An evaluation of support groups for patients with long-term chronic pain and complex psychosocial difficulties

There is a significant group of chronic pain patients with complex psychosocial needs who are frequent users of hospital outpatient departments and who do not participate in or benefit from traditional pain management treatments and are convinced there is a medical solution to their problems. They are a particularly challenging group of patients to help, often shunned by medical and psychological professionals. A new type of ten-session psycho-social group for these patients that is less demanding than traditional pain management group programmes is investigated. It is designed to foster the development into community-based self-help groups and reduce the need for professional support and unnecessary medical intervention. Accounts of four groups of patients who participated in support groups and successfully established their own groups is presented. To assess changes in motivation, mood and pain disability standardized questionnaire measures were given before and after group attendance. Findings suggest that patients benefited and took increased responsibility for their pain management but did not demonstrate positive changes on measures of mood or level of pain disability. Patients experienced satisfaction with the groups and established their own self-help community groups. The positive experience of participants and staff suggests further work with support groups would be productive for this group of patients.     

The difficulties assessing spiritual distress in palliative care patients: a qualitative study

This paper reports on a focus group study aimed at exploring the difficulties that palliative care healthcare professionals encounter while assessing the spiritual distress of their patients. Three focus groups were conducted in a hospice (n = 15). Participants were all healthcare professionals working in the hospice in-patient unit. Interviews were taped and later transcribed. The data was analysed through content analysis. Emergent themes included: lack of vocabulary around spiritual issues, personal issues surrounding death and dying, training issues, fear of being unable to resolve spiritual problems, time constraints and difficulty separating spiritual and religious needs. Participants provided a number of recommendations for improving care. This pilot study has generated useful data in relation to how spiritual care of patients might be improved. Despite the abundance of academic publications and policies on spirituality, this area is not integrated well into palliative care.     

Positive psychotherapy effectiveness study and quality assurance

Positive Psychotherapy is a form of short-term psychotherapy based on an in-depth psychological approach, resulting from cross-cultural psychotherapy. After a brief introduction to some central elements of the theory of Positive Psychotherapy (PPT), the first results of the effectiveness study will be discussed in this paper. an assessment of alterations in symptoms, as well as changes in the way subjects feel and behave, which occurred in the period of time between the beginning and after the end of therapy will be presented here. In a longitudinal study, patients treated with PPT showed a distinct reduction of symptoms as well as improvement with regard to the way the subjects experience and behave compared to the control group, where no significant changes were observed. an additional cross-section comparison between the post-measures of the prospective assessment of PPT patients and retrospective assessments of PPT patients was carried out. No significant differences between the assessments made directly after finishing PPT and the assessments made within three different time spans after finishing PPT (a) 3-10 months; b) 10 months-4 years; c) 4-5 years) were found. This finding is viewed as an indication of the lasting stability of the therapeutic effects of PPT, which can still be detected up to five years after finishing PPT.     

L’auto efficacité créative,la flexibilité cognitive et le soutien à l’innovation comme antécédents du comportement innovant

The necessity to innovate is a concern for many practitioners and researchers. This research aims to demonstrate the role of cognitive flexibility and of the climate of support for innovation in developing innovative behavior at work. The mediating role of creative self-efficacy is tested. The results confirm that cognitive flexibility and the climate for work group innovation are antecedents of the innovative behavior.     

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.