empirical studies and that REBT research is in serious trouble. A balanced approach, analyzing both the strengths and weakness, suggest that REBT has hundreds of research articles and that high-quality studies tend to support REBT’s basic theory and efficacy. However, to strengthen this conclusion and to fully explore the potential of REBT, shortcomings of REBT research need to be corrected, and high-quality studies promoted. This is particularly important since, although effective, cognitive-behavioral psychotherapies have not yet reached “the desired standard” of efficacy and effectiveness, as about 30–40% of people are still nonresponsive to these interventions Thus, REBT could be a platform of reinvigorating empirical studies on the efficacy/effectiveness and theory of cognitive-behavioral models of psychopathology and human functioning. Mount Sinai School of Medicine, Biobehavioral and Integrative Medicine Programs, New York, USA.     

A Preliminary Report on Short-Term Group Psychotherapy on An Acute Adolescent Male Service

This article alerts us to consider depression as a relatively frequent cause of impasse in the course of group psychotherapy. The authors recommend the combined use of antidepressant medication along with group psychotherapy when such depression is confirmed independently outside the group. Common obstacles and pitfalls preventing successful combined treatment are reviewed; the depressive logjam is differentiated from common resistance; and profiles of responders versus nonresponders are described. A rationale of the combined treatment, its results, and implications for group therapists are all delineated.     

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.     

The making of a group psychotherapist: Needs and goals for graduate and postgraduate training

Group therapy is a widely practiced, effective, but underrated specialty. Unfortunately, group therapy seems to be taught more haphazardly, with less attention to quality, than is individual therapy. Group therapy has a technique, history, and literature of its own and should be taught independently from individual psychotherapy. The training of psychiatric residents is particularly crucial for group therapy to prosper and be seen as more prestigious. A common core of experience is vital for training in group therapy, whether the trainee's background is psychiatry, psychology, social work, pastoral counseling, or nursing. This core consists of: 1) clinical experience doing group therapy; 2) supervision; 3) a professional training group experience; 4) observation of experienced group therapists; 5) exposure to current thinking in the field; 6) personal group therapy; and 7) a didactic course in theory and technique. Clinical experiences involving cotherapy and combined individual and group treatments are especially useful, both as training and as treatment modalities.He is on sabbatical leave from John Jay College of Criminal Justice where he is Professor of Psychology and was founding Chairman of the Psychology Department.The authors wish to thank Arnold Rachman, Ph.D., Michael Lapidus, M.D., Fayek Nakhla, M.D., Nyapati R. Rao, M.D., and Dorothy Gartner, Ph.D., for their helpful comments on earlier versions of this paper, and Ms. Deloris J. Johnson for her typing and editorial assistance.     

Process and content in a long-term PTSD therapy group for Vietnam veterans

Process and content were studied in four 16-session segments of a psychodynamically oriented therapy group for Vietnam veterans suffering from posttraumatic stress disorder (PTSD). On the Group Climate Questionnaire (GCQ-S), the group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions than contrasting samples of neurotic and psychotic groups. There was no evidence of group stages. Topics related to symptoms of PTSD were discussed most frequently (43.1%), followed by issues concerning relations with others (32.4%),general group therapy issues (13.7%), and other topics (10.8%). Clinical implications of these findings are discussed.The authors thank Tom Metzler, M.A., and Heidi Ronfeldt, B.S., for their assistance with the data analysis.Parts of this paper were presented at the American Group Psychotherapy Association Annual Meeting, February 15–20, 1993, San Diego, CA.     

The psychometric properties of the Hebrew version of Cloninger's Tridimensional Personality Questionnaire

The Hebrew Tridimensional Personality Questionnaire was administered to over a thousand individuals in the community, 16–78 years of age. Factor analysis was run first on individual items, and then on the 12 sub-scales described by [Cloninger, C.R., Pryzbeck, T.R., & Svrakic, D.M. (1991). The TPQ: US normative data. Psychological Reports, 69, 1047–1051)]. The factor analyses were restricted to four orthogonal factors in order to attempt confirmation of the corrected four-factor solution [Stallings, M.C., Hewitt, J.K., Cloninger, R.C., Heath, A.C., & Eaves, L.J. (1996). Genetic and environmental structure of the TPQ: three or four temperament dimensions? Journal of Personality and Social Psychology, 70 (1), 127–140)]. In the individual item analysis four orthogonal factors recognizable as Novelty Seeking, Reward Dependence, Harm Avoidance and Persistence emerged. However only up to half of the items originally ascribed to each factor loaded sufficiently and exclusively on the appropriate factor. When the 12 sub-scales were entered into factor analysis the four orthogonal factors were produced, and the structure satisfactorily confirmed. A few exceptions to orthogonality were observed. The data were analyzed for sex differences and age effects. Women scored higher than men did on most sub-scales of Harm Avoidance and Reward Dependence. The younger group (up to 21 years of age) scored higher on Novelty Seeking and Reward Dependence and lower on Harm Avoidance than the older group, but no sex by age interaction was detected. Preliminary normative Israeli data are supplied, and implications of the group differences discussed.     

A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants

Nordhov, S. M., Kaaresen, P. I., Rønning, J. A., Ulvund, S. E. & Dahl, L. B. (2010). A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants. Scandinavian Journal of Psychology, 51, 385–391. The background for this study was that nurturant child‐rearing attitudes are associated with positive development in low birth weight (LBW) infants. The objective was to study child‐rearing attitudes and early intervention (EI) in parents of LBW infants from 12–36 months corrected age. LBW infants (BW < 2000 g) were randomized to an intervention (IG) or a control group (CG). The EI consisted of seven in‐hospital sessions prior to discharge, then four home visits. A Child Rearing Practices Report was administered at 12 (mothers only), 24 and 36 months. A total of 146 infants were randomized. The mean BW in IG was 1396 (SD 429) g and 1381 (436) g in CG. The mean GA was 30.2 (3.1) weeks in IG and 29.9 (3.5) weeks in CG. Mothers in IG reported significantly more nurturant child‐rearing attitudes at 12 and 24 months. There was a significant change in restrictive and nurturant attitudes over time. It was concluded that EI may lead to more nurturant child‐rearing attitudes in mothers of preterms.     

Abstracts

Veevers, J. E. (1990) Traumas versus strens: a paradigm of positive versus negative divorce outcomes. Journal of Divorce and Remarriage Kiser, L.J., Pugh, R.J., McColgan, E. B., Pruitt, D. B. and Edwards, N. B. (1991) Treatment strategies for victims of extra-familial child sexual abuse. Journal of Family Psychotherapy Bloch, S., Sharpe, M. and Allman, P. (1991) Systemic family therapy in adult psychiatry. British Journal of Psychiatry Crisp, A. H., Norton, K., Gowers, S., Halek, C., Bowyer, C., Yeldham, D., Levett, G. and Bhat, A. (1991) A controlled study of the effect of the therapies aimed at adolescent and family psycho-pathology in anorexia nervosa. British Journal of Psychiatry Dunn, J. and Plomin, R. (1991) Why are siblings so different? The significance of differences in sibling experiences within the family. Family Process     

Early group bias in the Faroe Islands: Cultural variation in children's group-based reasoning

Recent developmental research demonstrates that group bias emerges early in childhood. However, little is known about the extent to which bias in minimal (i.e., arbitrarily assigned) groups varies with children's environment and experience, and whether such bias is universal across cultures. In this study, the development of group bias was investigated using a minimal groups paradigm with 46 four- to six-year-olds from the Faroe Islands. Children observed in-group and out-group members exhibiting varying degrees of prosocial behaviour (egalitarian or stingy sharing). Children did not prefer their in-group in the pretest, but a pro-in-group and anti-out-group sentiment emerged in both conditions in the posttest. Faroese children's response patterns differ from those of American children [Schug, M. G., Shusterman, A., Barth, H., & Patalano, A. L. (2013). Minimal-group membership influences children's responses to novel experience with group members. Developmental Science, 16(1), 47–55], suggesting that intergroup bias shows cultural variation even in a minimal groups context.     

Paranoia and instability of self-esteem in adolescents

This study examined whether paranoid beliefs are associated with instability of self-esteem (SE) as hypothesized by Bentall et al. [Bentall, R. P., Corcoran, R., Howard, R., Blackwood, N., & Kinderman, P. (2001). Persecutory delusions: A review and theoretical integration. Clinical Psychology Review, 21, 1143–1192] in a community-based sample. Measures assessing SE, SE instability, paranoid ideation, and depressive symptoms were completed by 131 adolescents. A significant association between paranoia and SE instability was observed, even when taking into account global SE and depressive symptomatology. The results replicate previous findings, providing further evidence for a relationship between paranoid ideation and SE instability. Further, this study utilises a new measure of SE instability and explores the relationship between paranoia and SE within a hitherto unstudied age group using a multidimensional model of paranoia.