Current practice of group therapy at university counseling centers: A national survey.

The purpose of this study was to gain an understanding of the current practice of group psychotherapy at university counseling centers. A group usage survey was developed and used to assess the current practice of group psychotherapy. Surveys were distributed to 232 counseling center directors, with 148 responding, yielding a return rate of 64%. The results of the study indicate that the typical group consists of 5–8 members, is co-led for 1.5 hrs, and meets weekly in the late afternoon. Results include information about group screening, preparation, and other group factors. Although group therapy is a widely practiced therapeutic modality, it appears that it is not carrying enough of the burden of treatment delivery despite the widespread administrative constraints on treatment length and the concurrent high level of demand for services in university counseling centers. Implications for practice and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structured activity: Discussion group psychotherapy for latency-aged children.

Describes a group psychotherapy design that applies principles and methods derived from both the psychoanalytic and behavioral models of group psychotherapy for latency-aged children. The design also uses such structuring techniques as selection of member-leaders to help the group organize itself and alternating activity and discussion periods. In initial group sessions, the therapist and group members focus on establishing prosocial rules and procedures for group interaction. In subsequent sessions, group members assume responsibility for maintaining the group structure and for confronting each others' problem behaviors, while the therapist focuses on clarifying and interpreting interaction among group members. The design is discussed in terms of changes in the structure, therapist role, and focus that occur as the group develops. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference considerations for the gay male when leading psychotherapy groups for gay men

During the last decade we have seen the development of gay-affirmative psychotherapy and an increase in the use of homogeneous psychotherapy groups for gay men. Today there is greater acceptance that homosexuality is a normal variant within human sexuality and that being gay both describes the focus of one's sexual and emotional expression and constitutes a central aspect of one's core identity. In their pursuit of full acceptance of their lesbian or gay identity, lesbians and gay men continue to experience pressures that are unique, however. Within a psychotherapy group, when the group leader is gay, the process by which the group members work on their transference reactions, as well as their internalized homophobia and shame, can evoke strong countertransference in the gay male group leader and his supervisor; this countertransference is at times distinctly different than that with a nongay group therapist. This article highlights many countertransference themes in such groups and proposes ways to identify and manage these themes.     

Assessment considerations in the identification of failing psychotherapy: Bringing the negatives out of the darkroom.

Although failures in psychotherapy are widely acknowledged, minimal attention has been given to their assessment. However, early detection of failing psychotherapy is essential if harmful and cost-ineffective outcomes are to be avoided. Prior approaches to the study of psychotherapy failure are considered and a conceptual framework for detecting failing treatment is presented. The identification of failing psychotherapy requires the use of assessment practices that are theory-based, ongoing, have treatment utility, and are sensitive to intermediate outcomes and individual change. It is recommended that specific strategies for the detection of failing treatment, and an integration of assessment and treatment practices more generally, can be advanced through the development of an assessment infrastructure that is sensitive to both clinical and research needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of ambulatory psychotherapy by patients with endogenous depression after inpatient psychiatric treatment

The long-term course of major depressive disorder is often accompanied by relapses or chronicity. Since psychosocial factors have been shown to be important predictors for the long-term outcome, psychotherapy along with drug therapy belongs to the standard methods of treatment. In spite of the effectiveness of psychotherapy, only some of the inpatients are treated with outpatient psychotherapy after hospital discharge. Within the framework of the Heidelberg depression study the authors examined what kind of, how many and for how long endogenously depressed patients sought out-patient psychotherapy after an inpatient treatment in a two-year follow-up. During the follow-up one half of patients were treated with outpatient psychotherapy. They were found to be younger, had suffered from more previous episodes, and their personality was more disturbed than those who had not undergone psychotherapy. The Expressed Emotion index did not make any further difference, whereas certain aspects of partnership quality did. The distinction between the two groups of patients is discussed regarding possible selection processes by treatment indication. It is pointed out that research on synergistic cooperation between members of the mental health services is highly desirable.     

Social climate comparison of mutual help and psychotherapy groups.

Mutual help groups for the mentally ill (n?=?33) were significantly different from psychotherapy groups (n?=?25) on 9 of 10 perceived social climate dimensions from the 90-item Group Environment Scale. The mutual help members perceived that their groups had more active leaders, greater group cohesion, more structure and task-orientation, and fostered more independence. The members of psychotherapy groups perceived that their groups encouraged more expression of negative and other feelings and showed more flexibility in changing the group's activities. The present findings could be used to improve cooperation and referrals between mutual help groups and the mental health community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on recruiting and retaining minorities in psychotherapy research

This article introduces a special section devoted to the issue of recruiting and retaining ethnic minorities in psychotherapy research. Although minorities make up approximately 27% of the population of the United States (U.S. Bureau of the Census, 1994), the major psychotherapy studies conducted to date have been based almost exclusively on White populations. In March 1994, however, a new policy of the National Institutes of Health (NIH) mandated that women and members of ethnic minority groups be included in all NIH-funded projects involving human participants, unless a clear and compelling rationale justifies their exclusion. Knowledge about effective and culturally sensitive means of contacting, recruiting, and retaining minorities is an important resource for researchers who now wish to conduct NIH-funded studies. In the series of articles constituting this special section, strategies and advice are provided for researchers who want to recruit and retain minorities in psychotherapy research.     

An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures.

Nonepileptic seizures (NES) are one of the most common functional (medically unexplained) symptoms seen by neurologists. Although most experts consider psychotherapy the treatment of choice, few therapeutic approaches have been described in detail. Given that NES occur in the context of many different psychopathologies, it remains uncertain whether there is 1 intervention that can benefit all comers or whether it is necessary to offer individualized psychotherapy. This article describes an approach grounded in psychodynamic interpersonal therapy but augmented with elements of cognitive–behavioral therapy, somatic trauma therapy, and the involvement of caregivers and family members. The approach was developed in the setting of a specialist psychotherapy service for patients with functional neurological disorders presenting to British hospital-based neurologists. The authors have previously shown that it is associated with significant improvements in psychological functioning, health-related functioning, and a symptom count. Three case reports illustrate how the treatment can be adapted to meet different patients' needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cohesion in group psychotherapy.

Insight into the therapeutic relationship in group psychotherapy requires an understanding of the treatment context. Cohesion is defined as the therapeutic relationship in group psychotherapy emerging from the aggregate of member leader, member-member, and member-group relationships. Using this definition, evidence for the relationship between cohesion, patient outcome, an treatment processes is reviewed. Six empirically supported principles that undergird the development and maintenance of cohesion are presented touching on pregroup preparation, ear group structure, leader interaction, feedback, leader modeling, and member emotional expression. The limitations the present research are discussed; leading to opportunities for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model of time-effective group psychotherapy for patients with personality disorders: the clinical model

This article describes a model of time-limited psychotherapy for patients with personality disorders that emphasizes the group as a social microcosm. The patient population described is relatively high functioning, although the majority of the group members meet DSM-III-R (American Psychiatric Association, 1987) criteria for an Axis II diagnosis. The clinical model's key theoretical concepts, for example, interpersonal focus; active therapist stance; emphasis on group interaction and processes; use of time limits; primary care/intermittent treatment philosophy; and emphasis on patients' strengths, goals, and resources are described. The relationships between the phases of group therapy and the key theoretical concepts are delineated.     

Treatments of hysteria

Treatment of hysteria requires establishing a management strategy. The first steps consist of symptomatic treatment (catharsis, counter-suggestion, hypnosis, narco-analysis, relaxation, focused psychoanalytical psychotherapy, drug therapy). Thereafter, an approach aiming to modify the psychic structure of the patient can be considered (supportive psychotherapy, psychoanalysis). Occasionally, a systemic approach is necessary. Although each facet of the treatment must be conducted by a specialist, one physician must supervise the overall strategy; this role falls naturally to the family doctor.     

Third-party payment and the outcome of psychotherapy.

Theorists have long debated whether the efficacy of psychotherapy is enhanced when clients are required to pay for their treatment. The aim of the present experiment was to assess this issue in a naturally occurring clinical setting. Clients in the study were individuals who had sought psychotherapy from a low-cost treatment center. One group of clients paid the fees normally charged by the treatment center, whereas another randomly selected group did not pay because a grant was used to cover the cost of their therapy. Results failed to reveal any reliable difference in the outcomes of clients who had paid for treatment and those whose treatment had been subsidized. These findings suggest that the effectiveness of psychotherapy is not impaired when someone other than the client pays for the therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effectiveness of group psychotherapy during the first three weeks of hospitalization. A controlled study

Insight-oriented group psychotherapy is a common modality of treatment on inpatient psychiatric wards, yet is effectiveness for acutely hospitalized patients has not been adequately studied. A comparison was made of the effects of three experimental conditions (insight-oriented group psychotherapy, activity-oriented task group, and unstructured control condition) on 86 acutely hospitalized psychiatric patients at a United States Air Force teaching hospital. The group psychotherapy and task group patients did not show greater improvement after 20 days of hospitalization than control patients. In fact, significantly more psychotic patients scored worse in the group psychotherapy condition. It is suggested that insight-oriented group psychotherapy may not be an effective treatment modality during the first 3 weeks of psychiatric hospitalization, especially for psychotic patients.     

Social stigma and self-esteem: The self-protective properties of stigma.

Although several psychological theories predict that members of stigmatized groups should have low global self-esteem, empirical research typically does not support this prediction. It is proposed here that this discrepancy may be explained by considering the ways in which membership in a stigmatized group may protect the self-concept. It is proposed that members of stigmatized groups may (a) attribute negative feedback to prejudice against their group, (b) compare their outcomes with those of the ingroup, rather than with the relatively advantaged outgroup, and (c) selectively devalue those dimensions on which their group fares poorly and value those dimensions on which their group excels. Evidence for each of these processes and their consequences for self-esteem and motivation is reviewed. Factors that moderate the use of these strategies and implications of this analysis for treatment of stigmas are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The contribution of group cohesion and group alliance to the outcome of group psychotherapy

The contribution to outcome of two group-process factors, group cohesion and group therapeutic alliance, was tested in the context of a randomized, controlled treatment trial for borderline personality disorder. Group members from four time-limited groups of an experimental model of group psychotherapy completed measures of group cohesion and group alliance at prespecified intervals across the 30-session therapy. Outcome was measured in terms of psychiatric symptoms, social adaptation, and indicators of behavioral dysfunction. The results showed that cohesion and alliance were correlated significantly and separately contributed to outcome on most of the dependent measures. Stepwise regression analyses showed, however, that when compared with cohesion, alliance accounted for more outcome variance on the dependent measures. The clinical implications of the findings and the limitations of the study are discussed.     

Therapeutic applications of groups: From Pratt's "thought control classes" to modern group psychotherapy.

The therapeutic application of groups has a long and nonlinear history. Group psychotherapy, drawing on research and applications from diverse fields, covers an array of topics from psychoeducation to analysis (often blurring the boundary between group psychology and group psychotherapy). The efficacy of group psychotherapy has been established in the empirical literature. The progression of topics or themes in group psychotherapy has moved from concerns about leadership to members, interactions, and the resultant group processes such as therapeutic factors. These topics of interest, assessed throughout the century using methodologies form simple tallies to complex sequential equation modeling, have become increasingly sophisticated to match the complexity of a system that attempts to track member-to-member, leader-to-member, and member-to-leader interactions. A brief look at the past nearly 100 years of group psychotherapy is reviewed here, highlighting history, research, extant theory, and application, all of which illuminate how group therapy acts as a change agent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guest editors' introduction.

The idea, or seed for this special series on psychotherapy training originally grew from a panel that took place at the 2006 North American Society of Psychotherapy Research (NASPR) conference in Burr Oak, Ohio. Although adhering to different theoretical perspectives and representing diverse professional backgrounds, the contributors to this panel (the authors in this series) agreed that little more than a dearth of research has been conducted on psychotherapy training. This knowledge gap, to a certain degree, mimics the current status of psychotherapy research. Given that we know that psychotherapy works, it seems reasonable to conclude that something is working in the training of psychotherapists. We are, however, less confident in our ability to explain how psychotherapy works, and, similarly, we are less knowledgeable about what are the most effective (and ineffective) elements of training. In our view, just as we pursue the question of how psychotherapy works in the hope of improving treatment outcomes, we should also pursue a greater knowledge base regarding psychotherapy training in the hope of improving training programs, and ultimately treatment outcomes. One goal of this series is to offer a variety of perspectives on effective psychotherapy training based on empirical knowledge, theory, and clinic experience. Another important goal of this series is to provide directives for future research on training, in the hope of providing a framework from which to begin addressing the aforementioned gap in the field's knowledge base. Thus, each of the four following papers is comprised of two parts: one addressing important elements of a training program and another that is focused on future directions for research on training. In addition to the common structure of the papers in this series, we believe that each paper plays a complimentary role in relation to the others. Although the authors of this series agree on the importance of training, they all believe that much more needs to be done to better understand and foster the development of effective therapists. As such, our hope in putting together this series was to encourage the field to actively pursue better ways to think about and conduct psychotherapy training, as well as to devote more energy in research aimed at addressing some of the critical questions raised by this complex endeavor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Removing the roadblocks: Group psychotherapy with substance abusers and family members.

Reviews the book, Removing the roadblocks: Group psychotherapy with substance abusers and family members by Marsha Vanicelli (1992). It is rare to find a theoretically guided treatment text covering the topics of family and addictive behaviors which avoids a heavy handed lecture on either the absolute unquestionable value of abstinence (and its supremacy as the only goal of treatment) or on the ridiculousness of abstinence-based treatment. Too often, the former are read only by adherents of AA, the latter by academics and apparently never shall the twain meet. Vannicelli, however, takes a different tack. Rather than get caught up in that debate, she takes a pragmatic stance based on the importance of affective experience and group process. She argues that substances minimize individuals' ability to truly experience the emotional reactions so central to the type of group therapy she outlines. This book is clearly directed at the practically oriented therapist. Issues are covered in a sensible and quite usable way. In fact, in some respects, the title is unfortunate in that many individual therapists who could benefit from at least some of Vannicelli's clinical experience are unlikely to select this "group psychotherapy" text. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient group psychotherapy for the elderly: an alternative to institutionalization

Two case studies illustrate the positive effects of group psychotherapy for elderly outpatients of a municipal hospital in an industrial community of Baltimore. Most of the outpatients were depressed about physical, mental, or social losses. A total of five brief therapy groups were established. Each group had a maximum of 12 members and met in the hospital for an hour and a half once a week for 12 consecutive weeks. Members could continue in subsequent 12-week sessions if they desired. As a result of their participation in groups, many members became involved in volunteer or part-time work, renewed contact with family and friends, and were better able to deal with life's stresses.     

A relational approach to group therapy for women with bulimia nervosa: moving from understanding to action

This article explains how the psychology of women can inform group treatment by translating relational theory (RT) into practice within a short-term outpatient bulimia group. First, the article provides a brief overview of a relational understanding of women's psychological development, the etiology and maintenance of bulimia nervosa, and group psychotherapy. Then, clinical vignettes illustrate the application of RT in practice through discussion of four main healing factors at work in the different stages of the group. Through promoting validation, self-empathy, mutuality, and empowerment, the leader helps group members identify and change relational patterns that have kept them connected with food and disconnected from themselves and others. The goal of treatment is to help members move toward mutually empathic and empowering relationships inside and outside the group.