Differential Effectiveness of Open Versus Closed Psychotherapy Groups: A Systematic Review

OBJECTIVE

This systematic review aimed to provide an overview of the state of research on the effectiveness of open versus closed psychotherapy groups, from the beginning of empirical research on these groups to the present.

METHODS

A literature search in seven databases and a supplementary search of the reference lists of 23 relevant articles were conducted between August 2022 and October 2023. Seventy-two articles were identified and screened for eligibility.

RESULTS

Twenty-seven articles met the inclusion criteria and were included in the review. Outcomes are reported by study design (randomized controlled trial, quasi-experimental, descriptive). Information on each study's sample, setting, types of groups, process versus outcome measures, and outcome evaluation is provided. Findings suggest that open and closed psychotherapy groups have the same effect on reducing symptoms of mental disorders. Perception of group cohesion was phase dependent in closed group therapies, whereas cohesion was perceived as more constant in open group therapies.

CONCLUSIONS

The question of how group therapy format may affect therapeutic outcomes and processes has been posed over the past 50 years, but trials are heterogeneous and robust conclusions cannot be made. Systematic research on the differential effectiveness of open versus closed psychotherapy groups is scarce. On the basis of empirical findings to date, no global superiority of either open or closed group therapy exists. Open and closed group therapies are equally effective, presumably because of different effect factors. An indication for open or closed group therapy must be made according to clinical requirements on a case-by-case basis.

Development and preliminary validation of the Group Cognitive Therapy Scale

Aim

The aim of this research was to create a scale to assess the competency of therapists who conduct group cognitive behavioral therapy (G-CBT). The scale is intended to serve as a tool to aid the training of therapists.

Methods

Three stepped studies were conducted. Process 1: Through literature review and experts' consensus process, essential skills for G-CBT were articulated and categorized according to the criteria of the Cognitive Therapy Scale, a well-established rating scale for evaluating clinicians' skills in individual cognitive behavioral therapy. The list of those skills was organized into a rating scale. Process 2: Behavioral anchors were added to each skill and were classified by the levels of difficulty (beginner, intermediate, and advanced levels), based on the rating by G-CBT experts. Process 3: Inter-rater reliability and validity of the rating scale were examined in a sample of 41 videotaped G-CBT sessions of actual clinical sessions and educational role-plays.

Results

The 12-item Group Cognitive Therapy Scale (G-CTS) was developed. It consists of 11 items that are adapted from the original Cognitive Therapy Scale, and a new 12th item called "Intervention using relationships with other participants," which describes therapists' skills to address group dynamics. The G-CTS showed excellent internal consistency (Cronbach's α: 0.95), satisfactory inter-rater reliability (interclass correlation coefficients: 0.65-0.88), and high predictive validity.

Conclusion

A novel rating scale to evaluate therapists' competency in G-CBT was developed and successfully validated. The G-CTS behavioral checklist created in this study provides concrete guidelines that can be used by therapists to hone their skills in G-CBT.

Psychosocial Benefits of Cooking Interventions: A Systematic Review

OBJECTIVES

Cooking interventions are used in therapeutic and rehabilitative settings; however, little is known about the influence of these interventions on psychosocial outcomes. This systematic review examines the research evidence regarding the influence of cooking interventions on psychosocial outcomes.

METHODS

A systematic review of the literature examined peer-reviewed research using Embase, PubMed, CINALH Plus, and PsychInfo with the following search terms: cooking, culinary, baking, food preparation, cookery, occupational therapy, mental health, mood, psychosocial, affect, confidence, self-confidence, self-esteem, socialization, and rehabilitation. Inclusion criteria were the following: adults, English, influence of cooking interventions on psychosocial outcomes. PRISMA guidelines were used.

RESULTS

The search yielded 377 articles; and 11 ultimately met inclusion criteria and were reviewed. Generally, the quality of the research was weak due to nonrandomization, unvalidated research tools, and small sample sizes. However, inpatient and community-based cooking interventions yielded positive influences on socialization, self-esteem, quality of life, and affect.

CONCLUSIONS

Finding benefits to cooking that extend beyond nutritional may be helpful in increasing motivation and frequency of cooking. This review suggests that cooking interventions may positively influence psychosocial outcomes, although this evidence is preliminary and limited. Further qualitative and rigorous quantitative research are needed to identify mechanisms by which cooking interventions may improve psychosocial outcomes.

The Relation of Client Behavior and Therapist Helping Skills to Reduced Aggression of Boys in Individual and Group Treatment

In this study behavioral processes in the individual and group therapies of aggressive boys were compared and the relationship between these variables and treatment outcome was examined. Level of aggression was the outcome variable, measured by both self-report and teacher-report instruments. Hill's Client Behavior System (CBS; Hill, 1986) with our own ad hoc categories of Reference to Literary Figures and Response to Another, and therapist Helping Skills System (HSS; Hill & O'Brien, 1999) were the behavioral process measures. In terms of the boys' behaviors, discriminant function analyses revealed that Reference to Literary Figures and Response to Another differentiated the treatment formats; with regard to therapists' behaviors, Questions and Challenge differentiated the modalities. Results offered partial support for the greater effectiveness of group, compared to individual, therapy in reducing aggression. Outcome, however, as measured by teacher reports of aggression, was adversely affected in group therapy by the presence of specific behaviors in the boys. Implications of the findings for modifying the group therapy program as well as for the search for process variables appropriate to the treatment of aggressive children are discussed.

Group Interventions for Patients with Cancer and HIV Disease: Part I: Effects on Psychosocial and Functional Outcomes at Different Phases of Illness

Group interventions for individuals facing cancer or HIV disease have drawn considerable attention among researchers and clinicians over the past 20 years. There is growing evidence that group services may be helpful, but which interventions are most effective for participants at which phases in the trajectory of disease has been less clear. Moreover, professionals working in different intervention settings (e.g., primary prevention vs. clinical care) and different disease sites (cancer vs. HIV disease) often have little awareness of relevant advances in other fields. Efforts to integrate findings in the literature may accelerate research and advance the standard of clinical care. The current article, the first in a series of four special reports, critically evaluates the efficacy of group interventions led by professional or trained facilitators for individuals confronted by cancer or HIV, across the spectrum of illness from elevated risk through advanced disease. We examine psychosocial and functional outcomes for different interventions directed toward different patient subgroups, trace common themes, highlight limitations, and offer recommendations for further research.

Group work with bereaved individuals: the power of mutual aid

Group work has been underused as an intervention with grieving clients. This is despite the fact that group membership offers bereaved individuals a number of unique advantages. In this article, the use of group work with bereaved individuals is examined, based on current theory and research. The role and skills of the group worker are identified and illustrated through the use of case examples. Challenges associated with working with groups for bereaved individuals also are discussed.

Children with and without learning disabilities: a comparison of processes and outcomes following group counseling

This study compared outcomes and processes in counseling groups of an expressive-supportive modality for children with learning disabilities (LD) and without them (NLD). Participants were 266 students (ages 10-18), all referred for emotional, social, and behavioral difficulties; of these, 123 were identified with LD and 143 were not. There were 40 groups in all--20 with LD children and 20 with NLD. Outcome variables included adjustment, social competence, and academic achievements. Process variables included bonding, group functioning, and client behavior. Analyses were nested using mixed models. Results indicated no differences in outcomes or process variables between populations except for academic achievements; some between-group differences were found in the effect of processes on outcomes. It was concluded that children with LD may be successfully treated in expressive-supportive counseling groups for their emotional and social difficulties.

Therapeutic Factors in Group Counseling: Implications for Audiologic Rehabilitation

The purpose of this article is to describe therapeutic factors that constitute mechanisms of change in group intervention. These therapeutic factors occur in groups with varied populations in varied settings and have important implications for group approaches to aural/audiologic rehabilitation. Factors included in the review are universality, instillation of hope, imparting information, altruism, imitative behavior, group cohesion, interpersonal learning, development of socializing techniques, recapitulation of the family, catharsis, and existential issues. The discussions largely are based on Irvin Yalom’s therapeutic factors but include references from a wide-range of sources throughout the medical, psychological, and rehabilitative fields.

Using therapeutic board games to promote child mental health

This article focuses on group work with children using a board game format. Combining the principles of group work and board games helps to engage and motivate children and adolescents to address and work through their difficulties. Lifegames are a series of six therapeutic board games developed for group work with children and adolescents who encounter adversity in their life as a consequence of bereavement, family break up, poor relationships, bullying, chronic illness or obesity. The games facilitate the understanding and disclosure of the complex feelings experienced by children and young people when they are confronted with traumatic life events. The games encourage and assist the participants to obtain and maintain behavioural change. Lifegames are a means to assist professionals in their group work with children and adolescents.

Group therapy for substance use disorders: what do we know?

Although group therapy is the most prevalent treatment modality for substance use disorders, an up-to-date review of treatment outcome literature does not exist. A search of the literature yielded 24 treatment outcome studies comparing group therapy to other treatment conditions. These studies fell into one of six research design categories: (1) group therapy versus no group therapy; (2) group therapy versus individual therapy; (3) group therapy plus individual therapy versus group therapy alone; (4) group therapy plus individual therapy versus individual therapy alone; (5) group therapy versus another group therapy with different content or theoretical orientation; and (6) more group therapy versus less group therapy. In general, treatment outcome studies did not demonstrate differences between group and individual modalities, and no single type of group therapy reliably demonstrated greater efficacy than others. Unique methodological and logistical hurdles encountered in research on group therapy for substance use disorders, as well as considerations for future research, are also discussed.