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.     

Couples psychotherapy group: Treatment of the married alcoholic

As part of an intramural research program of the National Institute of Alcohol Abuse and Alcoholism focused on the psychobiogenetics of familial alcoholism, a psychodynamically oriented married couples psychotherapy group was formed. Its purpose was to determine whether this modality could be utilized as an outpatient treatment approach to identify and modify interpersonal interactions that affect both drinking behavior and the quality of family and marital life. This paper, a clinical case report, presents follow-up data and disusses both themes that emerged in the therapy process and the usefulness of this modality in the treatment of the married alcoholic.She was formerly Chief, Unit of Family Studies, Laboratory of Clinical Studies, National Institute of Alcohol Abuse and Alcoholism (NIAAA).At the time this paper was written, she was a Research Social Worker, Laboratory, of Clinical Studies, NIAAA, Bethesda, Maryland.     

Treatment of alcoholic couples in outpatient group therapy

This paper summarizes special issues that group leaders are likely to encounter when adapting their skills to outpatient group therapy with alcoholic couples. More specifically, the paper: (a) discusses the advantages of treating alcoholic couples in a group as opposed to individual couple's therapy; (b) outlines the parameters of a couples group with alcoholic members that differentiate it from working with other kinds of couples in group; and (c) provides guidelines and techniques for tackling some of the specific kinds of problems and situations that arise.This paper was presented at the Annual Meeting of the American Group Psychotherapy Association, New York City, February, 1985.The author wishes to acknowledge the contribution of Geraldine Alpert, Ph.D., whose thoughtful comments and discussion helped to crystallize the concepts presented.     

A long-term case study with sadistically-tinged countertransference elements

The American Journal of Psychoanalysis - This case report sketches the psychoanalytically-informed supportive psychotherapeutic treatment of a single man through his life challenges over a...     

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.     

Religious and national group identification in adolescence: A study among three religious groups in Mauritius

Religious group identification is an important but understudied social identity. The present study investigates religious group identification among adolescents of different faiths (Hindu, Muslim, Christian) living in multicultural Mauritius. It further explores how religious and national group identities come together among religious majority and minority adolescents. For three age groups (11 to 19 years, N = 2152) we examined the strength of adolescents’ religious and national group identification, the associations between these two identities, and the relationships to global self‐esteem. Across age and religious group, participants reported stronger identification with their religious group than with the nation. Identification with both categories declined with age, with the exception of Muslims, whose strong religious identification was found across adolescence. The association between religious and national identification was positive, albeit stronger for the majority group of Hindus and for early adolescents. We examined the manner in which religious and national identities come together using a direct self‐identification measure and by combining the separate continuous measures of identification. Four distinct clusters of identification (predominant religious identifiers, dual identifiers, neutrals, and separate individuals) that were differently associated with global self‐esteem were found. Dual identifiers reported the highest level of global self‐esteem. The clusters of identification did not fully correspond to the findings for the direct self‐identification measure. The results are discussed in terms of the meaning of dual identity and the positive manner in which adolescents can manage their multiple identities while taking into account the ideological framework in which those identities are played out.     

Managing group process in nonprocess groups: Working with the theme-centered psychoeducational group

While there has been a recent proliferation of groups for consultative and psychoeducational purposes, little has been written about using the group process in these nonprocess groups. This paper investigates the management of various group processes in a group whose contracted focus is teaching stress management skills. Distinctions are made between psychotherapeutic and theme-centered psychoeducational process management. Many group processes can be predicted given the group's normal developmental stages, while other ongoing group processes arise spontaneously. A working dialogue between the presented content and the emerging process is necessary in order for psychoeducation to be personalized and most fully assimilated. A clinical vignette follows the evolution of a stress management group conducted for high-level executives who have been identified as manifesting Type-A behaviors. For each session, the format and material content are briefly outlined, the emerging group process is described, and the clinical interventions involved in the process management are discussed.     

Psychoanalytically oriented short-term groups for outpatients: Unsettled issues

The psychoanalytic approach to short-term group therapy for outpatients has been less prevalent than other approaches. Unsettled issues associated with this approach concern the feasibility of carrying out psychoanalytic work on an ongoing basis, patient selection, group composition, patient preparation, therapist technique, and cotherapy. Recent literature relevant to a conceptual consideration of these issues is reviewed. A vignette from a recent therapy group is presented as part of a clinical consideration of the issues. In addition, practical suggestions for conducting such groups are provided.This article was derived from a paper presented at the Seventh Annual Meeting of the Canadian Group Psychotherapy Association, October 16, 1986, Mont Tremblant, Canada.     

Multiple-family group treatment of outpatients with schizophrenia: impact on service utilization

The impact of multiple-family group treatment (MFGT) on outpatient and inpatient mental health service utilization of 97 persons with schizophrenia was investigated. Participants were randomly assigned to standard care (n = 44) or standard care plus MFGT (n = 53). Service use for a year prior to randomization, the 2-year study period, and a 1-year follow-up were examined. Relative to standard care participants, the MFGT group had reduced community hospitalization during year 1 of the intervention and reduced state hospitalization at follow-up. During the intervention period, MFGT participants demonstrated a significant increase in outpatient utilization as a direct consequence of the intervention. However, when service use was summed across 3 years post-randomization, no group differences were observed. Results suggest that implementation of MFGT in a community mental health setting reduces inpatient service at specific time periods, without significantly increasing outpatient service utilization. These findings add to other outcomes from this study that demonstrate decreased psychiatric symptoms and caregiver distress.     

Very long-term retention of a first language without rehearsal: A case study

A case study is presented of an American sign language-using deaf woman whose life circumstances were such that she had no opportunities to use her sign language over nearly 40 years, but whose recall of its lexicon and syntax were almost unimpaired when she resumed its use after that period. Implications for the role of memory in first language learning are compared with results for second languages, and the role of rehearsal and interference in remembering over very long periods is considered.     

Understanding how groups work: a study of homogeneous peer group failures

The study examines thirty-six homogeneous peer support groups that failed to positively benefit most of the participants. Outcomes were assessed pre and one-year post using measures of mental health, marital relationships, and motherhood role indices. Four central group process characteristics previously found to be common in successful peer support groups were used as a framework for developing a series of post hoc hypotheses. The groups were found to be low on cohesiveness defined behaviorally, saliency, cognitive structures for reframing common dilemmas, and limited in the range of therapeutic experiences.     

A group therapist perspective on self-help groups

The author provides an overview of self-help groups in terms of their origins, growth, scope, and effectiveness, and then compares these groups with professionally conducted psychotherapy groups. A framework for evaluating group helping systems is proposed which includes five principal dimensions: the helping group as a social microcosm; technological complexity/simplicity; psychological distance/closeness between helper and helpee; specificity/generality of help methods; and differentiation versus nondifferentiation among participants. The author concludes his article by recommending four strategies for how group therapists can contribute to self-help groups.     

The dream in group therapy: A reappraisal of unconscious processes in groups

Addressing the issue of the existence of a group unconscious, this paper views dreams as providing potential evidence on the question. Dream material presented by various members in each of three psychotherapy groups is considered. In each group, convergences were found in the material presented by separate individual dreamers. By integrating a conceptual model of neurological information processing during REM dream sleep with a variety of behavioral research, a conceptual model is offered for the development of a group disposition, which represents an overlap of both individual and shared group psychic content. Group phenomena of cohesion and dependency are derived from this conceptual model.