Psychodynamic Group Therapy Research Articles

Drop-out from a psychodynamic group psychotherapy outpatient unit

Background. Drop-out from psychotherapy is common and represents a considerable problem in clinical practice and research. Aim. To explore pre-treatment predictors of early and late drop-out from psychodynamic group therapy in a public outpatient unit for non-psychotic disorders in Denmark. Methods. Naturalistic design including 329 patients, the majority with mood, neurotic and personality disorders referred to 39-session group therapy. Predictors were socio-demographic and clinical variables, self-reported symptoms (Symptom Check List-90-Revised) and personality style (Millon Clinical Multiaxial Inventory-II). Drop-out was classified into early and late premature termination excluding patients who dropped out for external reasons. Results. Drop-out comprised 20.6% (68 patients) of the sample. Logistic regression revealed social functioning, vocational training, alcohol problems and antisocial behavior to be related to drop-out. However, early drop-outs had prominent agoraphobic symptoms, lower interpersonal sensitivity and compulsive personality features, and late drop-outs cognitive and somatic anxiety symptoms and antisocial personality features. Clinical and psychological variables accounted for the major part of variance in predictions of drop-out, which ranged from 15.6% to 19.5% (Nagelkerke Pseudo R-Square). Conclusion. Social functioning was consistently associated with drop-out, but personality characteristics and anxiety symptoms differentiated between early and late drop-out. Failure to discriminate between stages of premature termination may explain some of the inconsistencies in the drop-out literature. Clinical implications. Before selection of patients to time-limited psychodynamic groups, self-reported symptoms should be thoroughly considered. Patients with agoraphobic symptoms should be offered alternative treatment. Awareness of and motivation to work with interpersonal issues may be essential for compliance with group therapy.

Heterogeneity of treatment changes after psychodynamic therapy within a one year follow‐up: A replication study

Naturalistic psychotherapy effect studies commonly report effect sizes for the total sample. However, a previous study of SCL-90 Global Severity Index (GSI) improvement in a large outpatient sample used a cluster analytic strategy and reported clinical relevant outcome trajectories that could be grouped into early within-treatment improvement, late improvement in the follow-up period, and deteriorating patients with slight improvement that was lost at follow-up. We explore GSI outcome trajectories and clinical significant change in a sample of 320 patients at a public psychiatric outpatient psychodynamic group therapy unit, the majority with anxiety, personality, and mood disorders. The study revealed large discharge and follow-up effect sizes but more than one third of the patients were without measurable improvement. The major clusters described above were confirmed, and revealed unique clinical and socio-demographic characteristics. Late improvers, as compared with early improvers, were characterized by anxiety symptoms and lack of network support after controlling for GSI at admission. Similarly, deteriorating patients had longer duration of illness and less favourable social characteristics compared with the other two groups. Early improving patients were less likely to have participated in short-term groups, and only one third participated in additional treatment compared with more than 69% of the other patients. Severe and socially affected psychiatric patients, and patients with anxiety and agoraphobic symptoms may be less optimally treated in short-term time limited psychodynamic groups. There is an obvious need for diversity of treatment offers, better integration of psycho-social treatment components, and long-term open ended treatment.

EPA-0344 – Psychodynamic group psychotherapy: a proposition for a new method

in psychodynamic group psychotherapy it is used to divide patients in different groups with direct access and/or after preliminary individual sessions. Since 2003 our research group started a new method. Aim of this study was to assess the value of this new methodology. we use: psychodynamic approach, 10–14 patients, open access for pathology, age, sex, starting and ending. Therapy begins with individual sessions. Therapy deals with symptoms, intra-psychic conflicts, and private issues. Meanwhile psychiatrist develops relational capacity of the patient, allowing him to enter group therapy. We continue, at the same time, with individual and group therapy, for a time different for each case. Then therapy continues in the group only, until its ends. The duration of the three steps is variable, but the total amount of time of the therapeutic approach is reduced by half in 10 years. Efficiency of this method is divided in three points. 1) Advantages for the single patient in the group: improvement of patient privacy; decrease of transferal resistance, acting-out and drop-out; economic advantages. 2) Advantages for group dynamics: decrease of aggressive behavior and interpersonal conflicts, improving of climate group; attenuation of hierarchal levels among patients, manipulation, fabrication, selfpity, narcissism. 3) Advantages for psychiatrist: continuous monitoring of the new patient or ‘difficult’ or risky patients with decrease of countertrasfert issues. This methodology is an effective alternative to the usual group therapy. It allows a thorough and solid approach to the patient, offering a larger possibility of patient recovery.

Relationship between Two Dimensions of Object Relations and Group Psychotherapy Attendance Rate in Borderline Personality Disorder Individuals

Aim: Recent studies showed that the quality of object relations in patients with personality disorders predict individual psychotherapy attendance rate. However, associations between these variables have led to inconsistent results for group psychotherapy. The aim of the present study was to verify whether two dimensions of object relations are associated with rates of attendance at group psychotherapy sessions. Methods: Thematic Apperception Test narratives of forty-one outpatients with borderline personality disorder (BPD) enrolled in a psychodynamic group therapy over a period of one year were rated on two variables of the Social Cognition and Object Relations Scale (SCORS): affective quality of representations and emotional investment in relationship. Results: Results indicated that these two affective dimensions of object relations were positively correlated with rate of attendance at group psychotherapy sessions after controlling for age of the participant. Conclusion: These results suggest that the quality of object relations could be a potential predictor for group therapy attendance. The results are discussed by taking into account the particular aspects of relational issues in group psychotherapy as opposed to individual psychotherapy.

Response to Nina K. Thomas and J. Scott Rutan: Is the Personal Political? And Who Benefits From Believing It Is Not?

reading Thomas’s and Rutan’s responses to “ConsciousnessRaising in a Gender Conflict Group” (this issue) raised many thoughts as well as the urge to answer every comment in detail. Instead, I discuss the deeper issues I think Thomas’s and Rutan’s comments touch upon, namely, complexity and multiplicity in groups and issues of power. Although the original article was written by both Dana Yarimi and me, we decided that only I would respond here because the model was developed by me and because, of the two of us, only I have led such groups. There are different types of groups and, as pointed out by Thomas and Rutan, consciousness-raising gender conflict groups are different from psychodynamic therapy groups in their aims, the setting, the style of group leadership, and the relations between the group leader and group members outside the group. Yet, some processes are common to all groups, even if they are not in their focus. I argue below that just as “all new groups have to say ‘hello,’” as Rutan nicely puts it, all group members, including group leaders, belong to social categories (e.g., gender, race), and these affect their perceptions, feelings, and reactions. Ac

Psychodynamische versus mentalisierungsbasierte Gruppenpsychotherapie – Versorgungsforschung in einer Tagesklinik

Psychodynamic Versus Mentalization Based Group Psychotherapy - Mental Health Services Research in a Day Hospital Group psychotherapy research in a day treatment setting is confronted with a series of problems. At the same time group psychotherapy research offers great potential, based on the common outlook of clinicians and researchers, to conceptualize, to implement and to explore group psychotherapies. This will be demonstrated on a current research project, which compares mentalisation based (MGBT) and psychodynamic group psychotherapy (PDGT) in the same day hospital. Initially we shall focus on the problem of adherence to a hands-on approach in both group psychotherapies, with special reference to the differences of interventions in group sequences. After this we we will outline our concept of the study design.

Psychodynamic therapy for adolescents suffering from co-morbid disorders of conduct and emotions in an in-patient setting: a randomized controlled trial

Co-morbid disorders of conduct and emotions can be regarded as childhood antecedents of further negative developments (e.g. manifestation of personality disorders in adulthood). We evaluated a manualized psychodynamic therapy (PDT) for adolescents with these co-morbid disorders. In a randomized controlled trial (RCT), 66 adolescents diagnosed with mixed disorders of conduct and emotions (F92 in ICD-10) were randomly assigned to a manualized in-patient PDT group or a waiting list/treatment-as-usual (WL/TAU) control condition. Diagnoses according to DSM-IV were also documented. Patients were compared using rates of remission as the primary outcome. The Global Severity Index (GSI) and the Strengths and Difficulties Questionnaire (SDQ) were used as secondary measures. Assessments were performed at baseline, post-treatment and at the 6-month follow-up. The sample consisted of severely impaired adolescents with high rates of further co-morbid disorders and academic failure. Patients in the treatment group had a significantly higher rate of remission [odds ratio (OR) 26.41, 95% confidence interval (CI) 6.42-108.55, p < 0.001]. Compared with the control group, the PDT group resulted in significantly better outcomes on the SDQ (p = 0.04) but not the GSI (p = 0.18), with small between-group effect sizes (SDQ: d = 0.38, GSI: d = 0.18). However, the scores of patients treated with PDT were post-treatment no longer significantly different from normative data on the GSI and within the normal range on the SDQ. The effects in the treatment group were stable at follow-up. Furthermore, most patients were reintegrated into educational processes. PDT led to remarkable improvement and furthered necessary preconditions for long-term stabilization. In future, PDT should be compared to other strong active treatments.

Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: A preliminary study

Background: The “Sveti Ivan” psychiatric hospital in Zagreb, Croatia, offers an outpatient Early Intervention Program for psychotic patients. This program consists of psycho-educational workshops and group psychodynamic psychotherapy. Two important objectives of the program are improving and maintaining adequate cognitive functioning. Aims: The current study examined changes in aspects of cognitive functioning in young patients with schizophrenia after 18 months and after 3 years of psychodynamic group psychotherapy. Methods: The study included 28 patients who attended the Early Intervention Program for young patients with psychotic disorders; 10 patients had completed only the psycho-educational part of the program (comparative group), and 18 patients continued with group psychodynamic psychotherapy (experimental group). All patients completed the Revised Beta Examination. Results: We observed a trend in the experimental group to achieve higher scores than the comparative group. The results for both groups tended to increase with time, and this increase was greater in the experimental group. Conclusions: While acknowledging the limitations of this preliminary study, we conclude that participating in psychodynamic group psychotherapy is related to increases in the cognitive functioning of patients with schizophrenia, and our results provide a sound basis for future research.

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.

SCL-90-R Symptom Profiles and Outcome of Short-Term Psychodynamic Group Therapy

Background. Psychodynamic group psychotherapy may not be an optimal treatment for anxiety and agoraphobic symptoms. We explore remission of SCL-90-R Global Severity Index (GSI) and target symptoms in 39 sessions of psychodynamic group therapy. Methods. SCL-90-R “target symptom” profile and GSI remission according to Danish norms were identified in 239 patients and evaluated according to reliable and clinical significant change. Results. Four major groups of target symptom cases (depression, interpersonal sensitivity, anxiety, and phobic anxiety) covered 95.7% of the sample. As opposite to phobic anxiety and anxiety patients, patients with interpersonal sensitivity obtained overall the most optimal outcome. The phobic anxiety scale, social network support, and years of school education were independent predictors of GSI remission, and a low anxiety score and absence of phobic anxiety target symptoms were independent predictors of remission of target symptom pathology. Conclusions. The negative results as associated with the SCL-90-R phobic anxiety scale and the phobic anxiety target symptom group are largely in agreement with recent studies. In contrast, whatever the diagnoses, patients with interpersonal sensitivity target symptom may be especially suited for psychodynamic group therapy. The SCL-90-R subscales may allow for a more complex symptom-related differentiation of patients compared with both diagnoses and GSI symptom load.

On the Similarities of Peace of Mind and Peace in the Valley

This article examines the practice of organization consultation using the adaptive leadership approach through a case example of a large system intervention in a peacemaking project in Nepal. The authors define core activities of the Adaptive Leadership model and provide parallels to psychodynamic group psychotherapy theory and technique that demonstrate how group therapists can apply their expertise to larger systems and arenas beyond the group therapy office.

Psychodynamic group psychotherapy versus body awareness intervention: a study on the effect of interventions on the burden of family caregivers of patients with Alzheimer's disease

Psychodynamic group psychotherapy versus body awareness intervention: a study on the effect of interventions on the burden of family caregivers of patients with Alzheimer's disease

Psychodynamische Kurzzeitgruppentherapie der sozialen Phobie: Beschreibung des Therapiekonzepts und einer Fallstudie

Based upon the concept of supportive-expressive therapy (SET), we developed a psychodynamic group treatment manual for social phobia, with a special focus on the patients' individual core conflictual relationship themes, their universality, as well as interventions promoting group processes and therapeutic factors of group therapy. We introduce the new concept and report results of a pilot case study (N=8). Analyses revealed a pre-post-treatment effect size of g=0.64 (95% CI [0.29; 1.00]) on the primary outcome measure, the Liebowitz Social Anxiety Scale (LSAS). Furthermore we obtained positive evidence with regard to acceptance, safety and feasibility of the psychodynamic group therapy concept for social phobia. Subsequent proof-of-concept studies are required to foster treatment development and to proof the replicability of results.

1191 – Completed audit of patients receiving individual psychodynamic psychotherapy and group therapy in a london psychodynamic psychotherapy service

Aim The aim of this study was to audit the effectiveness of individual psychodynamic psychotherapy and group therapy in a London psychotherapy service. Methods The data between January 2002 and July 2012 were reviewed. Of 255 profiles with an End-of-therapy form, 121 (47.45%) patients provided analyzable data at initial assessment and last session. Data was extracted on sociodemographic and mental health characteristics, responses on End-of-Therapy form, and item scores on CORE-OM on each time of measurement. Results Patients who terminated prematurely did not differ from those who completed on most of the patient characteristics despite age (t=2.16, p Conclusions Our findings further substantiate the effectiveness of IPP. Yet, it is premature to conclude that GT is not as effective as IPP due to small sample size in this study. In fact, this audit was more difficult to carry out than anticipated due to client and data attrition. Recommendations for future audit are discussed.

Five cases of sexual addiction under Short-term Psychodynamic Group Psychotherapy

, and because of this, psychodynamic psychotherapy is a good choice of treatment. We aim to report the evolution of five sex addicts, who underwent short-term psychodynamic group psychotherapy (STPGP). Our specific goal is investigate the effect of the STPGP on SC.The five patients also had impulse control disorder or drug/alcohol dependence, and were all Brazilian men over 18 years of the Institute of Psychiatry at Clinicas’ Hospital of University of Sao Paulo Medical School (HC-FMUSP). All of them met the Goodman’s criteria for sex addiction

Group-as-a-Whole and Complexity Theories: Areas of Convergence. Part II: Application to Group Relations, Group Analysis, and Systems Centered Therapy

Complexity theory is a scientific paradigm concerned with the ways in which order (determinism) and disorder (unpredictability, turbulence, chaos) combine to produce emergent higher levels of organization. The group-as-a-whole is an example of a living system where interactions among individuals, often at ‘the edge of chaos’, lead to group-qua-group dynamics. In Part I (Group Analysis 45(3)), the author considered the respective paradigms underlying group dynamics and complexity. Some basic concepts of complexity theory were discussed, and recent literature on complexity and group psychotherapy were reviewed. In the current article, the author considers the implications of complexity theory for three predominant frameworks for dynamic group psychotherapy and group-as-a-whole theory: Bion’s basic assumptions and the related Tavistock and A.K. Rice Institute group relations approaches; Foulkes’ group analysis, and Agazarian’s systems-centered therapy.

Group-as-a-Whole and Complexity Theories: Areas of Convergence. Part I: Background and Literature Review

Complexity theory is a scientific paradigm concerned with the ways in which order and disorder (unpredictability, turbulence, chaos) combine to produce emergent higher levels of organization in living systems. The group-as-a-whole is an instance where interactions among individuals, often at ‘the edge of chaos’, lead to group-qua-group dynamics. The paradigms underlying group psychology and complexity theory are considered. Group theory developed along the lines of Enlightenment science, with its emphasis on order and linear causation, while complexity theory reflects the newer sciences of quantum physics and chaos theory, which are based on uncertainty and disorder, respectively. Some basic concepts of complexity theory are discussed, and recent literature on complexity theory and group psychotherapy is reviewed, to provide a background for exploring the potential implications of complexity theory for three dominant theoretical frameworks for dynamic group psychotherapy: Bion’s basic assumptions, Foulkes’ group analysis, and Agazarian’s systems-centered therapy. These will be taken up in Part II, to be published in a subsequent edition of Group Analysis.

Psychodynamic Therapy for Depression in Women with Infants and Young Children

It has long been known that the rate of depression is high among women with infants and young children. In recent research a psychodynamic therapy group was found to be beneficial for a self-selected, postnatal subgroup of women who were of middle socio-economic status (SES), educated and who met DSM-IV criteria for clinical or subclinical depression. The current study sought to replicate these findings with individual psychodynamic therapy and to compare outcomes for three psychodynamic treatment conditions: individual, group, and combined individual and group. Patients began and left treatment from each of the three psychodynamic therapy conditions on a self-determined basis. Pre- and postintervention DSM-IV Global Assessment of Functioning (GAF) were obtained by reliable blind raters. A ten-variable, self-administered postintervention outcome questionnaire provided further data. Women (n = 58) in all three therapeutic conditions showed statistically significant improvement in their pre-to-post GAF and large treatment effects. On the questionnaire, they indicated that they were affected positively by all three conditions. Statistically significant differences among treatment conditions favored the individual treatment. Psychodynamic therapy appears well suited for the population of women in this study, especially when administered on an individual basis. The model employed here emphasized receiving and developing empathic emotional attunement, insight into one's relationships and early experiences, and a process for expressing feelings and resolving problems. Compared to group and combination therapies, the individual treatment may afford the greatest opportunity for receiving and developing these features and, thus, the best outcomes.

Maternal representations and emotional availability among drug-abusing and nonusing mothers and their infants.

Both negative and idealized maternal prenatal representations may constitute a risk for mother-infant interaction. This study analyzed the role of maternal prenatal representations and pre- to postnatal representational change in predicting mother-infant emotional availability (EA) among 51 drug-abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self-as-mother, and self-as-woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008) at 4 and 12 months. The results showed that drug-abusing mothers had more negative prenatal representations of the self-as-woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self-as-mother predicted mother-infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother-infant EA whereas for drug-abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug-abusing mothers should aim at supporting the development of a realistically positive view of motherhood.