Ethnocultural considerations in group psychotherapy

Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation

BACKGROUND

Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical "how to" components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment?

METHODS

To create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish "core" and "malleable" components, and provide a conceptual framework for considering various options for implementing the malleable components.

RESULTS

We identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions.

CONCLUSION

While further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.

Differences that Make a Difference: Diversity and the Process Group Leader

Traditional group therapy often does not directly address how group leaders can work with oppression and marginalization that occurs between group members. Many group psychotherapists believe that attention to social justice concerns is not within their roles as group leaders and, consequently, may not address issues of member oppression and marginalization. Conflict emerging out of cultural differences can have far-reaching consequences if not accurately identified and effectively managed by group leaders. The purpose of this article is to provide an understanding of factors that contribute to group leaders fostering a climate that facilitates an exploration of cultural issues, along with clinical examples illustrating diversity-related issues that may arise.

Group Psychotherapy in Specialty Clinics for Substance Use Disorder Treatment:The Challenge of Ethnoracially Diverse Clients

Minimal research has explored how clinicians address race and ethnicity considerations in the context of group psychotherapy within substance use disorder (SUD) specialty treatment settings. This article is an exploratory qualitative study in an effort to narrow this gap, using data from semi-structured interviews with 13 group clinicians at three outpatient SUD specialty clinics in the United States. Results are drawn from the portion of coded material pertaining to ethnoracial considerations. A predominant theme from the interviews was the importance of individualized care in terms of "meeting clients where they are at." However, minimal attention appears to have been given to addressing clients' demographic diversity. Overall, ethnoracial considerations were minimally addressed in groups, with clinicians framing such primarily in terms of "cultural" factors relevant to clinics' treatment philosophies. Moreover, limited attention was reportedly given to acknowledgment of social inequities faced by ethnoracial minority clients (e.g., racial discrimination), even though a few clinicians reported concern that minority clients were less engaged in treatment. Clinical implications of these findings and recommendations for future research are discussed.

AGPA at 75: Past, Present, and Future

This special issue of IJGP celebrates the 75th anniversary of the founding of AGPA in 1942. We asked clinicians representing 18 group therapy models to apply their knowledge of the model to a clinical vignette. Their responses to the eight questions were often illuminating. The depth and breadth of contributions to this anniversary issue celebrate the fundamental health of our "large group" institution-one that is committed to the pluralistic and evolving nature of the professional family we call AGPA.

The Culture of the Group and Groups from Different Cultures

Culture and groups are intertwined. Culture is essential in crystallizing our social identity and provides the common understandings that allow the social world to have a meaning. Culture is constituted from many groups that have common values. The social unconscious of a certain culture is reflected in groups, especially in large groups. This paper explores different aspects of the social unconscious and describes how the individual and the group/society always coexist. The concept of the binocular vision is used to integrate between two approaches to the social unconscious. Groups from different cultures and their unique features are described and entering a group is analyzed as a kind of immigration to a new culture.

Group psychotherapy in women with a history of sexual abuse: what did they find helpful?

AIMS AND OBJECTIVES

To define the effects of group psychotherapy in women with a history of sexual abuse, to find possible predictors for dropout and treatment outcome rates and to find which therapeutic factors of group psychotherapy are perceived by group members to be most helpful.

BACKGROUND

Sexual abuse of women is a global concern and causes many psychiatric and psychological sequelae. Group psychotherapy is one of the preferred treatment modalities.

DESIGN

Prospective cohort study.

METHODS

Forty-seven women with a history of childhood and/or adulthood sexual abuse were recruited for weekly 12-session group psychotherapy. Subjects were given the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Clinician Administered Post-traumatic Stress Disorder Scale, the Dissociative Experiences Scale, the Childhood Trauma Questionnaire and the Group Therapeutic Factors Questionnaire. Re-evaluations were made after the 6th and 12th session and also at a six-month follow-up session.

RESULTS

Group psychotherapy significantly reduced participants' levels of depression (screening/12th session mean scores, 22.45/11.10), anxiety (15.45/4.32) and symptoms of post-traumatic stress disorder (42.27/9.32), and this decline became statistically significant at the 6th session and tended to persist at the six-month follow-up. Higher levels of dissociative symptoms at baseline were associated with less response to treatment, but higher levels of attendance at group sessions. Group members rated existential factors (41.40 ± 12.39), cohesiveness (37.42 ± 8.32) and universalism (37.56 ± 7.11) as the most helpful therapeutic factors.

CONCLUSION

Group psychotherapy was significantly effective in reducing levels of depression, anxiety and posttraumatic stress disorder symptoms in this sample of women. Dissociation had a significant effect on both treatment outcome and treatment adherence. For this sample of women, group psychotherapy was most helpful for reducing feelings of stigma, isolation and shame.

RELEVANCE TO CLINICAL PRACTICE

Group psychotherapy can be used as a preferred treatment method for women from different cultural backgrounds with a history of sexual abuse.

Culturally informed child psychiatric practice

Child and adolescent psychiatrists are already serving an increasing population of culturally and ethnically diverse patients and families in their practices and in different agency settings. This article discusses adaptations to practice that enable child and adolescent psychiatrists to address the diverse clinical and cultural needs of this emerging population. Special attention is given to work in psychotherapy and in agency settings where diverse children and youth are found in large numbers.

Perceptions of Turkish psychiatric inpatients about therapeutic factors of group psychotherapy

Many studies on therapeutic factors in group psychotherapy were done during the 1970s and 1980s, primarily with Western samples, The present study was carried out in a psychiatric inpatient clinic in Turkey. Using Yalom's (1975) therapeutic factor questionnaire administered at discharge, patients rated existential factor, instillation of hope and self-understanding as the most helpful factors and identification as the least helpful. There were significant differences among patients with regard to gender, age, education, comorbid personality disorder, but not with Axis I diagnosis or number of attended sessions. Patients' and psychiatrist's rating showed significant differences. Differences between this Turkish sample and those reported in common Western literature are discussed under the light of relatedness psychology, which is an important concept of cross-cultural psychology.

Cognitive-behavioral treatment groups for people with chronic physical illness in Hong Kong: reflections on a culturally attuned model

This study describes and evaluates a cognitive-behavioral treatment group for people with chronic physical illness in Hong Kong. We developed a group protocol based on the understanding that Chinese people generally prefer a structured group format, expect group leaders to be active and directive, and are not used to expressing opinions and emotions in groups. The experimental and waitlist control groups had 38 and 35 participants, respectively. A standardized questionnaire was administered to all participants before and after the group treatment. Results suggest that members of the experimental group showed improvements in mental health, negative automatic thoughts, and negative emotions when compared to those in the waitlist control groups, and at the end of group treatment. Implications for designing and running a culturally attuned CBT group for Chinese people are discussed.

Culturally competent systems of care for children's mental health: advances and challenges

There has been a remarkable growth in cultural diversity in the United States over the past 20 years. The population of minority groups has increased at a much faster rate than the European-background population in America, and faster even among children and youth. At the same time, minority youth face increasing disparities in their mental health and in access to mental health services. These are related to the multiple challenges they already face in socioeconomic status, but are aggravated by the lack of culturally competent services that can address their specific mental health needs within the context of their culture, family, and community. This paper reviews the current knowledge about the mental health of culturally diverse youth in the United States, and provides guidance on approaches to address the disparities they face.

Group therapy for depressed elderly women

We describe and evaluate a group therapy program targeting depression among elderly residents (N=303) of subsidized high-rise apartments in Nashville, TN. This eclectic program was comprised of 12 sessions (a total of 24 hours) that included modules on exercise and preventive health behaviors, cognitive and re-motivation therapy, reminiscence and grief therapy, and social skills development. Our multivariate regression analyses of pre-post measures using the Geriatric Depression Scale (GDS) showed that the effects of the group therapy varied by race, age, and level of initial depression among the participants. The program was effective in reducing depression, but only among Caucasian women who reported at least moderate depression prior to the program, and it yielded greater benefits for women between 55 and 75 years of age.

Sibling dynamics and group psychotherapy

The role of sibling dynamics in group psychotherapy has received relatively little attention in the literature. Our clinical experience suggests that sibling issues regularly arise in the practice of group psychotherapy. This article provides an integrative view of sibling relationships from a family systems and self psychology orientation to group therapy. Special emphasis is placed on developmental and cultural differences as they affect sibling dynamics and the group leader's role. A number of case examples are offered to illustrate ways to view clinical challenges in a manner consistent with the influence of sibling relationships on group members and group process.