Therapeutic Factors and Member Satisfaction in an Online Group Intervention During the COVID-19 Pandemic

The purpose of the present study was to evaluate members' perceptions of the therapeutic factors during a group intervention that was designed to mitigate the adverse psychological effects of the coronavirus pandemic and the imposition of restrictive measures, their satisfaction with the online format of the intervention, and how these are associated with the intervention's outcomes. The participants (N = 44, M _age  = 31.93, SD = 8.09) were Greek adults who attended a 2-week, voluntary, online group intervention. To assess the effectiveness of the intervention, 1 week before and 1 week after implementation, participants completed several questionnaires measuring their demographic characteristics, empathy, resilience, affectivity, feelings of loneliness, depression and anxiety levels, and feelings of fear regarding the outbreak. One week after the intervention, they also completed two questionnaires evaluating the therapeutic factors and their satisfaction and impressions regarding telemental health counseling. Analyses showed that the most frequently cited therapeutic factor was guidance, followed by acceptance, self-disclosure, universality, and instillation of hope. Therapeutic factors of catharsis, self-disclosure, guidance, self-understanding, vicarious learning, and therapeutic alliance correlated with elements of empathy, resilience, loneliness, positive emotions, symptoms of anxiety and depression, and fear of the coronavirus. Satisfaction with the online format of the intervention was associated to universality, elements of empathy, and symptoms of depression. More specifically, member satisfaction was negatively correlated with improvement in personal distress and depression, an unexpected finding that may be attributed to the brief duration of the present intervention. The practical value of the results for the development and implementation of online psychological interventions during a crisis is discussed.

Therapeutic Factors in Adolescents' Groups With and Without Movies

The study explores the therapeutic factors in two types of group interventions--film therapy (n = 69) and affective support therapy (n = 48) for Arab adolescents (ages 13-14) in Israel. Film therapy is a relatively new method for groups, aimed at enhancing adolescents' engagement in the process of group counseling. Six-hundred students from 11 schools were screened for the level of parent-adolescent conflict, based on a self-report measure. The 117 students who met the cutoff point constituted our sample. They were randomly divided into 12 small groups (6 in each type of intervention). A previous study reported the outcomes of these two interventions, showing equal progress in both groups (compared to control). The current study explores process variables, specifically therapeutic factors, in an attempt to enhance our understanding of those outcomes. Results indicated common therapeutic factors across both types of intervention. The factors of relationship-climate and other- versus self-focus were ranked the highest and, contrary to expectations, were significantly higher in affective support therapy than in film therapy.

How can adolescent aggression be reduced? A multi-level meta-analysis

Aggressive behaviour among adolescents has significant social and economic costs. Numerous attempts have been made to intervene to reduce aggression in adolescents. However, little is known about what factors enhance or diminish intervention effectiveness. The present systematic review and meta-analysis, therefore, seeks to quantify the effectiveness of interventions to reduce aggressive behaviour in adolescents and to identify when and for whom such interventions work best. Sixteen databases were searched for randomised controlled trials that assessed interventions to reduce aggression among adolescents. After screening 9795 records, 95 studies were included. A multi-level meta-analysis found a significant overall small-to-medium effect size (d = 0.28; 95% CI [0.17, 0.39]). More effective interventions were of shorter duration, were conducted in the Middle East, were targeted at adolescents with higher levels of risk, and were facilitated by intervention professionals. Potentially active ingredients were classified using the Behaviour Change Technique Taxonomy. Behavioural practice and problem solving were components of more effective interventions targeted at the general population. Overall the findings indicate that psychosocial interventions are effective in reducing adolescent aggression. Future trials need to assess the effect of individual techniques and their combination to identify the key components that can reduce aggression in adolescents.

Group Intervention with Aggressive Children and Youth Through Bibliotherapy

Aggression in the school is one of the most disturbing behaviors that teachers and students face. It is usually addressed through preventive treatments, leaving the highly aggressive students unaffected. Group psychotherapy is a viable method to treat aggressive youth, despite reservations raised in the professional literature, when therapy is adjusted to this unique population. Aggressive children and youth are quite resistant to change, thus, creative methods are needed to engage them in therapy. This article suggests an innovative intervention, using bibliotherapy as an adjunct to an integrative theory of treatment, adjusted to the specific characteristics of aggressive children. The article describes the intervention, its theoretical foundation, and provides wide evidence for its effectiveness with aggressive children and youth.

Why Do People Prefer Individual Therapy Over Group Therapy?

The current study aims to identify the reason people avoid group therapy despite its recognized effectiveness. Participants were 224 university students, men and women from two ethnic groups (Jewish and Arab) in Israel. We asked them to mark their preference for individual or group therapy on a 7-point scale and add five arguments in favor and against each type of therapy. Results verified the tendency to prefer individual over group therapy, with minor gender or ethnic effects. Participant arguments indicated accuracy in identifying the strength of group therapy, but various fears limit their enthusiasm about group therapy. The discussion focuses on possible ways to overcome those fears.

An Exploratory Study of Member Attraction, Climate, and Behavioral Outcomes of Anger-Coping Group Therapy for Children with Emotional Disturbance

This exploratory study examined member attraction, group climate, and behavioral outcomes of anger-coping group therapy with children in an urban school. Two facilitators co-led a 6-week cognitive-behavioral group intervention with five children who were identified with either emotional disturbance (ED) or exhibited difficulty with anger management. Pretest and posttest ratings on the Behavioral Assessment System for Children (BASC) were gathered from children, parents, and teachers. Children also completed the Group Attitude Scale (GAS) after the first, middle, and last group session. All group sessions were videotaped, and three independent observers viewed the tapes and completed the Group Climate Questionnaire–Short Form (GCQ-S) following each session. Results indicated that the children formed a cohesive, healthy functioning group. Parents indicated significant improvement in children's behavior on the BASC, although teachers and children did not note these changes. Clinical implications for interventions for children with ED and directions for future research are discussed

Feedback to semi-professional counselors in treating child aggression

OBJECTIVE

To investigate the impact of outcome feedback provided to semi-professional counselors of children and adolescents at risk for aggressive behavior, following group treatment.

METHOD

Participants included 230 aggressive children and adolescents and 64 educators in a quasi-experimental design of 3 conditions: experimental group with feedback, experimental group without feedback, and control group (no treatment). The current study employed a feedback system based on self-report aggression scores measured after each session, provided to teachers, including an alert system and weekly follow-up group support.

RESULTS

Outcomes were more favorable for the treatment children than the control group, but feedback had no impact on the results.

CONCLUSION

Outcome feedback provided to group therapists does not have an effect on children and adolescents' reduction of aggression. Further research is needed to identify possible reasons for failure to show feedback effect.

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.

Treating Mothers of Aggressive Children: A Research Study

In this empirical investigation, three conditions in the group therapy of aggressive children were compared: Child only treatment, Mother + Child treatment, and a notreatment control. The 75 participating children, all Druze from two cities in Israel, were assigned equally and randomly to the three conditions, 25 children in each. In addition, the mothers of these children participated in the study, with 25 of them treated in groups. A semi-structured treatment program using bibliotherapy was conducted, with some modifications, in the two therapy conditions. Results indicated that, compared to the control group, both treatment conditions were effective in reducing aggression, although the Mother + Child condition showed significantly greater gains on the children's self-report measure. With regard to maternal coping, gains were greater in the Mother + Child treatment group than in the Child treatment group on four of six subscales. Finally, three associations were found between reductions in children's aggression and changes in maternal coping.

Non-Metric Multidimensional Scaling Profile Analysis of Non-Growth Change in Groups

Whether groups develop in stages, cycles, or combinations of cycles within stages, processes guiding group development rarely follow monotonic growth patterns (e.g., linear). Standard statistical methods cannot be used to model non-growth processes because they assume that all group members manifest the same growth pattern. We demonstrate how non-metric multidimensional scaling (MDS) profile analysis detects population-level latent normative profiles of non-growth change for repeatedly measured group processes (therapeutic factors) and estimates their association with an external outcome measure (interpersonal problems). Thirty-three individuals participating in counselor training groups reported critical incidents for each of 22 consecutive sessions. Independent judges coded critical incidents using a therapeutic factors rating scheme. Three normative therapeutic factor non-growth profiles were retained, one of which (cycles of interpersonal exploring followed by retreating to safety) predicted decreases in interpersonal problems between pre-test and post-test. Identifying normative- and member-specific change patterns may aid practitioners in matching therapeutic strategies with therapeutic needs.

The mood disorders association of british columbia psychiatric urgent care program: a preliminary evaluation of a suggested alternative model of outpatient psychiatric care

OBJECTIVE

To describe an alternative model of psychiatric outpatient care for patients with mood and anxiety disorders (the Mood Disorders Association of British Columbia Psychiatric Urgent Care Program or the MDA Program) using group medical visits (GMV) and (or) email communications in lieu of individual follow-up appointments.

METHOD

Annual costs of the MDA Program were compared with average costs of private psychiatrists offering outpatient care and patients being treated in a mental health centre. In addition, questionnaires as to patient satisfaction with the MDA Program intake, GMV experience, and family physician satisfaction with the MDA Program were administered.

RESULTS

The MDA Program model of care is significantly more cost effective than individual psychiatric outpatient care or health authority mental health centre care for patients with moderate or severe illness. Patients and family physicians were very satisfied with the model of care and GMVs offered.

CONCLUSIONS

The MDA Program model of care appears to be efficient and cost-effective, and patients and referring physicians appear satisfied with the care offered in this program.

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.

School-based integrated and segregated interventions to reduce aggression

The goal of the study was to assess two types of school-based interventions--a class intervention (integrated) and a small group counseling (segregated) intervention for highly aggressive children--and to determine which is more efficacious in reducing individual and classroom aggression, lessening internalizing and externalizing behavior, and increasing positive classroom relationships. The study, conducted in Israel, included 904 children from 13 schools. In each school, one age level was selected and divided randomly into three experimental conditions: psychoeducational class intervention, small group counseling, and control. In all classrooms, the highly aggressive children were identified a priori (n=166). Analyses were conducted separately for the aggressive children and their nonaggressive classmates, in a nested procedure (mixed models). Results showed similar positive outcomes on all variables in both treatment groups, and higher compared with the control group. The discussion focuses on the strengths of each type of intervention.

Overcoming our resistances to "doing" evidence-based group practice: a commentary

This commentary focuses on how the articles in the group therapy issue of the Journal of Clinical Psychology: In Session can address the resistances that many group practitioners exhibit to "doing" evidence-based practice (EBP). The articles attempt to overcome the resistances to practicing evidence-based group therapy through a process of education and skills training. A major issue cutting across the articles is the narrow focus of incorporating empirical findings only from studies specifically examining psychotherapy groups. The author argues that incorporating research from the whole field of group dynamics research can increase the empirical basis for evidence-based practice.

Psychosocial interventions for disruptive and aggressive behaviour in children and adolescents: a meta-analysis

BACKGROUND

The effects of psychotherapy in reducing aggressive behaviours in children and adolescents using meta-analysis were estimated.

METHOD

Sixty-five studies were included, covering 4,971 cases. Teacher reported change in aggression, change in social functioning, and changes in parental distress were calculated.

RESULTS

The mean effect size (ES) of change in aggression in studies with untreated controls was 0.62 and in studies without untreated controls the ES was 0.95. In studies with or without untreated controls, the ESs in teacher reported aggression was 0.41 and 0.63, the ESs in changes in social functioning was 0.42 and 0.49, and the ESs in changes in parental distress was 0.39 and 0.47, respectively.

CONCLUSION

Psychosocial treatments aimed at reducing aggressive behaviour have positive effects and additional treatment effects are moderate. In the moderator analysis, studies with untreated controls obtained significantly larger ESs if the sample size was small. Similarly, in studies without untreated controls, studies presenting diagnostic information, and studies with younger children resulted in significantly larger ESs, and studies applying behavioural interventions obtained significantly larger ESs as compared to studies applying family therapeutic interventions. There is still a need to further develop effective outpatient interventions for children being disruptive, and especially for adolescents.

The effect of affective bibliotherapy on clients' functioning in group therapy

Abstract The effect of affective group bibliotherapy (GB) was compared to affective group therapy (GT) on patients' functioning in therapy and their session impression. Three small groups totaling twenty-five in-patients in a hospital in Israel participated in the study. Clients concurrently participated in both group types, undergoing three sessions in each condition. In-therapy behaviors were assessed through the Client Behavior System (CBS; Hill & O'Brien, 1999). Results indicated that in the GB condition compared to the GT condition, clients showed less resistance, used simple responses less frequently, and expressed greater affective exploration. The Session Evaluation Questionnaire (SEQ; Stiles et al., 1994) was used to measure clients' impressions of the sessions. Results indicated that patients evaluated the two treatment conditions equally. Overall, the results support earlier findings, suggesting that affective bibliotherapy can be an effective method of treatment.