Report on a Systematic Review of the Efficacy and Clinical Effectiveness of Group Analysis and Analytic/Dynamic Group Psychotherapy

This article reports on a systematic review to assess the efficacy and clinical effectiveness of group analysis and analytic/dynamic (A/D) group psychotherapy. Systematic literature searches were undertaken; 34 primary studies and 19 reviews met the inclusion criteria and their data was extracted. Of the primary studies, the randomized controlled trials provided evidence for the efficacy and clinical effectiveness of group therapy approaches in a range of clinical problems, but not for specific benefits of any particular theoretical approach. The controlled studies and observational studies gave support for the use of group psychotherapy in a variety of conditions.

The review of reviews confirms that group therapies in general are more effective than wait list or standard care controls. Methodological challenges encountered and recommendations for further research are presented, along with a more detailed discussion of the implications of the review for the research community.

Systematic review of practice-based research on psychological therapies in routine clinic settings

PURPOSE

To review the published material on practice-based research and to compare results with benchmarks derived from efficacy studies.

METHODS

Electronic and manual searches were carried out up to and including 2008. Studies were screened for content relevance and selected according to specified inclusion criteria. Data were extracted from all studies that met criteria and were quality assessed using an adapted version of a checklist designed for the appraisal of both randomized and non-randomized studies of health care interventions. Studies were synthesized according to (1) the type of problem being treated and (2) study design using descriptive and meta-analytic methods where appropriate.

RESULTS

Psychological treatment conducted in routine clinic settings is effective for a range of client problems, particularly common mental health problems (uncontrolled effect size = 1.29; 95% CI = 1.26-1.33, N = 10,842). When benchmarked against data from efficacy studies, practice-based studies yielded effect sizes that fell short of the selected benchmark. In contrast, the practice-based studies achieved the benchmark for percentage of clients meeting a stringent criterion for recovery.

CONCLUSIONS

Clients receiving treatment as normally delivered within routine practice report significant relief of symptoms. However, the result of comparisons with efficacy benchmarks is dependent on the outcome index used. Notwithstanding this, substantive factors are also likely to contribute. Therefore, in addition to attending to methodological issues, further work is required to understand the relative contribution of these factors.

The effectiveness of psychodynamic-interpersonal therapy (PIT) in routine clinical practice: a benchmarking comparison

AIMS

To investigate the effectiveness of psychodynamic-interpersonal therapy (PIT) in a routine clinical practice setting.

METHODS

Full pre-post data were available on 62 out of a total of 67 patients aged between 19 and 60 years. Patients were seen over a 52-month period (2001-2005) receiving a course of PIT therapy (mean number of sessions = 16.9, median number of sessions = 16). The outcomes were assessed using a range of outcome measures: the 32-item version of the Inventory of Interpersonal Problems (IIP-32), the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and the Beck Depression Inventory - Second Edition (BDI-II). Study data were benchmarked against comparative national and local data.

RESULTS

There were significant pre-post reductions on all measures: IIP-32 effect size (ES) = 0.56; CORE-OM ES = 0.76; BDI-II ES = 0.76. Reliable and clinically significant change was achieved by 34% of clients on the BDI-II and by 40% of clients on the CORE-OM. Clients with high pre-therapy levels of interpersonal problems had poorer outcomes.

CONCLUSION

Benchmarking our results against both national and local comparative data showed that our results were less favourable than those obtained where PIT had been used in efficacy trials, but were comparable with reports of other therapies (including cognitive behavioural therapy (CBT)) in routine practice settings. The results show that PIT can yield acceptable clinical outcomes, comparable to CBT in a routine care setting, within the context of current limitations of the practice-based evidence paradigm.