Identifying emergent leaders in psychotherapy groups

This paper is the second in the series on group development and emergent leadership. It describes the design of a sociometric instrument which will be used for the identification of the four emerging leaders from the perspective of the group participants themselves. These four leaders, Task, Emotional, Scapegoat and Defiant, perform ongoing maintenance functions in the group and take up the critical function of spokesmen in the group's dialectical processing of phase-specific, group level issues. The goal here is to design an instrument which would allow both clinician and researcher to identify these critical persons early in a group's life.Ariadne P. Back is in private practice in Chicago, Illinois.     

Interpersonal conflict in group therapy: An object relations perspective

The aim of this paper is to demonstrate how object relations theory can be used to understand and regulate interpersonal conflict in group psychotherapy. Such concepts as projective identification, intersubjectivity and the analytic third are used to describe how conflict emerges in group psychotherapy and how it can be worked through. Case material is also provided to illustrate concepts and techniques in promoting a group's transition from a paranoid/schizoid to a depressive position. Positive aspects of the concept of projective identification are discussed including its use as a form of communication, a method of reducing anxiety and reintegrating previously dangerous and threatening aspects of the self.The paper was funded by Evan F. Lilly Memorial Trust Grant PV 13,067.     

Group climate in a stress discussion group for medical interns

In order to better characterize group process, the short form of the Group Climate Questionnaire (GCQS) was used to study a stress discussion group for medical interns. This group was found to be significantly different from a normative psychotherapy group sample along three major dimensions: Engaged, Avoiding and Conflict. The group members were cohesive, involved and open, yet respectful of each other's privacy. These results are discussed with respect to the group's goals and leadership.The authors thank George Fein, Ph.D., for statistical assistance.     

Self psychology in pastoral counseling

This article provides a general explication of how a pastoral counselor might use the self psychology perspective in conjunction with theological and ethical approaches. A particularly appropriate structure for this explication is self psychology's theory and practice of psychoanalytic psychotherapy as a two-phase process: an observation-understanding phase, in which empathic introspection is the central method, and an explanation-interpretation phase, in which by these empathic means the therapist hopes to consolidate further and mobilize developmentally an individual or group's self-cohesion. Each of these phases and the self psychology theory behind them provide an organizing rubric by which we can discuss how theological and ethical approaches might be carried out in a working alliance with the self psychology framework.     

Symbolization of experience in the process of group development

This paper applies some of the concepts of the theory of experiencing (as developed within the client-centered school of thought) to psychotherapy process in the small group. The ideas of Rogers and Gendlin regarding how change occurs in psychotherapy are applied to the process of development in the group-as-a-whole. The role of perception and symbolization of experience in the process of group development is examined. A case example from group psychotherapy is used to illustrate the process of formation, the change of shared perceptions among the group members, and the importance of these perceptions to the functioning of the group.     

Modifications of Yalom's interactional group therapy model as a mode of treatment for alcoholism

As a result of a review of the literature and especially Brown and Yalom's (1977) clinical report, it is suggested that the preferred mode of treatment for alcoholism is group psychotherapy. The group's ability to provide support, structure and reinforcement for abstinence make it a powerful catalyst in the recovery process. In measures of time, efficacy and recovery, group psychotherapy generally succeeds where other treatment modalities frequently fail.     

Joining group psychotherapy: developmental considerations.

This article examines the experience of new members joining an ongoing psychotherapy group. The group's stage of development and the new member's personality development are suggested to be important variables in this significant event. The experience of joining is found to share some things in common with the beginning phase of group for the group as a whole, but also noted are some unique elements. The process of joining is viewed as a highly anxious event for the new member, with antecedents in the individual's life experience. The new member is compromised by not knowing the group members, nor their shared history, norms, and dynamics. Concurrently, the group may experience a range of fears, wishes, and anxieties about the new member. Developmental considerations for the new member and the stage of group help to inform intervention strategies.     

The process of scapegoating in a neonatal nurses' group

This paper reviews the literature on scapegoating, elaborating on the underlying mechanisms before describing the process of scapegoating as it occurred in a neonatal nurse support group. Illustrative vignettes are used to discuss how scapegoating was used by group members to avoid painful feelings arising from their care of extremely ill infants. Group process is related to the stages of the group's development as feelings were addressed more directly and the need to use scapegoating as a defense decreased.     

A process analysis of group development

A process analysis of group development forms the basis of a methodology for identifying group phase boundaries and describing moment-to-moment process in psychotherapy groups. This paper presents the general rationale for identifying variables, the statistical technique for producing graphs and the first of three variables used in the process analysis. The focus is on phases two and three as defined by Beck's theory of group development. The first variable tracks the members' responses toward the Scapegoat Leader in terms of supportiveness, criticism or hostility. Results on two groups show a clear shift in responses from negative to supportive as the group moves from phase two to phase three.     

The Developmental Path to Expertise in Group Psychotherapy

This paper describes a trajectory by which an individual achieves expertise in group psychotherapy. Five developmental stages are posited. In the decisional-anticipatory stage, interest is developed in group psychotherapy. In the trainee stage, the individual masters the knowledge base of group psychotherapy and obtains fledgling experiences in a group. In the novice stage, the individual obtains additional experience in running groups and becomes socialized into a community of group psychotherapists. In the proficiency stage, the individual narrows his or her group psychotherapy focus and obtains more specialized experience in that area. At this time, supervisory and consultation skills are often developed. In the final stage of expertise, the expert must engage in a process of recognizing its limits and must devise ways to maintain it. Research that focuses on one aspect of expertise, level of experience, is reviewed. Three dimensions of difference are identified: (a) complexity of conceptualization of members and interventions; (b) fostering openness and engagement; and (c) focusing on process.     

团体心理治疗中凝聚力的概念及测量研究述评

团体心理治疗中的凝聚力最初多被定义为人际信任、吸引和卷入,随着研究的深入,凝聚力的概念逐渐向多维的方向发展。对凝聚力的测量主要有MacKenzie的团体氛围量表、Lese等的治疗因素-凝聚力分量表及Piper的凝聚力量表等。目前团体心理治疗领域的研究对凝聚力的认识缺乏一致性。从凝聚力的概念建构着手,探索团体心理治疗过程,开发评估工具,构建系统的理论和模型,是值得国内研究者关注的方向。     

Borderline personality disorder level predicts change in depressiveness after short‐term group psychotherapy: A study in a daily psychiatric clinic

The project examined the comorbidity between depression symptoms and the level of borderline personality organisation among patients admitted for group psychotherapy (Study 1). It also aimed to analyse how the level of borderline personality organisation relates to the reduction in depression symptoms after short‐term psychotherapy (Study 2). The study was conducted in a day clinic where patients were receiving psychotherapy for emotional problems affecting their functioning (N = 57). The study used the Borderline Personality Inventory (BPI) and the Patient Health Questionnaire. The analysis showed that BPI was positively related to depression symptoms. The higher borderline personality organisation patients presented when entering group psychotherapy, the greater was the decrease in depression symptoms after 3 months of psychotherapy. We discuss the results in relation to the notion that the presence of depression could be a positive prognostic indicator for patients with borderline personality.     

An exploratory study of videotapes of long-term group psychotherapy of outpatients with major and chronic mental illness

This study explored patterns emerging in videotaped sessions of group psychotherapy with seven outpatients of a large mental health facility. The 22 sessions spanned the 12th to 27th months of the group's existence. Group members had long histories (25–50 years) of symptoms characteristic of schizophrenia. Each session was rated on the Group Environment Scale. One session from a group in its earlier stages was also rated on the same instrument to give some indication of baseline patterns. Analyses of changes across the 15 months were not statistically significant. However, some GES subscales, including Cohesion, Independence, and Self-Discovery, showed relatively high mean levels across the 15-month period. These elevations are discussed as suggesting the codevelopment of orientations that have sometimes been viewed as incompatible and unattainable for schizophrenics. Interpreted clinically, the GES patterns help to elaborate recent findings about the relatively good success of long-term group therapy with such populations. The study, although merely suggestive, illustrates the potential for gleaning solid and clinically useful data from group psychotherapy research.The authors would like to thank Drs. Jill Rierdan, Nina Fieldsteel, Joseph Christy, and an anonymous reviewer for their suggestions, Kendra Bryant for serving as the reliability rater, and Janet Eltinge for her skilled videotaping.     

A training outline for conducting psychotherapy process ratings: An example using therapist technique

Aims: This study addresses the effects of structured training on the development of coding skills used in psychotherapy process research. Method: Participants included graduate trainees enrolled in an APA approved Clinical PhD programme. A course outline for training is reviewed and examined in relation to ratings of therapist techniques used during psychotherapy sessions. Results: The effects of this structured training protocol for raters resulted in good to excellent levels of interrater reliability. Different groups of raters were compared along multiple factors such as level of graduate training, training received on a particular measure, and psychotherapy experience. Discussion: The implications of these findings for rater training in psychotherapy process research are discussed.     

Group-as-a-whole systems theory and practice

Group-as-a-whole systems theory is presented and applied to the practice of group psychotherapy. The individual and the group are conceptualized as two isomorphic systems in a hierarchy of living systems. The basic component of the group-as-a-whole is its subgroups, which exist independent of individuals whose subgroup memberships may change while subgroups remain stable. Subgroups come together around similarities and separate on differences, and contain differences for the group-as-a-whole to integrate in relationship to primary and secondary goals. The primary goals of system survival and maturation take precedence over the secondary goals, which relate to the environment. Goal achievement and individual change is explained as a function of group dynamics. In a therapy group, the dynamics of each phase of group-as-a-whole development serve as a major therapeutic force. Within each member, salient developmental issues are aroused, which resonate with the issues that the group is in the process of mastering. The task of the group-as-a-whole therapist is to facilitate the developmental process at both the group and the individual level. Therapeutic interventions are designed to facilitate the discrimination and integration of information at the boundaries between systems and subsystems: within the individual member system (intrapersonal) and between individual member systems (interpersonal), within the group-as-a-whole system, within subgroups, between subgroups, and between all systems in the relevant hierarchy and their environments.     

Evaluation of a Combined Cognitive Behavioural Therapy and Interpersonal Process Group in the Psychotherapy Training of Clinical Psychologists

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence‐based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence‐based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy. The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self‐reflection and self‐practice. Eleven participants who participated in the training in 2008 completed the Counseling Self‐Estimate Inventory at pre‐ and post‐training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self‐practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self‐awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.     

Parallel Group Treatment of Pre-School Children and Their Mothers

Object relations concepts are applicable in children's group psychoanalytic psychotherapy. The author attempts to explore and delineate areas in which developmental conflicts in object relations, emotional deprivations, traumas, and family pathologies are recapitulated in the group, and how the manifestations of pathologies can be rectified by the process and formation of the group and the role of the therapist as a “new object” in the management of individual and group transferences. Clinical examples are presented.     

The written summary in group psychotherapy revisited

This paper addresses the use of the weekly written summary with patients in group psychotherapy. In an effort to stimulate group process and effect cotherapist communication, the authors instituted this group recording in an ongoing psychodynamically oriented mixed adult group. While the utilization of this device did, in fact, stimulate the group process and became an important part of the group's life, the therapists additionally saw significant effects upon their working alliance. These included increased focused dialogue upon group dynamics, more purposeful planning for group interventions, and heightened awareness of the significance of interventions in the group.Ms. Bosman-Clark is formerly Clinical Instructor, Department of Psychiatry, Baylor College of Medicine.     

Acting out in group psychotherapy

Acting out is a common occurrence in group psychotherapy. After a brief review of relevant psychoanalytic and group psychotherapy literature, this paper presents various kinds of acting out by the individual group members and the handling of such acting out by the therapist, discusses acting out by the group as a whole, and gives a brief overview of acting out by the group therapist. Specific examples are given of acting out and ways of dealing with it.     

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.