A consideration of factors influencing the utilization of time-limited, short-term group therapy

Preliminary Effectiveness of Group Interpersonal Psychotherapy for Young Kenyan Mothers With HIV and Depression: A Pilot Trial

OBJECTIVE

The authors adopted a task-sharing strategy in which lay health workers delivered group interpersonal psychotherapy (IPT-G) in primary care clinics in Nairobi, Kenya, to young mothers with HIV and depression. The study examined the acceptability, feasibility, and effectiveness of IPT-G in improving depression and antiretroviral therapy adherence.

METHODS

Twenty-four mothers (ages 18-24 years and 6-12 weeks postpartum) participated. The women were randomly assigned to IPT-G or to a waitlist. Eight lay providers administered the IPT-G sessions across 8 weeks. The primary outcome was pre- to postintervention change in depression scores as measured on the Edinburgh Postnatal Depression Scale. The secondary outcome was antiretroviral therapy adherence. All waitlist participants subsequently received the intervention, and a secondary outcome, within-group analysis, was conducted and included those participants.

RESULTS

Participants' median age was 23.0 years, 17 (71%) lived with a partner, and 19 (79%) had fewer than two children. The intervention group had a mean±SD depression score of 15.9±4.3 at baseline and 6.8±7.0 postintervention. For the waitlist control group, the mean score was 17.3±5.9 at baseline and 13.2±6.6 at the first follow-up. Waitlist participants had significantly greater mean depression scores than did intervention group participants at the first follow-up (after the intervention group's 8-week IPT-G) (β=6.42, 95% confidence interval=1.17 to 11.66, p=0.017). No difference was observed between groups in antiretroviral therapy adherence.

CONCLUSIONS

This study provides preliminary evidence that IPT-G led by community health workers may have benefits for postpartum depression among young mothers with HIV.

Évaluation des effets de l’activation comportementale de groupe pour le traitement de la dépression sévère en milieu clinique

Bien que l’efficacité de la thérapie d’activation comportementale (AC) pour le traitement de la dépression ait été établie à travers de nombreux essais aléatoires et contrôlés, les études ayant évalué l’efficacité de l’AC, lorsqu’implantée dans les établissements du réseau de la santé, sont rares et les données la supportant sont insuffisantes. Cette étude s’intéresse à l’AC appliquée de manière à tenir compte de la réalité clinique des milieux et des patients. Elle évalue les effets de l’AC de groupe pour le traitement de la dépression sévère en milieu clinique auprès d’une population hétérogène en termes de diagnostic (dépression unipolaire et bipolaire) et de comorbidité (Axes I et II). Les 45 participants souffrant de dépression sévère ont été recrutés en milieu hospitalier et ont reçu une intervention de groupe d’AC de 10 séances. Des questionnaires ont été administrés afin d’obtenir des données prétraitement, posttraitement et 4 semaines suivant la fin du traitement. Les résultats soutiennent les effets de l’AC de groupe pour le traitement de la dépression sévère en milieu clinique auprès d’une population hétérogène, de même que pour le maintien des acquis à court terme. Les effets de l’AC ont également été observés sur l’ensemble des mesures d’activation comportementale, de renforcement, d’anxiété, d’adaptation sociale et de qualité de vie ainsi que sur les symptômes de dépression bipolaire.

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.

Group Interventions for Patients with Cancer and HIV Disease: Part III. Moderating Variables and Mechanisms of Action

Growing evidence supports the value of group interventions for individuals who are at risk for or have developed cancer or HIV disease. However, information is more limited concerning how these services can be delivered in an optimal manner, and what processes contribute to their benefits. Parts I and II of this review examined the efficacy of different interventions for individuals at different phases of illness, ranging from primary prevention to late-stage disease, in both psychosocial and biological domains. The current paper examines some of the factors other than phase of illness that might influence group treatment effects (e.g., intervention parameters, participant characteristics), and explores mechanisms of action.

Underutilization of short-term group therapy: enigmatic or understandable?

Given the evidence for the efficacy, applicability, and efficiency of the group therapies, they appear to be underutilized by clinicians, therapists, and researchers. This article considers reasons for their underutilization. The article also considers procedures for lessening patient and therapist tendencies to resist participating in the group therapies relative to individual therapies. Underutilization not only deprives patients of effective treatment for a wide range of problems but deprives therapists from experiencing fascinating and rewarding therapeutic processes. That has been the experience of the author after more than 35 years of conducting and studying group therapies.

Auswahl von Patienten für eine Gruppenpsychotherapie

Zusammenfassung. Mit dem Group Selection Questionnaire (GSQ) wurde ein ökonomisches Instrument für die Klinik und Forschung entwickelt, das Informationen über die Erwartungen von Patienten an eine Gruppentherapie, ihre Bereitschaft, mit anderen Teilnehmern in einer positiven Art zu interagieren und ihre Tendenz, in einer Gruppe dominierendes Verhalten zu zeigen, erheben soll. In der vorliegenden Arbeit wurde versucht, die Ergebnisse einer von Cox et al. (2004) in den USA beschriebenen Studie zum GSQ an zwei klinischen Stichproben (n = 267 und n = 385) aus dem deutschen Sprachraum zu replizieren. Zwei Teilstichproben von Psychotherapiepatient(inn)en aus acht bzw. fünf stationären Behandlungseinrichtungen wurden im Rahmen der Studie untersucht. Die Patienten wurden gebeten, einmalig vor der ersten Gruppensitzung die 19 Fragen des GSQ zu beantworten. Ziel dieser Studie war es, die Faktorenstruktur des GSQ durch konfirmatorische Faktorenanalysen zu überprüfen. Die Überprüfung erfolgte vorrangig mit Hilfe von Strukturgleichungsmodellen. An der ersten Stichprobe wurde deutlich, dass die deutschen Patienten eine moderate Übereinstimmung mit den amerikanischen Probanden bei der Beantwortung des GSQ zeigten. Mit einem geringfügig modifizierten Modell konnte allerdings eine sehr gute Übereinstimmung erzielt werden. Die verbleibenden Items luden auf denselben Faktoren wie dies in früheren GSQ-Studien mit einer bosnischen bzw. einer amerikanischen Stichprobe gezeigt werden konnte ( Cox et al. 2004 ). Die Kreuzvalidierung dieses Ergebnisses an einer weiteren Patientenstichprobe bestätigte letztlich das Faktorenmodell, wenngleich insgesamt gesehen die psychometrische Qualität der Subskala Dominanz noch zu wünschen übrig lässt. Der GSQ könnte ein geeignetes Screening-Instrument werden, mit dessen Hilfe Kliniker effizient bereits vor Behandlungsbeginn Aussagen darüber treffen können, welche Patienten mit höherer Wahrscheinlichkeit eine Gruppentherapie frühzeitig abbrechen bzw. weniger profitieren werden. Um dies zu bestätigen, sind nun allerdings auch im deutschen Sprachraum Verlaufsstudien nötig.

Changing the guard: new leadership for an established group

When the leader of an established therapy group decides to leave, the group may wish to continue with a new leader. This decision deserves careful exploration. The transfer of leadership to a new leader is a powerful event in a group. New leaders often experience strong countertransference reactions. Specific recommendations for new leaders include meeting individually with each continuing member, helping the group stabilize and process the meaning of the change, and developing ownership of the leader role. When managed successfully, a leadership transition can strengthen the group cohesion and offer important therapeutic opportunity.

Patient personality and time-limited group psychotherapy for complicated grief

We used a randomized clinical trial to investigate the interaction of two patient personality characteristics (quality of object relations [QOR] and psychological mindedness [PM]) with two forms of time-limited, short-term group therapy (interpretive and supportive) for 139 psychiatric outpatients with complicated grief. Findings differed depending on the outcome variable (e.g., grief symptoms, general symptoms) and the statistical criterion (e.g., statistical significance, clinical significance, magnitude of effect). Patients in both therapies improved. For grief symptoms, a significant interaction effect was found for QOR. High-QOR patients improved more in interpretive therapy and low-QOR patients improved more in supportive therapy. A main effect was found for PM. High-PM patients improved more in both therapies. For general symptoms, clinical significance favored interpretive therapy over supportive therapy. Clinical implications concerning patient-treatment matching are discussed.

Joining with resistance: addressing reluctance to engage in group therapy training

Although research has documented the effectiveness of group psychotherapy, trainees are often reluctant to embrace this modality. This reluctance may reflect an informed choice based on knowledge, interest, and skill. Alternatively, reluctance may reflect misinformation or resistance due to conflicted feelings that arise from group dynamics. The latter are a major obstacle to the success of group therapy training and treatment programs. Understanding the origins of this reluctance and the developmental challenges of group therapy for trainees better equips supervisors to address this difficulty. This article uses case examples to illustrate how trainee reluctance emerges. It also provides strategies for working with hesitant trainees. The success of group therapy programs rests on the supervisor's ability to manage trainees' inhibitions to group therapy.

The group psychotherapy movement at the millennium: some historical perspectives

Although almost a century old, group psychotherapy has experienced an unprecedented expansion over the last 50 years. By the 1970s, human helping groups had found application in virtually all the human services, including the media. The growth of professional organizations for group work specialists was accompanied by a burgeoning literature and by accelerated research endeavors. The recent advent of the managed health care "revolution" has shaken the very foundations of this prospering group psychotherapy movement. Undue pressure from third-party payers for greater accountability and for cost-containment has come to threaten the traditional autonomy and dedication to quality of care by group therapy practitioners. Professional organizations have begun to meet these challenges by educational endeavors addressed at insurers, legislators, and the public. Current training programs and literature for clinicians have focused on the need for a new "business orientation" and on less costly group treatment measures (i.e., short-term and combined). Given group therapy's proven effectiveness, coupled with its practitioners' flexibility, the movement is bound to regain its secure footing at the dawn of the new millennium.

Group therapy program development: clinician-administrator collaboration in new practice settings

Despite being practiced widely and applied to many conditions, group therapy is underutilized in some segments of the market. One important reason for its underuse is the lack of a model for group program development. Program development requires an integrated effort involving many disciplines. Effective collaboration between clinicians and administrators is an essential but underappreciated component in the development of group programs in independent practice associations.

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.