Short-term Group Therapy Research Articles

Public's View of Mental Health Services for the Elderly: Responses to Dear Abby

Public's View of Mental Health Services for the Elderly: Responses to Dear Abby

Implementation and Benefits of Psychooncological Group Interventions in German Breast Centers: A Pilot Study on Supportive-Expressive Group Therapy for Women with Primary Breast Cancer

Background: Psychosocial treatment is an integral component in today’s comprehensive breast cancer care. The main goal of this study was to test the feasibility (benefits and acceptance) of supportive-expressive group psychotherapy (SEGT), a short-term breast cancer-specific group therapy developed and tested in Anglo-American countries, within breast centers in Germany. Patients and Methods: The study was realized as a single-group pre-post design. Data were analyzed by combining quantitative and qualitative research methods. The sample consisted of 49 women with breast cancer stage 1 or 2 according to TNM classification (tumor, node, metastasis). Results: The results indicate positive acceptance of the group intervention. Quality of life, tumor-related fatigue and coping strategies improved after SEGT. 1 year after the intervention, the patients report lasting positive results from the group intervention. Conclusions: This pilot study illustrates the importance of psychooncological group interventions for breast cancer patients and indicates that this form of outpatient psychooncological care is feasible within the German health care system, and breast centers in particular. Effectiveness has to be investigated in randomized controlled trials.

Interpersonal predictors of outcome following short‐term group therapy for complicated grief: a replication

The current study represented a replication of previous research, addressing measures of interpersonal relatedness as predictors of outcome for dynamically oriented, short-term group (STG) psychotherapy for patients presenting with complicated grief. In an analysis of data from a comparative trial of two forms (interpretive, supportive) of STG therapy (n = 107), Ogrodniczuk, Piper, McCallum, Joyce and Rosie reported that three distinct indices of interpersonal relatedness-quality of object relations, current social functioning and attachment insecurity-each had significant relationships with measures of treatment outcome, with attachment insecurity emerging as the strongest predictor. The current study (n = 110) was based on data from a subsequent trial of the two therapy approaches that examined the effect of group composition on outcome, by Piper, Ogrodniczuk, Joyce, Weideman and Rosie. Predictor variables and outcome factors involved in the current analyses were similar or identical to those employed by Ogrodniczuk et al., and an identical analytic strategy was followed. Only the patient's attachment insecurity emerged as a strong predictor of psychotherapy outcome, providing a replication of the key finding from the previous study. The clinical implications and limitations of the results are discussed.

Impact of Alexithymia on Treatment Outcome: A Naturalistic Study of Short-Term Cognitive-Behavioral Group Therapy for Panic Disorder

Background: It is often suggested in the literature that alexithymic patients are less responsive to psychotherapy than nonalexithymic patients. However, few empirical studies have examined this issue. Furthermore, it is unclear whether or not alexithymia itself may improve during psychotherapy. Methods: Fifty-five consecutive outpatients with panic disorder received short-term cognitive-behavioral group therapy (CBGT) and were followed up 6 months later. Nineteen patients (35%) were on concomitant antidepressant medication. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20). Both completers and intention-to-treat analyses were calculated, taking into consideration the potentially confounding effect of comorbid conditions. Results: Baseline alexithymia did not predict outcome of CBGT, neither at posttreatment nor at follow-up. The presence of comorbid axis I disorders predicted nonresponse at posttreatment but not at follow-up. TAS-20 total scores decreased over time, with the TAS-20 factors 1 (difficulty identifying feelings) and 2 (difficulty describing feelings) decreasing significantly, while factor 3 (externally oriented thinking) remained largely stable. Conclusions: These findings are encouraging for cognitive-behavioral therapists working with patients with alexithymia who suffer from panic disorder: CBGT outcome does not appear to be negatively affected by alexithymia, and some alexithymic characteristics may even be reduced following CBGT. Assessing alexithymia at treatment onset may be useful for individually tailoring therapeutic interventions.

Auftragsfokussierende Gruppenkurztherapie - Ergebnisse einer Evaluation

A short description outlines the development of commission focused short-term therapy (AFoG) for children and adolescents. Subsequently the generic principles of psychotherapy are applied to AFoG in order to underline the basic assumptions of this variation of systemic group therapy. Behavioural changes arising in different contexts (school, family, group therapy) show the need for an appropriate flexibility of group therapy techniques. The evaluation was accomplished using the Child Behaviour Checklist (CBCL 4-18) at the beginning and 3 month after the end of the group therapy. The results show positive effects which finally are discussed critically.

A Decade of Parent and Infant Relationship Support Group Therapy Programs

A 10-year experience with a unique, short-term community group therapy program, Parent and Infant Relationship Support (PAIRS) for high risk infants and their parents is discussed. The program offers ten, 2-hour closed weekly group therapy sessions for mothers and their babies, following a parallel conjoint model of group work. The aims of the PAIRS group program are threefold: to increase positive parent-infant interaction and secure attachment, to decrease maternal postnatal depression, and to foster optimal infant development. Evaluation of the program has shown promising results in comparison with a control group. Clinical case material is used to illustrate therapeutic processes underlying the positive outcomes.

Effectiveness of short-term psychodynamic group therapy in a public outpatient psychotherapy unit

Background: Short-term psychodynamic group therapy in heterogeneous patient groups is common in the public Danish psychiatric system but is in need of evaluation. Aim: To investigate improvement in 39-session psychodynamic group therapy using three criteria: 1) effect size (Cohen's d), 2) statistically reliable improvement, and 3) clinical significant change (CSC). Methods: Pre–post treatment naturalistic design based on 236 outpatients with diagnoses of mood (9.7%), neurotic (50.8%), and personality disorders (39.4%). Symptom change was evaluated on the SCL-90-R Global Severity Index (GSI) and subscales. Analyses were conducted on the total sample and after exclusion of 32 GSI pre-treatment no-cases. Results: The total sample GSI effect size was 0.74 indicating a moderate to large effect size (ranging from 0.67 in depressed to 0.74 in neurotic and personality disorder patients), which increased to 1.02 after exclusion of pre-treatment no-cases (ranging from 0.98 to 1.11 in depressed and personality disorder patients, respectively). However, in the GSI pre-treatment case sample, 43.1% were unchanged or deteriorated, 27% reliably improved and 29.9% obtained CSC status (ranging from 23.8% of the neurotic to 42.9% of the depressed patients). Conclusion: Short-term psychodynamic group therapy is associated with medium to large or large effect sizes. However, even though many of the patients reliably improve, a substantial part of the patients are still, after therapy, within the pathological range compared with Danish norms. Clinical implications: Patients referred to public outpatient treatment settings may need alternative or longer treatment than 39 sessions of psychodynamic group therapy over 3 months.

Exploring Interactions of Improvers and Deteriorators in the Group Therapy Process: A Qualitative Analysis

This study examined the interactions of individuals who showed symptom improvement and those who showed deterioration during the course of short-term group psychotherapy. A qualitative hermeneutic analysis was used to identify and describe themes from the group interactions. Both broad group themes, as well as themes specific to improvers and deteriorators, were found. Findings suggest that the differences in group behavior between those who get worse and those who improve are subtle and thus difficult for group leaders to detect. Although the differences were not immediately apparent, a deeper examination of group process did reveal distinct patterns for deteriorators that were different from those of improvers. These patterns of interaction are discussed as well as variables related to client, leader, and group as a whole that may have contributed to the outcome of group members.

Status of Psychological Trials in Breast Cancer Patients: A Report of Three Meta-Analyses

This systematic review reports the results of three meta-analyses addressing the clinical efficacy of psychological interventions in breast cancer patients. Three outcome variables were examined: anxiety, depression and quality of life. Several moderator variables were found to both account for inter-trial heterogeneity and interact with treatment efficacy; methodological quality, prognosis, treatment type, orientation and duration. A clinically moderate treatment effect was found for anxiety (−0.40, 95% CI, −0.72 to −0.08, N = 1278). This was not robust to study quality, but remained stable for patients with more advanced disease. Short-term group therapy was more effective than longer term intervention and individual ones. A clinically moderate-to-strong effect was found in trials assessing depression (−1.01, 95% CI, −1.48 to −0.54, N = 1324). A more robust finding of −0.47 (95% −0.69 to −0.24) was based on methodologically more reliable studies treating patients with high psychological morbidity. Intervention was shown to have moderate effects on improving QOL (0.74, 95% CI, 0.12 to 1.37, N = 623), though it was not robust to study quality. Findings suggest that short-term treatments with a focus on coping may be more suitable for early breast cancer patients. Patients with advanced breast disease appear to benefit more from longer term interventions which emphasize support. Recommendations are also made for future clinical trials.

Follow-up outcome in short-term group therapy for complicated grief.

Simon Fraser UniversityThis study investigated 4 types of outcome over a 6-month follow-up period for 84psychiatric outpatients who had been treated for complicated grief using short-termgroup therapy. The 4 types differed in regard to whether and when patients achievedclinically signiÞcant change on a primary grief outcome variable. Approximately halfof the patients achieved clinically signiÞcant change by the end of treatment andmaintained it over follow-up (maintenance). Another quarter of the patients reportedclinically signiÞcant change, but only at follow-up (delayed recovery). A few patientsachieved clinically signiÞcant change at the end of treatment, but not at follow-up(relapse). Finally, nearly a quarter of the patients failed to achieve clinically signiÞcantchange (nonrecovery). The Þndings suggest that investigators look beyond the end oftreatment when assessing improvement in patients treated with short-term grouptherapy for complicated grief. Inclusion of delayed recovery patients can substantiallymodify conclusions about the usefulness of short-term therapies for complicated grief.Delayed recovery patients differed from the other types of patients on greater perceivedsocial support and greater change during the follow-up period.Keywords: follow-up outcome, delayed recovery, short-term group therapy, compli-cated grief

The effect of short-term cognitive-behavioral group therapy on adolescents with attachment difficulties.

This study was designed to investigate the effect of short-term cognitive-behavioral group therapy on fourteen adolescents with attachment difficulties. All of the participants in this study had a history of child abuse/neglect and have been in foster or adoptive care. Participants were divided into two male adolescent groups and two female adolescent groups. Each participant completed the Reynolds Adolescent Adjustment Screening Inventory (RAASI; Reynolds, 2001) pre – and post group intervention. A six-week group intervention resulted in a significant change in self-ratings on measures of both externalizing and internalizing adjustment problems. Results of the study are encouraging given that there is a stigma among adolescents, especially males, related to disclosing in groups with peers (Black & Rosenthal, 2005).

Therapeutic Alliance and Cohesion Variables as Predictors of Outcome in Short–Term Group Psychotherapy

The current study explored the relative ability of aggregate therapeutic alliance and cohesion variables to predict short–term group therapy outcome. Data were collected from a comparative trial of two forms of time–limited group psychotherapy for complicated grief (Piper, McCallum, Joyce, Rosie, & Ogrodniczuk, 2001). The therapeutic alliance and elements of the cohesion construct were measured from the perspectives of each patient and the group therapist at intervals during the groups; scores were aggregated across assessments. Hierarchical multiple regression analyses, adjusting for the effects of treatment approach (interpretive vs. supportive) and specific group membership, demonstrated that the patient–rated alliance was a consistent predictor of outcome. Two cohesion measures, reflecting other participants’ (therapist, other members) views of the patient’s “fit” with the group, also accounted for variation in outcome. Implications of the findings for research and clinical practice, and the limitations of the measurement approach taken in this study, are considered.

Group composition and group therapy for complicated grief.

This prospective study investigated the impact of group composition on the outcome of 2 forms of time-limited, short-term group therapy (interpretive, supportive) with 110 outpatients from 18 therapy groups, who presented with complicated grief. The composition variable was based on the patient's level of quality of object relations. The higher the percentage of patients in a therapy group who had a history of relatively mature relationships, the better the outcome for all patients in the group, regardless of the form of therapy or the individual patient's quality of object relations score. The findings have direct clinical implications for composing short-term therapy groups for outpatients with complicated grief and possibly for other types of group therapies and patient problems.

Effects of Growth Hormone on Craniofacial Growth

This study determined the effects of growth hormone (GH) therapy on craniofacial growth in idiopathic growth hormone deficiency (GHD). Fifty-seven patients (33 boys and 24 girls; age range 4.5 to 16.7 years) with GHD were investigated and categorized into three groups according to the duration of GH therapy: the untreated group, the short-term therapy group, and the long-term therapy group. Their lateral cephalometric radiographs were studied, and craniofacial measurements were assessed by age and sex by using matched standard deviation scores. In the untreated group, the anterior cranial base, total facial height, maxillary length, mandibular total length, mandibular body length, and ramus height were smaller than the standard values. In comparison with the untreated group, the long-term therapy group had a significantly larger upper facial height (P < .05), maxillary length (P < .01), and ramus height (P < .01) measurements. Children who received long-term GH replacement therapy showed increased growth of the craniofacial skeleton, especially the maxilla and ramus. These findings suggest that GH accelerates craniofacial development, which improves occlusion and the facial profile.

Ambulante verhaltenstherapeutische Gruppentherapie bei Zwangsstörungen – ein effektiver Behandlungsansatz?

In addition to specific therapeutic effects, cognitivebehaviouraltreatment of obsessive-compulsive disorder (OCD) in agroup setting may offer considerable economic advantages. Thisexplorative study evaluates the effectiveness of a standardized cognitive-behavioural short-term group therapy. In order to provide criteriafor a differentiated assignment to different treatments and toadjust treatment programmes for patients at risk for treatment failure,predictors for therapy outcome were investigated. Patients andMethods: 45 OCD patients who completed a 10-session (150 mineach) symptom-focused outpatient cognitive-behavioural grouptherapy were examined before and after treatment. Results: Thegroup therapy significantly improved average ratings of obsessivecompulsivesymptoms and general psychological distress. Definingtherapy response as a 35% decline of the Yale-Brown ObsessiveCompulsive Scale total score, 31% of the patients could benefitfrom treatment. ‘Clinically significant’ symptom reduction wasachieved by only 16% of the patients. The predictor analysis suggeststhat even patients with complex disorders reduce their symptomssignificantly during group treatment. Treatment response wasneither influenced by initial symptom severity, duration of illnessand depressive symptoms nor by level of education. Only dependentpersonality traits were identified as risk factors for negativetreatment outcome. Conclusions: The group programme hasproven to be as effective for a broad spectrum of OCD patients asother group concepts described in the literature. The rather low responserates suggest that a short group intervention may not beequivalent to long-term individual cognitive-behavioural therapy.Short-term group therapy could possibly rather be used as a specificpreparation for individual cognitive-behavioural therapy.

Men, women, and their outcome in psychotherapy

Abstract This article presents a discussion of the author's research on differences in psychotherapy outcome between men and women. Two studies are highlighted. The first concerned differential responses of men and women to interpretive and supportive models of short-term individual psychotherapy. This study found that men benefited more in interpretive therapy than supportive therapy. Conversely, women benefited more from supportive therapy than interpretive therapy. The second study concerned differential responses of men and women to interpretive and supportive models of short-term group psychotherapy and also examined possible mediators of differential response. The study found that women, compared with men, had superior responses in both types of group therapy. The generally poor response of men could be attributed, in part, to their lower levels of commitment to the groups and their lower levels of compatibility with the other (primarily female) group members. The article concludes with thoughts abo...

Treatment Compliance in Different Types of Group Psychotherapy

This study examined the effect of age on attending and completing different types of group therapy among psychiatric outpatients, and whether cohesion among group members mediates the effect of age on attendance. The sample consisted of 139 outpatients who began short-term interpretive or supportive group psychotherapy. Hierarchical regression analysis and Kaplan-Meier survival analysis were used to test the effect of age on attending and completing therapy. Mediation analysis was used to examine whether cohesion mediated the effect of age. Significant associations between age, session attendance, and termination status were found for patients receiving supportive group therapy. Age was directly related to attending and completing therapy. Quality of the relationships among patients (i.e., cohesion) was found to mediate the effect of age on attendance. Depending of the type of group therapy offered, younger patients may be at risk for poor treatment adherence. Difficulty forming positive relationships with other group members may contribute to this risk.

Randomized, Controlled Trial of the Effectiveness of Short-Term Dynamic Psychotherapy and Cognitive Therapy for Cluster C Personality Disorders

Objective: This study compared the effectiveness of short-term dynamic psychotherapy and cognitive therapy for out-patients with cluster C personality disorders. Method: Patients (N=50) who met the criteria for one or more cluster C personality disorders and not for any other personality disorders were randomly assigned to receive 40 weekly sessions of short-term dynamic psychotherapy or cognitive therapy. The most common axis I disorders in the patient group were anxiety and depression diagnoses. Therapists were experienced, full-time clinicians and were receiving manual-guided supervision. Outcome variables included symptom distress, interpersonal problems, and core personality pathology. Measures were administered repeatedly during and after treatment, and change was assessed longitudinally by means of growth modeling procedures. Results: The overall patient group showed, on average, statistically significant improvements on all measures during treatment and also during a 2-year follow-up period. Significant changes in symptom distress after treatment were found for the group of patients who received short-term dynamic psychotherapy but not for the cognitive therapy patients. Despite these differences in intragroup changes, no statistically significant differences between the short-term dynamic psychotherapy group and cognitive therapy group were found on any measure for any time period. Two years after treatment, 54% of the short-term dynamic psychotherapy patients and 42% of the cognitive therapy patients had recovered symptomatically, whereas approximately 40% of the patients in both groups had recovered in terms of interpersonal problems and personality functioning. Conclusions: Both short-term dynamic psychotherapy and cognitive therapy have a place in the treatment of patients with cluster C personality disorders. However, factors other than treatment modality may discriminate better between successful and poor outcomes. Such factors should be explored in future studies.

Use of the Social Relations Model by Group Therapists: Application and Commentary

This article presents research findings concerning the relationship of patient positive regard to the outcome of time–limited, short–term group therapy for psychiatric outpatients with complicated grief. The Social Relations Model (SOREMO) of David Kenny was used to investigate this relationship. While the patient’s ratings of positive regard of others in the group, known as the Perceiver Effect, accounted for the most variation of the patients’ ratings, the other patients’ rating of the patient’s positive regard, known as the Target Effect, was directly related to favorable change. In addition, a simpler method was used to calculate variables that were analogous to the Perceiver Effect and Target Effect variables of the SOREMO. These variables yielded similar outcome findings. Because of limitations and difficulties associated with learning and using the SOREMO, the simpler method represents a more feasible choice for group therapists who are primarily clinicians or group therapists who wish to collect a small amount of data on an ongoing basis. Even experienced group therapy researchers are likely to find the SOREMO program challenging to use.

Level of Alliance, Pattern of Alliance, and Outcome in Short–term Group Therapy

This study investigated the relationships between initial level of alliance, pattern of alliance over sessions, and outcome in a sample of 107 patients who completed short–term group therapy for complicated grief. Both patient–rated alliance and therapist–rated alliance were studied. For patient–rated alliance, both the initial level of alliance and the linear pattern of alliance were directly and significantly related to favorable outcome. For therapist–rated alliance, no significant direct relationships with outcome were found. Instead, significant interaction effects were found. For patients with relatively high initial alliance, the greater the increase in alliance over sessions, the better the outcome. For patients with relatively low initial alliance, the greater the decrease in alliance over sessions, the better the outcome. Explanations for the findings are considered as well as possible clinical implications.