The feasibility, acceptability and effectiveness of a feedback-informed group treatment (FIGT) tool for patients with anxiety or depressive disorders

Monitoring treatment progress by the use of standardized measures in individual therapy, also called feedback-informed treatment (FIT), has a small but significant effect on improving outcomes. Results of FIT in group therapy settings are mixed, possibly due to contextual factors. The goals of this study were to investigate the feasibility, acceptability and effectiveness of a feedback-informed group treatment (FIGT) tool, based on the principles of the Contextual Feedback Theory and earlier FIGT research. Patients with anxiety or depressive disorders following interpersonal or cognitive behavioural group psychotherapy (IPT-G or CBT-G) were randomized to either feedback (n=104) or Treatment As Usual (TAU; n=93). In the feedback condition, patients filled out the Outcome-Questionnaire 45 (OQ-45) weekly in a FIGT tool and therapists were instructed to discuss the results in each session. Dropout, attendance and outcomes were measured. Additionally, in the feedback condition, OQ-45 response, feedback discussions and acceptability by patients and therapists were assessed. Results showed no differences on dropout, but lower attendance rates in the feedback condition. Although therapists reported high rates of feedback use and helpfulness, patients experienced that results were discussed with them only half of the time and they were also less optimistic about its usefulness. The findings indicate that the FIGT instrument was partially feasible, more acceptable to therapists than patients, and was not effective as intended. Future research is needed to discover how feedback can be beneficial for both therapists and patients in group therapy.

Beyond treatment modalities: Clinical decisions and relational dynamics that facilitate change in group treatments

This commentary on six articles comprising this Journal of Clinical Psychology: In Session issue on the therapeutic process in group psychotherapy brings together relevant clinical challenges and opportunities concerning the unique processes of change in group treatments. As illustrated by these six inspiring group therapy cases, therapy groups may vary widely in content and context. To balance the rich clinical illustrations of successful group treatments and the different theoretical formulations offered in these case studies, we highlight the processes that these treatments appear to have in common. Specifically, we describe the clinical considerations about the group format and the group members. We also reflect on the relational dynamics as they play out within the complex interplay between group leaders and group members; the facilitation of the corrective emotional experience as a change mechanism in group therapy, as well as the relational challenges and opportunities inherent in group treatments more generally. It is hoped that in this issue, clinicians will not only be inspired by the clinical description of successful change processes in group treatments but will also be reminded of the therapeutic nuances and opportunities of this multilayered treatment format.

Working together: An investigation of the impact of working alliance and cohesion on group psychotherapy attendance

OBJECTIVES

Group psychotherapy holds considerable potential for cost-effective treatment delivery. However, issues with client attendance can compromise the efficacy of such treatments. To date, client specific factors are amongst the most researched predictors of attendance in psychotherapy, with much less of a focus given to process factors, particularly in the group therapy context. This study aimed to determine which process factors influenced attendance in the context of a group therapy programme for adults with anxiety. It was hypothesized that (1) the working alliance and group cohesion would be moderately correlated, (2) both the working alliance and group cohesion would explain unique variance in session attendance, and (3) the working alliance would act as a moderator for attendance, when group cohesion was low.

DESIGN

The study utilized a within participants design.

METHODS

Participants were 91 adults (aged 18-74 years) who took part in a 9-week, transdiagnostic cognitive behavioural group therapy programme for the treatment of anxiety disorders.

RESULTS

Working alliance and group cohesion were significantly, but only moderately correlated (rs ranging .41 to .55). Together, working alliance and group cohesion significantly predicted total session attendance (17.70% variance explained). Working alliance did not moderate the relationship between group cohesion and session attendance.

CONCLUSIONS

The importance of individual and group processes in influencing group therapy engagement is highlighted, including the role of fostering bonds within the group and between clients and therapists.

PRACTITIONER POINTS

A complex array of process factors has been argued to influence treatment outcomes in group therapy The quality of the relationship between group therapy clients, as well as the relationship between a client and the therapist, predict session attendance. The quality of the relationship between the client and the therapist may be the most important predictor of session attendance. Therapists should foster positive relationships between each client and the therapist in group therapy, as well as assisting each client to foster positive relationships with other group members.

Referral for group or individual treatment? Factors for consideration in the case of self-referred individuals with a sexual interest in minors

In Germany, several treatment programs offer psychotherapy for individuals with a sexual interest in minors (SIM) who are currently not in contact with the criminal justice system. The patients present anonymously in relation to the health insurance and judicial system. Group therapy plays an important role in these programs. However, to date there is poor empirical evidence on indication criteria for group vs. individual treatment for this specific group of individuals. This study examined individuals with SIM who voluntarily participated in a treatment program in Hamburg. We investigated via post-hoc analysis whether there were significant differences regarding readiness to participate in group therapy, dynamic risk factors, psychopathic characteristics, impulsivity and empathy between individuals indicated for group therapy (n = 26) and individuals referred for individual therapy (n = 47). Results show that individuals referred for individual therapy were significantly more impulsive than individuals referred for group therapy, but comparable in respect to readiness to participate in group therapy, dynamic risk, psychopathy, and empathy. These findings suggest that assignment to group vs. individual therapy is mainly based on other criteria than these characteristics. Implications for clinical practice and future research are discussed.

Effects of Live and Educational Music Therapy on Working Alliance and Trust With Patients on Detoxification Unit: A Four-Group Cluster-Randomized Trial

BACKGROUND

Lyric analysis is a commonly utilized music therapy intervention for clients in substance abuse rehabilitation wherein participants interpret song lyrics related to their clinical objectives. For these patients, working alliance and trust in the therapist represent consequential factors that may influence outcomes. However, there is a lack of randomized controlled music therapy studies investigating working alliance and trust in the therapist within lyric analysis interventions for patients with addictions.

OBJECTIVE

The purpose of this study was to quantitatively differentiate live versus recorded and educational versus recreational music therapy interventions via measures of working alliance and trust with patients on a detoxification unit.

METHOD

Participants (N = 130) were cluster randomized in a single-session posttest-only design to one of four conditions: Live educational music therapy, recorded educational music therapy, education without music, or recreational music therapy. Dependent measures included working alliance and trust in the therapist. Educational music therapy interventions were scripted lyric analyses.

RESULTS

There was no statistically significant between-group difference in any of the measures. Although not significant, a greater number of patients and research participants attended live educational music therapy sessions.

CONCLUSIONS

Between-group descriptive data were consistently similar but attendance trends may have implications for engaging patients and billing. Implications for clinical practice, limitations of the study, and suggestions for future research are provided.

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.

Intern Evaluation in University Counseling Centers

This article discusses the need for more rigorous evaluations due to the demands faced by today's intern, as well as the practical challenges faced by intern evaluators. Recommendations are provided to strengthen the process of intern evaluation. The strengths and weaknesses of scales that can be used to evaluate interns are discussed. A framework is given for developing an intern rating system, considering both what areas of intern training to evaluate and how to select appropriate content items. Finally, a 7-point intern professional growth scale is presented that focuses on the development of applied skills throughout the internship year. Exit criteria are offered.

Modeling group process constructs at three stages in group psychotherapy

This study examined the relationships among group therapy processes measured by the Working Alliance Inventory-Short Form, the Therapeutic Factors Inventory Cohesiveness subscale, and the Group Climate Questionnaire-Short Form in a sample of 145 patients attending 18 psychodynamic groups. Five hypothesized models were tested early in therapy (Sessions 3 and 4) using multilevel confirmatory factor analysis. Two three-factor models approached conventional standards of model fit. By merging these two models, a three-factor model consisting of member-leader alliance, positive bonding relationship, and negative relationship fit the data well. Later in therapy, member-leader bonding was no longer important to member-group cohesion, indicating that cohesion and alliance and the member-leader versus member-group bonding represent different processes.

Therapeutic Factors in Group Counseling: Implications for Audiologic Rehabilitation

The purpose of this article is to describe therapeutic factors that constitute mechanisms of change in group intervention. These therapeutic factors occur in groups with varied populations in varied settings and have important implications for group approaches to aural/audiologic rehabilitation. Factors included in the review are universality, instillation of hope, imparting information, altruism, imitative behavior, group cohesion, interpersonal learning, development of socializing techniques, recapitulation of the family, catharsis, and existential issues. The discussions largely are based on Irvin Yalom’s therapeutic factors but include references from a wide-range of sources throughout the medical, psychological, and rehabilitative fields.

Why study group therapy?

Group therapy training is highly valuable for the overall professional practice of psychotherapy. Learning to be a group therapist means learning about shame, resistance, fears of engulfment and abandonment, maintaining a self in relation to others, promoting empathic connection, strong affects in the moment, multiple experiences of the same interaction or event, and group dynamics. These concepts are highly relevant to all clinical work and other aspects of professional life. Training in group therapy should place greater emphasis on its broader applicability.

A model of the effects of node-link mapping on drug abuse counseling

This paper examines the effectiveness of a promising cognitive enhancement technique called node-link mapping. Maps provide a concrete, visual, and computationally efficient means for exploring personal issues, and have received substantial empirical support. We introduce two models to provide a framework for understanding how node-link mapping improves substance abuse counseling. The TCU Process Model reviews the general process of substance abuse treatment. The second model reflects an effective treatment session. Implications of the models and node-link mapping findings are discussed, as well as future research directions.

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.

Node-link mapping for counseling cocaine users in methadone treatment

Treatment engagement problems associated with cocaine-using opioid addicts were addressed using a cognitively enhanced counseling strategy. Analysis of client urines, participation, and counselor ratings of clients over a 6-month period during treatment indicated that the use of node-link mapping--a multipurpose visual representation strategy for communication--produced better results for both low and high cocaine-using opioid addicts in methadone maintenance than those treated without this enhancement.

Models of group psychotherapy: sifting through confusion

This editorial introduces a series of articles by leading proponents of the ten major models of group psychotherapy to appear in the International Journal of Group Psychotherapy. These theoretical contributions will be published throughout 1992 as a dedication to the American Group Psychotherapy Association's (AGPA) 50th anniversary. In the present article, the author reports results from a recent survey of senior clinicians within AGPA who expressed their opinions about the central issues that practitioners should understand during the working phase of group treatments. Statistical comparisons among action-oriented, interpersonal, and psychodynamic respondents to the questionnaire revealed striking differences in how therapeutic interventions were conceptualized. These findings are outlined as a preface to the first three articles in the series.