The association of process with outcomes in child group therapy

"It's ok that I feel like this": a qualitative study of adolescents' and parents' experiences of facilitators, mechanisms of change and outcomes in a joint emotion regulation group skills training

BACKGROUND

Emotion regulation difficulties underlie several psychiatric conditions, and treatments that focus on improving emotion regulation can have an effect on a broad range of symptoms. However, participants' in-depth experiences of participating in emotion regulation treatments have not been much studied. In this qualitative study, we investigated participants' experiences of a joint emotion regulation group skills training in a child and adolescent psychiatric outpatient setting.

METHODS

Twenty-one participants (10 adolescents and 11 parents) were interviewed about their experiences after they had participated in a seven-session transdiagnostic emotion regulation skills training for adolescents and parents. The aim of the skills training was to decrease emotion regulation difficulties, increase emotional awareness, reduce psychiatric symptoms, and enhance quality of life. The skills training consisted of psychoeducation about emotions and skills for regulating emotions. The interviews were transcribed and analysed using reflexive thematic analysis.

RESULTS

The analysis resulted in three overarching themes: Parent - Child processes, Individual processes, and Group processes. The result showed that participants considered an improved parent-child relationship to be the main outcome. Increased knowledge, emotion regulation skills and behavioural change were conceptualised as both mechanisms of change and outcomes. The group format, and the fact that parents and adolescents participated together, were seen as facilitators. Furthermore, the participants experienced targeting emotions in skills training as meaningful and helpful.

CONCLUSION

The results highlight the potential benefits of providing emotion regulation skills training for adolescents and parents together in a group format to improve the parent-child relationship and enable the opportunity to learn skills.

Systematic literature review and meta-analysis of the relationship between adherence, competence and outcome in psychotherapy for children and adolescents

The extent to which therapist adherence to guidelines and clinician skill or competence may play a role in the prediction of therapeutic outcomes remains inconclusive. This systematic literature review and meta-analysis considers whether adherence or competence predicts youth outcome in child and adolescent psychotherapy, and whether there are any identifiable factors which moderate the strength or direction of this relationship. A systematic literature search identified 35 studies in 52 papers. The studies contained 29 effect sizes for the relationship between adherence and outcome, while nine effect sizes were extracted for competence, and a further five effects measured a composite of adherence and competence constructs, referred to as fidelity in this report. The meta-analysis indicated a small but significant relationship between therapist adherence and outcome, although the small size of effect suggests that outcomes are likely to be more strongly associated with factors other than adherence. No significant relationship was identified between competence or composite fidelity and outcome. Although variance was observed in effect sizes, no significant moderation by client group, intervention type, or implementation measure informant was identified. Further study is needed to understand the specific circumstances under which adherence and outcome are related.

In-session behaviours and adolescents' self-concept and loneliness: A psychodrama process-outcome study

As adolescents spend many hours a day in school, it is crucial to examine the ways in which therapeutic practices in schools promote their well-being. This longitudinal pilot study examined the contribution of school-based psychodrama group therapy to the self-concept dimensions and perceived loneliness of 40 Israeli adolescents (aged 13-16, 60% boys) in public middle schools. From a process-outcome perspective, we also examined the understudied trajectory of adolescents' in-session behaviours (process variables) and its associations with changes in their self-concepts and loneliness (outcome variables). Psychodrama participants reported increases in global, social, and behavioural self-concepts and a decrease in loneliness compared to the control group. In-session productive behaviours increased and resistance decreased throughout the therapy, but varied process-outcome relationships were found. The study suggests that conducting further research into the process-outcome relationships in psychodrama group therapy is warranted to pinpoint specific mechanisms of change. Suggestions for future studies are provided.

Recollections of Being in Child Expressive Arts Group Therapy: A Qualitative Study of Adult Former Clients' Conceptions of Their Therapy as Children

The current study aims to explore, through the eyes of adult former clients, the experience of being in expressive arts group therapy (EAGT) as a child. By focusing on the memories of adults, the study allowed the exploration of former clients' understanding of what the therapy was about and its effects on their lives. Semi-structured open-ended interviews were conducted with 20 adult former clients who, as children, had participated for at least one year in EAGT. Findings point toward the background of the empathic, attuned, safety, together with the fostering of the capacity to enter into spontaneous creative states, as central themes in participant' recollections of the therapeutic process. Further findings relate to the implicit and long-term quality of the therapeutic effect.

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.

Processes and outcomes in prevention-focused time-limited groups for girls

Processes and outcomes in 8-week prevention-focused, school-based groups for preadolescent girls were assessed in a naturalistic study. Specifically, whether such groups would facilitate their social-emotional development and whether affiliative processes in the groups were related to outcome were explored. In addition to expecting the groups to be effective, it was hypothesized that affiliative processes would be directly related to outcome and, more particularly, that increased positive affiliative feelings from the group toward the individual would be more predictive of positive treatment outcome than increased positive feelings from the individual toward the group. While findings did not support these hypotheses linking process to outcome, ancillary analyses revealed that different patterns of affiliation over time (i.e., U-shape pattern versus inverted U-shape pattern) distinguished the high- versus low-outcome participants, respectively.