Time-limited Group Research Articles

Time-Limited Group Psychotherapy for Moderately Alcohol Dependent Patients: A Randomized Controlled Clinical Trial

Time-Limited Group Psychotherapy for Moderately Alcohol Dependent Patients: A Randomized Controlled Clinical Trial

Inpatient Group Therapy in a Managed Health Care Environment: Application to Clinical Nursing Practice

This article applies Gunderson's (1978) conceptual framework of the therapeutic milieu and Yalom's (1985) therapeutic factors in group therapy to the inpatient time-limited therapy group in the managed health care environment. Case examples demonstrate how Gunderson's therapeutic processes (containment, support, structure, involvement, validation) serve as a foundation to support Yalom's therapeutic factors. The combina tion of these two frameworks can serve as a model for a plan of care that promotes suc cessful inpatient group therapy sessions in the time constraints of managed care. Constructive inpatient group therapy can be the catalyst for patients to continue with treatment after discharge. (J Am Psychiatr Nurses Assoc [1998]. 4, 145-152)

Time-Limited Group Psychotherapy for Moderately Alcohol Dependent Patients: A Randomized Controlled Clinical Trial

In recent reviews of treatment of alcohol dependence, psychodynamic group psychotherapy has been evaluated as being comparatively less effective than other methods. Some North American studies have, however, demonstrated differential treatment effects for subgroups of alcohol dependent patients. The focus of the present study was on the evaluation, in a different cultural setting, of psychodynamically oriented time-limited group psychotherapy for a homogeneous subgroup of moderately alcohol dependent male and female patients. After randomization, 49 patients completed either cognitive behavioral or psychodynamically oriented time-limited group treatment. At the 15 months follow-up, patients from both treatment orientations had improved. A majority of the patients in the psychodynamic group treatment, however, seemed to have been able to maintain a more positive drinking pattern during the whole follow-up period compared to the patients in the cognitive behavioral treatment who seemed gradually to deteriorate. A substantial amount of the variance in number of nondrinking days at follow-up was in addition to treatment orientation explained by degree of anxiety at admission. In vorliegenden Zusammenfassungen von Behandlungsmaßnahmen der Alkoholabhängigkeit erwiesen sich psychodynamische Gruppenpsychotherapien als vergleichsweise wenig effektiv gegenüber anderen Methoden. Es gibt allerdings einige nordamerikanische Studien, die differentielle Behandlungseffekte fü Subgruppen alkoholabhängiger Patienten nachweisen. Der Schwerpunkt der vorliegenden Studie war die Evaluation einer psychodynamisch orientierten, zeitlich begrenzten Gruppenpsychotherapie bei einer homogenen Subgruppe moderat alkoholabhängiger Männer und Frauen, die in einem anderen kulturellen Umfeld durchgeführt Wurde. Nach einer Randomisierung wurden 49 Patienten entweder in einer kognitiven-behavioralenoder einer psychodynamischen Gruppenbehandlung therapiert. In einer 15- Monats-Katamnese zeigten sich Patienten beider Behandlungsbedingungen gebessert. Die Mehrzahl del Patienten aus der psychodynamischen Gruppentherapie schien allerdings in der Lage, ein positivers Trinkmuster während des Katamnesezeitraums aufrechtzuerhalten, wenn man sie mit den patienten der anderen Behandlungsbedingungen verglich. Diese verschlechtertensich graduell. Ein beträchtlicher Teil der Varianz der anzahl alkoholfreier Tage konnte-neben der Orientierung der Gruppentherapieerklärt werden, durch das Ausmaß an Angst bei der Aufnahme. Dans des revues récentes au sujet du traitemende l'alcoolisme, la thérapiede groupe psychodynamique aété jugée moin efficace que d'autres méthodes. Quelques études nord-américaines ontcependant pu démontrer des effets différents en fonction du sous-groupe de patients alcooliques. Dans un contexte culturel différent, la présent étude a mis le focus sur l'évaluation de la psychothérapie de groupe à Durée Limitée, d'orientation psychodynamique, pour un sous-groupe homogène de patients modérément dépendants aà I'alcool, hommes et femmes. Suite à la randomisation, 49 patients ont suivi soit un traitement Cognitivo-comportementaliste, soit une thérapie de groupe psychodynamique, limitée dans le temps. 15 mois après la terminaison, les patients des deux orientations thérapeutiques étaient améliorés. Cependant,une majorité des patients du groupe à orientation Psychodynamique semblait avoir pu maintenir un schéma de consommation d'alcool plus positif durant toute la période catamnestique, alors que les patients du traitement congnitivo-comportementaliste semblaient de détériorer progressivement. L'Orientation thérapeutique mise à part, une partie substantielle de la variance du nombre de jours sans alcool durant la catamnèse s'explique par le degré d'anxiété à I'admission. En revisiones recientes del tratamiento de la dependencia la alcohol, al psicoterapia grupal psicodinámioca fue evaluada como comparativamente menos efective que otros métodos. Sin embargo, algunos estudios norteamericanos han demostrado efectos diferenciales en los tratamientos de subgrupos de pacientes dependientes del alcohol. El foco de este estudio fue la evaluación, en un encuadre culturaldiferente, de la psicoterapia grupal de tiempo limitado psicodinámicamente orientada aplicada a un subrupo homogéneo de pacientes hombres y mujeres moderadament dependientes del alcohol. Después de la randomizació, 49 pacientes completaron un tratamiento cognitivo-comportamental o uno grupal psicodinámico de tiempo limitado. A los 15 meses de seguimiento, los pacientes de ambas orientaciones terapéuticas habian mejorado. Sin embargo, la mayoria de los pacientes en tratamiento grupal psicodinámico parecieron poder mantener una pauta de ingesta alcohólica más positiva durante todo el período de seguimiento comparada conlos pacientes en tratamiento cognitivo-comportamental, quienes parecieron deteriorase gradualmente. Un monto substancial de la variancia en el número de días de abstinencia duranteel seguimiento se explicó, además de por la orientació del tratamiento, por el grado de ansiedad enla admision.

Time-Managed Group Psychotherapy: Effective Clinical Applications

Back to table of contents Previous article Next article Book ReviewFull AccessTime-Managed Group Psychotherapy: Effective Clinical ApplicationsAlbert J. Villapiano, , Ed.D., C.G.P.Albert J. VillapianoSearch for more papers by this author, , Ed.D., C.G.P.Published Online:1 Jun 1998https://doi.org/10.1176/ps.49.6.838AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Roy MacKenzie has made another important contribution to the group treatment literature in support of time-effective and diagnosis-related group treatment models. His previous books entitled Introduction to Time-Limited Group Psychotherapy and Effective Use of Group Therapy in Managed Care helped those of us working in and consulting to diverse clinical settings rethink the way we provided our services.These earlier works gave us some direction on how the health care landscape was changing in regard to managed care, and they summarized the rationale and clinical justification for time-limited and diagnosis-related groups in a variety of settings. Now that a solid research base supports the efficacy of group treatment, including time-limited models, MacKenzie's current book builds nicely on his previous writings, addressing theory, clinical applications, and program development issues.MacKenzie thoughtfully describes a generic model of psychotherapy applicable to group treatment that transcends any one theoretical focus and that recognizes the therapeutic forces at work in group treatment. It draws from interpersonal, dynamic, cognitive, and behavioral schools of thought. Most clinicians who have led groups in a variety of settings will quickly relate to the importance of this integrative approach in meeting the needs of diverse populations and clinical presentations.Much of the book is devoted to a review of the theory and practice of time-managed group psychotherapy. Both experienced and novice group clinicians will appreciate the attention to detail and the specific suggestions about tailoring style and technique to the different stages of a group's life and members' behavior. It is refreshing to read about the importance of a continuum of leadership activity and the emphasis on the value of support and education. MacKenzie asserts that structure and a relatively higher level of leader activity can lessen group members' anxiety, make self-disclosure easier, and accelerate members' involvement. These are all critical issues in time-limited group experiences, where the opportunity for the gradual development of group process does not always exist.The author supports massaging the interactional process and holding session debriefings to increase the likelihood of personal understanding and cognitive integration of the group experience. He encourages the use of homework, such as journal writing, to take learning outside the session. Depending on the group focus, a variety of cognitive-behavioral interventions are employed, such as training to challenge negative thinking patterns.The final third of the book addresses systems issues in developing group programs. Included are a helpful readiness checklist, a review of several models of group therapy, and an appendix with useful forms, scales, and information sheets. The group therapy models apply the principles of the generic model to a range of purposes or topics, such as crisis intervention, eating disorders, and substance abuse. These sections are not how-to manuals, but rather helpful guidelines for experienced clinicians or novice clinicians receiving supervision.Time-Managed Group Psychotherapy: Effective Clinical Applications is a valuable text for group clinicians and for those wishing to develop their group leadership skills. It presents an integrative model of thinking about groups and embraces the importance of diverse and flexible applications of group leadership skills. I also appreciate MacKenzie's acknowledgment of the importance of skill development, support, and outside-of-therapy activity, such as homework, to improve patient-client outcomes—issues all too often neglected in more traditional behavioral health care practice.Dr. Villapiano is director of training and consultation for Innovative Training Systems in Newton, Massachusetts, and is in private practice in Newton.by K. Roy MacKenzie; Washington, D.C., American Psychiatric Press, 1997, 453 pages, $67.50

When Seronegative Gay Male Therapists Work with Seronegative Gay Male Clients

With the growing awareness of the impact of AIDS on seronegative gay men comes a need for clinicians to respond effectively to this population's unique issues. Seronegative gay male therapists, however, often face the same unaddressed issues shared by their clients. Therapy groups focusing on the concerns of uninfected gay men are relatively new, and therefore few of the seronegative gay male therapists facilitating these groups have had a forum for examining their own experiences as uninfected survivors of the epidemic. Consequently, these clinicians must navigate various countertransference feelings (e.g., overidentification with clients) as they interpret group issues that match their own concerns (e.g., seroconversion fears, survivor guilt). Using their personal experiences as cotherapists of time-limited groups for seronegative gay men, the authors outline identification and group-process issues, and offer strategies for managing and using countertransference reactions to benefit clients in this work.

Time-limited group treatment of children.

SALVATORE LOMONACO, M.D.,* SAUL SCHEIDLINGER, Ph.D.** SETH ARONSON, Psy.*** While the mushrooming recent use of short-term treatment modalities for adults, related, in part at least, to the cost-cutting efforts of the country's managed health care system, is relatively well-known,l the parallel growing practice of time-limited groups for children, has so far not been appropriately covered in child psychotherapy's textbooks. This is especially regrettable since the journal literature suggests a current predominance of these abbreviated child-group approaches in clinical work. Time-limited group treatment will be viewed in this paper as encompassing 8 to 25 sessions over the course of six months. Fewer are intervention, while more are long-term psychotherapy. Historical Precedents The beginnings of clinical psychotherapy groups for children were understandably anchored in the then prevailing broader psychodynamic model of open-ended, and long-term reconstructive interventions.23 These approaches were preceded and accompanied, however, by less intensive psychoeducational kinds of shorter-term group modalities, especially diagnostic groups,4 as well as groups associated with therapeutic camping.5 In the 1950s and 1960s, in tandem with these developments, pediatric hospital wards had employed short-term groups for their child patients.6 Characteristically, ever changing in line with the flux of medical admissions, these groups emphasized cathartic expressions of fears, corrections of anxieties and of distortions, provision of factual information, and, above all, companionship and mutual support.7,8 At about the same time, psychoeducational groups for so-called children-at-risk, made their appearance. Conceptualized within the context of primary prevention, Churchill9 used discussion groups for siblings of hospitalized psychiatric patients aimed at modifying the strains and stresses inherent in such situations. Anthony10 similarly relied on the abbreviated group medium to help children of psychotic parents. Besides offering factual information about the illness, the group sessions were designed to help these children cope with the irrational conduct of their elders, as well as to achieve a degree of distance and of objectivity from the psychotic elements in their lives. In the field of community mental health, time-limited children's groups also emerged during the 1960s as part of the War on Poverty, within the context of crisis intervention. Located in clinics, in schools, and in youth-serving organizations, children-of-divorce groups addressed themselves to offer the millions of affected youths ongoing support through shared information and emotional expression. The sense of a peer communality, coupled with the disavowal of blame for the parental discord, were expected to prevent the emergence of personality pathology.11,12 Through the impetus from related community mental health programs, inner-city schools also developed special groupings for children with learning disabilities and behavioral problems. Self-esteem-enhancing activities, together with the release of feelings, were expected to lead to improvements in children's attitudes and behavior.13 While all of the time-limited group-intervention modalities discussed so far fall into the general category of psychoeducation, the following sparser approaches were more strictly clinical in character. They, thus, entailed specially trained group therapists who worked in clinical settings, with child-patients in small, carefully planned groups to effect repair of diagnosed dysfunctions.14 In the inpatient context, the literature of the 1970s carried only three references that pertained to short-term groups. The first, by Abramson, Hoffman and Johns,lf dealt with an open-ended play group for severely impulsive, hospitalized, elementary school-aged children. The twiceweekly sessions emphasized verbal interventions in response to the content of the play, to group interactions, and to emotional ideations. …

Time-Limited, Goal-Oriented Therapy: Diary of a Stop-Smoking Group

Nicotine is an extremely addictive substance and although many smokers try to stop permanently, few succeed, even with support. Most stop smoking programmes for individuals or groups involve the use of nicotine replacement (gum or patches), but a time-limited group where members focus on the primary task can achieve high levels of smoking cessation without the use of nicotine replacement. This article follows the progress of ten heavily dependent smokers, most of whom had some form of smoking-related disease, over a five-week stop smoking programme at an NHS hospital. A year later five group members are not smoking.

A group for the adult daughters of mentally ill mothers: looking backwards and forwards.

A closed time-limited therapy group was conducted for four women who had all been raised by mentally ill mothers. Themes recurring frequently included hatred of self and mother, current lack of extended family support, current parenting difficulties, ongoing stigma and isolation. All group members perceived themselves as troubled despite others' perceptions of them as resilient. The results for the individuals treated are outlined using clinical material, as statistical analysis was not undertaken. All were able to cease individual therapy. Conclusions focus on the benefits of such a group process of recognition and affirmation of the profound consequences of a mother's mental illness on her daughters and thence to grandchildren. The possibility of primary prevention using techniques from infant-parent and child-group therapy is discussed.

The current status of psychotherapy research in schizophrenia

After a preponderance of psychoanalytically orientated individual psychotherapy, family therapy dominated in recent years, in most cases of limited duration. Family therapy proved very helpful in unburdening relatives and deemotionalising familiar surroundings. Earlier studies demonstrated the significance of family therapy for relapse prevention, but controlled studies could not show that these methods were more effective than careful neuroleptic medication. Time-limited group psychotherapy was also criticised for lack of controlled studies. Though these modalities were shown to be effective in individual cases, long-lasting and relapse-preventing effects could not be shown. Psychological therapies lasting for only some months obviously overcharge patients in some cases and may occasionally even have counterproductive effects.

Three-Year Follow-up and Clinical Implications of a Mindfulness Meditation-Based Stress Reduction Intervention in the Treatment of Anxiety Disorders

A previous study of 22 medical patients with DSM-III-R-defined anxiety disorders showed clinically and statistically significant improvements in subjective and objective symptoms of anxiety and panic following an 8-week outpatient physician-referred group stress reduction intervention based on mindfulness meditation. Twenty subjects demonstrated significant reductions in Hamilton and Beck Anxiety and Depression scores post-intervention and at 3-month follow-up. In this study, 3-year follow-up data were obtained and analyzed on 18 of the original 22 subjects to probe long-term effects. Repeated measures analysis showed maintenance of the gains obtained in the original study on the Hamilton {F(2,32)= 13.22; p < 0.001} and Beck {F(2,32) = 9.83; p<0.001} anxiety scales as well as on their respective depression scalgs, on the Hamilton panic score, in the number and severity of panic attacks, and on the Mobility Index—Accompanied and the Fear Survey. A 3-year follow-up comparison of this cohort with a larger group of subjects from the intervention who had met criteria for scredning for the original study suggests generalizability of the results obtained with the smaller, more intensively studied cohort. Ongoing compliance with the meditation practice was also demonstrated in the majority of subjects at 3 years. We conclude that an intensive but time-limited group stress reduction intervention based on mindfulness meditation can have long-term beneficial effects in the treatment of people diagnosed with anxiety disorders.

Feeling like a Motherless Child: A Support Group Model for Adults Grieving the Death of a Parent

This article presents a rationale and model for a time-limited bereavement support group for adults who are grieving the death of their parent(s) as an adult. The model is based on assumptions about the particular needs and issues of this population, and about the grieving process in general. The screening process and structure of group sessions are described, and the sequence of seven group themes are presented. Finally, some of the clinical impressions of the authors are offered, so that other professionals can use the model as a starting point for designing similar groups for the same population.

The Contribution of Group Cohesion and Group Alliance to the Outcome of Group Psychotherapy

ABSTRACTThe contribution to outcome of two group-process factors, group cohesion and group therapeutic alliance, was tested in the context of a randomized, controlled treatment trial for borderline personality disorder. Group members from four time-limited groups of an experimental model of group psychotherapy completed measures of group cohesion and group alliance at prespecified intervals across the 30-session therapy. Outcome was measured in terms of psychiatric symptoms, social adaptation, and indicators of behavioral dysfunction. The results showed that cohesion and alliance were correlated significantly and separately contributed to outcome on most of the dependent measures. Stepwise regression analyses showed, however, that when compared with cohesion, alliance accounted for more outcome variance on the dependent measures. The clinical implications of the findings and the limitations of the study are discussed.

Maturing Gay Men

Two time-limited groups were offered for gay men age 40 and over. From pre-group interviews a list of interest areas was constructed. Interpersonal relations with other gay men emerged as the primary concern. In an effort to describe and organize the concerns group members expressed about their relationships, a model based on the work of Bell and Weinberg and the ethnographic work of Evelyn Hooker was developed. The model is a typology consisting of three dominant sociosexual interactive fields: the Sexual Market Field, the Primary Relationship Field and the Social Network

The efficacy of activity group therapy in a residential treatment center

Time limited Activity Group Therapy (14 sessions) was conducted for children and adolescents in an inpatient setting by a graduate class taking Family and Group Psychotherapy Methods. The professor of the course was present at each session to supervise and act as facilitator and therapist when necessary. Mental Health Workers (MHWs) from the facility were also present and incorporated into the sessions. The description of the group sessions including the types of activities, group structure, and leadership approaches are presented. The outcome data suggest that patients derived considerable therapeutic benefit and demonstrated improved psychosocial functioning as a result of their group experiences. The training and educational benefits garnered by both the graduate students and the MHWs as a result of the partnership between the treatment facility and the university are discussed.

The Effects of Pretraining on Group Psychotherapy For Incest-Related Issues

ABSTRACTThe effects of written, cognitive pretraining on self-reported self-disclosure and cohesion in group psychotherapy were studied. Subjects were members of time-limited psychotherapy groups that focused on incest-related issues. The experimental groups were given written cognitive pretraining designed to increase self-reported self-disclosure and cohesion. The control groups received general group information. Subjects in the pretrained groups reported higher levels of self-perceived self-disclosure than the control groups after sessions 4 (p = .003) and 8 (p = .003). Self-reported self-disclosure did not increase over time for pretrained or nonpretrained subjects. Cohesion did not differ across groups, but increased over time for experimental subjects (p = .008), and not for control subjects.

Me and my shadow : Therapy with sexually abused pre-adolescents

The purpose of this paper is to describe the use of solution focused techniques with preadolescent children who have been sexually abused and to present a therapeutic model that: 1) represents a blending of traditional psychological theoretical ideas with the more recent solution focused techniques; 2) presents a unique time-limited group format for assisting children to come to know and like their authentic selves; and 3) provides the therapist with the opportunity to expand his or her roles. In this model, the path from “false self” to “authentic self” is conceptualized as an interplay among abuse events, family relationships, and other life contexts.

Therapeutic focusing in time-limited group psychotherapy.

Therapeutic focusing in time-limited group psychotherapy.

A Gestalt Therapy Theory Application to the Practice of Group Leadership

Abstract A framework consisting of both theory and practice is presented to guide group leaders in making effective interventions. A variety of time-limited groups including business, educational and therapy groups are discussed. Theory derived from Gestalt therapy and group development literature is outlined. Group leaders are encouraged to alternate interventions at the intrapersonal, interpersonal and group levels of process and to support a group's natural developmental tendencies.

Therapeutic focusing in time-limited group psychotherapy.

Therapeutic focusing in time-limited group psychotherapy.

Development of Social Skills in Boys with Brain Tumors

Abstract Children with brain tumors often experience organically based illness- and treatment-related sequelae that interfere with the development of complex social skills necessary for confident, mutually satisfying interactions with peers. This article describes a structured, time-limited group focused on the development of social skills in boys who have a brain tumor. Social support and medical education were additional components. A parallel group for parents focused on relevant issues that arose in the boys∗ group and on the parents' general concerns about their child's social integration. The uniqueness of this program stemmed from the combination of development of social skills, specificity and homogeneity of the target population, highly structured group interventions, and parallel parent group. The program's efficacy in developing specific social skills was reported by both the boys and their parents. The authors recommend offering similar group interventions to other medically ill children and t...