Group therapists' training: what predicts learning?

How can learning effects be measured in Balint groups? Validation of a Balint group questionnaire in China

BACKGROUND

Balint groups aim to reflect doctor-patient relationships on the basis of personal cases. This study reports the validation of a questionnaire aimed at the identification of learning processes among Balint group participants in China.

METHODS

This multicenter cross-sectional study was conducted during Balint group sessions in Beijing, Guangzhou and Shanghai. A heterogeneous sample of different professional groups was intended to adequately capture the reality of Balint work in China. After a Balint group session, the participants were asked to complete the Mandarin version of the Balint group session questionnaire (BGQ-C) and the group questionnaire (GQ), an internationally validated instrument to assess central dimensions of therapeutic relationships during group processes.

RESULTS

Questionnaires from n = 806 participants from 55 Chinese Balint groups, predominantly comprising individuals with a medical background, were analyzed. Most participants were female (74.6%), and the average age was 34.2 years old (SD = 9.4). The results indicated good to very good reliability (Cronbach's α = .70 to .86; retest r_s = .430 to .697). The verification of the construct validity of the BGQ-C showed satisfying convergent (r_s = .465 to .574) and discriminant validity (r_s = -.117 to -.209). The model was tested with a confirmatory factor analysis of a three-factor model (standardized root mean square residual = .025; comparative fit index = .977; Tucker-Lewis index = .971). The 3 empirically identified scales resulted in good model fit with the theoretical dimensions of Balint work postulated in the literature: "reflection of transference dynamics in the doctor-patient relationship", "emotional and cognitive learning" and "case mirroring in the dynamic of the group". Due to the high correlations between the factors, a single-factor model was possible. A group comparison between the German and Chinese samples showed different loadings across cultures.

CONCLUSIONS

The BGQ-C is a quick-to-complete, item-based measuring instrument that allows the relevant dimensions of Balint group work to be recorded. This study suggests good psychometric properties of the Chinese version. Nevertheless, it must be assumed that the composition of constructs in the two countries is different.

Group cohesion in group-based personal practice

BACKGROUND

Personal practice (PP) is an integral component of many psychotherapy training programmes. It aims to promote personal and professional growth and is often conducted in a group format (g-PP). Group cohesion is one of the most researched mechanisms in group psychotherapy, but has rarely been studied in the context of g-PP.

AIMS AND METHOD

This exploratory study examines the associations between cohesion, satisfaction with g-PP, its impact on personal and professional development, and theoretical orientation in a sample of n = 329 German psychotherapy trainees. Cohesion was assessed with the group questionnaire (GQ-D; Positive Bonding, Positive Working, Negative Relationship).

RESULTS

Overall, participants reported high levels of all outcome variables. Positive Bonding was the strongest predictor of satisfaction with g-PP (β = 0.46, p<.001). While trainees in cognitive behaviour therapy reported significantly better cohesion scores (d≥0.31), trainees in psychodynamic therapy reported significantly higher satisfaction with g-PP and its impact on their developments (d≥0.30).

CONCLUSIONS

Group cohesion appears to be an important factor in g-PP that should be actively promoted by group leaders. However, longitudinal study designs are needed to better understand the emergence of cohesion in g-PP as well as potential moderating factors.

Effect of group leaders on doctors' learning in Balint groups

OBJECTIVE

Although effective Balint leadership is viewed as essential for good Balint practice, nearly no quantitative research is available regarding the importance of the person of the group leader in Balint group outcome. This study aims to identify Balint group leaders' impact on "typical Balint" learning processes in Balint groups.

METHOD

A total of 1460 medical doctors in 352 Balint groups in Germany, Austria, and Switzerland were investigated. Based on the three learning dimensions of the Balint Group Session Questionnaire, statistical analyses were conducted to identify differential effectiveness in Balint leadership.

RESULTS

On the basis of the mean scores of the Balint Group Session Questionnaire items across all group participants of each group leader, the 80 certified Balint group leaders were clustered into two groups of more and less effective leaders by a hierarchichal cluster analysis. Mixed model analyses revealed that the effectiveness of the person of the Balint group leader was the most predictive factor for learning effects.

CONCLUSIONS

Training for Balint group leaders should take into account that effective learning processes in Balint groups are strongly related not only to the method itself but also to the person of the group leader.

[How effective are Balint group leaders?]

How effective are Balint group leaders?

OBJECTIVES

Balint leadership until today is based on views of experts. Empirical research is still lacking. This paper reports about leadership effects in Balint groups measured by the newly developed Balint Group Questionnaire (BGSQ). The questionnaire comprises three scales: Scale 1 - Reflection of Transference Dynamics in the Doctor-Patient Relationship, Scale 2 - Emotional and Cognitive Learning, Scale 3 - Case Mirroring in the Group Dynamic.

RESULTS

87 out of 107 cooperating Balint group leaders had six or more participants who filled out the questionnaire after a Balint session. Based on the scale scores of the BGSQ from 1459 medical participants we found three clusters of differentially effective leadership. 52 leaders (59.8 %) belonged to the most effective cluster in scale 1, 11 leaders (12.6 %) were particularly effective in scale 2, and 21 leaders (24.1 %) in scale 3. Five out of 87 leaders were found most effective for all three scales. No other influencing factors predicted leadership effectiveness.

CONCLUSIONS

This is the first quantitative study to differentiate leadership effects on learning processes of participants of Balint groups. The importance for training of Balint group leaders is discussed. More research regarding predictive variables and helpful leadership interventions is needed.

Group dynamics are associated with weight loss in the behavioral treatment of obesity

OBJECTIVE

To assess whether group dynamics are associated with weight loss, session attendance, and self-monitoring adherence after 6 months of lifestyle intervention for obesity.

METHODS

Women with obesity (N = 125; mean ± SD BMI = 37.84 ± 3.94 kg/m(2) ; age =  51.99 ± 10.81 years) participated in a 24-week group-based lifestyle weight loss intervention and achieved a weight loss of 9.13 ± 7.15 kg after 6 months. Participants reported their perceptions of group conflict, avoidance, engagement, social support, and attraction at the end of treatment. Multiple regression with forward selection assessed which group dynamic variables were associated with weight loss, attendance, and adherence.

RESULTS

Greater perceived group conflict was associated with smaller weight losses (β = 1.833, P = 0.044) and lower attendance (β = -2.313, P = 0.002) and adherence rates (β = -2.261, P = 0.030). Higher group attraction was associated with higher attendance rates (β = 0.051, P = 0.039). The association between perceived conflict and weight change was mediated by attendance and adherence (P = 0.019).

CONCLUSIONS

Findings demonstrate that group dynamics associate with weight loss outcomes, attendance, and adherence. Addressing conflicts and fostering acceptance among group members may promote success in group-based lifestyle interventions for obesity.

Effects of individual cohesion and patient interpersonal style on outcome in psychodynamically oriented inpatient group psychotherapy

The influence of patients' interpersonal traits in interaction with experienced individual cohesion (i.e., each patient's feeling of belonging to the group) was investigated in a sample of 327 inpatients with mixed diagnoses. High cohesion and an increase in cohesion emerged as predictive for symptom improvement in a multilevel regression model. This influence was moderated by the affiliation dimension: In dismissive patients, an increase of cohesion over the course of treatment was helpful; in affiliative patients, symptom improvement was correlated with a slight decrease of cohesion. The findings highlight the therapeutic importance of group therapy and point to the differential influence of individually experienced group cohesion.

Perceived Group Climate as a Predictor of Long-Term Outcome in a Randomized Controlled Trial of Cognitive-Behavioural Group Therapy for Patients with Comorbid Psychiatric Disorders

Background: Research on group therapy indicates that various dimensions of the helpful relationship qualities (cohesion, climate, empathy, alliance) are associated with outcome. However, the use of a wide variety of empirical scales makes comparisons between studies as well as generalizations somewhat difficult. Although a generic, trans-theoretical measure such as the Group Climate Questionnaire-Short Form (GCQ-S; MacKenzie, 1983) is available and applicable to most treatment conditions, it has never been tested with cognitive-behavioural group therapy. Aims: To investigate perceived dimensions of group climate (engagement, avoidance and conflict) as predictors of long-term (1 year) follow-up in a manualized, structured time-limited cognitive-behavioural group therapy (CBGT) for out-patients with comorbid psychiatric disorders. Methods: Data from 27 patients were analysed using hierarchical multiple regression analyses. Outcome measures used were general symptomatic complaints (SCL-90-R), interpersonal problems (IIP-64), specific mood- and anxiety symptoms (BDI; BAI) and early maladaptive schemas (YSQ). After controlling for scores on the relevant dependent variables at both intake and treatment termination, dimensions of group climate measured close to termination were entered as predictors in separate analyses. Results: Higher ratings of engagement were associated with reduced scores on all outcome measures at follow-up, except for anxiety symptoms (BAI). Higher ratings of avoidance were associated with lower anxiety symptoms at follow up, whereas ratings of conflict were unrelated to all follow-up scores. Conclusions: The results provide partial support for the use of the GCQ-S as a predictor of long-term follow-up in CBGT, and highlights perceived engagement as the most important dimension. Clinical implications are discussed.

Ambulante psychodynamische Kurzgruppenpsychotherapie bei Patienten mit somatoformen Störungen 1Diese Arbeit ist Prof. Dr. Jürgen Ott gewidmet (†2003)

Zusammenfassung. Die Wirksamkeit tiefenpsychologischer Kurzgruppenpsychotherapie bei Patienten mit somatoformen Störungsbildern wird nachgewiesen. Am Beispiel von sechs ambulanten Gruppen zu je 20 Sitzungen mit insgesamt 50 Patienten werden hohe Effektstärken im symptomatischen, interpersonellen und allgemeinen Funktionsbereich bis zu einem Jahr Katamnese nachgewiesen. Darüber hinaus ließen sich prozessanalytisch Patientenmerkmale als prognostisch relevant für den Therapie-Outcome feststellen. Hierzu gehören als ungünstiger Prädiktor die zusätzliche Diagnose einer Persönlichkeitsstörung sowie als günstiger Prädiktor eine besondere Fähigkeit, vom Beginn der Gruppentherapie an eine intensivere, positiv getönte, emotionale Beziehung zur Gruppe herzustellen, die offensichtlich die Arbeitsfähigkeit in einer psychodynamischen Gruppe günstig beeinflusst. Konsequenzen im Hinblick auf Behandlungslänge von somatoformen Beschwerden werden diskutiert.

Beziehungserleben und Therapieergebnis in stationärer Psychotherapie

OBJECTIVES

Inpatient psychotherapy includes the patient's manifold contacts with different therapists, nurses and fellow patients. The present study investigated the association between these multiple relationships and therapy outcome.

METHODS

Pre-post measures of symptom load (Brief Symptom Inventory), interpersonal problems (IIP) and self-efficacy (SEB) were used to define three groups with positive (N=129), unchanged (N=44) or negative (N=40) outcome. These groups were compared 1) by their alliance with an individual therapist, their relationship to the therapeutic team, their experience of cohesion and climate concerning fellow patients in the ward (measured weekly by the "Stationserfahrungsbogen" SEB), and 2) by their differences in mean correlations between the courses of relationship experiences and symptom load.

RESULTS AND CONCLUSIONS

Cohesion and relationship to the therapeutic team were not associated with therapy outcome. Therapeutic alliance with the individual therapist and climate among fellow patients turned out to be moderate indicators of the therapeutic outcome. It is recommended to include these process parameters systematically into the process diagnostics of inpatient psychotherapy.