Slow-open Group Research Articles

Slow Open Dialectical Behavior Group Therapy for Adolescents and Parents: Comparison between Groups

Introduction: The study’s objective is to explore the common behavior of the participants in four slow open groups taking part in a Dialectical Behavior Therapy (DBT) skills training. The experiment population consisted of two groups of adolescents and two of some of their parents or legal guardians. We compared the groups via their answers to the “absurd questionnaire” during the training sessions. Methods: the participants had to select one image in each of 50 pairs in a questionnaire (“absurd questionnaire”). In this experiment, we were able to administer a version of the questionnaire to the participants before forming the groups. We analyzed the differences between the four groups, considering their initial picture choices and how these evolved, the changes in the choices, the flux, and the answers’ focus. Results: The presence of a questionnaire administered before the group experience allows us to distinguish between socio-cultural orientation and group effects. A strong orientation precedes the group formation, is partially lost during the group activity and is eventually recovered at the end of the group work. In addition, there are apparent similarities between the same age groups (parents and adolescents), while family ties seem to play a lesser role in shaping the group’s behavior. Conclusions: The slow-open setting appears to render the groups more susceptible to the external environment. While we can observe the formation of a group identity distinguishable from the “clan loyalty” via a decrease in the initial orientation, this is short-lived, and the external environment asserts its eventual dominance. Family ties are less effective than generational kinship in shaping the groups’ behavior.

Dialectical Behavior Group Therapy for Adolescents and Parents: Analysis of Answer Entropy

Introduction: The work’s purpose is to study the group behavior of the members of six therapeutic groups, two closed and four slow-open, involved in a Dialectical Behavior Therapy (DBT) class. We studied three groups of teenagers and three of their parents or legal guardians. We confronted the groups’ responses to an “absurd questionnaire” submitted during the training, and we concentrated on the entropy of the response. Methods: The research method consists of a questionnaire administered to training attendees. Participants chose one picture in each one of 50 couples (“absurd questionnaire”). In this work, we could propose a questionnaire to each trainee before the first meeting of the groups. We studied the longitudinal evolution of entropy, and we also compared the six groups according to their first picture choices and their evolution, the changes in the choices, the number of changes (flux), and the divergence or convergence toward the initial answer (focus). We have also analyzed the frequency of entropy variation via the Fourier transform. Results: We find the maximum statistical difference between parents’ and adolescents’ closed groups. The entropy trend is steeper in the adolescent closed group. The entropy evolution depends more on the age group (parents or adolescents) in closed and slow-open groups than on the setting. We found an increase in entropy from the beginning to the end of the training in all the groups. Conclusions: The clear outcome of this study is the augmentation in entropy in all the groups regardless of the settings (closed or slow-open) and possibly a similar entropy’s dominant oscillation frequency, that is, the number of complete cycles in the training interval, regardless of the type of group and the training duration.

Slow Open Dialectical Behavior Group Therapy for Adolescents and Parents: Longitudinal Study of Unconscious Orientation

Introduction: The study’s objective is to explore the existence and the evolution of common behavior of the participants to four slow open groups taking part in a Dialectical Behavior Therapy (DBT) skills training. Two groups were composed of adolescents and two of their respective parents. We analyzed their evolution via the answers to the “absurd” questionnaire. Methods: The “absurd questionnaire,” composed of 50 pairs of images, was administered to the participants who had to choose one image from each pair. In this experiment, we were able to submit a version of the questionnaire to the participants before forming the groups. We have analyzed their initial picture choices and how these evolved, considering the changes in the choices, the differences in the four groups, the flux, and the answers’ focus. Results: In the four groups, we found statistical evidence that both the pictures’ initial choices and their evolution during the training are not simply governed by randomness. The initial picture choice in each pair is highly skewed toward one of the two pictures in each pair. We compare the longitudinal evolution of the picture’s choice in the four groups. Conclusions: The results show that the answers to the questions are strongly polarized already before the groups convene, revealing an initial socio-cultural bias. The group environment causes relaxation of this strong initial bias and subsequent recovery. This relaxation could indicate the formation of a “group continuum,” coming from the entanglement of individuals’ psyches, creating a group entity having its own identity. In the slow-open groups, the participants are mainly subject to clan loyalties.

Painting together: A parent-child dyadic art therapy group

The Painting Together Group was a slow open group which used art making, play and talking to strengthen parent-child relationships. This 10-month pilot was co facilitated by Shona Lavey-Khan, a CAMHS clinical psychologist and Dean Reddick, an art therapist working in a local authority nursery school and children’s centre. This report evaluates the pilot group using both quantitative data and an analysis of themes developed from clinical notes, observations, supervision and artwork. A critical assessment of the group provides reflection on areas of challenge, opportunity and planned future developments.

Group therapists: combine alliance building with paying specific attention to the patient’s perception

Abstract In slow-open groups as well as therapies of less than ten sessions, each group session holds importance. Patients, therapists and co-therapists have different perspectives and may gain different experiences from a group session. This study investigates the perspectives of patients, therapists and co-therapists on alliance, new insights and therapist techniques in the same group session. Do the three actors perceive these group aspects similarly or differently? Which group aspects are related with the outcome coping? One hundred and forty-nine sessions of a cognitive behaviour therapy group have been investigated. Patients, therapists and co-therapists gave ratings on their perceived alliance, group topics and insights as well as therapists’ technique competency. Concerning new insights, there was concordance between patients and co-therapists (r = .211, p < .05). Concerning alliance, there was a concordance between patients and therapists (r = .327, p < .01). Therapists focusing on alliance building was associated with lower patient outcomes in terms of work coping (β = –.391). The quality of therapeutic techniques was the same in groups with higher and lower outcomes. Patients’ perception of whether they felt good in the group session was explanative for session outcome, while therapists’ perceptions and context conditions (supervision, number of participants) was not. Patients, therapists and co-therapists have different perspectives on the same group therapy session. Patients’ perceptions are associated with session outcomes. A lower session outcome must not be associated with a poor technique performance of the therapist. Therapists should not only be aware of alliance building and correct technical performance, but they must also be aware of patients’ perceptions of the group process and outcome. Key learning aims The present research is the first evaluation of group session aspects and session outcomes in rehabilitation patients with work anxieties in slow-open groups. We will learn: (1) Whether patients’, therapists’ and co-therapists’ perceptions of the same group session are similar or different; (2) Whether group sessions that result in worse outcomes are different from group sessions resulting in a better outcome; (3) Which aspects of the group session are predictive for a better outcome.

The ‘Invisible Refugee’

This paper concerns what I call ‘the Invisible Refugee’ and the exploration of this in the domains of both the external world and the internal world. I borrow the term ‘refugee’ from the external world, and consider its metaphorical aspects with regard to the internal world. I will illustrate my ideas with clinical data from one of my slow-open groups, and then offer a further theoretical comment.

“I know you think I think – therefore I am”. Mentalisation based therapeutic community: a description

PurposeThe mentalisation based therapeutic community (MBTC) is a group experience which promotes the acquisition of the capacity to mentalise. Members of the community gain greater emotional stability and psychological robustness. The paper aims to discuss these issues.Design/methodology/approachMBTC works with three theoretical principles: the intrapsychic, interpersonal and social. It is a slow open group where each member completes a ten-week course. The approach is deliberately non-interpretive with an emphasis on personal responsibility and accountability in order to promote clarity of mind.FindingsThe authors’ experience is that the model engages group members with few drop outs.Originality/valueThe combination of mentalising and the use of therapeutic community principles within in MBTC has enhanced outcomes for group members.

“No Maths, No Physics (So I Spray My Bars with Lyrics)”: Rap/Music Therapy with Young Men at a Young Offender Institution

This paper describes work undertaken at a young offender institution, focusing on the therapeutic use of improvised or ‘freestyle’ and original rap. In particular it uses material and analysis pertaining to two individuals who formed part of a slow open group for outpatients detained in the main prison. A background to the work sets the scene. Next the author details the role of this specific form of therapy within the institution addressing the aims of the work and the background of the clients. The main body of the paper examines the nature of this work from a psychodynamic perspective, incorporating concepts of Klein, Winnicott, Holmes and Bowlby. This relates to the setting, client group and the use of rap as a therapeutic intervention, with focus on original rap lyric-writing and the stylistic and cultural connotations of the genre. Original lyrics and therapeutic techniques specific to clients are drawn upon and discussed.

Changing Sex or Changing Minds: Specialist Psychotherapy and Transsexuality

Hormones and surgery are the mainstay of treatments available routinely for transsexual patients in the UK. The condition and approach to it by mental health professionals are explored within the paper by the author who has run a specialist psychotherapy service for patients with gender dysphoria for eight years at The Portman Clinic in London. In the paper he describes the challenges posed by the therapist in treating these patients and important factors in the treatment to enable psychotherapy to be a useful treatment option. He details some of his experience of treating transsexual patients within a homogenous outpatient slow-open group analytic psychotherapy group.

TrEATit - Intensive ambulante Gruppentherapie von Jugendlichen mit Essstörungen

We present an intensive outpatient group treatment for girls with eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder) additionally to/instead of inpatient treatment or individually treatment by psychotherapists. The therapy concept is primarily behaviour therapy oriented, encouraging the self-management-abilities of the patients thereby learning self-determination and responsibility in dealing with their illness. The slow-open group concept provokes group cohesion, solidarity and support among girls, who share similar age-related development-stages and eating disorders. Other than cognitive behaviour therapy and the principles of self-management we use client-centered therapy, art-, dance- and nutritional therapy. For each patient an individual treatment plan is adapted depending on age, individual symptoms, problems and motivation. Each member of the group has to accept defined group rules during the group sessions. The group takes place twice a week and on one Saturday per month. The adolescents stay in their social environment. Transfer of therapeutic success into daily life therefore is immediate and longlasting. Duration of therapy is between four months and one year, longer only in complex cases. Parallel to the parent/patient cooperation a parental psycho-educative group is available.

A Therapist’s Different Style of Intervention in Two Group Treatments

In this paper we compare interventions of the same group analyst in two different groups - a traditional slow-open group of six out-patients with Eating Disorders diagnosis (all female; age: 16-26) and a time-limited, group of eight outpatients (different in age and sex) with organic vision disturbances. Our aim was to see if the same group therapist adopts different therapeutic interpretative interventions in the two groups, depending on the aims of each group and the different patients’ diagnosis. The sessions were recorded, transcribed and coded by the Code of Analysis of the Therapeutic Field Style (SCAT). In the traditional group, the therapist’s intervention style is focused more on interpretative individual interventions than the time-limited group. Similarly, the DCA patients used more interpretative interventions in all the therapy stages. The results show that the Organizational Area is of great importance in the conducting of both groups.

Analysis of the Therapeutic Course of an Eating Disorders Group

This paper documents how eating disorders are treated through homogeneous slow-open groups, alternating small groups with larger groups. The work performed was tested using transference and countertransference analysis supported by the use of the MRG grid.

Undertaking Psychotherapy Research

This article argues for more research and audit by group psychotherapists in order to inform clinical practice and to influence resource allocation. Problems encountered in research are described. The need for careful planning is emphasized. The choice of outcome measures is discussed and also the choice of research protocol by symptom questionnaire or by change in use of psychiatric services. An account is given of the CORE outcome measure. Reasons for missing data are given and ways are suggested of analysing incomplete data that can provide useful information, using as an example figures from our outcome study on a slow-open group of 94 patients.

Undertaking Psychotherapy Research

This article argues for more research and audit by group psychotherapists in order to inform clinical practice and to influence resource allocation. Problems encountered in research are described. The need for careful planning is emphasized. The choice of outcome measures is discussed and also the choice of research protocol by symptom questionnaire or by change in use of psychiatric services. An account is given of the CORE outcome measure. Reasons for missing data are given and ways are suggested of analysing incomplete data that can provide useful information, using as an example figures from our outcome study on a slow-open group of 94 patients.

Group-Analytic Psychotherapy of Psychosis

This article describes some ideas, both theoretical and clinical, related to the group-analytic treatment of psychosis, in the context of a Psychotherapy Day-Hospital that runs weekly in a multi-racial and deprived district in England. Clinical vignettes refer to different developmental stages in the life of a slow-open group. Strikingly, after certain initial misgivings, therapists and patients felt that the group experience increased their enthusiasm.

Group-Analytic Therapy of Borderline Patients in a Day Hospital Setting

The authors discuss the treatment of borderline patients in a slow open group within a psychodynamically-informed Day Hospital. The patients formed an `anti-group', a pathological organization, thereby seeking to avoid paranoid-schizoid and depressive anxiety. Containment of staff in such a setting is essential if they in turn are to maintain their own containing function.

Group analytic therapy with schizophrenic outpatients

This paper describes a model for group analytic psychotherapy with patients who have been psychotic, namely, schizophrenics and manic depressives. The groups are run on the group centered principles of S. H. Foulkes. They are continuous, slow-open groups, in line with these patients' needs for long-term therapy. A theory is proposed which justifies treating these patients in group-centered groups despite their great dependency needs. The paper also describes the task of the therapist in building and running such a group.

Trends in Group Psychotherapy with Borderline Patients

Qualitative and quantitative evaluation over six years of a slow-open group of borderline patients showed the importance of the following therapeutic factors: confrontation of the pleasure principle with the reality principle; group norms as stabilizing factors; the amplifying versus the buffering effects of the group on emotions and cognitions; acting out or acting in, remembering and working through; and narcissistic reinforcement.