Long-term Psychodynamic Group Research Articles

Was geht „kurz“ in psychodynamischen Gruppenbehandlungen? Ein Therapieangebot aus der Praxis und ein vorsichtiges Plädoyer für neue Wege und neue Diskussionen

Referring to Manuel Becker’s article about new German legal options of short-term group therapy in this journal (2021, 57, S. 167-186) we reflect upon the impact factor of restricted time in psychodynamic group therapy and present a compact offer of short-term group therapy on three weekends, developed in clinical practice. We consider this concept a module between the new primary group therapeutic care and long-term psychodynamic group therapy. Feed-back and ideas of colleagues are welcome.

Značenje simptoma shizofrenog bolesnika tijekom trajanja grupne psihoterapije i nakon njenog završetka

Značenje simptoma shizofrenog bolesnika tijekom trajanja grupne psihoterapije i nakon njenog završetka

Process-outcome relationships in short- and long-term psychodynamic group psychotherapy: Results from a randomized clinical trial.

Process-outcome relationships in short- and long-term psychodynamic group psychotherapy: Results from a randomized clinical trial.

Object relations and self-esteem in young adults with schizophrenia in long-term psychodynamic group psychotherapy

IntroductionPsychodynamic concepts describe object relations deficits in patients with schizophrenia originating from their earliest developmental stage, which is due to reduced ability of direct caregivers to adequately stimulate the child, as well as genetic factors. During psychodynamic group psychotherapy, members through psychotherapy gradually release the old family roles and experiment with new models of behaviour and thus change internalized object representations.AimThe aim of this study was to investigate changes in object relationships and self-esteem in the psychodynamic group psychotherapy in young patients suffering from schizophrenia.Subjects and methodsThe study included a total of 41 patients diagnosed with schizophrenia. Before joining the psychodynamic group therapy and after two years of participation in the treatment, all patients completed a test of object relations and the Rosenberg self-esteem scale.ResultsComparison of the results in two time periods showed downward trend results in all tested dimensions of object relations, a statistically significant difference was found for dimension symbiotic fusion: after two years of participation in the psychodynamic group psychotherapy, patients had significantly expressed less need for symbiotic relationships. Self-esteem was higher in the second period of testing, but without statistical significance.ConclusionTaking into account the limitations of this study, we can conclude that the results are encouraging. During psychodynamic group processes in young patients with schizophrenia there is a trend of positive changes in terms of object relations and self-esteem and a significant reduction in the need for symbiotic merging.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Presence of personality disorder moderates the long-term effects of short-term and long-term psychodynamic group therapy: A 7-year follow-up of a randomized clinical trial.

Presence of personality disorder moderates the long-term effects of short-term and long-term psychodynamic group therapy: A 7-year follow-up of a randomized clinical trial.

Patterns of Change in Interpersonal Problems During and After Short-term and Long-term Psychodynamic Group Therapy: A Randomized Clinical Trial

Objective: In this study, we compared the patterns of change in interpersonal problems between short-term and long-term psychodynamic group therapy. Method: A total of 167 outpatients with mixed diagnoses were randomized to 20 or 80 weekly sessions of group therapy. Interpersonal problems were assessed with the Inventory of Interpersonal Problems at six time points during the 3-year study period. Using linear mixed models, change was linearly modelled in two steps. Earlier (within the first 6 months) and later (during the last 2.5 years) changes in five subscales were estimated. Results and conclusion: Contrary to what we expected, short-term therapy induced a significantly larger early change than long-term therapy on the cold subscale and there was a trend on the socially avoidant subscale, using a Bonferroni-adjusted alpha. There was no significant difference between short-term and long-term group therapy for improving problems in the areas cold, socially avoidant, nonassertive, exploitable, and overly nurturant over the 3 years.

The Effectiveness of Short- and Long-Term Psychodynamic Group Psychotherapy on Self-Concept: Three Years Follow-Up of a Randomized Clinical Trial

We compared differences in self-concept change across three years after short-(STG) and long-term (LTG) psychodynamic group psychotherapy, in a mixed sample of outpatients. Self-concept was assessed at baseline and three years later, using the Structural Analysis of Social Behavior Questionnaire. Vector scores Affiliation and Autonomy were primary, and the eight cluster scores–self-free, self-affirm, self-love, self-protect, self-control, self-blame, self-attack, and self-neglect–were secondary outcome measures. Within group univariate analyses showed change in LTG across three years on the vector scores Affiliation and Autonomy, while STG only changed on Autonomy. Comparisons between STG and LTG demonstrated a significantly larger improvement in Affiliation in LTG than in STG. This difference was explained by a higher improvement in the cluster scores of self-blame, self-attack, and self-neglect in LTG, dimensions that weight negatively on the Affiliation score. Patients with more serious self-neglect and harsh, punitive self-attack/self-blame may profit more in long-term than in short-term groups.

A Substance Called Food: Long-Term Psychodynamic Group Treatment for Compulsive Overeating

Obesity has proven difficult to treat. Many approaches neglect to address the deep-rooted underlying psychological issues. This paper describes a psychodynamically oriented approach to treating compulsive overeating as an addiction. Common to all addictions is a compulsion to consume a substance or engage in a behavior, a preoccupation with using behavior and rituals, and a lifestyle marked by an inability to manage the behavior and its harmful consequences. The approach represents a shift away from primarily medical models of intervention to integrated models focusing on the psychological underpinnings of obesity. Long-term psychodynamic group psychotherapy is recommended as a primary treatment.

Personality disorder moderates outcome in short- and long-term group analytic psychotherapy: A randomized clinical trial.

In a randomized clinical trial, short- and long-term psychodynamic group psychotherapy (STG and LTG, respectively) schedules were equally effective for the 'typical' patient during a 3-year study period. Although several studies have reported good effects for patients with personality disorders (PD) in diverse forms of psychotherapy, the significance of treatment duration is unclear. Therefore, we tested the hypothesis that PD patients would improve more during and after LTG than STG. A randomized, longitudinal, prospective study contrasting the outcomes during and after short- and long-term dynamic group psychotherapies. One hundred and sixty-seven outpatients with mood disorders, anxiety disorders, or PD were randomized to STG or LTG (respectively, 20 or 80 weekly sessions of 90 min each). Outcome measures are as follows: symptoms (SCL-90-R), interpersonal problems (IIP-C), and psychosocial functioning (GAF split version: GAF-Symptom and GAF-Function). PD pathology (number of PD criteria items) was selected a priori as a putative moderator of treatment effects. Change during the 3-year study period was assessed using linear mixed models. The study was registered at ClinicalTrials.gov as NCT 00021417. Our hypothesis was supported, as patients with PD improved significantly more regarding all outcome variables in LTG than STG. For patients without PD, the rate of change was similar across 3 years; however, the rate of change in symptoms and interpersonal problems was higher in STG during the first 6 months. The effectiveness of LTG is higher for patients with co-morbid PD. Patients without PD do not appear to experience additional gain from LTG. Clinical implications: LTG demonstrates better effectiveness than STG for patients with personality disorder co-morbidity (PD). Patients without PD do not appear to experience additional gain from attending LTG. Correct initial allocation to treatment duration may prevent disruptive breaks in relationships and lead to both human and economic cost savings. Limitations: Trials on mixed diagnostic samples may limit the ability to fully assess change for specific diagnostic groups. Therapists were unable to select patients and compose their own groups. Although this condition might increase the generalizability of the results, it may also have restricted the therapists and the clinical situation inadvertently.

Comparison of short- and long-term dynamic group psychotherapy: randomised clinical trial

There are no randomised clinical trials comparing the outcomes of short- with long-term psychodynamic group psychotherapy. To compare differences in outcome during and after short- and long-term group psychotherapy. In total, 167 out-patients with mood, anxiety and personality disorders were randomised to short- or long-term group therapy (20 or 80 weekly, 90 min sessions). Outcome measures were: symptoms (Symptom Checklist 90 - Revised), interpersonal problems (Inventory of Interpersonal Problems - Circumplex) and psychosocial functioning (Global Assessment of Functioning (GAF) split version: GAF-Symptom and GAF-Function). Change over the 3-year study period was assessed using linear mixed models. The study was registered in clinicalTrials.gov as NCT00521417. Patients in both groups made significant gains. A significantly larger symptomatic change over time was found for long-term compared with short-term therapy, but no significant differences were detected for the three remaining outcome variables. There was a higher number of premature terminations in the long-term (33.3%) compared with the short-term group (8.6%). Short- and long-term therapy seem equally effective for typical out-patients seeking group psychotherapy, except for symptomatic distress.

Development of Group Climate in Short- and Long-Term Psychodynamic Group Psychotherapy

This study examined the development of group climate using the Engaged, Conflict, and Avoiding subscales of the Group Climate Questionnaire—Short Version (GCQ-S) in a sample of 145 patients attending either short- (20 sessions) or long-term (80 sessions) psychodynamic group psychotherapy. Linear mixed models were used to compare changes in group climate over time. Engaged developed along similar lines in the two psychotherapy formats. During the first 18 sessions, conflict and avoidance decreased toward the termination of the short-term groups, in contrast to an increase in this still-early stage of the long-term groups. When compared according to the stages of therapy (early, middle, late), a low-high-low pattern for conflict and avoidance emerged in both psychotherapy formats, with a stronger decrease toward termination in long-term groups. This finding can be seen as reflecting an accelerated progress of development within the short-term groups, and a delayed but strengthened process in the long-term groups. Review of empirical studies indicated that most theories of group development have a relatively narrow range of validity, but the parallel pattern of group climate found in this study across early, middle, and late stages for short- and long-term groups suggests that the perspective of developmental stages is still important to both group process theory and clinical practice.

Examining patients' and other group members' agreement about their alliance to the group as a whole and changes in patient symptoms using response surface analysis.

There is a lack of research examining patients' and other group members' agreement about their therapeutic alliance. In the present study, the person-group (P-G) fit model was adopted to predict that the group member symptom reduction will be greater when the group member's and the other group members' perceptions of their alliance to the group-as-a-whole fit and are high. In addition, the effect of disagreement between the group member and the other group members in their perceptions of the group alliance on the individual's outcome was investigated by using response surface analysis. Thirty-two patients from 5 long-term (> 1 year) psychodynamic group treatments were studied. Participants filled out the California Psychotherapy Alliance Scale-Group (CALPAS-G; Gaston & Marmar, 1993) and the Outcome Questionnaire-45 (OQ-45; Lambert et al., 1996) monthly over the course of group treatment until termination. As hypothesized, patient's symptom reduction was greater when there was agreement between the group member and the other group members that their alliance to the group as a whole was strong. Contrary to the authors' hypothesis, a lack agreement on alliance to the group as a whole between the patient and the other group members was not related to less symptom reduction, as lack of fit increased, symptom reduction decreased. Also contrary to the authors' hypothesis, when other group members saw their alliance to the group as a whole as stronger than did the patient, there was increased symptom reduction. The findings suggest that the P-G fit model may be a useful strategy to examine group process variables in the psychotherapy context.

Psychodynamic Group Psychotherapy: Impact of Group Length and Therapist Professional Characteristics on Development of Therapeutic Alliance

Little research has been done on therapeutic alliance in group psychotherapy, especially the impact of treatment duration and therapist professional characteristics. Therapeutic alliance was rated by patients on the Working Alliance Inventory-Short Form at three time points (sessions 3, 10 and 17) in a randomized controlled trial of short-term and long-term psychodynamic group psychotherapy. As predictors we selected therapist clinical experience and length of didactic training, which have demonstrated ambiguous results in previous research. Linear latent variable growth curve models (structural equation modeling) were developed for the three Working Alliance Inventory-Short Form subscales bond, task and goal. We found a significant variance in individual growth curves (intercepts and slopes) but no differential development due to group length. Longer therapist formal training had a negative impact on early values of subscale task in both treatments. There was an interaction between length of the therapists' clinical experience and group length on early bond, task and goal: therapists with longer clinical experience were rated lower on initial bond in the long-term group but less so in the short-term group. Longer clinical experience influenced initial task and goal positively in the short-term group but was unimportant for task or significantly negative for goal in the long-term group. There was no mean development of alliance, and group length did not differentially impact the alliance during 6 months. Early ratings of the three Working Alliance Inventory-Short Form subscales partly reflected different preparations of patients in the two group formats, partly therapist characteristics, but more research is needed to see how these aspects impact alliance development and outcome. Therapists should pay attention to all three aspects of the alliance, when they prepare patients for group therapy. In psychodynamic groups, length of therapy does not differentiate the overall level or the development of member-leader alliance. Within psychodynamic groups, each individual appear to have their unique perception of the member-leader alliance. Therapists with longer formal psychotherapy training may be less successful in establishing early agreement with patients on the tasks of psychodynamic group psychotherapy. Patients perceive a somewhat lower degree of early emotional bonding with the more clinically experienced therapists in long-term psychodynamics groups. Therapists with more clinical experience may contribute to a stronger degree of initial agreement with patients on the tasks and goals of short-term group psychotherapy.

Wirksamkeit ambulanter Gruppenpsychotherapie in Deutschland: Ergebnisse der PAGE-Studie

Summary Effectiveness of Outpatient Group Psychotherapy in Germany – Results of the PAGE-Study The PAGE study underlines the effectiveness of long-term psychodynamic and psychodra matic outpatient group therapies in a naturalistic setting. 40 experienced group therapists cooperated, and complete outcome data of 244 patients from psychodynamic groups and of 91 patients from psychodramatic groups (pre-post) were obtained. The effect sizes are consi derably high (ES PA = 1.33 and ES PD = 1.01) compared to internationally reported effect sizes of psychotherapeutic treatments. They highlight the importance of long-term therapeutic treatments with a severely and chronically disturbed clientele. A direct comparison between both approaches – psychodynamic and psychodramatic group therapy – is not possible due to significant differences in treatment lengths and patient demands. Approximately 2.000 treatment goals were obtained from all participating patients and provide information regarding the relationship between intrapsychic and interpersonal treatment goals of patients undergoing group psychotherapy.

P02-363 - Changes in cognitive functioning during group psychodynamic psychotherapy with young psychotic patients

ObjectivesCognitive impairment is considered to be one of the central features of schizophrenia and it has been so since original descriptions of illness by Kraepelin and Bleuler. Deficits are already present at the first-episode of illness. Some researches conclude that deficits do not change over time, while others suggest that deficits can be reduced. The objective of this research is comparison of cognitive functions of psychotic patients who participated group psychotherapy with those ho did not.MethodIn this paper, by means of Revised Beta Examination (measure of non-verbal intellectual ability) we observe changes in cognitive functioning of 29 psychotic patients who participated in the psychodynamic group psychotherapy within the Early Interventions Program and compare their cognitive achievements with results of matched 32 psychotic patients who received “treatment as usual”. Answers were analyzed qualitatively and quantitatively.ResultsImprovement in cognitive functions was observed in both investigated and control group, but improvement in patients who are participants of long-term psychodynamic group psychotherapy was better than in the group of patients who were not treated in that manner with statistical significance.ConclusionsPsychiatric hospital “Sveti Ivan” offers an extensive outpatient Early Intervention Program for psychotic patients in the critical period of their illness - up to five years from onset. The program includes psychoeducation workshops for the patients and their family members together, group psychodynamic psychotherapy for the patients and group psychotherapy for the family members. Our results indicate better effectiveness of Program when compared to “treatment as usual”.

P03-111 - Influence of psychodynamic group oriented psychotherapy on quality of life in patients with psychotic disorders

ObjectivesGroup psychotherapy along with psychopharmacological therapy and sociotherapy is an important and frequently applied therapeutic method. Numerous studies indicate that group psychotherapy affects the functioning in patients with psychotic disorders in terms of improving the cognitive, emotional and social functioning and generally contributes to a better quality of life (Kanas, 1996).The aim of this study was to assess the impact of psychodynamic oriented group psychotherapy on the quality of life in patients with psychotic disorders and to compare the obtained results with the results of patients with psychotic disorders who did not participate in psychodynamic group psychotherapy.MethodPatients included in this study have completed psychotherapy group five years ago and were in regular outpatient treatment together with regular application of medication therapy. The applied method was Quality of Life Scale (Krizmanić, Kolesarić). Answers were analyzed qualitatively and quantitatively.ResultsThe quality of life in the group of patients who completed long-term psychodynamic group psychotherapy was better than in the group of patients who were not treated in that manner, although there are no statistically significant differences. The most important differences were in the area of intimacy, professional occupation and in the area of family relations.ConclusionIt can be concluded that long-term psychodynamic group psychotherapy has a positive influence on quality of life of patients with psychotic disorders.

Long-term psychodynamic group psychotherapy for eating disorders: A descriptive case report

Fifteen women with long-standing histories of eating and other disordered behavior participated in a psychodynamically oriented psychotherapy group over a 3-year period. This article provides a number of observations on this group and describes how a variety of organizational. patient, therapist, and treatment variables combined to help as well as hinder favorable outcome in group members. The implications of these findings for assessment, preparation, selection, and intervention are discussed, and recommendations are offered for working with more recalcitrant eating disordered people in pup in the future.

Psychodynamic group therapy for male survivors of sexual abuse

The group therapy literature on male sexual abuse is very preliminary and concerned solely with short-term support models. This paper describes a long-term psychodynamic therapy group for male survivors that has been running successfully in a clinic setting for almost three years. This combined group and individual treatment approach presupposes the selection of men who are capable of using group process to explore basic personality and relationship problems. With sexually abused men, certain treatment issues are paramount. These concern the safety of group boundaries, power and control, facilitating intimacy, handling shame and guilt, and the effects of trauma. Special attention is given to the gender-related dynamics and conflicts that occur in a group of male survivors with a male leader.

Group therapy with bulimic women: A self-psychological approach

Long-term psychodynamic group therapy is an important tool in the process of engaging bulimic women in treatment and in helping them work through both the symptom and the underlying characterological problems of the disorder. The authors utilize concepts from self-psychology, particularly “selfobject” needs and the therapist's empathic stance, to explain some of the dynamics of bulimia and the ways in which group therapy addresses them. An example from one of the authors' groups demonstrates this. The multiple selfobject transferences that develop in a group, coupled with the therapist's empathic interpretations, fostered the development of internal structure that explains the bulimic's gradual ability to dispense with her symptoms. The authors believe that groups provide a setting in which that structure can be developed.