A systems analysis of a failure to test the effectiveness of waiting-list group therapy.

This nonexperimental effectiveness study attempted to evaluate the utility of a brief waiting-list group. The setting was a university clinic providing treatment for an inner-city population. Health delivery and staff dynamics made it difficult to conduct clinical research in this treatment-oriented setting. The nonrandom design allowed for patient choice, with few clients attending more than two group sessions, thus decreasing its impact. Managed-care pressures decreased staff cooperation with our research objectives, resulting in very low return rates in testing and follow-up data. A social systems analysis, highlighting staff and institutional ambivalence, is used to understand the failure to adequately test the effectiveness of waiting-list group therapy. Recommendations are offered to investigators who contemplate conducting clinical research with limited resources.

The waiting-list group.

This report describes a pilot study of a waiting-list group (preliminary process group [PPG]) that provided treatment for applicants to a university affiliated, urban mental health center. All individuals on the treatment waiting list were informed of the PPG. This semistructured group, meeting weekly, began with members presenting their problems, followed by free discussion, and ending with goal setting for the next week. Approximately one seventh (35 out of 262) of the clinic's applicants during a 4 1/2-month period chose to enter the PPG. They differed from those who chose not to participate (wait list) by being older and less educated. Approximately 80% of both wait-list and PPG participants subsequently entered therapy. Significantly more PPG patients than those on the wait list entered group treatment. The PPG served clinic needs by providing prompt service for self selected individuals and by supporting the group therapy program.

Affect and therapeutic process in groups for chronically mentally ill persons.

A dynamic group treatment model for chronically ill persons allowing them to determine the frequency of attendance empowers the members and potentiates group development. This format respects patients' needs for space as represented by missed meetings. In this context, absences are formulated as self-protective and self-stabilizing acts rather than as resistance. In an accepting, supportive environment, members can be helped to explore affects and gain insight into their behaviors. A clinical example illustrates patients' examination of the meaning of missing and attending sessions, with particular focus on intensity of involvement, autonomy, and control. In the process of testing the therapist and group, members show capacity to gain insight into recent in-group and extra-group behaviors.

Transference neurosis in group psychotherapy: the concept and the reality.

The contribution of Durkin and Glatzer to examination of transferences and the therapeutic process emphasizes the nature of peer transferences that of are sufficient depth to resolve personality conflicts. In the past two decades additional emphasis on the totality of the treatment relationship and of self psychology has added to understanding elements in the transference and curative process. A clinical illustration provided by Durkin and Glatzer is reexamined in light of these advances.

Frustration, anger, and the significance of alter-ego transferences in group psychotherapy.

When working with narcissistically vulnerable and angry patients in group psychotherapy one must take into account the entire treatment context. Interaction takes place among the identified patient, the other members, the therapist, and the image of the group as a whole. In members' counter-reactions to the difficult person, group-destructive forces frequently are stimulated. The offending individual may flee, or the group may reach an impasse in which little growth occurs. In this communication, I have focused on alter-ego relationships and transferences as a way of understanding aspects of group formation and destruction. Angry patients may have intense wishes to be like others and to feel part of the human condition. They suffer from feeling alone. Disruption of an alter-ego relationship may result in rage. A self-psychological perspective in concert with knowledge of group dynamics enables the clinician to formulate ways of intervening in problematic group interactions. The therapist's capacity to attend to the vulnerabilities of the self of all persons involved in the group is often severely tested, particularly under circumstances of emotional contagion. Elucidation of twinship and alter-ego transferences may help stabilize difficult patients and enable them to restart their psychological growth.

Combining psychopharmacotherapy and group psychotherapy: problems and advantages.

This report presents the responses to the authors' survey of therapists' attitudes and perceptions regarding the problems and advantages of combining pharmacotherapy with group psychotherapy. Group therapists representing physicians, psychologists, and social workers were asked about their practices and attitudes regarding this practice. One hundred forty-three valid responses were received to the questionnaire (response rate = 55.4%). No significant differences among the three professions were found in years of experience, number of groups conducted, or percentage of included patients taking medication. The authors categorized the responses for both problems and advantages. The problem categories were medication arrangements and effects, impact on the group processes, relationship to the therapist, and interprofessional collaboration. The advantages were identical except for the initial category, which addressed group composition. The responses reflect clinicians' concerns, both positive and negative, and provide a framework for therapists to examine their practices.

The place of self psychology in group psychotherapy: a status report.

This article reviews the growing contribution of self psychology to group psychotherapy. The basic self-psychological concepts as they are applied to group dynamics and the treatment process are explored. Transference, countertransference, and self-restitutive patterns are illustrated in a clinical vignette that includes a "difficult" patient's impact upon the interactional and group-as-a-whole processes. Several directions for future investigation are described.

Combining group psychotherapy and pharmacotherapy: a survey.

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their "typical" outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication. Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.

Treatment of the chronically mentally ill: an opportunity for the group therapist.

This article focuses on the therapist's task of engagement in the group treatment of the chronic mentally ill. The dynamics of individual and group processes are reviewed with an emphasis on the contributions of social, interpersonal, and intrapsychic factors. Drawing upon the observations of Friedman (1988), the presentation explores therapists' efforts to restore their inner balance by (1) acting like a therapist, that is, according to their theory; (2) satisfying their curiosity; and (3) eliciting "something desirable," which is formulated as the therapist's search for interactive responses. Examples illustrate these elements as they emerge in group psychotherapy.

The flexible boundaried group: format, techniques, and patients' perceptions.

The model of a flexible boundaried group was developed to manage the problem of irregular group attendance of chronic mentally ill patients. The central element in the model enables patients to determine, within limits, the frequency with which they will attend sessions. Review of attendance records and patient interviews from one flexible group suggest that members adhere to their contractual agreement and are accepting of irregular attenders. This finding has been supported by experiences in three additional groups composed of chronically ill individuals. These groups, comprised of regular, core attenders and peripheral members, become cohesive and form a viable therapeutic treatment structure.

Dimensions of experiential learning at group relations conferences.

Four hundred and seventy-seven professionals attended thirteen group relations conferences. Conferences varied across three dimensions: context, including sponsorship and history: design, involving duration, intensity (residential setting) and complexity; and linkages, the social and authority ties between members and staff. Three month follow-up questionnaires were collected from sixty percent of participants. Significantly more self-assessed learning was reported by those who attended the residential than the non-residential conferences. The results, from a large diversified sample, suggest that a combination of training in a residential setting, strong institutional sponsorship and pre-existing authority and social linkages between members and staff resulted in the most reported learning. Group relations conferences provide unique learning opportunities for mental health professionals, (Correa et al. 1981) and have been increasingly used in the United States and Europe during the last twenty years. Despite this, there is little research evaluating the outcomes of such training in terms of member learning or the differential effectiveness of the alternative forms of conferences currently available. Conferences vary along three major dimensions: a) context, including the institutional sponsorship as well as the history of previous conferences held at the same site, b) design, including the duration, intensity and number of events which make up the conference, and c) linkages, the social and authority relations among members and staff. A review of the first decade of group relations work in the United States concluded that the characteristics of a conference, including the setting have an important impact on member learning, (Klein 1978).(ABSTRACT TRUNCATED AT 250 WORDS)

Learning during group dynamics training: the effects of silent versus traditional training formats.

According to practicing group psychotherapists, the two most valued components of training for group psychotherapy are: (1) the opportunity to conduct a therapy group under supervision, and (2) participation in experiential training (Dies 1974). It is no wonder, then, that a large spectrum of experiential training models has emerged (Lakin, Lieberman, and Whitaker 1969). What is learned from the various models relates to the milieu, the leader, and the group composition (Stone and Green 1978), and in part depends on the particular training format. In contrast to descriptions of training, however, is the relatively limited formal evaluation of the learning which occurs in these programs. This paper will focus on an evaluation of the learning which took place during the group dynamics component of group psychotherapy training. The effect on learning of variations in format in which the leader is either silent or explicates group processes was tested.