Group Psychotherapy Research that the Practitioner Might Actually read

Transcription

1 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.

2 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 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.

4 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: researcher practitioner 4

5 From Tasca, G. A. et al. (2015). What clinicians want: Findings from a psychotherapy practice research network survey. Psychotherapy, 52, 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

6 1. Irrelevance. Therapists complaints about psychotherapy research Greene, L.R. (2012). Group therapist as social scientist, with special reference to the psychodynamically oriented psychotherapist. American Psychologist, 67, 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

7 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

8 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,

9 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,

10 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, 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.

11 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,

12 7. Case studies How can we construct and refine theory from detailed clinical observation? Tasca, G. et al. (2011) Interpersonal processes in psychodynamicinterpersonal and cognitive behavioral group therapy: A systematic case study of two groups. Psychotherapy, 48,

13 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, 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 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, 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, it is important to differentiate among therapists and to include dimensions of therapists in studies of therapeutic outcome. 5.

15 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, Greene, L.R., et al. (1985). Splitting dynamics, self representations and boundary phenomena in the group psychotherapy of borderline personality disorders. Psychiatry, 48,

16 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, [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, Krogel, J. et al. (2013) The Group Questionnaire: A clinical and empirically derived measure of group relationship. Psychotherapy Research, 23, [Positive bonding; positive working; negative relationship]

17 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, 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, Lerner, M. (2013) Preliminary evaluation of an observational measure of group cohesion for group psychotherapy. J. Clinical Psychology, 69,

18 How many therapeutic factors are there? 11? 12? 3? 4? Joyce, A. et al. (2011). Factor structure and validity of the Therapeutic Factors Inventory Short Form. Group Dynamics, 15, as we have moved toward identifying fewer, more global and interdependent therapeutic factors, we are approaching more clarity about the underlying mechanisms of therapeutic changes in the group modality. Kivlighan, D M. Jr. & Holmes, S E. (2004). The Importance of Therapeutic Factors: A Typology of Therapeutic Factors Studies. In DeLucia-Waack, J L. et al.(eds) Handbook of group counseling and psychotherapy. Thousand Oaks, CA: Sage, pp continuing to identify specific client populations and creating yet another ranking of therapeutic factors is not going to be a beneficial strategy for enhancing our knowledge about the role of therapeutic factors in group treatment.

19 Studies of good and poor outcomes in the same group Gazzillo, F. et al. An empirical investigation of analytic process: Contrasting a good and poor outcome case. Psychotherapy, 51, Iwakabe, S. (2011) Extending systematic case study method: Generating and testing hypotheses about therapeutic factors through comparisons of successful and unsuccessful cases. Pragmatic Case Studies in Psychotherapy, 7, Case comparison is one of the most powerful methods in case study research, since analyzing two or more similar types of cases with contrasting outcomes can result in generalizable knowledge that goes beyond what one single case study can offer. Lundkvist-Houdoumadi, I & Thastum, M (2013) A Cool kids cognitive behavioral therapy group for youth with anxiety disorders: Analysis of the process and outcome of responders versus nonresponders. Pragmatic Case studies in Psychotherapy, 9,

20 Georgakopoulou, I. (2013) Psychodynamic-cognitive therapy. Journal of Psychotherapy Integration, 23, Rivera, M. & Darke, J (2012). Integrating Empirically Supported Therapies for Treating Personality Disorders: A Synthesis of Psychodynamic and Cognitive-Behavioral Group Treatments. IJGP, 62, Studies of integrative approaches to group work Cognitive-behavioral and psychodynamic Psychoeducative and process Lawson, D (2010). Comparing cognitive behavioral therapy and integrated cognitive behavioral therapy/psychodynamic therapy in group treatment for partner violent men. Psychotherapy, 47, Watzke, B., et al. (2008) Comparison of therapeutic action, style and content in cognitive-behavioural and psychodynamic group therapy under clinically representative conditions. Clinical Psychology & Psychotherapy, 15,

21 Ettin, M. et al. (1987) Managing group process in nonprocess groups: Working with the theme-centered psychoeducational group. Group, 11, Ongoing group processes or hidden agendas arise spontaneously, owing to the idiosyncratic character or circumstances of the members, the eliciting quality of the didactic material, evolving interactions among participants, and reactions (realistic and transferential) to the manner and sensitivity of the group leader s presentational style.no amount of careful planning or captivatingly colorful presentation can prevent dynamic group processes from arising. The leader s only choice is how and when to use group process to support psychoeducational aims. To maximize learning opportunities, the psychoeducational group leader must be attuned to the stirrings within the group. Ongoing attention to group processes allows for proper presentational timing, selection of relevant informational points, and a sensitivity as to when it is advisable or even necessary to interrupt and punctuate the lesson plan in the service of ventilation, integration, and assimilation.

22 Conclusion You don t need to know your F-test from your t-test, but reading the psychotherapy process literature can help you sharpen your clinical acumen and conceptual skills. 22