Structural models of psychotherapy groups and their effect on inpatients with borderline personality disorders: Patients' perceptions

This research compares the way in which various group structural models affect self-understanding, interpersonal relationships and catharsis in hospitalized patients with borderline personality disorders. Each of the models is characterized by a different combination of group focus and leadership style. Three psychotherapy groups were chosen as paradigms: the dynamic psychotherapy group; the therapeutic games group, and psychodrama group. Sixty three inpatients with borderline personality disorders participated in the study. The one-way ANOVA yielded significant differences between the group models. Results of the post-hoc t-test showed that the dynamic and the games groups were perceived by the patients as more beneficial than psychodrama.     

Group climate in an open-ended cancer support group

A number of well-described, controlled studies assessing cancer support group intervention support their effectiveness. All of these experimental groups have been close-ended and typically involve six to eight weekly sessions. Because many cancer patients are unable or unwilling to participate in closed, extended-session groups, there is particular need for analysis of the effectiveness of short-term, open-ended groups. Additionally, objective measures are needed to delineate the factors contributing to a successful outcome in cancer support groups. We used the Short Form of the Group Climate Questionnaire (GCQ-S) to characterize 23 sessions in an open-ended, short-term, Veterans Hospital based cancer support group. The cancer group scored significantly lower on the Avoiding and Conflict dimensions (p<.001) compared to a normative psychotherapy group sample. There was no difference on the Engaged dimension. This pilot study suggests that a cancer support group in this setting can create an environment where members are cohesive and take responsibility for their own change process, while keeping interpersonal conflict to a minimum. Based on these preliminary findings, we encourage controlled clinical trials examining the efficacy of open-ended cancer support groups.At the time of this study, Dr. Daroff was a resident in Psychiatry, University of California, San Francisco.     

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.     

Increasing senior citizen participation in a community-based nutritious meal program

Two experiments were conducted to compare the effects of several prompting and reinforcement procedures on the participation of elderly citizens in a nutritious meal program. Experiment I employed a variation of the multiple-baseline design across three groups of approximately 60 households each. Elderly persons not previously participating in the program were introduced to the following conditions: (1) public service radio announcements for four weeks to advertise the meal program and the availability of free transportation, (2) a home visit that served as a personal invitation and a second prompt for participation, (3) a followup telephone call, and (4) an incentive menu for participation, which was sent through the mail. Results indicated that the home visits and incentives were both effective as recruitment procedures and superior to other conditions; however, incentives proved to be the most cost-effective intervention. Experiment II used a variation of the multi-element design to compare the effects of scheduled activities and incentives in maintaining higher levels of participation by those persons who had attended the meal program at least once in the past, but whose current rate of participation was low. Results showed that activities improved attendance levels somewhat and that incentives substantially increased the number of meal program participants. Data from these experiments thus indicate that relatively inexpensive procedures may be used effectively to increase the extent to which elderly persons make use of potentially beneficial community-based services.     

Standardized classroom management program: Social validation and replication studies in Utah and Oregon

A comprehensive validation study was conducted of the Program for Academic Survival Skills (PASS), a consultant-based, teacher-mediated program for student classroom behavior. The study addressed questions related to: (a) brief consultant training, (b) subsequent teacher training by consultants using PASS manuals, (c) contrasts between PASS experimental teachers and students and equivalent controls on measures of teacher management skills, student classroom behavior, teacher ratings of student problem behaviors, and academic achievement, (d) reported satisfaction of participants, and (e) replication of effects across two separate school sites. Results indicated that in both sites significant effects were noted in favor of the PASS experimental group for (a) teacher approval, (b) student appropriate classroom behavior, and (c) four categories of student inappropriate behavior. Program satisfaction ratings of students, teachers, and consultants were uniformly positive, and continued use of the program was reported a year later. Discussion focused upon issues of cost-effectiveness, differential site effects, and the relationship between appropriate classroom behavior and academic achievement.     

Peer tutoring among elementary students: educational benefits to the tutor

To determine whether tutoring might be academically beneficial to the tutor, this study investigated the acquisition of spelling words by three elementary students in a peer tutoring program. The experimental design allowed a simultaneous comparison of each child's gain in performance on comparable word lists on which the child tutored another child, was tutored by another child, or neither gave nor received tutoring. The children's spelling improved nearly an equivalent amount on those words on which they tutored another child as on the words on which they were tutored; no such change was noted on the words on which they neither gave nor received tutoring. These findings, that peer tutoring is profitable for the tutor as well as the tutee, provide a basis for recommending peer tutoring as one method of individualizing education.     

EFFECTS OF DIRECT,INTERMITTENT, AND VICARIOUS REINFORCEMENT PROCEDURES ON THE DEVELOPMENT AND MAINTENANCE OF INSTRUCTION-FOLLOWING BEHAVIORS IN A GROUP OF YOUNG CHILDREN1

A group of young children (mean age: 2.5 yr) were instructed to follow different requests by a teacher in a day-care setting. Experiment I verified that mean group instruction following was low (10%) despite the opportunity for “observational learning”, i.e., the group of 12 children could watch a nonreinforced adult comply with the teacher's request. In Experiment II, when positive consequences were provided contingent on the adult model's behavior, mean group instruction following was relatively unaffected (14%). When direct reinforcement was given to four peer models, each for several sessions, the individual performances of three of the four peer models was elevated (from 50% to 80%); however, the mean performance of the remaining nonreinforced children (N = 7) was only moderately affected (21%). When reinforcement contingencies were again changed, so that each group member was provided direct, but intermittent reinforcement, mean group performance increased substantially to levels of over 70%. Once instruction following was high, presentation of reinforcement only to one peer model sufficed to maintain performance whereas earlier, this same vicarious reinforcement procedure had failed to establish group compliance. The maintenance of instruction-following behavior when reinforcement was applied solely to one child was interpreted mainly in terms of a high resistance to extinction following a history of intermittent reinforcement rather than a “vicarious”- or “self”-reinforcement mechanism. Finally, removal and re-introduction of group intermittent reinforcement, respectively, lowered performance (to levels of 40%) and elevated (to levels of 65%) the group's performance.     

THE REDUCTION OF STEALING IN SECOND GRADERS USING A GROUP CONTINGENCY1

Three classes of second graders served as subjects in this study of the effects of two types of intervention programs upon stealing: (1) an antistealing lecture with no specific contingency implied, and (2) a direct group contingency applied, whereby children were rewarded with (a) extra free time for no thefts, (b) allowed normal free time if stolen items were returned, and (c) punished with loss of free time if stolen items were not returned. A multiple-baseline design across the three classes showed the group contingency to be effective in reducing stealing behavior; the anti-stealing lecture was ineffective.     

RELATIVE EFFECTIVENESS OF TEACHER ATTENTION AND THE “GOOD BEHAVIOR GAME” IN MODIFYING DISRUPTIVE CLASSROOM BEHAVIOR1

A variety of behavioral procedures have been employed in recent years to modify disruptive classroom behavior. Such methods have been developed with the belief that curtailing disruptive behavior would strengthen positive classroom performance. In this study, two procedures, the good behavior game and the teacher-attention method, were compared to determine short-run effectiveness. Four teachers (two fourth-grade and two fifth-grade) implemented both methods in their classrooms over a five-week period. Presentation of methods was alternated in a counterbalanced design to control for order effects. Each of the four classrooms consisted of 25 students. A time-sampling procedure was used to record the presence or absence of disruptive behavior within 15-second intervals. Disruptive behavior was defined as any talking-out or out-of-seat behavior without permission. The results indicated that both procedures were effective in modifying disruptive classroom behavior, but that the good behavior game reduced disruptive behavior significantly better than the teacher-attention method. In addition, all teachers preferred the game to the teacher-attention procedure. This reaction seemed related to the effort involved in initiating the two activities. The good behavior game required less effort on the teacher's part. However, use of the game alone raises certain ethical considerations. One such issue involves abuse of peer pressure. Also, there is a possibility that negative rules may tend to promote resentment. Positively stated rules would ameliorate that problem. Another relates to the possibility that some teachers might be carried away by the ease of the game's implementation to the extent that behavior control becomes the primary objective in the classroom. As a result, one might consider use of the game to maximize short-term change, but then phase out this procedure in favor of another method (e.g., teacher attention) for long-run effects.     

INCREASING EXTENDED CARE FACILITY RESIDENTS' ATTENDANCE AT RECREATIONAL ACTIVITIES WITH CONVENIENT LOCATIONS AND PERSONAL INVITATIONS1

Residents of extended care facilities generally exhibit a low level of attendance at recreational and therapeutic activities. Spatial arrangement of rooms, prompting, snacks, and small prizes have been suggested as factors that affect attendance. The present study examined the effects of an extensive system of prompts and the location of activity areas on the attendance of residents at a variety of activities. Twenty-six subjects were randomly selected from the ambulatory population of the facility. The first time each subject entered the activity room during the first 6 min of an activity session their name was recorded. Reliability measures were taken at 10 sessions, with a 95% mean agreement between observers. The variables examined were the amount of individualization of subjects (experimental group I: names announced versus experimental group 2: names not announced), room location (central or peripheral), use of names in announcements (activity only versus activity and group I names), and mode of announcement (PA system only versus PA system and in-person). A counter-balanced group design with repeated measures was used, with a randomly determined order of application of experimental treatments. An analysis of variance split plot 2.222 (Kirk, R. E. Experimental Design: Procedures for the Behavioral Science. Belmont, Ca.: Brooks-Cole, 1968.) of the level of subject attendance yielded significant main effects for room location, F(1, 24) = 5.47, p < 0.05, and type of announcement, F(1, 24) = 9.10, p < 0.01, and significant interactions for Individualization × Use of Names in Announcements, F(1, 24) = 5.57, p < 0.05, and Room Location × Mode of Announcement, F(1, 24) = 7.90, p < 0.01. The results indicate that using a centrally located room and announcement of resident names increases attendance at a variety of activities. The increased social and environmental interaction generated by activity attendance has potential therapeutic benefits for the residents involved. Furthermore, the kind of information reported here and by others should be taken into consideration by planners of a variety of group living facilities, ranging from nursing homes to residential treatment cottages.