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Group Psychotherapy Research That the Practitioner Might Actually Read

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Group Psychotherapy Research That the Practitioner Might Actually Read Group Psychotherapy Research that the Practitioner Might Actually read Les R Greene, Ph.D. Department of Veterans Affairs and Yale University Dept. of Psychiatry Greene, L.R. (in press) Group Psychotherapy Research Studies that Therapists Might Actually Read: My Top-10 List. International Journal of Group Psychotherapy. The Pick-your-news Inventory For each item below, imagine that you are sitting at the breakfast table with a psychotherapy newsletter that reports on two recent group psychotherapy papers. You have time to read only one. Check (√) the one you prefer to read 1)____ Mentalization-based group therapy for inpatients with borderline personality disorder: Preliminary outcome findings OR ____Structure and leadership in mentalization-based group therapy for borderline personality disorders: A clinical analysis. 2)____A randomized clinical trial of group cognitive processing therapy compared with group present-centered therapy for PTSD among active duty military personnel. OR ____Applying group process theory in the development of a model of group therapy for partners of combat veterans with post-traumatic stress disorder. 2 3.____A randomized controlled trial on the efficacy of mindfulness-based cognitive therapy and a group version of cognitive behavioral analysis system of psychotherapy for chronically depressed patients. OR ____Acceptance -based group therapy and traditional cognitive behavioral group therapy for depression: Exploring mechanisms of change 4. ____The capacity to use the group as a corrective symbiotic object in group analytic psychotherapy: Its empirical relationship to outcome. OR ____On making a home amongst strangers: Reflections on the paradox of group psychotherapy. 5.____A research study on the mechanisms of change in an emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. OR ____Client-centered/experiential group psychotherapy with borderline clients: Conceptual analysis of specific processes and challenges. For the following item circle the number that best reflects your professional identity, ranging from psychotherapy researcher to practitioner: 1 2 3 4 5 researcher practitioner 4 From Tasca, G. A. et al. (2015). What clinicians want: Findings from a psychotherapy practice research network survey. Psychotherapy, 52, 1-11. Top preference: Studies of the therapeutic relationship and mechanisms of change [inner workings] Understanding mechanisms of change Therapeutic relationship and its effect on outcomes Problems in the therapeutic relationship (alliance ruptures/repairs) Common factors across therapies (alliance, empathy, expectations) Boundaries of the therapeutic relationship Least preferred: Treatment manuals Real-world applications of manual-based interventions Using manuals and their effects on outcomes Adherence to manuals and their effects on process) 5 Therapists’ complaints about psychotherapy research 1. Irrelevance. Greene, L.R. (2012). Group therapist as social scientist, with special reference to the psychodynamically oriented psychotherapist. American Psychologist, 67, 477-489. “The typical pre-post ANOVA methodology that analyzes differences averaged over groups of people is simply not capable of addressing such theoretically and clinically core issues as the optimal timing of an intervention, the mechanisms underlying the effectiveness of the intervention, and for whom such an intervention would be most beneficial.” 2. The stacked deck phenomenon: Outcome studies employing non bona fide or absent control groups. “Doing something is better than doing nothing” Pristine laboratory conditions vs. the messiness of 'real world' practice 6 3. Dissemination of EBTs or the lack of researcher-clinician dialogue Greene, L.R. (2014). Dissemination or dialogue? American Psychologist. …the longstanding split or standoff between researcher and therapist is analogous to a dysfunctional marriage with both partners feeling abused and ignored. Insisting only that the partner must change just doesn’t work; it inevitably leads to counterattack or stonewalling. The process of healing a bad marriage, like the problem of resolving the estrangement between researcher and practitioner, entails efforts at restoring empathic understanding of the other and, ultimately, a shared commitment for mutuality and reciprocity. Two-way communication between equals, albeit with differing needs and values, rather than an exclusive top-down dissemination, is needed for the advancement of both science and practice. 4. Failure to replicate, or can I trust the treatment manual? 7 Thesis: Shifting psychotherapy research away from its purely outcome-oriented focus to studies that explore more of the nuances and inner workings of the here-and-now clinical situation can bring researchers and practitioners together. Pascual-Leone, A. & Andreescu, C. (2013). Repurposing process measures to train psychotherapists: Training outcomes using a new approach. Counseling and Psychotherapy Research, 13, 210-219. 8 10. Moderator analyses Different strokes for different folks Or One shoe does not fit all Gallagher, M., Tasca, G. et al. (2014) Attachment anxiety moderates the relationship between growth in group cohesion and treatment outcomes in group psychodynamic interpersonal psychotherapy for women with binge eating disorder. Group Dynamics, 18, 38-52. 9. Mediator analyses Greene, L., (2012) Studying the how and why of therapeutic change: The increasingly prominent role of mediators in group psychotherapy research. International Journal of Group Psychotherapy, 62, 325-331 It may be easier to demonstrate change than to uncover or discover hidden, underlying processes, especially when they do not necessarily derive from one’s preferred theoretical framework. 8. Sequential analyses How does what happens over time affect outcome? Gold, P. B., Kivlighan, D. M. Jr., & Patton, M. J. (2014). Non-metric multidimensional scaling profile analysis of non-growth change in groups: A demonstration. Small Group Research, 45, 235-265. 7. Case studies How can we construct and refine theory from detailed clinical observation? Tasca, G. et al. (2011) Interpersonal processes in psychodynamic- interpersonal and cognitive behavioral group therapy: A systematic case study of two groups. Psychotherapy, 48, 260-273. 6. Training effects How and what kinds of training make a difference Kivlighan, D M. Jr. & Kivlighan, D. M III (2009) Training related changes in the ways that group trainees structure their knowledge of group counseling leader interventions. Group Dynamics, 13, 190-204. Kivlighan, D. M. Jr. & Tibbits, B. M. (2012) Silence is mean and other misconceptions of group counseling trainees: Identifying errors of commission and omission in trainees' knowledge structures. Group Dynamics, 16, 14-34. 5. Therapist effects Melter, R. (2014). Countertransference experiences of psychotherapists conducting group psychotherapy with combat veterans. Dissertation Abstracts International: Section B: The Sciences and Engineering, 74(7- B)(E). Lorentzen, S. et al. (2012). Psychodynamic group psychotherapy: Impact of group length and therapist professional characteristics on development of therapeutic alliance. Clinical Psychology & Psychotherapy, 19, 420-433. Blatt, S J. et al (1996) Characteristics of effective therapists: Further analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64, 276-1284. “…it is important to differentiate among therapists and to include dimensions of therapists in studies of therapeutic outcome.” 4. Methods and measures to study interpersonal relations in the group Markin, R. D. & Kivlighan, D. M. Jr. (2008) Central relationship themes in group psychotherapy: A social relations model analysis of transference. Group Dynamics, 12, 290-306. Greene, L.R., et al. (1985). Splitting dynamics, self representations and boundary phenomena in the group psychotherapy of borderline personality disorders. Psychiatry, 48, 234-245 3. Studies of core group processes What are the process variables that really make a difference? Kivlighan, D (2014) Three important clinical processes in individual and group interpersonal psychotherapy sessions. Psychotherapy, 51, 20-24. [here-and now focus; disclosing clients’ impact messages; corrective emotional experience] Johnson, J. et al. (2005) Group Climate, Cohesion, Alliance, and Empathy in Group Psychotherapy: Multilevel Structural Equation Models. Journal of Counseling Psychology, 52, 310-321. Krogel, J. et al. (2013) The Group Questionnaire: A clinical and empirically derived measure of group relationship. Psychotherapy Research, 23, 344-354. [Positive bonding; positive working; negative relationship] You say cohesion and I say cohesiveness Hornsey, M. J. et al. (2009) Group processes and outcomes in group psychotherapy: Is it time to let go of 'cohesiveness'? IJGP, 59, 267-278. “One option would be to stop talking about cohesiveness and…use more specific constructs, [such as] identification, homogeneity and interdependence” Hornsey, M. J. et al. (2012) Testing a single-item visual analogue scale as a proxy for cohesiveness in group psychotherapy. Group Dynamics, 16, 80-90. Lerner, M. (2013) Preliminary evaluation of an observational measure of group cohesion for group psychotherapy. J. Clinical Psychology, 69, 191-208. How many therapeutic factors are there? 11? 12? 3? 4? Joyce, A. et al. (2011). Factor structure and validity of the Therapeutic
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