Long-term Group Psychotherapy Research Articles

Group-as-a-whole interpretations in short-term group psychotherapy

The usefulness of therapists making group-as-a-whole interpretations in long-term group therapy was actively debated in the 1960s and 1970s. Advantages and disadvantages were delineated. An often-cited survey study of therapy groups that had emphasized group-as-a-whole interpretations found that many patients were dissatisfied with the therapist’s technique and the outcome of therapy. Although group-as-a-whole concepts subsequently became a part of the theory of many orientations of group therapy, there has appeared to be reluctance among many therapists to make group-as-a-whole interpretations, especially in short-term group therapies. Contrary to this tendency, an argument is made and a case illustration presented, which advocate the use of group-as-a-whole interpretations in short-term group therapies.

From Tenuous to Tenacious Link

Abstract The author's experience with long-term group psychotherapy is described. He shows how differing theoretical traditions might come together and provides clinical material illustrating how substance misusers cautiously attach and ‘scan’ the group situation; if the uncertainty and storms can be weathered, deeper and more meaningful attachments result, thus helping to build on recovery.

Predictors of change after long‐term analytic group psychotherapy

In a study of long-term (mean=32.5 months) analytic group psychotherapy we explored the relationships among six predictors shown to influence outcome in short-term group studies and five outcome variables (Global Assessment of Functioning [GAF], Global Symptom Index [GSI], Inventory of Interpersonal Problems-Circumplex [IIP-C], Global Improvement, and Chief Complaints), assessed after termination of therapy. In this study, we wanted to test whether the same variables also predicted patients' status at follow-up, 1 year after termination. Bivariate correlations and multiple regression analyses were used. Initial status and treatment duration up to 2.5 years turned out to be strong positive predictors of status at both time points. Contrary to findings from many short-term studies, presence of personality disorder, high initial severity, chronicity, and less optimistic expectations had no predictive power at either time. Higher age predicted a less favourable status at follow-up in secondary exploratory analyses. The findings suggest that different patients may benefit from long-term versus short-term group psychotherapy. More studies should examine patient aptitude and the significance of the time factor (Aptitude-Treatment Interaction [ATI-effects]).

Duration of Anticoagulation Following Venous Thromboembolism

Patients with venous thromboembolism (VTE) are susceptible to recurrent events, but whether prolonging anticoagulation is warranted in patients with VTE remains controversial. To review the available evidence and quantify the risks and benefits of extending the duration of anticoagulation in patients with VTE. PubMed, EMBase Pharmacology, the Cochrane database, clinical trial Web sites, and a hand search of reference lists. Included studies were randomized controlled trials with results published from 1969 through 2004 and evaluating the duration of anticoagulation in patients with VTE that measured recurrent VTE. Excluded studies were those enrolling only pure populations of high-risk patients. Two independent reviewers assessed each article for inclusion and exclusion criteria, with adjudication by a third reviewer in cases of disagreement. Fifteen of 67 studies were included in the analysis. Two independent reviewers performed data extraction using a standardized form, with adjudication by the remainder of the investigators in cases of disagreement. Data regarding recurrent VTE, major bleeding, person-time at risk, and study quality were extracted. If patients in the long-term therapy group remained receiving anticoagulation, the risk of recurrent VTE with long- vs short-term therapy was reduced (weighted incidence rate, 0.020 vs 0.126 events/person-year; rate difference, -0.106 [95% confidence interval {CI}, -0.145 to -0.067]; P<.001; pooled incidence rate ratio [IRR], 0.21 [95% CI, 0.14 to 0.31]; P<.001). If anticoagulation in the long-term therapy group was discontinued, the risk reduction was less pronounced (weighted incidence rate, 0.052 vs 0.072 events/person-year; rate difference, -0.020 [95% CI, -0.039 to -0.001]; P = .04; pooled IRR, 0.69 [95% CI, 0.53 to 0.91]; P = .009). The risk of major bleeding with long- vs short-term therapy was similar (weighted incidence rate, 0.011 vs 0.006 events/person-year; rate difference, 0.005 [95% CI, -0.002 to 0.011]; P = .14; pooled IRR, 1.80 [95% CI, 0.72 to 4.51]; P = .21). Patients who receive extended anticoagulation are protected from recurrent VTE while receiving long-term therapy. The clinical benefit is maintained after anticoagulation is discontinued, but the magnitude of the benefit is less pronounced.

Effects of increasing doses of a bolus injection and an intravenous long-term therapy of taurolidine on subcutaneous (metastatic) tumor growth in rats

Experimental studies have shown that taurolidine suppresses intraperitoneal tumor growth following local application in rats. In opposite, a single intravenous therapy affected neither intraperitoneal nor subcutaneous growth of malignancies. Thus, an intravenous long-term therapy with taurolidine was investigated in rats after administration of a subcutaneous tumor load. VEGF and TNFalpha production and their effects on tumor growth have not been elucidated so far. VEGF and TNFalpha levels of rat colon adenocarcinoma cells (DHD/K12/TRb) were analyzed in the supernatant undergoing treatment of increasing taurolidine doses in vitro. Besides the cell experiments rats were treated intravenously. At the beginning of the operation, 10 000 colon adenocarcinoma cells were applied subcutaneously at the back of the rats. Then the animals (n = 80, BD IX rats) were randomized into eight groups and underwent a standardized midline laparotomy for 30 min. At the end of the operation the animals were given either a bolus (1 ml Ringer's solution) or a long-term intravenous therapy (7 days, eight-hourly 1 ml 1%, 2%, or 3% taurolidine) were performed. For long-term therapy, a jugularis vein port catheter system was placed and left for 1 week. The influence on subcutaneous tumor growth, animal growth, general side effects and leukocyte/granulocyte levels were analyzed. Total tumor weights were determined 4 weeks after cell application. The VEGF and TNFalpha levels decreased rapidly after taurolidine therapy with low doses in vitro. The subcutaneous tumor growth showed a downtrend of tumor weight (P = 0.075) with a statistical significance in solid tumor counts (P = 0.04) at the back of the animals. A slight and temporary depression in animal growth was observed only in long-term therapy groups. Independent of the therapeutic agents and the application forms, the operation itself caused a slight leukopenia shortly after the operation compensated by a moderate leukocytosis in the following course. Fast injections of taurolidine led to a reduction of breathing rate. Only the intravenous long-term therapy of 3% taurolidine led to a slight downregulation in subcutaneous tumor growth. The changes of leukocyte counts were not affected by taurolidine. Fast injections have to be avoided. The findings prompted us to start new experiments to determine the influence of increasing doses of taurolidine on progressive tumor growth in rats.

Commentary on “Therapist-Initiated Termination”

Therapist-initiated termination poses several unique problems for both the group and the therapist. This paper describes the termination process from the point of view of this therapist's experience in planning the termination of her group therapy practice. The reactions of other analysts to her decision to retire and the group processes and individual patient's reactions in this long-term psychoanalytic therapy group are described in detail. The author follows the group process and her own inner processes in the final six months of the group. The importance of the working through of the termination phase of therapy is supported by the experiences that were shared by the group and the therapist.

Effect of intravesical instillation on performance of uCYT+ test

Objectives To assess the influence of intravesical instillation of epirubicin or bacille Calmette-Guérin (BCG) in patients with bladder cancer on the clinical performance of the uCyt+ test, which traces the three monoclonal antibodies M344, LDQ 10, and 19A211 in urothelial cells. Methods A total of 267 patients with a mean age of 70.5 years (range 35 to 87) were included in this prospective study. All patients were being followed up after complete transurethral resection of superficial urothelial cancer. All patients received a single instillation of 80 mg epirubicin within 24 hours of transurethral resection and 163 underwent subsequent cycles of chemotherapy with epirubicin or immunotherapy with BCG. This was because of multifocality, high-recurrence, or high-grade urothelial cancer. At the next control, all patients underwent urinary cytology, with the uCyt+ test performed on liquid-based cytology (ThinPrep), subsequent cystoscopy, and evaluation of any suspicious lesion by biopsy. Patients who underwent intravesical BCG therapy underwent random bladder cold biopsy after every instillation series. Results Of the 267 patients, 8 could not be evaluated by uCyt+ because of insufficient cells. Of the remaining 259 patients under assessment, 86 had proven urothelial cancer. In the 101 patients under assessment with only a single intravesical instillation of epirubicin (group 1), the overall sensitivity for cytology and the uCyt+ test was 44.7% and 76.6%, respectively. Cytology had a specificity of 90.7% and uCyt+ of 64.8%. The negative predictive value for cytology and uCyt+ was 65.3% and 76.1%, respectively. Of the 158 patients under evaluation who were treated with long-term intravesical therapy (group 2), the overall sensitivity and specificity for cytology and the uCyt+ test was 37.8% and 84.6% and 94.9% and 70.6%, respectively. The negative predictive value for cytology and the uCyt+ test was 83.1% and 93.3%, respectively. Statistical analysis showed no statistically significant difference between the overall sensitivity ( P = 0.512) and specificity ( P = 0.558) for the uCyt+ test in the two groups of patients. Conclusions The sensitivity and specificity of the uCyt+ test are not significantly affected by intravesical long-term treatment with epirubicin or BCG.

Predictors of Change during Long-Term Analytic Group Psychotherapy

Background: All studies on patient variables as predictors of outcome are on short-term groups. Therefore, we wanted to study predictors of outcome in an observational study of 69 out-patients treated in long-term, analytic group therapy (mean = 32.5 months). Methods: Based on results from research on short-term groups, we selected 6 predictor variables representing central domains (demographics, diagnosis, initial severity of disturbance, chronicity, expectancy, and treatment duration) and explored their relationship with 5 outcome variables (Global Assessment of Functioning, Global Severity Index, Inventory of Interpersonal Problems-Circumplex, global improvement, and chief complaints) by multiple regression analyses. Results: Treatment duration up to 2.5 years was a strong positive predictor. Contrary to findings from many short-term studies, the presence of personality disorder, chronicity, and high initial severity of symptoms were not associated with less favourable outcome. Furthermore, marital status was not a positive predictor, and expectancy of a better outcome was only positively related to 1 of the outcome variables. Highly tentative results from exploratory stepwise regression analyses indicated that interpersonal problems on the subscale of ‘coldness’ might also be a negative predictor in long-term therapy. Conclusions: The study indicates that predictors of outcome in long-term group therapy may be different from those found in short-term therapy.

Revenge and Forgiveness in Group Psychotherapy

Noticing in society a culmination of vengeful actions between nations and a simultaneous tendency to ask publicly for forgiveness made the author curious how these phenomena manifest themselves in long-term analytic group psychotherapy. Working through feelings of shame and guilt followed by mourning seems necessary in order to give up a need for revenge or come to acceptance and possible forgiveness. The group as a place to find emotional justice has been highlighted in a vignette.

Specialized Psychotherapeutic Group Analysis: How Do We Make Group Analysis Suitable for `Non-Suitable' Patients?

This paper summarizes ten years experience of running long-term analytic group psychotherapy with severely bulimic women, the majority borderline personalities. The positive results documented suggest that modified group analysis can be an alternative choice in the treatment of bulimic patients, who are non-responders to short-term Cognitive-Behavioural Therapy. The article focuses on adapting the patients, the group and the therapists themselves to provide the opportunity to treat patients who may seem `non-suitable' members of an analytic group. Essential elements outlined include a thorough assessment interview, time and timing during therapy, and positive attunement from therapists. Other contributing factors were an immediate response to signs of imminent drop-out and being able to sustain the group matrix as a carrier of hope.

The Change Process of a Patient in Long-Term Group Psychotherapy: Measuring and Describing the Change Process

Given the complexity of analytic therapies and individual change, it seems desirable to introduce more objective and quantitative measures into the clinical situation in assessment of change. A traditional case study describes one patient's change pattern in symptomatic distress, interpersonal relations and self-esteem during 44 months of group analysis. We hypothesized that change described by repeated applications of self-report measures (SCL-90-R, HP, and SASB) would converge with the clinical narrative. This was confirmed for symptoms and interpersonal problems. However; in early and middle phase of therapy during periods of deterioration, negative aspects of her self-image at worst (self-attack, self-neglect) improved. During the same periods she suffered from a pronounced feeling of depersonalization. For the remaining part of the therapy; including a period after a miscarriage later in therapy, she was able to experience the negative aspects of her self-image at worst. The feeling of depersonalization was then much less pronounced. Her complex SASB-patterns may represent a split of internal self-representations, seen in certain personality disorders. More studies are needed.

Efficacy of long-term interferon therapy in chronic hepatitis B patients with HBV genotype C

Infection with Hepatitis B virus (HBV) genotype C predominates in Japan. We analyzed the efficacy of interferon (IFN) alpha or beta in the treatment of chronic hepatitis B patients with HBV genotype C and the clinical predictors for therapeutic response. Forty-three genotype C-infected, chronic hepatitis B e antigen (HBeAg)-positive patients (32 men and 11 women with a mean age of 35.6+/-10.1 years) who had been treated with IFN therapy were retrospectively studied. The patients were classified into two treatment groups. Short-term therapy group was administered a 5-6 MU dose three times weekly for 4 weeks, and the long-term therapy group for 24 weeks. At the end of the follow-up period, 4 (15%) of 27 short-term therapy group patients and 6 (38%) of 16 long-term therapy group patients had normalized serum ALT levels and seroconversion of HBeAg to anti-HBe (p=0.137). Multivariate analysis for parameters most important for the efficacy of IFN therapy was performed using Cox proportional hazard models in order to investigate the association between baseline characteristics of patients and the response to IFN treatment. As a result, the p-values of IFN treatment group and sex were <0.05, and both factors can be recognized as independent significant factors (relative risk, 2.93 and 2.53; p=0.027 and 0.040, respectively). Furthermore, the cumulative rates of seroconversion of HBeAg to anti-HBe analyzed by the Kaplan-Meier method was significantly higher in the female group (p=0.015) and in the long-term IFN therapy group (p=0.0046). In summary, long-term IFN therapy may be more effective than short-term IFN therapy for patients with chronic HBV genotype C infection.

Change During and After Long-term Analytic Group Psychotherapy

There are very few empirical studies of long-term, analytic group psychotherapy. Sixty-nine patients in long-term analytic group psychotherapy were evaluated from pretherapy to posttherapy, and one year after termination. The primary outcome measures were the Symptom Checklist-90 (Revised) and the Inventory of Interpersonal Problems. In addition, the Global Assessment of Functioning (GAF) was scored independently by two evaluators. The average time in treatment was 32.5 months. The patients improved significantly during treatment, up to 30 months, on all measures. The improvement continued during the follow-up period. Sixty to 86% of the patients were recovered or significantly changed at follow-up.

Four-year follow-up study of sertraline and fluvoxamine in long-term treatment of unipolar subjects with high recurrence rate

We prolonged from 24 to 48 months a follow-up study of unipolar subjects with high recurrence rate treated with fluvoxamine ( N=25) and sertraline ( N=22). During the two-year additional period a significant risk of recurrences was observed during the third year of follow-up, without differences in the two long-term therapy groups. During the fourth year no patients showed new episodes of illness.

Some Aspects of Intimacy in an Analytic Therapy Group

Abstract Failure to establish or sustain intimacy is a major reason most patients give for entering therapy, and this is especially so for group therapy. Their hope is that through the here-and-now nature of the group, the peer feedback from the group, and the development of interpersonal dynamics withinthe group, an atmosphere will be created in which issues of trust and intimacy can be safely explored and worked through. After a brief review of theliterature on the subject, case material will be used from the presenter's practice, notably excerpts from a session of a long-term (25 years) analytic therapy group illustrating members' attempts to establish and foster intimacy on the one hand, and to defend against and avoid it, on the other. Discussion will focus on the identification of mechanisms that encourage or deter the development of intimacy.

Long-term Group Psychotherapy for Women Who Are Survivors of Childhood Abuse

(2000). Long-term Group Psychotherapy for Women Who Are Survivors of Childhood Abuse. Psychoanalytic Inquiry: Vol. 20, No. 2, pp. 330-349.

Response to DiNunno's “Long-Term Group Psychotherapy for Women Who Are Survivors of Childhood Abuse”

Trauma impels people both to withdraw from close relationships and to seek them desperately. The profound disruption in basic trust, the common feelings of shame, guilt, and inferiority, and the need to avoid reminders of the trauma that might be found in social life, all foster withdrawal from close relationships. But the terror of the traumatic event intensifies the need for protective attachments. The traumatized person therefore frequently alternates between isolation and anxious clinging to others [Herman, 1992, p. 56].

Group Therapy for Survivors of Childhood Sexual Abuse Who Are Severely and Persistently Mentally Ill

BACKGROUND: Few researchers have investigated the effectiveness of long-term group psychotherapy with women who have a core issue of childhood sexual abuse, particularly those who are designated as being severely and persistently mentally ill (SPMI). Women so labeled are usually treated within a biological framework. Medications and supportive care are often the preferred therapies, denying the necessity of dealing with past traumatic issues. OBJECTIVES: The objective of this pilot study was to determine the outcome of long-term; time-limited group therapy with women designated as SPMI. The study addressed rate of improvement in symptomatology and self-esteem scores in women who are SPMI and those not designated SPMI.a STUDY DESIGN: A quasi-experimental design was used. The sample (N = 72) consisted of women older than 18 years who were sexually abused as children. The experimental group was made up of women labeled SPMI (n = 13), and the control group was composed of those who had not been designated SPMI (n = 59). The intervention consisted of 50 weeks of group therapy using a family systems modeL The instruments, which included the Beck Depression Inventory, the Symptom Check List-90-Revised and the Rosenberg Self-Esteem Scale, were administered at sessions I and 50. RESULTS: Results indicated that women labeled SPMI had lower self-esteem and higher symptomatology scores before receiving the group therapy, but both groups achieved comparable improvement in scores at the end of 50 weeks of group therapy. CONCLUSION: The results indicated that women labeled as SPMI could benefit from group therapy that addressed the core issue of childhood sexual trauma.

Group therapy for survivors of childhood sexual abuse who are severely and persistently mentally ill*1

Background : Few researchers have investigated the effectiveness of long-term group psychotherapy with women who have a core issue of childhood sexual abuse, particularly those who are designated as being severely and persistently mentally ill (SPMI). Women so labeled are usually treated within a biological framework. Medications and supportive care are often the preferred therapies, denying the necessity of dealing with past traumatic issues. Objectives : The objective of this pilot study was to determine the outcome of long-term, time-limited group therapy with women designated as SPMI. The study addressed rate of improvement in symptomatology and self-esteem scores in women who are SPMI and those not designated SPMI. Study Design : A quasi-experimental design was used. The sample (N = 72) consisted of women older than 18 years who were sexually abused as children. The experimental group was made up of women labeled SPMI (n = 13), and the control group was composed of those who had not been designated SPMI (n = 59). The intervention consisted of 50 weeks of group therapy using a family systems model. The instruments, which included the Beck Depression Inventory, the Symptom Check List-90-Revised, and the Rosenberg Self-Esteem Scale, were administered at sessions 1 and 50. Results : Results indicated that women labeled SPMI had lower self-esteem and higher symptomatology scores before receiving the group therapy, but both groups achieved comparable improvement in scores at the end of 50 weeks of group therapy. Conclusion : The results indicated that women labeled as SPMI could benefit from group therapy that addressed the core issue of childhood sexual trauma.

The Man from Big Sur

ABSTRACTNine Ninety-Nine is a novel about the life and literary work of a paranoid schizophrenic writer, who was hospitalized between 1958 and 1984. He rarely looked people in the face, but, instead, stared at their shoes, ankles, and socks. Living in a closed ward, daily he studied the Bible and edited the Ward M Quarterly, a magazine devoted to the struggle against all authority figures. Over the decades, David Hoffnung the narrator, received many treatments. In this chapter, he describes his experiences in long-term group psychotherapy.