Comparative outcome in time-limited individual and group psychotherapy

Consistency of Matter

This article presents a comparative analysis of individual and group psychotherapy process research. Commonalities between these to treatment formats are identified across the therapeutic dimensions of relationship, interventions, and factors. The distinctive characteristics of group treatment are explored, and conceptual implications are tendered for the practice and study, of group counseling and psychotherapy.

Relationship education in community settings: effectiveness with distressed and non-distressed low-income racial minority couples

Couple relationship education (CRE) programs are intended to prevent negative couple outcomes, however, some evidence suggests couples in greater distress may still benefit. The current study examined pre- and postchanges in relationship functioning of 362 low-income African American and Hispanic couples. Outcomes (dedication and communication) were assessed by examining differences between two distinct groupings of couples; distressed (both partners reporting clinically significant distress) and nondistressed (neither partner reporting clinically significant distress) couples. Distressed couples at predemonstrated large-sized gains in all outcome variables, as compared to nondistressed couples. Those who participated in the single-couple format demonstrated lower gains in positive communication as compared to those in the group format. Implications for distressed couples in CRE programs are offered.

Short-term psychodynamic psychotherapies for common mental disorders

BACKGROUND

Since the mid-1970s, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Early published meta-analyses of STPP, using different methods and samples, have yielded conflicting results, although some meta-analyses have consistently supported an empirical basis for STPP. This is an update of a review that was last updated in 2006.

OBJECTIVES

To evaluate the efficacy of STPP for adults with common mental disorders compared with wait-list controls, treatments as usual and minimal contact controls in randomised controlled trials (RCTs). To specify the differential effects of STPP for people with different disorders (e.g. depressive disorders, anxiety disorders, somatoform disorders, mixed disorders and personality disorder) and treatment characteristics (e.g. manualised versus non-manualised therapies).

SEARCH METHODS

The Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR) was searched to February 2014, this register includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, DARE and Biological Abstracts (all years to July 2012) and all relevant studies (identified to 2012) were fully incorporated in this review update. We checked references from papers retrieved. We contacted a large group of psychodynamic researchers in an attempt to find new studies.

SELECTION CRITERIA

We included all RCTs of adults with common mental disorders, in which a brief psychodynamic therapy lasting 40 or fewer hours in total was provided in individual format.

DATA COLLECTION AND ANALYSIS

Eight review authors working in pairs evaluated studies. We selected studies only if pairs of review authors agreed that the studies met inclusion criteria. We consulted a third review author if two review authors could not reach consensus. Two review authors collected data and entered it into Review Manager software. Two review authors assessed and scored risk of bias. We assessed publication bias using a funnel plot. Two review authors conducted and reviewed subgroup analyses.

MAIN RESULTS

We included 33 studies of STPP involving 2173 randomised participants with common mental disorders. Studies were of diverse conditions in which problems with emotional regulation were purported to play a causative role albeit through a range of symptom presentations. These studies evaluated STPP for this review's primary outcomes (general, somatic, anxiety and depressive symptom reduction), as well as interpersonal problems and social adjustment. Except for somatic measures in the short-term, all outcome categories suggested significantly greater improvement in the treatment versus the control groups in the short-term and medium-term. Effect sizes increased in long-term follow-up, but some of these effects did not reach statistical significance. A relatively small number of studies (N < 20) contributed data for the outcome categories. There was also significant heterogeneity between studies in most categories, possibly due to observed differences between manualised versus non-manualised treatments, short versus longer treatments, studies with observer-rated versus self report outcomes, and studies employing different treatment models.

AUTHORS' CONCLUSIONS

There has been further study of STPP and it continues to show promise, with modest to large gains for a wide variety of people. However, given the limited data, loss of significance in some measures at long-term follow-up and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.

Underutilization of short-term group therapy: enigmatic or understandable?

Given the evidence for the efficacy, applicability, and efficiency of the group therapies, they appear to be underutilized by clinicians, therapists, and researchers. This article considers reasons for their underutilization. The article also considers procedures for lessening patient and therapist tendencies to resist participating in the group therapies relative to individual therapies. Underutilization not only deprives patients of effective treatment for a wide range of problems but deprives therapists from experiencing fascinating and rewarding therapeutic processes. That has been the experience of the author after more than 35 years of conducting and studying group therapies.

Short-term psychodynamic psychotherapies for common mental disorders

BACKGROUND

Over the past 40 years, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Four published meta-analyses of STPP, using different methods and samples, have found conflicting results.

OBJECTIVES

This review evaluated the efficacy of STPP relative to minimal treatment and non-treatment controls for adults with common mental disorders.

SEARCH STRATEGY

We searched CCDANCTR-Studies and CCDANCTR-References on 25/4/2005, CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, DARE and Biological Abstracts were also searched. We contacted triallists and checked references from papers retrieved.

SELECTION CRITERIA

All randomised controlled trials (RCT) of adults with common mental disorders, in which a brief psychodynamic therapy lasting less than 40 hours in total, and provided in individual format, were included.

DATA COLLECTION AND ANALYSIS

Three reviewers working in pairs evaluated studies. Studies were selected only if pairs of reviewers agreed they met inclusion criteria. A third reviewer was consulted if two reviewers could not reach consensus. Data were collected and entered into Review Manager. Study quality was assessed and scored by pairs of raters. Publication bias was assessed using a funnel plot. Sensitivity analyses were also conducted.

MAIN RESULTS

23 studies of 1431 randomised patients with common mental disorders were included. These studies evaluated STPP for general, somatic, anxiety, and depressive symptom reduction, as well as social adjustment. Outcomes for most categories of disorder suggested significantly greater improvement in the treatment versus the control groups, which were generally maintained in medium and long term follow-up. However, only a small number of studies contributed data for each category of disorder, there was significant heterogeneity between studies, and results were not always maintained in sensitivity analyses.

AUTHORS' CONCLUSIONS

STPP shows promise, with modest to moderate, often sustained gains for a variety of patients. However, given the limited data and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.

[The experience of public service users with group psychotherapy: a qualitative study]

OBJECTIVE

To assess the experience of public service users in a time-limited psychotherapeutic group dynamic intervention.

METHODS

Eleven patients were randomly selected from a group of 52 who had participated in an efficacy study and were interviewed in-depth. Their account was submitted to content analysis, according to the Grounded Theory methodology.

RESULTS

In general, patients accepted well and positively evaluated the psychotherapy intervention. The main findings were the importance of patient's interaction with the group participants, and their therapeutic course after the intervention, when most of them carried on with psychotherapy.

CONCLUSIONS

The psychotherapeutic intervention was well accepted among the patients, had a favorable outcome and stimulated them to proceed with psychotherapy.

A comparison of short-term group and individual therapy for sexually abused women

OBJECTIVE

To compare the effectiveness of 10 sessions of group therapy with that of 10 sessions of individual therapy in a sample of 86 adult women seeking treatment for the effects of childhood sexual abuse.

METHOD

Participants were randomly assigned to the 2 treatment modalities and tested at assessment, pretherapy following a 10-week wait condition, posttherapy, and 6-month and 12-month follow-up.

RESULTS

Participants had fewer symptoms and better psychosocial functioning posttherapy and were further improved at the 6- and 12-month follow-up. Neither treatment modality was superior to the other. Approximately one-half of the sample sought further treatment during the follow-up periods.

CONCLUSIONS

Improvement in symptoms and functioning was associated with short-term treatment in both modalities, but many patients remained distressed and required further treatment. Future research should investigate whether sexually abused women who meet criteria for specific diagnoses require more focused and/or longer-term therapy.

Education as Psychiatric Intervention The Cognitive-Behavioral Context

1. The cognitive behavioral treatment context is essentially an educational function that focuses on eliciting changes in attitude and judgment, values, methods of cognitive processing, correction of distorted thinking, re-examination of internalized core assumptions, and subsequently, behavior. 2. The behavioral framework presumes that behavior is learned and can be unlearned or relearned, and that psychiatric disorders are severely complicated by maladaptive and dysfunctional attempts to compensate. 3. The cognitive models involve validation, remotivation, resocialization, reality testing through increasing coping and problem solving abilities, and increasing self esteem and a sense of personal control.

Group psychotherapy and managed behavioral health care: current trends and future challenges

The rising cost of health care within the private and public sectors has created an increased demand for the management of benefit dollars. This trend has significant implications for group psychotherapists, as group modalities offer cost-effective ways of delivering services to traditional outpatient and inpatient populations. Continued cost-containment pressures and increasing attention to outcome studies will fuel trends toward briefer, manualized group treatments and intensive group outpatient programs as alternatives to hospitalization. Quality-based demands will challenge payors to (a) address biases against group psychotherapy among providers and patients and (b) integrate recent process-and-outcome research in determining the appropriateness of group versus individual modalities for particular patients and presenting problems.

A consideration of factors influencing the utilization of time-limited, short-term group therapy

Previous reviews of the research literature and a new review conducted for this article were examined for evidence of the efficacy, applicability, and efficiency of time-limited, short-term group therapy (TSGT). Strong evidence for all three factors was found. Additional patient and therapist factors influence the effectiveness and utilization of TSGT in clinical settings, however. Some are analogous to criteria routinely considered in the use of medication such as "ease of administration" and "side effects." Others are particularly relevant to therapists, such as lack of training and experience, organizational difficulties, and negative reactions to managed-care initiatives. Optimal matching of patient and treatment also affects treatment decisions. Implications for clinicians and administration are considered.

Brief group treatment and managed mental health care

There is increasing interest in the application of brief group psychotherapy to treat a wide variety of patient conditions. This paper reviews a selected set of controlled and comparison studies of brief, outpatient group treatment with adults, and considers findings that support the effectiveness of this approach. Authors discuss barriers to the use of brief group interventions and make recommendations regarding increased utilization of this approach in managed mental health settings.

Where is here and when is now? The adaptational challenge of mental health reform for group psychotherapy

The structure of health care delivery is in a period of rapid change. An understanding of psychotherapy service use patterns indicates the importance of time categories as well as the relevance of group techniques. Traditional interpersonal and psychodynamic group techniques may be modified for time-limited use without sacrificing basic values and with demonstrated effectiveness. Adapting to a more fiscally stringent practice environment requires the clinician to undertake a difficult process of transition. As professionals our task is to prepare ourselves for this challenge and to let the health care system know that proper practice guidelines are necessary to achieve effective treatment for our patients.

Beyond the interpersonal circumplex in group psychotherapy: the structure and relationship to outcome of the Individual Group Member Interpersonal Process Scale

Development of a new scale to measure patient behavior in group psychotherapy, the Individual Group Member Interpersonal Process Scale (IGIPS), is described. This scale captures clinically important aspects of how patients act in group, including how they respond to the other group members. The IGIPS was applied to videotapes of the first four sessions of seven 15-session outpatient therapy groups (52 patients) in the Mental Health Department of a health maintenance organization. The scale was found to have five factors (Activity, Interpersonal Sensitivity, Comfort with Self, Self-Focus, and Psychological Mindedness). Patient behavior that was moderate on two IGIPS dimensions was connected with better outcome than was that of patients with more extreme behavior in either direction.