Where is here and when is now? The adaptational challenge of mental health reform for group psychotherapy

Assessment of Change after Long-Term Psychoanalytic Group Treatment: Presentation of a Field Study of Outpatients from Private Psychiatric Practice

The main purpose of this article is to underline the importance of doing clinical research on long-term, dynamic group psychotherapy as it is carried out in practice (effectiveness study). After a review of the outcome literature, which mainly consists of experimental studies (efficacy studies), an effectiveness study from a private practice will be described with some preliminary results. Experiences from implementation of a research project in clinical practice are presented and the strengths and limitations of the two research methods are discussed.

The Group Therapist’s Shame: A Much Undiscussed Topic

The topic of shame in group therapy has received limited attention in the group therapy literature. When the topic has been addressed, the focus has been on the shame of the group members. The shame of the group leader and its effect on leadership efficacy and group process has received inadequate attention, given what seems to be its power and prevalence. In this article we examine shame and the group therapist with regard to (1) potentially shameful topics and (2) dynamics that evoke shame. Suggestions for both the mitigation of shame and the enhancement of the leader's self-esteem in dispatching the role and functions of group therapist are offered. In discussing this subject, we propose to normalize group therapist shame by emphasizing the challenges and complexity of group leadership. While the examples illustrate an array of emotions, our purpose is to focus on their shameful elements because they are (1) frequently ignored or overlooked; (2) not made explicit; or (3) discussed in other terms, such as narcissism. In doing so, we invite the reader to consider the clinical utility of the hypothesis that shame has a powerful presence and impact on our leadership image and effectiveness.

Predictors of the therapeutic alliance in group therapy for individuals with treatment-resistant auditory hallucinations

OBJECTIVES

This study hypothesized that several baseline client characteristics (i.e. age, symptoms, insight, social functioning) would significantly predict client-rated group alliance in out-patients with schizophrenia spectrum disorders.

DESIGN

Hierarchical linear modeling (HLM) was used to evaluate the contributions of selected baseline individual client characteristics and group level characteristics to client-rated group alliance at the sixth session of group therapy. The effect of treatment type (CBT vs. ST) on group alliance and interaction with predictor variables were also analysed. Finally, correlations were computed to explore the relationship between group alliance, attendance, and treatment engagement.

METHODS

Sixty-three out-patients who had treatment-resistant auditory hallucinations were randomly assigned to either group CBT, which targeted reduction of distress associated with hallucinations, or group ST, which focused on improving social integration.

RESULTS

Results indicate that a stronger group alliance at the mid-point of treatment was associated with overall higher levels of group insight, and lower individual autistic preoccupation and social functioning at the baseline assessment. In addition, stronger group alliance was significantly correlated with higher attendance rates and therapists' ratings of treatment compliance.

CONCLUSIONS

These findings have implications for determining group composition and identifying clients low in therapeutic engagement. Suggestions for future research on group alliance are also discussed.

Altruism and creative expression in a long-term older adult psychotherapy group

This article describes the use of altruism and creative expression in an older adult psychotherapy group. These interventions, for which theoretic rationale and clinical examples are provided, are designed to decrease feelings of powerlessness that accompany life changes; to facilitate insight into feelings, coping, and preventative strategies for adaptation to change and loss; and to combat stereotypes, false beliefs, and myths imposed by a youth-oriented society. An integrated therapeutic model, combining psychodynamic, supportive, and cognitive/behavioral approaches, was used in the design of this group intervention for older adults. The authors, using rich clinical examples coupled with discussion of related theoretic background, provide the psychotherapist with an interesting perspective on this unique use of group psychotherapy with older adults. Such groups can provide a context within which to offer these patients the hope of relatedness, the opportunity to gain independence, and a heightened sense of integrity and possibility in one's later years.

An invitation to join in difficulty: realizing the deeper promise of group psychotherapy

Group psychotherapy has proven effective in treating an impressive array of specific problems. Clinical experience has also shown its utility in alleviating the more general, and very costly, alienation and pain with which the human condition is often fraught. Recent changes in health care delivery reflect a marketplace that emphasizes cost containment, brevity and specificity of treatment, and a narrowed focus of training. Techniques are often valued above relationships. In this climate, we are in danger of losing sight of group therapy's deeper promise; the experiential lesson that human beings must move toward each other with involvement and a commitment to understanding in response to the inevitable difficulties that arise as we share time, space, and resources.

Supervision and staff training for children's group psychotherapy: general principles and applications with cumulatively traumatized, inner-city children

Cumulatively traumatized children frequently benefit from theme-centered, trauma-focused psychotherapy groups, which promote recovery from trauma and enhance ego functioning. Unfortunately, even as children's group programs proliferate, therapists are still routinely assigned to supervisors who neither understand nor appreciate the modality. Modality-specific supervision is critical in treating traumatized children in groups, because such children are at significant risk of retraumatization. This article surveys and discusses problematic supervisory practices; advocates modality-specific supervision focusing on peer interaction, multiple transference enactments, and group culture; and describes a process-oriented consultation group that facilitates modality-specific cognitive and affective learning.

Group psychotherapy and managed behavioral health care: current trends and future challenges

The rising cost of health care within the private and public sectors has created an increased demand for the management of benefit dollars. This trend has significant implications for group psychotherapists, as group modalities offer cost-effective ways of delivering services to traditional outpatient and inpatient populations. Continued cost-containment pressures and increasing attention to outcome studies will fuel trends toward briefer, manualized group treatments and intensive group outpatient programs as alternatives to hospitalization. Quality-based demands will challenge payors to (a) address biases against group psychotherapy among providers and patients and (b) integrate recent process-and-outcome research in determining the appropriateness of group versus individual modalities for particular patients and presenting problems.