The differential effectiveness of group psychotherapy: A meta-analytic perspective.

The differential effectiveness of group psychotherapy was estimated in a meta-analysis of 111 experimental and quasi-experimental studies published over the past 20 years. A number of client, therapist, group, and methodological variables were examined in an attempt to determine specific as well as generic effectiveness. Three different effect sizes were computed: active versus wait list, active versus alternative treatment, and pre- to posttreatment improvement rates. The active versus wait list overall effect size (0.58) indicated that the average recipient of group treatment is better off than 72% of untreated controls. Improvement was related to group composition, setting, and diagnosis. Findings are discussed within the context of what the authors have learned about group treatment, meta-analytic studies of the extant group literature, and what remains for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic review of the effectiveness of inpatient group psychotherapy.

The effectiveness of inpatient group therapy was estimated in a meta-analysis of 24 controlled and 46 studies with pre-post-measures published between 1980 and 2004. Diagnosis, theoretical orientation and the role of the group in the particular treatment setting were used to examine differential effectiveness. Beneficial effects were found for inpatient group therapy in controlled studies (d = 0.31) as well as in the studies with pre-post-data (d = 0.59). Differences in the homogeneity of patient improvement effect sizes were found across different diagnostic categories. Furthermore, greater improvement was exhibited in mood disorder patients when compared to mixed, psychosomatic, post traumatic stress disorder (PTSD), and schizophrenic patients replicating recent findings from meta-analyses of outpatient group treatment. A comparison between controlled studies and pre-post-measure studies indicated no improvement for waitlist patients which contradicts previous reports. Implications for therapy and future research are discussed within the context of methodical considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review.

The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p .10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Co-therapists and the creation of a functional psychotherapy group: A group dynamics perspective.

This article supports Dugo and Beck's (1997) proposal that co-therapy teams should move through the early phases of their own development as a team before meeting with a therapy group. Effective leaders facilitate group development by meeting the needs of the group at various stages. To do this, co-therapists must agree on the nature of those needs. Co-therapists need to develop a united front, a shared purpose, and a shared action plan. If these are lacking, the chances of successful outcomes are diminished. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bias in meta-analytic estimates of the absolute efficacy of psychotherapy.

Meta-analytic estimates of the absolute efficacy of psychotherapy indicate an effect size of approximately 0.80. However, various biases in primary and meta-analytic studies may have influenced this estimate. This study examines 4 nonsystematic biases that increase error variance (i.e., nonrandomized designs, methodological deficiencies, failure to use the study as the unit of analysis, and violations of homogeneity), 4 underestimation biases that primarily concern psychometric issues (i.e., unreliability of outcome measures, failure to report nonsignificant effect sizes, nonoptimal composite outcome measures, and nonstandardized outcome measures), and 8 overestimation biases (i.e., excluding nonsignificant effects from calculations of effect size estimates, failure to adjust for small sample bias, failure to separate studies using single-group pre-post designs vs. control group designs, using unweighted average effect sizes, analyzing biased partial samples that reflect treatment dropout and research attrition, researcher allegiance bias, publication bias, and wait-list control group bias). Wherever possible, evidence regarding the magnitude of these biases is presented, and methods for addressing these biases separately and collectively are discussed. Implications of the meta-analytic evidence on psychotherapy for the effect sizes of other psychological interventions are also considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of group psychotherapy for older adult clients: A meta-analysis.

This review examined the effectiveness of group psychotherapy for older (55+) adults. Results from 44 studies with pre-post designs and 27 controlled studies indicated that group psychotherapy benefits older adults, with average rs of .42 and .24 for pre-post and controlled designs, respectively. The type of therapy provided and the age of the clients were associated with pretreatment to posttreatment improvement. Clients in cognitive-behavioral group therapy improved more than those receiving reminiscence therapy. The older the average age of the group members, the less they benefited from therapy. Number of sessions attended, length of therapy sessions, the percentage of women in the group, and client living situation were not significant moderators of outcome. Overall, group interventions for older adults appear to be effective and the average effect size for pre-post studies was quite similar to those yielded by meta-analyses of group therapy with younger adults and adolescents. However, the average effect size for controlled studies of group therapy with older adults appears to be somewhat smaller than the values reported in meta-analyses with younger clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Views from a distant shore: A social psychological perspective on group psychotherapy.

A brief commentary is offered on M. McCallum and W. E. Piper's (see record 1999-08068-001) article that describes their research on the effectiveness of a group psychotherapy program for treating patients with personality disorders. One set of comments examines the strengths and weaknesses of that article, whereas another set identifies potential linkages between the article and social psychological work on small groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Men's development and psychotherapy: A psychoanalytic perspective.

Addresses the issue of men's defensive autonomy by considering research on women's growth and development (e.g., C. Gilligan, 1982). The balancing of autonomy and affiliation as proposed by H. Kohut (1971) and W. S. Pollack (1983) is suggested as a solution for the developmental dilemmas between being relationally connected vs self-stabilizing that can lead to emotional distress in men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Catharsis in psychotherapy: A new perspective.

Reviews contemporary thinking about catharsis in psychotherapy, which is still dominated by J. Breuer and Freud's work with the cathartic method. Psychoanalysts view the fact that Freud abandoned catharsis as evidence of its ineffectiveness, while the emotive therapies developed in the 1960's returned to Freud's earliest view that neurosis results from repressed affect and can be cured by cathartic uncovering. Emotional memories continue to be thought of as foreign bodies lodged in the human psyche and requiring purgation. It is argued that this view divorces people from responsibility for their conduct and encourages a fractionation of human experience into feeling, thought, and action. It is proposed that catharsis is, instead, a label for completing a previously restrained or interrupted sequence of self-expression. It is accompanied by recovery manifestations of some sort, for example, tears or angry shouting. Implications of this view for psychotherapeutic practice are proposed, using examples of patients going through catharsis. It is concluded that therapists should allow catharsis as a means of helping patients discover their predilections, but should recognize this as a preliminary step. After blocked aspects of self have been discovered, then the patient must begin to claim responsibility for choosing more congruent actions and appropriate social expressions, thereby defining a richer, more satisfying existence. (60 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral therapy and group interpersonal psychotherapy for the nonpurging bulimic individual: A controlled comparison.

Evaluated the effectiveness of group cognitive-behavioral treatment (CBT) and group interpersonal psychotherapy (IPT) for binge eating. 56 women with nonpurging bulimia were randomly assigned to 1 of 3 groups: CBT, IPT, or a wait-list control (WLC). Treatment was administered in small groups that met for 16 weekly sessions. At posttreatment, both group CBT and group IPT treatment conditions showed significant improvement in reducing binge eating, whereas the WLC condition did not. Binge eating remained significantly below baseline levels for both treatment conditions at 6-mo and 1-yr follow-ups. These data support the central role of both eating behavior and interpersonal factors in the understanding and treatment of bulimia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy.

This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical significance of psychotherapy for unipolar depression: A meta-analytic approach to social comparison.

[Correction Notice: An erratum for this article was reported in Vol 55(3) of Journal of Consulting and Clinical Psychology (see record 2008-10745-001). The data presented in Table 2 were incorrect because a row and a column were inadvertently omitted. The corrected Table 2 appears in the erratum.] This study used meta-analysis to study the clinical significance of psychotherapy for symptoms of unipolar depression. The following questions were addressed: How similar is the posttherapy adjustment of depressed adults to that of nondepressed adults? Is this adjustment maintained at follow-up? What dimensions of treatment, therapists, or design are associated with clinical significance? Using the Beck Depression Inventory (BDI), we calculated composite BDI norms from 28 published studies. Sixty effect sizes (from 31 outcome studies utilizing the BDI) were calculated. The results indicated that psychotherapy produces outcomes that have moderate clinical significance and that are well-maintained at follow-up, that individual therapy is associated with greater clinical significance than group treatment, and that type of therapy is not related to improvement. Alternative approaches for operationalizing clinical significance as the return of individuals to normal levels of functioning are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment delay, outcome, and satisfaction in time-limited group and individual psychotherapy.

As part of a randomized clinical trial in which we compared outcome in time-limited individual and time-limited group psychotherapy, patients were interviewed and completed a battery of assessment measures. All participants in the study were then randomly assigned to one or the other treatment modality. There were inevitable delays before patients began their assigned therapies. Group treatment patients waited an appreciably longer period of time, on average, than did individual treatment patients (48 days vs. 31 days). Nonetheless, it was only for individual therapy patients that we found a highly significant relationship between this delay and treatment satisfaction at the completion of therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Noninterpretive interventions in psychoanalysis and psychotherapy: A developmental perspective.

One of the more important issues confronting psychoanalysis and psychotherapy seems to involve the clinical and theoretical aspects of so-called noninterpretive interventions. Advances in infant research, developmental psychology, and clinical theory may aid in shedding new light on the role and mechanisms of action of a variety of noninterpretive interventions and clinical concepts, including validation and confirmation, mirroring, clarification, "holding environment," negative therapeutic reactions, and others. In addition, these advances may enhance the understanding of the nature of change in psychoanalysis and psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance in individual psychotherapy.

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as “alliance,” “therapeutic alliance,” “helping alliance,” or “working alliance” were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r = .275 (k = 190); the 95% confidence interval for this value was .25–.30. The statistical probability associated with the aggregated relation between alliance and outcome is p     

A comparison of computer-based versus traditional individual psychotherapy.

Professional psychologists are challenged to determine the appropriate use of interactive computer therapy programs. Although such programs have the potential of enhancing delivery of mental health services and reaching ever broader audiences, they raise serious clinical, legal, ethical, and practical concerns. This article reports on a controlled clinical trial comparing short-term traditional individual therapy with a computer-based intervention among 90 adults overseen by a therapist. Results were favorable and comparable in both conditions, with individual therapy outperforming computer-based therapy on some measures. The practitioner's use of computer-based psychotherapy interventions is discussed and some guidelines offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploratory in-session process research in individual psychotherapy: A review.

The goal of exploratory process research is to describe what occurs within psychotherapy sessions, eventually leading to the development of theories based on the accumulation of replicated results. Several areas in which exploratory methods are currently being used are described: therapist techniques, client behavior, covert processes, process models, interactions between therapist and client, and therapy events. Additionally, several areas in which exploratory methods would be useful for future research are described: the links between client personality characteristics, therapy process, and outcome; the timing and quality of therapist interventions; and client readiness for the therapist interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative outcomes for individual cognitive-behavior therapy, supportive-expressive group psychotherapy, and sertraline for the treatment of depression in multiple sclerosis.

This study compared the efficacy of 3 16-week treatments for depression in 63 patients with multiple sclerosis (MS) and major depressive disorder (MDD): individual cognitive- behavioral therapy (CBT), supportive expressive group therapy (SEG), and the antidepressant sertraline. Significant reductions were seen from pre- to posttreatment in all measures of depression. Intent-to-treat and completers analyses using the Beck Depression Inventory (BDI; A. T. Beck, C. H. Ward, M. Medelson, J. Mock, & J. Erbaugh, 1961) and MDD diagnosis found that CBT and sertraline were more effective than SEG at reducing depression. These results were largely supported by the BDI-18, which eliminates BDI items confounded with MS. However, the Hamilton Rating Scale for Depression (M. Hamilton, 1960) did not show consistent differences between treatments. Reasons for this inconsistency are discussed. These findings suggest that CBT or sertraline is more likely to be effective in treating MDD in MS compared with supportive group treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)