A closed model of short-term inpatient group psychotherapy

Cohesiveness, an essential element in successful therapy groups, is difficult to establish and maintain in inpatient settings where group membership is constantly changing. Cohesiveness can be increased by the use of a closed group model, in which all members begin the group on a specified day and remain in the group for a predetermined number of sessions. Such groups must work through four developmental phases. The first phase, in which group members overidentify with the problems of other members, is followed by a phase characterized by disenchantment with the group. In the third phase members seek to achieve both independence and intimacy simultaneously, and the final phase involves separation from the group. According to the author, the primary disadvantage of closed therapy groups is that they can be used only in certain settings.     

Pretraining for group psychotherapy. A cognitive-experiential approach.

Pretherapy training for group psychotherapy is conceptualized in terms of learned conditions of preparedness (objectives) and in terms of methods of preparation (procedures). Controlled studies of pretraining for group psychotherapy were reviewed in reference to these two dimensions and their effects. A controlled study of pretraining involving five outpatient therapy groups that used a new cognitive-experiential approach to pretraining was performed. Pretrained groups had significantly higher patient attendance and significantly fewer dropouts than nonpretrained groups.     

The group psychodynamic psychotherapy approach to patients with psychosis

In writing about the group setting in treatment of patients with psychosis the author is drawing from his long clinical practice and his writings on the subject. He underlines the value of group-analytic concepts, formulated by S.H.Foulkes, as well as needed modifications when patients with psychosis are in question. Through clinical examples he will explain his experiences and discuss some specific features concerning inpatients and outpatients group psychodynamic psychotherapy for patients with psychosis. A special attention will be directed towards the dynamics of the therapist's/therapeutic team's roles, and to the need of continuous supervision.     

Attachment characteristics and psychotherapy outcome following inpatient psychodynamic group treatment

Within a reanalysis of the "Kiel Group Psychotherapy Study", the videorecorded intake interviews of 34 patients were analyzed using the adult attachment prototype rating. Three subgroups, differentiated according to their attachment patterns (avoidant, ambivalent, mixed insecure) differed marginally with respect to their treatment success, with ambivalent patients showing the most positive outcome (escpecially with regard to symptom- and self-system-related outcome criteria). In addition, there were indications for a differential assessment of group related therapeutic factors by the subgroups. Patients with an avoidant attachment pattern evaluated group-related factors such as cohesion and altruism as least helpful. The study is discussed in relation to existing findings on the significance of attachment related variables for the indication and prognosis of psychotherapy.     

A postrationalist approach to emotional reciprocity in psychotherapy

In a postrationalist approach to cognitive psychotherapy the therapeutic relationship becomes a tool for exploring, by which, the patient manages to understand the rules which govern the rigid logical processes of his own personal meaning organization. A more accurate knowledge of one's own attitudes is the crucial variable that lets the patient assimilate problematic experiences. The therapist role assume the form of a "strategical oriented emotive disturber" who is extremely careful to utilize the emotional swings that he live in reciprocity with the patient, and who is aware of is own, as it is his emotions which modulate the patient's perceptions and understanding of problems.     

Results of psychodynamic inpatient psychotherapy in relation to diagnosis

Therapy outcome is analysed according to the main diagnoses in a 5 years' sample of psychodynamic inpatient psychotherapy (n=461) and controlled in a 6-9 months follow-up (n=312). Therapy effects, as measured in a pre-post comparison of the patients' self-rating, are generally good and especially noticeable for affective and anxiety disorders, whereas the effects for somatoform disorders are relatively low. The opposite tendencies are seen in follow-up, i.e. relapses in anxiety and affective disorders, and further improvement in somatoform disorders. A surprisingly positive outcome is shown for personality disorders and especially for severe personality disorders (e.g. Borderline). Regardless of the diagnoses, 80% of the patients show a high degree of satisfaction with their treatment and its outcome.     

Adapting milieu approaches to acute inpatient care for schizophrenic patients

Classic therapeutic community or milieu therapy techniques are not applicable in many contemporary acute-treatment settings, which emphasize crisis intervention, short stays, psychotropic medication, and cost containment. However, milieu techniques can be integrated with an understanding of biological and psychosocial factors to provide a framework for the acute, short-term treatment of schizophrenic patients. After reviewing recent biological and psychosocial research, the authors outline three principles for incorporating such research with milieu techniques: creating a holding environment, developing a graduated therapeutic program, and focusing on common patient needs. Application of these principles in a short-stay setting will provide an intensely supportive treatment environment that allows the use of many different therapies and modulates stresses on staff.     

From feelings of imprisonment to group cohesion: A qualitative analysis of group analytic psychotherapy with dual diagnosed patients admitted to an acute inpatient psychiatric unit

Objectives: Group cohesion, the establishment of hope, and the expression of feelings have been said to be the basic ingredients of group psychotherapy. To date, there is few literature describing therapeutic processes in short stay settings such as acute psychiatric wards and with special patient groups such as addictions. Our goal with this study is to describe and analyze group processes in such contexts. Methods: We used a qualitative methodology combining constant comparative methods and hermeneutical triangulation to analyze therapeutic narratives in the context of a group analytic process carried following Foulkes’ and Yalom’s styles. Results: The results provide a picture of the therapeutic process including the use of norms to strengthen group cohesion facilitating the expression of emotions in early stages of group development. Conclusions: This analysis is intended to be a guide for practitioners implementing group therapy in contexts involving several constraints, such as acute psychiatric wards.     

A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial

This study tests the effectiveness of adding an eight-month, thirty-session schema-focused therapy (SFT) group to treatment-as-usual (TAU) individual psychotherapy for borderline personality disorder (BPD). Patients (N = 32) were randomly assigned to SFT-TAU and TAU alone. Dropout was 0% SFT, 25% TAU. Significant reductions in BPD symptoms and global severity of psychiatric symptoms, and improved global functioning with large treatment effect sizes were found in the SFT-TAU group. At the end of treatment, 94% of SFT-TAU compared to 16% of TAU no longer met BPD diagnosis criteria (p < .001). This study supports group SFT as an effective treatment for BPD that leads to recovery and improved overall functioning.     

A practical approach to the psychotherapy of the borderline patient

Guidelines for the ordinary psychotherapist in the day-to-day office treatment of so-called borderline patients are presented. Practical pointers for handling problems of diagnosis, working alliance, transferences, middle phase, and termination are given, followed by a brief discussion of the future of the concept of borderline patient.     

Effects of adult inpatient group psychotherapy on attachment characteristics: An observational study comparing routine care to an untreated comparison group

Abstract

This study investigated the changes in attachment characteristics of patients undergoing inpatient group psychotherapy in routine care. We collected data from 265 consecutively recruited patients and 260 non-clinical control persons using self-report measures of attachment, depression, and socio-demographic characteristics. The effects of treatment on patients were analyzed using propensity score techniques (propensity strata and logit-transformed propensity scores) in combination with a generalized analysis of covariance. A moderate increase of attachment security was found which could be attributed to a decrease both in attachment anxiety and avoidance. Pre-post improvements in attachment with regard to romantic partnerships were stable after a 1-year follow-up. Furthermore, we found significant treatment-covariate interactions indicating that subjects with particularly high treatment propensities (propensities were highly correlated with depression and attachment anxiety) improved the most in terms of attachment security. Our results are encouraging for psychotherapeutic practice in that they provide evidence that long-term attachment improvements can be reached via psychotherapy. Our results will also provide a sound basis for future studies in the field of clinical attachment research, e.g., studies examining whether improved attachment security is correlated to symptom improvements in different psychological disorders.