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.     

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.     

The Integrated Therapy of Family Members—A Case Report

Winnicott's concept of the “transitional space” is used in an effort to develop a conceptual unity between intra- and interpersonal dynamics. It is proposed that in their work together, the members of a therapy group develop a shared psychic “group space” derivative from the interaction of the “transitional space” of each, and within which the actual interpersonal transactions and influences take place. Possible underlying bases for such a theoretical concept are considered, as well as its implications for group therapy.     

Interpersonal rigidity and complementarity

The relations among behavioral complementarity, interpersonal rigidity, as indicated by the Interpersonal Adjective Checklist (IAS, Wiggins, 1995) vector score, and interpersonal distress, as indicated by the Inventory of Interpersonal Problems (IIP, Horowitz, Rosenberg, Baer, Ureno, & Villasenor, 1988), were examined in two studies. In Study 1, 214 undergraduates viewed videotapes depicting different interactions and then provided their responses. In Study 2, 122 undergraduates interacted in randomly paired dyads on a mutual task. These interactions were videotaped and the interchanges were rated using the Interpersonal Communication Ratings Scale (ICRS, Strong, Hills, & Nelson, 1988). The extent to which each participant demonstrated complementary behavior was determined. Results of the studies demonstrated support for interpersonal rigidity as related to complementarity and as a moderator of the adaptability of behavior. Further complementarity was a mediator in the behavioral rigidity–interpersonal distress relation.     

Mental Health and Mental Disorder: A Sociological Approach,edited by Arnold M. Rose

This paper presents a model of group analysis based on Aristotle's causal notions. Aristotle's concept of man as a social animal provides a philosophical rationale for an interpersonal treatment forum. His causal theory supplies an encompassing atheoretical model for examining, understanding, and changing “things which have in themselves the source of their changing or staying unchanged.”

Attention to the four causal foci is suggested as the basis for a full-ranging group analysis. Material cause examines: “what” makes a thing what it is. Efficient cause investigates “how” various behaviors and emotions are set in motion. Final cause searches out “where” behavior is aimed. Formal cause traces “why” behaviors take particular forms.

It is suggested that a “cause for pause,” in the ongoing group process, is the emergence of a powerful and specifiable trend, whether a transference, poignant interaction, or groupwide conflict. The “pause to cause” is examined in detail, as each causal foci is elaborated. A sequential analysis moving from “what > how > where > why” is suggested at three levels of possible intervention: individual, interpersonal, and group as a whole. In conclusion, the timing, advantages, and restrictions of such a causal approach are considered.     

Valoración de un programa de habilidades interpersonales en niños superdotados

Certain research studies report that a number of gifted children show social adaptation issues, as well as problems with social and interpersonal skills, while others consider that this does not occur. In this regard, Neihart, Reis, Robinson and Moon (2002) speaks of a resilience approach versus a risk approach. From the risk viewpoint, this paper presents the benefits of applying training programs in interpersonal skills as to prevent potential problems in gifted children. For this reason, we aim to evaluate the effectiveness of a training program for solving interpersonal problems in this population. Participants include 40 gifted children aged 7 to 13, divided into a treatment group and a control – waitlisted – group. Program application results show significant differences in direct assessment measurements in the treatment group. An increase in effect sizes between the treatment group and the control group is also detected, in favor of the former, and a relationship between the children's learning potential and the benefits obtained is also confirmed. In short, the training program proves effective in interpersonal problem-solving skill improvement in children with high intellectual capacity.     

Group therapy with dual-diagnosed adolescents

This paper presents an eclectic orientation to group therapy, which guides the authors' clinical work with adolescents diagnosed as both mentally ill and mentally handicapped. Highlighted are the treatment needs and the difficulties working with this population, theories of group process and their implication for treatment, and specific clinical techniques that foster individual and group growth. Specificallly, this paper outlines the clinical rationale and group interventions used in a process-oriented group for dual-diagnosed adolescents residing in a residential setting. This group is designed to develop the clients' interpersonal understanding and skills, which will hopefully enhance their overall adaptation and functioning in the residential milieu. It is believed that the integration of a variety of theoretical approaches is critical for group therapy with this population.He was Senior Cottage Therapist or Unit Director at the William Roper Hull Child and Family Services, Calgary, Alberta, while doing group work with dualdiagnosed adolescents.He was a Cottage Therapist at Hull Child and Family Services, while doing the group work cited in this pape     

The Efficacy of an Integrated Theoretical Approach to Group Psychotherapy for Male Inmates

To assess the efficacy of an interpersonal process-oriented and cognitive-behavioral group psychotherapy program, 36 incarcerated male adults were assigned to either a treatment group (n = 20) or a no treatment control group (n = 16). Outcome measures consisted of paper-pencil self-report instruments, institutional behavioral data, and structured interviews with the group therapists (n = 3). Results indicated no significant changes in inmates' level of defensiveness, empathy, or institutional behavior; however, the inmates reported universally positive reactions to the treatment program. The group therapists also perceived the treatment program as efficacious, particularly in fostering a cohesive group atmosphere and increasing inmate responsibility for group leadership. Implications for practice and research are discussed.     

Cognitive and affective patterns of alcoholics: Implications for group therapy

Alcoholics bring unique problems with them into treatment. This paper reviews the research on their cognitive and affective patterns of behavior. These include a low expectation of success in interpersonal relationships, the use of denial, insensitivity to mood states, and faulty attribution patterns. These difficulties hamper the expressive dimensions of their relationships with others and manifest themselves in the group therapy setting. Recommendations for facilitating group cohesion and developing an agenda are presented. Also discussed are the interactional means by which the work of the group is done. The supportive interchange is noted as a method by which group members gain access to the deeper layers of each other. The remedial interchange is the interactional means by which group members challenge each other and resolve conflicts.     

Levels of interpersonal complementarity: a simplex representation

The relations among different measures of interpersonal behavior and complementarity across level were examined in one session of a sample of therapy dyads (N = 26) and in an interaction between college students (N = 108). Four levels of complementarity, trait, aggregate situation, behavioral interchanges, and behavioral interchanges with base rates removed were examined as they covaried among themselves and with interaction evaluations. The four levels of complementarity were found to be fit by a simplex structure, and this structure was related to interaction evaluation in both samples. The complementarity-evaluation relation was mediated by base-rate-corrected complementarity. Implications relative to the operationalization of complementarity are discussed.     

HIV‐related stigma in social interactions: Approach and avoidance behaviour in a virtual environment

People living with HIV are a stigmatized group in our society, especially homosexual people living with HIV. One of the behavioural manifestations of stigmatization is an increased interpersonal distance kept during social interactions. Immersive virtual environment technology enables the experimental study of social interactions in an accurate and relatively unobtrusive manner. Using a virtual hospital room, we measured to what extent diagnosis (HIV, cancer or broken leg) and sexual orientation (homosexual or heterosexual) were related to approach behaviour (based on the interpersonal distance and the speed of approach), and the degree patients were looked at (as was obtained from an additional exploration of our head orientation data). Moreover, implicit and explicit attitudes were predicted to moderate this relationship. Participants (N = 50) were healthy, heterosexual students. A main effect of diagnosis revealed larger interpersonal distances from patients with HIV than from patients with cancer. Also, an interaction effect demonstrated that distances were largest when the HIV patient was homosexual. Furthermore, a main effect of diagnosis showed that HIV and cancer patients were approached more slowly than broken leg patients, an effect that was larger for HIV than for cancer patients. In addition, head orientation analyses revealed that patients with HIV were relatively ‘looked at’ more often as well as relatively ‘looked away from’ less often than patients with cancer and patients with a broken leg. None of these effects however were found to be moderated by implicit and explicit attitudes. These findings provide behavioural evidence for the stigmatization of people living with HIV and homosexuals with HIV in particular. Copyright © 2015 John Wiley & Sons, Ltd.     

Prototypical similarity,self-categorization,and depersonalized attraction: A perspective on group cohesiveness

In contrast to traditional approaches that widely equate group cohesiveness with interpersonal attraction, self-categorization theoryargues that self-categorization depersonalizes perception in terms of the group prototype, and transforms the basis of interindividual attitude (liking) from idiosyncracy into prototypicality. An implication is that while attraction in interpersonal relationships relates to overall similarity, attraction among group members is based on prototypical similarity. To test this idea, subjects (N = 219) participated in an experiment in which they reported their attitude towards an individual who would be their partner, or a fellow group member (of either group ‘Visual’ or group ‘Tactile’) for a subsequent task. Subject-target similarity varied on each of two dimensions: dimension ‘A’ was more prototypical of group ‘Visual’, and dimension ‘F’ of group ‘Tactile’. The independent variables of social orientation (interpersonal, group ‘Visual’, group ‘Tactile’), similarity on dimension A (A ±), and dimension F(F±) were manipulated in a 3 × 2 × 2 design. The three hypotheses tested in this experiment were generally supported. Subjects preferred prototypically similar group members to interpersonal partners, and downgraded prototypically dissisimilar group members (HI). Identification was positively related to target evaluation (H2), more strongly for prototypically similar than dissimilar targets (H3), and the identification-attraction relationship was mediated by perceived prototypical similarity. Group-based effects were independent of perceptions of overall similarity.     

Interpersonal Problems,Mindfulness, and Therapy Outcome in an Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder

Objective: To better understand the role interpersonal problems play in response to two treatments for generalized anxiety disorder (GAD); an acceptance-based behavior therapy (ABBT) and applied relaxation (AR), and to examine how the development of mindfulness may be related to change in interpersonal problems over treatment and at follow-up. Method: Eighty-one individuals diagnosed with GAD (65.4% female, 80.2% identified as white, average age 32.92) were randomized to receive 16 sessions of either ABBT or AR. GAD severity, interpersonal problems, and mindfulness were measured at pre-treatment, post-treatment, 6-month follow-up, and 12-month follow-up. Results: Mixed effect regression models did not reveal any significant effects of pre-treatment interpersonal problems on GAD severity over treatment. After controlling for post-treatment GAD severity, remaining post-treatment interpersonal problems predicted 6- but not 12-month GAD severity. Participants in both conditions experienced a large decrease in interpersonal problems over treatment. Increases in mindfulness over treatment and through follow-up were associated with decreases in interpersonal problems, even when accounting for reductions in overall GAD severity. Conclusions: Interpersonal problems may be an important target of treatment in GAD, even if pre-treatment interpersonal problems are not predictive of outcome. Developing mindfulness in individuals with GAD may help ameliorate interpersonal difficulties among this population.     

Therapeutic immediacy across long-term psychodynamic psychotherapy: an evidence-based case study

C. E. Hill (2004) recently developed the concept of therapist immediacy to capture discussion by the therapist about the therapeutic relationship that occurs in the here-and-now of a therapy session. This concept has been expanded to include discussion about the therapeutic relationship by both the client and therapist, captured by the term therapeutic immediacy (K. Kuutmann & M. Hilsenroth, 2011). Although prior research has examined the use of therapeutic immediacy across short-term treatment, the present study is the first to examine the use of immediacy across a long-term (4 years) psychotherapy. Also, this is the first study to assess the interrater reliability of therapeutic immediacy, which was found to achieve good to excellent levels across raters. The most frequently used categories of client and therapist immediacy are presented. Finally, the authors provide an in-depth qualitative examination of 5 therapeutic immediacy segments across the treatment judged by the raters to have high levels of depth/intensity (4.5 or higher out of 5) to examine the role of therapeutic immediacy in exploring meaningful treatment issues. Clinical utility, potential limitations, and future research on therapeutic immediacy are discussed.     

Overcoming Negative Aspects of Perfectionism through Group Treatment

The tendency to hold and pursue excessively high standards for oneself and for others can interfere with academic achievement. Counsellors who work in university settings are often presented with students whose capabilities do not reflect their levels of achievement. This study reports on the evaluation of an eight-week group intervention designed to help university students shift from negative and often debilitating perfectionism to positive and enhancing perfectionism. The group treatment focused on changing attitudes, beliefs, feelings, and interpersonal interactions affected by perfectionism using combined cognitive-behavioral and interpersonal approaches. Standardized measures, including the Beck Depression Inventory (Beck et al., BDI-II manual. San Antonio: The Psychological Corporation, 1996), the Beck Anxiety Inventory (Beck and Steer, Beck Anxiety Inventory: Manual. San Antonio: The Psychological Corporation, 1993), and the Multidimensional Perfectionism Scale (Hewitt and Flett, Journal of Personality & Social Psychology, 60, 456–470, 1991a), provided data for pre- and post analysis of a treatment group (n = 30), and comparison groups of students attending group programs on career planning (n = 30) and attending psychology classes (n = 30). Results show that students participating in the treatment group significantly reduced their levels of depression, anxiety, and perfectionism in comparison to students who did not attend the treatment program. Implications of the findings suggest the importance of considering perfectionism on a continuum of negative and positive influences while helping students to address the intrapersonal and interpersonal dimensions of perfectionism.     

Attitudes toward seeking professional psychological help among Chinese students at a UK university

Aim: In this study we aimed to investigate whether Chinese international and British home students at a university in the United Kingdom differed in their attitudes towards seeking psychological help. Method: The total sample comprised 323 participants. Participants completed measures to assess their attitudes toward seeking professional psychological help (recognition of need for psychological help, stigma tolerance, interpersonal openness, confidence in mental health practitioners). Results: Chinese students reported significantly less interpersonal openness than that reported by British students. Contrary to prediction, however, no significant group differences were found on any of the other mental health attitudes (i.e. recognition of need for psychological help, confidence in mental health practitioners or stigma tolerance). Within‐group contrasts also showed that Chinese students reported lower scores on interpersonal openness than on stigma tolerance and confidence in mental health practitioners. In contrast, British participants reported less confidence in mental health practitioners and recognition of the need for psychological help than reported for stigma tolerance and interpersonal openness. Conclusion: The findings highlight the need for a greater understanding of students' cultural inclinations toward mental health issues and cultural attitudes that may hinder and/or facilitate students' access and engagement with psychological services in higher education institutions.     

III. Kantian intuitions

By way of a reply to Charles Parsons's paper in the Nagel Festschrift, Kant's notion of intuition (Anschauung) is examined. It is argued that for Kant the immediate relation which an intuition has to its object is a mere corollary to its singularity. It does not presuppose (as Parsons suggests) any presence of the object to the mind. This is shown, e.g., by the Prolegomena § 8, where the objects of intuitions a priori are denied by Kant to be so present. They yield knowledge, not in virtue of their immediacy but in virtue of their ideality.     

Trusting strangers: The benefits of reciprocal self-disclosure during online computer-mediated communication and mediating role of interpersonal liking

Reciprocal self-disclosure has reportedly been associated with increased interpersonal trust. However, existing research mainly focuses on online disclosure between acquaintances and overlooks the types of reciprocal disclosure, especially in the initial interactions between strangers communicating online. This study aimed to investigate how three types of reciprocal self-disclosure (turn-taking reciprocity, extended reciprocity and non-reciprocity) contribute to trust and the mechanism of positive interpersonal liking, and whether any effect was instant and stable or increased across two interactions during computer-mediated communication (CMC). Participants were assigned to one of the three reciprocal disclosure conditions and engaged in online interactions. Self-reported and behavioural results demonstrated higher levels of interpersonal trust and liking in the second interaction phase than in the first across all conditions. The turn-taking reciprocity condition showed higher interpersonal trust than did the extended condition, and higher interpersonal liking than did the extended and non-reciprocity conditions; this effect was apparent in both interactions. These findings help us understand the relationship between online self-disclosure and interpersonal trust, suggesting that certain patterns of communication with strangers (e.g., turn-taking reciprocity) may foster more positive social outcomes during CMC over time, while demonstrating the importance of immediacy in synchronous conversations.     

Psychoanalysis and the Education of the Child by Gerald H. J. Pearson

A conceptualization is presented which encourages a renewed exploration of the way in which psychiatric patients discuss their medications in the group therapy setting. It is suggested that process-oriented group therapiststend to harbor subtle prejudices which may inhibit examination of this material. If we listen to medication-related discourse more carefully, we find that patients disclose important information about hopes and fears about treatment, self-efficacy, attitudes about control and authority, and other sensitive or disowned parts of experience. The process of interactions about medicines often reveals interpersonal difficulties, particularly around intimacy. Suggestions for intervening more effectively with this type of material are presented. The importance of medication attributions in revealing curative fantasies is discussed.     

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.