Group Training Objectives (revised June/2013)

POST-GRADUATE TRAINING OBJECTIVES IN GROUP PSYCHOTHERAPY Drs. Molyn Leszcz, Phil Maerov, Shari Kirsh, Leo Murphy, Jan Malat I. PREAMBLE

The following standards for training in group psychotherapy delineate guidelines for minimum expectations for training in the modality of group therapy. It is expected that residents will be able to fulfil these requirements as they rotate through different clinical settings during the course of their residency. In general, comprehensive training involves a mix of clinical work, supervision, seminars (core seminar provided in PGY 2 year), observation of group work and experiential learning in a group format (annual Group Psychotherapy Day). The intention is to provide training in group therapy approaches that use the group as the agent for therapy and not only a setting. Commonly this will be a psychodynamic/interpersonally based model of group therapy. Competence using this model is necessary to conduct many types of groups, as the psychodynamic/interpersonal model offers instruction in the fundamental principles of group psychotherapy. Exposure to other models of group therapy is also encouraged, notably cognitive and behavioural groups.

Please contact Jan Malat, the Modality Lead for Group Psychotherapy if you have any questions at [email protected]; 416 535-8501 ex. 6669.

II. WORKING KNOWLEDGE TRAINING OBJECTIVES IN GROUP THERAPY

A. Knowledge 1) Indications and contraindications for group therapy 2) Range of group treatments and their applications in relation to particular patient diagnoses and treatment settings 3) Group dynamics in treatment groups and organizational activities 4) Leadership variables 5) Efficacy of group therapy 6) Process of referral for group therapy 7) Usefulness as a collaborative treatment

B. Skills 1) To be able to recommend group therapy appropriately and successfully 2) To evaluate and prepare patients for group therapy 3) To identify and address group dynamics and group phenomenon manifested in the group 4) To be able to work effectively as an individual therapist in a conjoint treatment arrangement (where patient receives group therapy from another therapist)

C. Attitudes 1) Awareness of the importance of group dynamics in therapy, educational, social and professional groups 2) Appreciation of the effectiveness of group therapy to ameliorate patient distress and to modify dysfunctional behaviour 3) Recognition that both process and content variables are generally present and require appropriate consideration 4) Practice in an ethical manner, including: i) ethical obligations as pertains to all psychotherapies, ensuring patient confidentiality, protecting the integrity of the patient-therapist relationship, prohibiting sexual contact between therapist and patient at any time and prohibiting any form of exploitation of the patient by the therapist; 1 ii) unique aspects of group therapy regarding confidentiality, and boundary maintenance in a multipersonal treatment; iii) to provide access to treatment without prejudice

D. Objectives 1) Participation in an introductory seminar for 3 hours. 2) Leadership or co-leadership of a treatment group on an inpatient unit or ambulatory setting for a minimum of 8 hours 3) Group psychotherapy supervision in a group or individual format for a minimum of 6 hours 4) Participation in experiential learning, including attending Group Day at least once during PGYII- PGYV years. 5) No clinical work should be done by trainees without supervision. Supervision entails a regular meeting at an established frequency between the group therapy supervisor and the group therapy trainee(s) 6) Seminar leaders and group therapy supervisors must be approved by the group psychotherapy Subcommittee

III. FOR RESIDENTS SEEKING FURTHER ADVANCED TRAINING (PROFICIENCY) IN GROUP THERAPY, OBJECTIVES INCLUDE:

A. Working Knowledge Requirements, plus:

B. Knowledge 1) History of group psychotherapy 2) Range of group psychotherapy models: 1 – behavioural 5 – psychoeducational 2 – cognitive 6 – expressive arts 3 – interpersonal 7 – self-help 4 – psychodynamic 8 – internet support groups 3) Range of group psychotherapy foci: 1 - different frames of group therapy - long-term or short-term; open or closed 2 - setting - inpatient, day hospital and ambulatory 3 - general and specific populations - ex. Homogenous populations, chronic mental illness, medical illness, addictions, eating disorders, mood disorders, multiple family groups 4 – age, culture and gender 4) Pre-therapy issues: 1 – selection 4 – treatment contract 2 - group composition 5 – setting/institution variables 3 - preparation of patients 5) Group therapy issues: 1 - developmental stages 9 - countertransference 2 - premature termination/drop-outs 10 - group therapy leadership 3 - therapeutic factors and their utilization 11 – co-therapy 4 - group process variables 12 - combined and conjoint individual and 5 - norms and boundaries group therapy 6 - working in the here-and-now 13 – termination 7 - defenses, resistances, roles and working 14 – impact of trauma through 15 – role of culture and gender 8 - transference 6) Research issues: 1 - critical appraisal 2 - outcome and efficacy with general and specific patient populations, including collaborative treatments 3 - process and outcome correlations 4 - predictors of outcomes

2 C. Skills 1) To plan and initiate the formation of a psychotherapy group 2) To intervene differentially at different group developmental stages 3) To identify and address practical issues regarding the norms and frame of the treatment 4) To appreciate the here-and-now and make appropriate links to the patient’s past; clinical formulation and schema 5) To be able to make a choice point analysis regarding level of intervention (i.e. individual versus interpersonal versus group as a whole) 6) To understand and address individual psychopathology manifested in the group 7) To deal with premature termination 8) To evaluate the process and outcome of treatment (including quantitative measurements) 9) To deal effectively with transference and countertransference 10) Management of crises and conflict 11) To prepare group members for termination

D. Attitudes 1) Appropriate therapist confidence and preparedness to conduct group psychotherapy

E. Objectives 1) Seminar series participation for a minimum of 12 hours, and where available, further hospital-based seminars; or equivalent guided reading 2) Clinical leadership or co-leadership of one psychotherapy group for a minimum of 30 hours. 3) Supervision should be for a minimum of 24 hours of weekly meetings (supervision entails a regular meeting at an established frequency between the group therapy supervisor and the group therapy trainee[s]). 4) Supervision should involve direct observation at regular intervals either directly or through audio- video recordings, where possible. 5) Residents should take the opportunity to observe experienced group therapists doing group therapy where available 6) Participation in two Group Days during PGYII-PGY5 years. 7) Seminar leaders and group therapy supervisors must be approved by the Group Psychotherapy Subcommittee.

IV. DOMAINS FOR EVALUATION:

A. Working Knowledge  Is the resident able to: 1) Appreciate the role of group therapy in contemporary mental health care 2) Recommend group therapy appropriately and successfully 3) Prepare patients for group therapy 4) Utilize and facilitate the group for therapeutic benefit 5) Identify and address group dynamics 6) Practice group therapy ethically 7) Work effectively as an individual therapist in a conjoint treatment

B. Proficiency  In addition to the Working Knowledge domains for evaluation, is the resident able to:

1) Plan and initiate the formation of a psychotherapy group 2) Evaluate patients for group therapy 3) Identify and address practical issues regarding the norms and frame of treatment 4) Make a choice point analysis regarding level of intervention (i.e. individual vs. interpersonal vs. group as a whole)

3 5) Intervene differentially at different group developmental stages 6) Work in the here-and-now and make appropriate links to the patient’s past and clinical formulation and schemas 7) Deal effectively with transference and countertransference 8) Deal with premature termination 9) Evaluate the process and outcome of treatment, including quantitative measurements 10) Prepare group members effectively for termination 11) Appraise group therapy literature critically 12) Work effectively in co-therapy 13) Lead groups with appropriate confidence 14) Practice group therapy ethically

III. GROUP DAY

Group Day is an annual educational even that occurs for the entire day on a Wednesday in early February. The objective of Group Day is to provide residents with an opportunity to experience and learn about group dynamics, cohesion, group leadership and group therapy principles, by participating themselves in a group of several hours duration.

There is no formal didactic component to the day. Learning on Group Day is experiential and occurs through the process of actual participation in the group. Participation is therefore required for the whole day. Group Day is endorsed by the Postgraduate Education Committee as a full day educational event and participation in Group Day is a component of overall training in Group Therapy. Residents have to participate in at least one Group Day during their residency for Working Knowledge and at least twice during their residency for Proficiency. Group leaders are faculty members of the Department of Psychiatry who are experienced in facilitating groups. Each of the groups will be composed heterogeneously to ensure a mix of participants regarding year of training, gender and prior experience.

Additional Training: Please contact Dr. Jan Malat if you are interested in electives. You may also refer to the document titled: “Training Opportunities.”

For additional training after graduation, the Canadian Group Psychotherapy Association (cgpa.ca) and American Group Psychotherapy Association (agpa.org) hold annual conferences.

4 REFERENCES 1. Alonso A: Training for group psychotherapy, in Group Therapy in Clinical Practice. Edited by Alonso A and Swiller H. American Psychiatric Press, Inc., Washington, DC, 1993 2. National Standards for Group Psychotherapy Training in Canada. Approved by the Board of C.G.P.A. at the 7th Annual Conference, October 1986 3. Salvendy J, Robson B, Babiak T: Group psychotherapy in psychiatric residency training. Academic Psychiatry 14(1), 1990 4. The Learning of Communication Skills and Psychotherapy. The Division of Psychological Medicine of the Department of Mental Health Sciences 5. St. Georges Hospital: Medical School Tooting, London, 1990 6. Yalom, ID., Leszcz, M, The Theory and Practice of Group Psychotherapy. 5th ed. New York: Basic Books, 2005. 7. Bernard H, Burlingame G, Flores P, Greene L, Joyce A, Kobos J, Leszcz M et al. (2008). Clinical Practice Guidelines for Group Psychotherapy. International Journal of Group Psychotherapy. 58(4); 455-541. 8. Lambert, M. J., & Ogles, B. M. (2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s Handbook of psychotherapy and behaviour change (5th Ed.). New York: Wiley. 9. Burlingame, G. M., MacKenzie, D. & Strauss, B. (2004). Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change. In M.J. Lambert (Ed.), Bergin and Garfields’ Handbook of psychotherapy and behavioral change (5th Ed., pp. 647-696). New York: Wiley & Sons. 10. Burlingame, G, Strauss B, & Joyce, A. (2013). Change Mechanisms and Effectiveness of Small Group Treatments In M.J. Lambert (Ed.), Bergin and Garfields’ Handbook of psychotherapy and behavioral change (6th Ed.). New York: Wiley & Sons. 11. Norcross, J & Goldfried, M. (2001). Handbook of Psychotherapy Integration. New York: Oxford University Press. 12. Wampold, B. (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. New Jersey: Lawrence Erlbaum Associates. 13. Weber, R.L. (2006). Principles of Group Psychotherapy. New York: American Group Psychotherapy Association. 14. MacNair-Semands, R. R. (2005b). Ethics in group psychotherapy. New York: American Group Psychotherapy Association. 15. Leszcz, M (1998). Guidelines for the Practice of Group Psychotherapy. In P Cameron, J. Ennis and J. Deadman (Eds.) Standards and Guidelines for the Psychotherapies. pp. 199-227. Toronto: University of Toronto Press. 16. Leszcz M & Kobos JC. (2008). Evidence-Based Group Psychotherapy Practice: Using AGPA’s Practice Guidelines to Enhance Clinical Effectiveness. Journal of Clinical Psychology: In Session. 64(11); 1238-1260.

GROUP PSYCHOTHERAPY: RECOMMENDED READINGS

I. Difficulties of the Beginning Group Therapist 1. Williams, M. (1966). Limitations, fantasies and security operations of beginning group psychotherapists. Int. J. Group Psychotherapy, 16:150-162. 2. Yalom, I.D. (1966). Problems of neophyte group therapists. Int. J. Social Psychiatry, 12:52-59. 3. Zaslav, M.R. (1988). A model of group therapist development. Int. J. Group Psychotherapy, 38:511- 519. 4. Burlingame, G, McClendon, D, & Alonso J (2011). Cohesion in group psychotherapy. In Norcross, J. C. (Ed). A Guide to Psychotherapy Relationships that Work(2nd ed.) (pp. 71-88). Oxford, United Kingdom: Oxford University Press. 5. Lonergan, E. C. (2000). Discussion of “Group therapy program development.” International Journal of Group Psychotherapy, 50(1), 43-45 6. Cox, P. D., Ilfeld, F., Ilfeld, B. S., & Brennan, C. (2000). Group therapy program development: Clinician-administrator collaboration in new practice settings. International Journal of Group Psychotherapy, 50(1), 3-24.

5 II. Models of Group Psychotherapy 1. Dies, R.R. (1992). Models of group psychotherapy: Sifting through confusion. Int. J. Group Psychotherapy, 42:1-17. 2. Kauff, P.F. (1979). Diversity in analytic group psychotherapy: The relationship between theoretical concepts and technique. Int. J. Group Psychotherapy, 29:51-65. 3. Rioch, M.J. (1970). The work of Wilfred Bion on groups. Psychiatry, 56-66. 4. Rutan, J.S. & Stone, W.N. (1993). History of small group therapy and practise. In, Psychodynamic Group Psychotherapy, Lexington: The Collamore Press, pg. 9-30.

III. Therapeutic Mechanisms in Group Psychotherapy 1. Bloch, S. (1986). Therapeutic factors in group Psychotherapy. In APA Annual Review V, pg. 679- 698. 2. Block, S. & Crouch, E. (1985). Acceptance. In Therapeutic Factors in Group Psychotherapy. Eds. S. Bloch & E. Crouch. New York: Oxford Universities Press, pg. 98-125. 3. Hawkins, D.M. (1986). Understanding reactions to group instability in psychotherapy groups. Int. J. Group Psychotherapy, 36:241-260. 4. Tschuschke, V., MacKenzie, K.R., Haaser, B. & Janke, G. (1996). Self-disclosure, feedback, and outcome in long-term inpatient psychotherapy groups. J. of Psychotherapy Practice and Research, 5:35-44. 5. Holmes, S. E., Kivlighan, D. M. (2000). Comparison of therapeutic factors in group and individual treatment process. Journal of Counseling Psychology, 47, 478-484. 6. Burlingame, G. M, Strauss, B., Joyce, A., MacNair-Semands, R., MacKenzie, K., Ogrodniczuk, J. & Taylor, S. (2006). Core Battery-Revised. New York: American Group Psychotherapy Association. 7. Johnson, J. E., Burlingame, G. M., Olsen, J A., Davies, D. R., Gleave, R L. (2005). Group climate, cohesion, alliance, and empathy in group psychotherapy: Multilevel structural equation models. Journal of Counseling Psychology, 52, 310-321. 8. Martin, D., Garske, J., Davis, M. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438-50. 9. Hopper, E.(2003). Traumatic experience in the unconscious life of groups: The fourth basic assumption. London: Jessica Kingsley Publishers. 10. Norcross, J & Goldfried, M. (2001). Handbook of Psychotherapy Integration. New York: Oxford University Press. 11. Piper, W. E., Joyce, A., McCallum, M., Azim, H., Ogrodniczuk, J. (2001). Interpersonal and supportive psychotherapies: Matching therapy and patient personality. Washington, DC: American Psychological Association. 12. Wampold, B. (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. New Jersey: Lawrence Erlbaum Associates.

IV. Interpersonal Learning in Group Psychotherapy 1. Leszcz, M. (1982). The interpersonal approach to group psychotherapy. Int. J. Group Psychotherapy, 42:42-67. 2. Rothke, S. (1986). The role of interpersonal feedback in group psychotherapy. Int. J. Group Psychotherapy, 36:225-240. 3. Yalom, I.D. (1986). Interpersonal learning. In APA Annual Review V, pg. 699-714. 4. Leszsz M & Malat J. (2012). The Interpersonal Model of Group Psychotherapy. In JL Kleinberg (Ed.) The Wiley-Blackwell Handbook of Group Psychotherapy pp. 33-58. Chicester: John Wiley & Sons Ltd

V. Selection and Preparation for Therapy 1. Bellak, L. (1980). On some limitations of dyadic psychotherapy and the role of the group modalities. Int. J. Group Psychotherapy, 30:7-21. 2. Grunebaum, H. & Kates, W. (1977). Whom to refer for group psychotherapy. Am. J. Psychiatry, 134:130-133. 3. Salvendy, J. (1993). Selection and preparation of patients and organization of the group. In H.I.

6 Kaplan and B.J. Sadock (Eds.) Comprehensive Group Psychotherapy, 3rd Ed., Baltimore: Williams and Wilkins, pg. 72-83. 4. Yalom, I.D. (1985). Preparation for group therapy. In The Theory and Practice of Group Psychotherapy. New York: Basic Books, pg. 285-298. 5. Burlingame, G. M., Fuhriman, A. & Johnson, J. E. (2002). Cohesion in group psychotherapy. In Norcross, J. C. (Ed). Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients (pp. 71-88). New York: Oxford University Press. 6. Martin, D., Garske, J., Davis, M. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438-50. 7. Anderson, C., John, O. P., Kelter, D., Kring, A. M. (2001). Who attains social status? Effects of personality and physical attractiveness in social groups. Journal of Personality & Social Psychology, 8, 116-132. 8. Joyce, A. S., McCallum, M., Piper, W. E., Ogrodniczuk, J. S. (2000). Role behavior expectancies and alliance change in short-term individual psychotherapy. Journal of Psychotherapy Practice & Research, 9, 213-225. 9. Burlingame, G. M., Strauss, B., Joyce, A., MacNair-Semands, R., MacKenzie, R., Ogrodniczuk, J. & Taylor, S. (2005). American Group Psychotherapy Association’s CORE Battery—Revised. New York, NY: American Group Psychotherapy Association. 10. Piper, W. E., Joyce, A., McCallum, M., Azim, H., Ogrodniczuk, J. (2001). Interpersonal and supportive psychotherapies: Matching therapy and patient personality. Washington, DC: American Psychological Association. 11. Piper, W. E., Ogrodniczuk, J. S., McCallum, M., Joyce, A., Rosie, J. S. (2003). Expression of affect as a mediator of the relationship between quality of object relations and group therapy outcome for patients with complicated grief, Journal of Consulting and Clinical Psychology, 71, 664-671. 12. McCallum, M., Piper, W. E., Ogrodniczuk, J.& Joyce, A. (2003) Relationships among psychological mindedness, alexithymia and outcome in four forms of short-term psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice, 76, 133-144. 13. MacKenzie, K.R. & Grabovac, A. D. (2001). Interpersonal psychotherapy group (IPT-G) for depression. Journal of Psychotherapy Practice and Research, 10, 46-51. 14. Chen, E. & Mallinckrodt, B. (2002). Attachment, group attraction, and self-other agreement in interpersonal circumplex problems and perceptions of group members. Group Dynamics: Therapy, Research and Practice, 6, 311-324. 15. Rabinowitz, F.E. (2001). Group therapy for men. In G.R. Brooks & G.E. Good (Eds.), The new handbook of psychotherapy and counseling with men: Vol.4. A comprehensive guide to settings, problems, and treatment approaches (pp. 603-621). San Francisco: Jossey-Bass. 16. Ogrodniczuk, J. S., Piper, W. E., Joyce, A. (2004). Differences in men’s and women’s responses to short-term group psychotherapy. Psychotherapy Research, 14, 231-43. 17. Bernard H, Burlingame G, Flores P, Greene L, Joyce A, Kobos J, Leszcz M et al. (2008). Clinical Practice Guidelines for Group Psychotherapy. International Journal of Group Psychotherapy. 58(4); 455-541.

VI. Conjoint Therapy 1. Ormont, L. (1981). Principles and practise of conjoint psychoanalytic treatment. Am. J. Psychiatry, 138:69-73. 2. Fisher, C. (2003). Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA: Sage Publications. 3. Nevonen, N, Broberg, A.G. (2006). A comparison of sequenced individual and group psychotherapy for patients with bulimia nervosa. International Journal of Eating Disorders, 39, 117-127. 4. Burlingame, G.M., Fuhriman, A., Johnson, J. (2004). Process and outcome in group counseling and group psychotherapy. In J.L. DeLucia-Waack, D.A. Gerrity, C.R.Kalodner & M.T.Riva (Eds.), Handbook of group counseling and psychotherapy (pp. 49-61). Thousand Oaks, CA: Sage. 5. Davies, D.R., Burlingame, G. M., & Layne, C. M. (2006). Integrating small group process principles into trauma-focused group psychotherapy: What should a group trauma therapist know? In L.A. Schein, H.I. Spitz, G. Burlingame, & P.R. Muskin (Eds.), Psychological effects of catastrophic disasters: Group approaches to treatment. New York: Haworth.

7 6. Kivlighan, D. M., Kivlighan, M.C. (2004). Counselor intentions in individual and group treatment. Journal of Counseling Psychology, 51, 347-353. 7. Ulman, K. (2002). The ghost in the group room: Countertransferential pressures associated with conjoint individual and group psychotherapy. International Journal of Group Psychotherapy, 52, 387- 407. 8. Segal, Z.V., Kennedy, S.H., Cohen, N.L., CANMAT Depression Work Group. (2001). Clinical guidelines for the treatment of depressive disorders v. combining psychotherapy and pharmacotherapy. The Canadian Journal of Psychiatry, 46(Suppl.1), 59S-62S. 9. Rosser, S., Erskine, A. & Crino, R. (2004). Pre-existing antidepressants and the outcome of group cognitive behaviour therapy for social phobia. Australian and New Zealand Journal of Psychiatry, 38, 233-239.

VII. Duration of Treatment and Premature Termination 1. Stone, W.N. & Rutan, J.S. (1984). Duration of treatment in group psychotherapy. Int. J. Group Psychotherapy, 34: 93-109. 2. Roback, M.B. & Smith, M. (1987). Patient attrition in dynamically oriented treatment groups. Am. J. Psychiatry, 144:426-431. 3. Bernard, H.S. (1989). Guidelines to minimize premature terminations. Int. J. Group Psychotherapy, 39:523-529. 4. Bernard H, Burlingame G, Flores P, Greene L, Joyce A, Kobos J, Leszcz M et al. (2008). Clinical Practice Guidelines for Group Psychotherapy. International Journal of Group Psychotherapy. 58(4); 455-541.

VIII. Developmental Stages 1. Gruen, W. (1977). The stages in development of a therapy group: Tell-tale symptoms and their origins in the dynamic group forces. Group, 1:10-26. 2. Mackenzie, K.R. & Livesley, W.J. (1984). Developmental stages: An integrating theory of group psychotherapy, pg. 247-251. 3. Beahrs, J., & Gutheil, T. (2001). Informed consent in psychotherapy. American Journal of Psychiatry, 158, 4-10. 4. Arrow, H., Poole, M. S., Henry, K. B., Wheelan, S., & Moreland, R. (2004). Time, change, and development: The temporal perspective on groups. Small Group Research, 35, 73-105. 5. Wheelan, S. A., Davidson, B., & Tilin, F. (2003). Group development across time: Reality or illusion? Small Group Research, 34, 223-245. 6. Ward, D. E; Litchy, M. (2004). The effective use of processing in groups. In J. L. DeLucia-Waack, D. A. Gerrity, C. R. Kalodner & M.T. Riva (Eds.), Handbook of group counseling and psychotherapy (pp. 104-119). Thousand Oaks, CA: Sage.

IX. Co-therapy 1. Roller, B. & Nelson V. (1993). Co-therapy. In H.I. Kaplan & B.J. Sadock (Eds.) Comprehensive Group Psychotherapy, New York: Williams and Wilkins, pg. 304-312.

X. Time-limited Group Therapy 1. Budman, S.M., Bennett, M.J. & Wisneski, M.J. (1980). Short-term group psychotherapy: An adult developmental model. Int. J. Group Psychotherapy, 30:63-76. 2. Klein, R.M. (1985). Some principles of short-term group therapy. Int. J. Group Psychotherapy, 35:309-330. 3. Budman, S.M., Derby, A., & Reclondo, J.P. (1988). Comparative outcome in time-limited individual and group psychotherapy, 38:63-86. 4. MacKenzie, K.R. (1993). Time-limited group theory and technique. In A. Alonso & H. Swiller (Eds.) Group Therapy in Clinical Practice, Washington: APPI, pg. 423-447. 5. Bieling PJ, McCabe RE, Antony MM (2006). Cognitive-Behavioral Therapy in Groups. New York: The Guilford Press.

XI. Projective Identification and Scapegoating

8 1. Scheidlinger, S. (1982). Presidential address: On scapegoating in group psychotherapy. Int. J. Group Psychotherapy, 32:131-143. 2. Goldstein, W.N. (1991). Clarification of projective identification. Am. J. Psychiatry, 148:153-161. 3. Rutan, S. (2005) Treating the difficult patient in groups. In L. Motherwell & J. Shays (Eds.), Complex dilemmas in group therapy: Pathways to resolution (pp. 41-49). New York: Brunner- Routledge. 4. Shields, W. (2000). Hope and the inclination to be troublesome: Winnicott and the treatment of character disorder in group therapy. International Journal of Group Psychotherapy, 50, 87-103.

XII. Therapist Transparency and Leadership 1. Brabender, V. (2006). Ethical awareness development in the group psychotherapist. Directions in Mental Health Counseling, 16(4), 43-54. 2. Brabender, V. (2002) Introduction to group therapy. In The ethical practice of group therapy (pp. 239-274). New York: John Wiley & Sons. 3. Dies, R.R. (1977). Group therapist transparency: A critique of theory and research. Int. J. Group Psychotherapy, 27:177-200. 4. Fisher, C. (2003). Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA: Sage Publications. 5. McCullough, J.P. (2002). Treatment for chronic depression: Cognitive behavioral analysis system of psychotherapy (CBASP). New York: The Guilford Press. 6. Shapiro, E. L. & Ginzberg, R. (2006). Buried treasure: money, ethics and countertransference in group therapy. International Journal of Group Psychotherapy, 56, 477-494. 7. Volkan, V.V. (1980). Narcissistic personality organization and "reparative" leadership. Int. J. Group Psychotherapy, 30:131-152. . XIII. Leadership Issues and Functions 1. Ormont, L.R. (1988). The role of the leader in resolving resistances to intimacy in the group setting. Int. J. Group Psychotherapy, 398:29-45. 2. Ormont, L.R. (1990). The craft of bridging. Int. J. Group Psychotherapy, 40:3-17. 3. Flowers, T.V. & Booraem, C.D. (1990). The frequency and effect on outcome of different types of interpretation in psychodynamic and cognitive-behavioural group psychotherapy. Int. J. Group Psychotherapy, 40:203-214. 4. Counselman, E. (2005). Containing and using powerful therapist reactions. In L. Motherwell & J. Shay (Eds.), Complex dilemmas in group therapy: Pathways to resolution (pp. 155- 165). New York: Brunner-Routledge. 5. Knauss, L. K. (2006). Ethical issues in record keeping in group psychotherapy. International Journal of Group Psychotherapy, 56, 415-430. 6. Brabender, V. (2002) Introduction to group therapy. In The ethical practice of group therapy (pp. 239-274). New York: John Wiley & Sons. 7. Beahrs, J., & Gutheil, T. (2001). Informed consent in psychotherapy. American Journal of Psychiatry, 158, 4-10.

XIV. Specific Treatment Issues 1. Yalom, I.D. & Vinogradov, S. (1988). Bereavement groups: Techniques and themes. Int. J. Group Psychotherapy, 38:419-446. 2. Leszcz, M. (1989). Group psychotherapy of the characterlogically difficult patient. Int. J. Group Psychotherapy, 39:311-337. 3. Matano, R.A. & Yalom, I.D. (1991). Approaches to chemical dependency: Chemical dependency and interactive group therapy: A synthesis. Int. J. Group Psychotherapy, 41:269-294. 4. Smokowski, P. R., Rose, S. D., & Bacallao, M. L. (2001). Damaging experiences in therapeutic groups: How vulnerable consumers become group casualties. Small Group Research, 32, 223-251.

XV. Research 1. Tillitski, J. (1990). A meta-analysis of estimated effect sizes for group versus individual versus control treatments. Int. J. Group Psychotherapy, 40(2):215-224.

9 2. Dies, R.R. (1993). Research on group psychotherapy overview and clinical applications. In. A. Alonso & H. Swiller (Eds.), Group Therapy in Clinical Practice, Washington: APPI, pg. 473-520. 3. Burlingame, G, Strauss B, & Joyce, A. (2013). Change Mechanisms and Effectiveness of Small Group Treatments In M.J. Lambert (Ed.), Bergin and Garfields’ Handbook of psychotherapy and behavioral change (6th Ed.). New York: Wiley & Sons.

XVI. Termination 1. McGee, T.F. (1974). Therapist termination in group psychotherapy. Int. J. Group Psychotherapy, 24:3-11. 2. Long, K., Pendleton, L. & Winter, B. (1988). Effects of therapist termination on group process. Int. J. Group Psychotherapy, 38:211-222. 3. Schermer, V.L. & Klein, R.H. (1995). Termination in group psychotherapy from the perspectives of contemporary object relations theory and self psychology. Int. J. Group Psychotherapy, 46:99-116. 4. Joyce, A. S., Piper, W. E., Ogrodniczuk, J. S., and Klein, R. H. (2007). Termination in Psychotherapy: A psychodynamic model of processes and outcomes. Washington, DC: American Psychological Association Press.

XVII Groups for Medically Ill 1. Leszcz, M, Sherman, A, Mosier, J, Burlingame, G, Ulman, KH, Cleary, T, Simonton, S, Latif, U, Hazelton, L, Strauss, B. Group Interventions for Patients with Cancer and HIV Disease: Part IV. Clinical and Policy Recommendations. International Journal of Group Psychotherapy. 54(4):539-556, 2004. Fellow under principal supervision of Molyn Leszcz. Senior Responsible Author. 2. Goodwin, PJ, Leszcz, M, Ennis, M, Koopmans, J, Vincent, L, Guther, H, Drysdale, E, Hundleby, M, Chochinov, HM, Navarro, M, Speca, M, Hunter, J. The Effect of Group Psychosocial Support on Survival in Metastatic Breast Cancer. NEJM. 345(24): 1719-1726, 2001. Co-Principal Author. 3. Leszcz, M and Goodwin, P. The Rationale and Foundations of Group Psychotherapy for Women with Metastatic Breast Cancer. International Journal of Group Psychotherapy. 48:245-274, 1998. Senior Responsible Author.

XVIII Geriatric Group Therapy 1. Leszcz, M. Geriatric Group therapy. In: Comprehensive Textbook of Psychiatry, IX Edition. ed. H.Kaplan and V.A. Sadock, 2009, pp. 4143-4149. Principal Author. 2. Leszcz, M. (1997). Integrated group therapy for the treatment of depression in the elderly. International Journal of Group Psychotherapy, 21(2), 89-113. 3. Saiger, G. M. (2001). Group psychotherapy with older adults. Psychiatry, 64(2), 132-145. 4. Schwartz, K. (2004). Concurrent group and individual psychotherapy in a psychiatric day hospital for depressed elderly. International Journal of Group Psychotherapy, 54, 177-201. 5. Schwartz, K. (2007). Remembering the forgotten: Psychotherapy group for the nursing home resident. International Journal of Group Psychotherapy, 57(1), 497-516.

XIX. Recommended Texts 1. Mackenzie, K.R. (1990). Introduction to time-limited group psychotherapy. Washington, DC: APPI. 2. Piper, W.E, McCallum, M. & Azim, H.F.A. (1992). Adaptation to loss through short-term group psychotherapy. New York: Guilford Press. 3. Rutan, J.S., Stone, W.N. & Shay JJ (2007). Psychodynamic group psychotherapy (4thd Ed.) New York: Guilford Press. 4. Yalom, ID., Leszcz, M, The Theory and Practice of Group Psychotherapy. 5th ed. New York:Basic Books, 2005.

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