Group Therapy Client Outcome and Satisfaction as a Function of the Therapists' Use of Rapid Assessment Instruments

Group therapists were encouraged to use Rapid Assessment Instruments (RAls), to assess the course of the group therapy and make therapeutic decisions on empirical grounds under three experimental conditions. In Condition 1, group therapists had 140 different RAIs and scoring instructions available and had been instructed in theiruse. Condition 2 was identical except that group therapists had computer-scoring programs available for each RAI. Condition 3 differed in that group therapists had computer administration and scoring programs available. Clients itn Condition 3 were administered more RAls than clients in Condition 2 who were administered more RAls than clients in Condition 1. Employing reductiont in DSMIII-R symptoms as an outcome measure, clients in Conditions 2 and 3 improved more over the course of the 16-week cognitive-behavioral groups thant clients in Conidition 1, and these same clients were also more satisfied with their group therapy experience. Thus greater computer assistance leads to greater RAI use, which in turn leads to great outcome and client satisfaction.

Assessing Group Processes

This study's aim is the comparison of group processes' development assessments among group members, direct observers, and indirect observers. The research population includes 50 heart patients, who participated in 7 support groups of 10 meetings each, and 35 social work students, who observed the groups. Data was obtainedfrom participants and observers through the Group Environment Scale (GES) and through a social support questionnaire, completed at three stages of the intervention: following the fourth, seventh, andfinal group meetings. Exceptfor the self-discovery variable, no other significant differences were found among the assessors. The main conclusion is that it is possible to place most of the burden of grading group processes in the hands of direct and/or indirect observers and to save the participants from this task. This conclusion is importantfor studies dealing with the efficacy of groups-especially when researching the connection between group processes and group outcomes.

The Efficacy of Group Therapy for Depression

This article reviews the empirical research on the efficacy of group therapy for depressive disorders from 1970 to 1986. The review was undertaken in light of a multidimensional classification system designed to clarify differences between conceptual and measurement parameters of the various studies. The results suggest that group interventions have shortterm efficacy in the alleviation of depressive symptomatology with an outpatient population. Although more research needs to be done before definitive conclusions can be drawn, the availablefollow-up data suggest that lasting well-being would be anticipated following successful group inten'ention. As there was nofocus on the process-outcome interaction, no conclusions could be drawn about factors responsible for the positive outcome found.

Therapeutic Environment and Outcomes in a U.K. Domestic Violence Perpetrator Program

This study examines the extent to which variations in program delivery affect the therapeutic environment and whether the therapeutic environment is associated with psychological and behavioral outcomes in a domestic violence perpetrator program. Seventy-seven offenders and 31 probation group tutors participated. It was found that groups with longer sessions were perceived more favorably by offenders than those with shorter sessions. A positive correlation was identified between group organization and offender attendance. No association between the therapeutic environment and posttreatment alleged reoffending within an 11-month follow-up period was identified. A supportive leader style was positively associated with the extent of clinically significant change identified on a range of psychological measures. These findings suggest that profeminist programs may exert a meaningful therapeutic effect.

Is therapist alliance or whole group cohesion more influential in group psychotherapy outcomes?

This study examined the differential ability of early in treatment measures of therapeutic alliance (Working Alliance Inventory), group cohesion (California Psychotherapy Alliance Scale for Group) and group climate (Group Climate Questionnaire) to predict outcome in a 16-session dynamic group psychotherapy for adults with major depression. Six successful therapy groups with 30 patients receiving psychodynamic group therapy were studied. Patient perceptions of the therapist alliance was not related to outcome, however, perceptions of levels of conflict and group members' ability to work actively and purposefully in treatment did predict outcome. Future research should further investigate how patients' perceptions of the whole group influence their clinical improvement.

Comprehensive evaluation: a holistic approach to evaluating domestic violence offender programmes

This article argues that the focus on behavioural outcomes in evaluations of domestic violence offender programmes has been too narrow, and that a more holistic approach incorporating investigation of the psychological characteristics of offenders and treatment characteristics may be required to determine what works, for whom, and under what circumstances. To this end, one interpretation of a comprehensive evaluation framework is outlined. The article hypothesises the insights to be gained by assessing the contribution of several potential mediating variables of the treatment process in the evaluation of these programmes. These variables are the heterogeneity of treatment targets in the target population; motivation to change; programme integrity variables; and therapeutic factors. The article concludes that only by implementing theoretically informed, multifaceted evaluations will we move closer to understanding the process of successful rehabilitation.

Psychological mindedness, work, and outcome in day treatment

A recently completed clinical trial that investigated the effectiveness of a group-oriented, day treatment program provided an opportunity to pursue a multidimensional approach to the prediction of treatment outcome. The sample consisted of 99 psychiatric outpatients, most of whom had received diagnoses of affective and personality disorders. The predictor variables included a patient personality characteristic (psychological mindedness), a group process variable (patient work), and their interaction. Univariate analyses revealed significant direct relationships between psychological mindedness and both work and favorable outcome, and between work and favorable outcome. Multivariate analyses indicated that psychological mindedness and work had independent significant relationships (additive or interactive) with several of the outcome variables. In combination they accounted for up to a quarter of the outcome variance. The results demonstrate the benefit of using a theoretically consistent multidimensional approach. The time-efficient nature of the predictor measures used in the study make them particularly amenable for use by clinicians and researchers.

Intensive analysis of therapeutic factors and outcome in long-term inpatient groups

Two long-term analytic inpatient groups comprised of severely disturbed neurotic and personality disordered patients were intensively investigated through process ratings and therapist and patient reports with regard to five therapeutic factors: cohesiveness, self-disclosure, feedback, interpersonal learning-output, and family re-enactment. The process variables were correlated with outcome assessments at 12 and 18 months following treatment. The study applied a single case (group) approach with replication to cross-validate the findings from one group to the next. Results demonstrated that all five therapeutic factors were meaningfully associated with clinical improvement. Although different treatment groups may generate unique psychological climates for producing change, the findings suggest that group cohesiveness is an important ingredient for effective group process to occur. The multimethod, multiperspective nature of this study lends considerable credence to the findings, despite the small sample size.

The role of evaluation in clinical practice: overview and group treatment illustration

A variety of intrinsic and extrinsic factors exert pressure on clinicians and researchers to forge a more effective alliance in their mutual efforts to understand treatment process and outcome. The authors provide a general framework and a specific group-therapy model to demonstrate how research measures can facilitate this integration and thereby improve the quality of service delivery. We divide treatment into four phases: negotiation, retention, enhancement, and evaluation, and illustrate how psychotherapists can use research instruments to overcome problems at each stage of intervention.

Therapeutic factors within in-patient and out-patient psychotherapy groups. Implications for therapeutic techniques

Therapeutic factors operative in in-patient and out-patient therapy groups were compared. These settings differ greatly, both in terms of the patient population they serve and the overall systems within which they operate. The study revealed significant differences between the therapeutic factors operative in these two settings, and suggested that clinicians should modify their techniques for running psychotherapy groups across settings, to take account of these findings.