The Transportability and Utility of Cognitive Therapy in South African Contexts: A Review

Cognitive therapy could be more widely promoted in South Africa given the great disparity between the need and provision of psychological therapies. Three possible objections to the promotion of cognitive therapy are considered: uncertainty surrounding the effectiveness of cognitive therapy in South African contexts; uncertainty surrounding the applicability in multicultural contexts; and suggestions that cognitive therapy is decontextualised and therefore objectionable in a country facing major social challenges. A systematic review of the literature indentified 15 outcome studies, and suggests that cognitive therapy is a viable and much-needed approach in South Africa.     

Groundhog day: The individual,the couple,the group and the space between

Abstract

The film Groundhog Day first came out in 1993. Five years later, it is still cited in a variety of contexts. The author proposes that this is because the film is a cultural artefact which both elucidates and frustrates the ideal of romantic love in the couple as the agent of internal change.

The author also proposes a re-viewing of the meaning of the concept of couple. The convergence of object relations theories with group analysis suggests that the mind works by repeating and externalizing internal group structures in social relationships. The couple, then, becomes an intermediary structure between the individual and the group where intimacy facilitates a re-working of group internal structures. It is the collapsing and the opening of the ‘space between’ which is the agent of change. This process creates strength, power and a feeling of wholeness. But it also implies the expression of anger, pain and disappointment. The author illustrates these points with an interpretation of the Groundhog Day film and with a clinical case study of a couple in therapy.     

Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy

According to cognitive-behavioral models of social anxiety disorder (SAD), four of the important maintaining mechanisms are avoidance, self-focused attention, anticipatory processing and post-event cognitive processing. Individual cognitive therapy (ICT) and cognitive behavioral group therapy (CBGT) both have substantial empirical support. However, it is unclear whether they achieve their effects by similar or different mechanisms. The aim of this study was to investigate whether changes in the four maintenance processes mediate clinical improvement in ICT and CBGT for SAD. We analyzed data from participants (N = 94) who received either ICT or CBGT in two separate RCTs. The results showed that ICT had larger effects than CBGT on social anxiety and each of the four potential mediators. More pertinently, moderated mediation analyses revealed significant between-treatment differences. Whereas improvement in ICT was mainly mediated by reductions in avoidance and self-focused attention, improvement in CBGT was mediated by changes in self-focused attention and in anticipatory and post-event processing. These results support the importance of the putative mediators, but suggest that their relative weights are moderated by treatment type.     

Treatment effectiveness of PMTO for children's behavior problems in Iceland: Assessing parenting practices in a randomized controlled trial

Findings are presented from an Icelandic randomized control trial (RCT) evaluating parent management training – Oregon model (PMTO?), a parent training intervention designed to improve parenting practices and reduce child behavior problems. In a prior report from this effectiveness study that focused on child outcomes, children in the PMTO condition showed greater reductions in reported child adjustment problems relative to the comparison group. The present report focuses on observed parenting practices as the targeted outcome, with risk by treatment moderators also tested. It was hypothesized that mothers assigned to the PMTO condition would show greater gains in pre‐post parenting practices relative to controls. The sample was recruited from five municipalities throughout Iceland and included 102 participating families of children with behavior problems. Cases were referred by community professionals and randomly assigned to either PMTO (n = 51) or community services usually offered (n = 51). Child age ranged from 5 to 12 years; 73% were boys. Contrary to expectations, findings showed no main effects for changes in maternal parenting. However, evaluation of risk by treatment moderators showed greater gains in parenting practices for mothers who increased in depressed mood within the PMTO group relative to their counterparts in the comparison group. This finding suggests that PMTO prevented the expected damaging effects of depression on maternal parenting. Failure to find hypothesized main effects may indicate that there were some unobserved factors regarding the measurement and a need to further adapt the global observational procedures to Icelandic culture.     

Book reviews

Current research on medically unexplained somatic symptoms (MUSS) shows a renewed interest in psychodynamic approaches. Patients with MUSS lack the capacity to mentalize about their feelings. They have an attachment history characterized by insecure attachment relationships. They have a personality trait that can be best described as self-critical perfectionism. Their insecure early attachment relations have had a negative impact on the development of their stress regulatory system. Staff of Psychotherapeutisch Dagcentrum, affiliated with the Department of Psychiatry of a general hospital in Tilburg, found dynamic interpersonal therapy (DIT) a suitable treatment model for the treatment program that was run for patients with MUSS. DIT was developed by Lemma, Fonagy, and Target in the UK for the individual treatment of patients suffering from depression. Subsequently, a variant of DIT was developed in order to make it suitable for application in a multidisciplinary group setting.     

Receiving slaps,receiving words. The violence of separation in a public service time limited psychotherapy group for adolescents

The authors propose a reflection on a time-limited psychoanalytic group for children, adolescents and families, run in a public service. Some patients in the group give accounts of violent relationships and traumatic experiences. The accounts of violent, interpersonal and intrapsychic relationships influence the group’s capacity of thinking, which leads to difficulties in the processing of symbolic aspects. The fundamental question is that of whether it is possible to work in a time-limited, institutional, psychoanalytical framework, in which psychotherapists have to attempt to give meaning to experiences which take place in a repetitive present, in a space/time in which the prospect of a conclusion appears to be inconceivable. By means of a clinical example, and with particular emphasis on the first sessions and the dream brought up by a patient who has been a victim of domestic violence, the authors discuss the possibility of modifying, chiefly from within, the feeling of the immutability of early psychic material, which is itself intrinsically violent.     

Countering Correctional Discourse

SUMMARY

This article discusses the development of a feminist support group for women prisoners enrolled in a six-month substance abuse treatment program in an adult correctional facility in Guam. After the completion of five Group cycles, a follow-up study was conducted in the community using qualitative, feminist, and participatory methods. Results indicate that the Group was successful in helping women prisoners to address trauma, addiction, and the stresses associated with incarceration. Nevertheless, participants reported having significant difficulty transitioning into the community upon release and 23% were sent back to prison for parole violations. Recommendations are outlined for gender-responsive programming, both within women's prisons and in the community, to support women offenders after release.     

Coming Out

No abstract available for this article.     

Products of Classes of Residuated Structures

The central result of this paper provides a simple equational basis for the join, IRLLG, of the variety LG of lattice-ordered groups (-groups) and the variety IRL of integral residuated lattices. It follows from known facts in universal algebra that IRLLG=IRL×LG. In the process of deriving our result, we will obtain simple axiomatic bases for other products of classes of residuated structures, including the class IRL×_s LG, consisting of all semi-direct products of members of IRL by members of LG. We conclude the paper by presenting a general method for constructing such semi-direct products, including wreath products.     

A modified DBT skills training program for oppositional defiant adolescents: promising preliminary findings

A modified skills training component of dialectical behavior therapy (DBT) was implemented in a group therapy format for non-suicidal outpatient young adolescents who met criteria for oppositional defiant disorder (ODD). Thirty-two youths completed the 16-week program, as well as pre- and post-treatment measures. The treatment was effective not only in decreasing negative behaviors, but also in increasing positive behaviors, per caregiver report. The youths reported a significant reduction in externalizing and internalizing symptoms and in depression. Reliable change indices indicated that far more participants were in the improved category than in the deteriorated category on the measures of interest. Despite the absence of control groups but consistent with the treatment outcome research literature for DBT-based treatments for other disorders, this study demonstrated that DBT skills training is feasible and shows promise in improving the behavior of ODD young adolescents.