Group psychotherapy with pathological gamblers

This paper reviews some of the group therapy techniques utilized in the authors' work with pathological gamblers. These conceptual tools ranged from rational-emotive psychotherapy to Zen philosophy which provided a background and foundation for working with pathological gamblers. Many therapeutic and antitherapeutic beliefs and behaviors of gamblers are discussed including narcissism, manipulative behavior, and rejection of Gamblers Anonymous. Each technique, behavior or belief discussed is explained in terms of how each affects the group process and how each is managed in group therapy.This paper represents a discourse on the group treatment of pathological gamblers primarily from the experiences of Julian Ingersoll Taber, Ph.D. who was the coordinator of the Gambling Treatment Program at the Cleveland Veterans Administration Medical Center for seven years. Dr. Taber is currently Chief of the Addictive Disorders Treatment Program at the Veterans Administration Medical Center in Reno, Nevada. Martin Paul Chaplin, Ph.D., who is specializing in the treatment of addiction, assisted in the theoretical and editorial aspects of this article. He worked under the aegis of Dr. Taber as an intern at the Gambling Treatment Program and currently has a position at Community Mental Health Services of Medina in Ohio.     

Criminal offenses in gamblers anonymous and hospital treated pathological gamblers

The purpose of this study was to compare the nature and prevalence of gambling and non-gambling related offenses in samples of pathological gamblers seeking behavioural treatment from a hospital-based program and those attending Gamblers Anonymous. A semi-structured interview schedule obtaining demographic data and details of the nature, frequency, and consequent legal action of criminal offenses committed was administered to 152 consecutive hospital treated pathological gamblers, and 154 Gamblers Anonymous attendees who volunteered to participate in the study. Of the total sample, 59% admitted a gambling-related offense, and 23% to a conviction. There was no difference in the proportion of hospital treated and Gamblers Anonymous subjects who offended. The most common gambling-related offenses were larceny, embezzlement and misappropriation. Gamblers committed a median of ten offenses over an average ten year period of pathological gambling with a median value of $ A 300¹ per offense. The median value for each non-gambling-related offense was $ A 130. Except for the significantly older mean age of Gamblers Anonymous subjects, hospital treated gamblers did not differ from Gamblers Anonymous attenders on relevant demographic features or parameters of gambling behaviour. Findings were interpreted to suggest a possible causal link between pathological gambling and the commission of non-violent property offenses.This study was supported by a grant from the Criminology Research Council. The views expressed are the responsibility of the authors and are not necessarily those of the Council. The contribution of Anna Frankova, Research Assistant, is gratefully acknowledged.     

The created relationship: Transference,countertransference and the therapeutic culture

The concepts of transference and countertransference are examined in the light of current knowledge about the unconscious. These are redefined as action patterns which are not conscious because they have not become integrated into the individual's meaning system. It is proposed that the process of therapy consists in part in a mutually interactive construction of the client's reality. In order for this construction to take place another construction, that of the therapeutic culture must come first.     

Psychopathology in pathological gamblers seeking treatment

High rates of psychiatric symptoms have been reported in pathological gamblers. This study of psychiatric comorbidity in pathological gamblers is the first to use structured psychiatric interviews assessing DSM-III-R Axis I and II disorders. The Structured Clinical Interview for DSM III-R (SCID-P, SCID-II) was administered to 40 (25 male, 15 male) pathological gamblers seeking outpatient treatment in Minnesota for gambling, and 64 (41 male, 23 female) controls. High lifetime rates of Axis I (92%) but not Axis II (25%) psychopathology were found in pathological gamblers as compared to controls. No differences between male and female gamblers were found in rates of affective, substance use or personality disorders. Females had higher rates of anxiety disorders and histories of physical/sexual abuse. Possible associations between psychiatric disorders and pathological gambling are discussed along with gambler typologies and implications for future research.The authors wish to gratefully acknowledge the assistance of: Gary Christenson, M.D., Carol Peterson, Ph.D., William Meller, M.D., Thomas Mackenzie, M.D.     

Executive functioning in Asian pathological gamblers

Two decades of neuropsychological research on predominantly Caucasian problem gamblers has unveiled significantly poorer performance on several domains of executive functioning (EF) relative to healthy controls. However, contradictory findings are widespread and evidence that pathological gamblers (PGs) are ‘impaired’ remains inconclusive. The study examined multiple facets of EF in 30 male, PGs seeking outpatient treatment in Singapore and 30 matched controls. CANTAB® tests of planning and organization/problem-solving, set-shifting, working memory and reflection impulsivity, were administered alongside the Barratt Impulsiveness Scale, Cognitive Failures Questionnaire and Dysexecutive Questionnaire. No significant group differences were found on any of the EF performance parameters, with performance falling in the healthy, unimpaired range for both groups. PGs did, however, report significantly greater impulsivity, everyday cognitive failures and symptoms of the dysexecutive syndrome. Exploratory analysis on a subgroup of PGs addicted to non-strategic gambling activities revealed poorer EF performance than among those addicted to strategic gambling activities. The findings suggest an absence of EF deficits despite higher trait impulsivity in Asian, predominantly strategic PGs. Hence, psychological interventions such as CBT and treatment approaches that emphasize the use of self-monitoring and informed decision-making to reduce impulsive behaviours should be suited to this population.     

Ego strength and achievement motivation in pathological gamblers

This paper argues that there area priori reasons to extract measures of ego strength and achievement motivation from the psychometric data base routinely collected from inpatient pathological gambers in order to clarify the meaning of these constructs and to evaluate their roles in personality organization. A sample of 57 subjects engaged in an inpatient treatment program for pathological gamblers was studied using Barron's Ego Strength Scale (ES) from the Minnesota Multiphasic Personality Inventory and two measures of achievement motivation from the California Personality Inventory, Achievement via Conformance (Ac) and Achievement via Independence (Ai). Compared to the standardization group norms on these instruments, pathological gamblers are significantly deficient in both ego strength and one type of achievement motivation, Ac. Clinical impressions of gamblers in treatment suggest that narcissistic characteristics are a major problem in treatment and that future research should attempt further detailed studies of ego structure in order to refine treatment objectives.     

Inpatient treatment of male pathological gamblers in Germany

Pathological gambling is viewed as a disease of unknown cause which requires treatment. Demographic and psychological traits of fifty-eight male patients are described. A control group of fifty-four patients with other addictions was used to determine the validity of a diagnostic test which aims to differentiate between harmless gambling behavior and addiction to gambling. This test is described along with the stages of pathological gambling and the process of treatment for the disorder. Most of the gamblers are young, often previously convicted of theft, highly indebted, in danger of committing suicide, and susceptible to other addictive substances, especially alcohol. Harmless, critical and chronic stages are described. Regarding in-patient treatment, it has proved to be useful to integrate individual members into groups of alcoholics as they are a therapeutic benefit to these groups. The pragmatic and symptom-oriented therapy proved to be good for gamblers as well. A follow-up with forty-nine patients for one year and twenty-five for two years found 71% abstinent after one year and 62% abstinent after two years of treatment. These results are similar to those obtained with alcoholics.     

Rapid onset of pathological gambling in machine gamblers

A particularly rapid onset of pathological gambling (PG-onset) through the use of gambling machines has been widely alluded to, but this is the first study to empirically examine the phenomenon. This study compared the latency of PG-onset in those who gambled primarily on machines, compared to those who gambled primarily on more traditional forms of gambling at PG-onset. Subjects were 44 adult pathological gamblers (PGs) seeking outpatient treatment in Rhode Island (17 females; mean age = 46.9). Subjects completed questionnaires and a diagnostic interview including a complete history of gambling activities and the course of PG. The latency of PG-onset was defined as the time (in years) elapsed between the age of regular involvement in the primary form of gambling and the age at which DSM-IV criteria were first met. Machine PGs (n = 25) had a significantly shorter latency of onset than did traditional PGs (1.08 years vs. 3.58 years). Females and machine PGs had a significantly older age of onset, but gender was not associated with latency of PG-onset. Lifetime comorbidity of either substance use disorders (SUDS) or depressive disorders (DDS) was also not associated with the latency of PG-onset. The results of the current study suggest that intrapersonal variables such as gender and comorbid disorders do not generally affect the speed with which people develop PG. Rather, the social, environmental, and stimulus features of mechanized gambling are implicated. Prospective longitudinal studies on the onset and course of PG are needed, as well as more basic research on the features of machine gambling that may contribute to rapid onset.     

Personality characteristics of sexual addicts and pathological gamblers

Personality characteristics of three groups were compared: sexual addicts (N=32, 6 females, 26 males, ¯x age=36.37), pathological gamblers (N=32, 13 females, 19 males, ¯x age=46.15), and non-addicts (N=38, 13 females, 25 males, ¯x age=39.65). The sexual addict group was significantly more anxious, depressed, obsessive-compulsive and interpersonally sensitive than the non-addict control group. The sexuai addict group was significantly more depressed than the pathological gambler group. The pathological gambler group was significantly more depressed than the non-addict control group, but was not significantly more anxious, obsessive-compulsive, or interpersonally sensitive. Neither addict group scored higher on levels of sensation-seeking or self-defeating behaviors than did the non-addict control group. The results supported the view that sexual addiction can be explained as a means of coping with anxiety, depression, obsessive-compulsiveness and interpersonal sensitivity whereas pathological gambling may be used as an anti-depressant but there is no significant relationship between that addiction and the other above-mentioned personality characteristics.     

Transference and countertransference in the treatment of adult survivors of abuse with a somatoform disorder

The understanding of transference and countertransference has changed a great deal since Freud introduced the terms. A case example indicates one way the patient’s and clinician’s past experiences and expectations interact to create a here and now relationship that is highly influenced by transference/countertransference. The understanding of both terms as aspects of a mutually constituted interaction has practice implications for the treatment of adult survivors of abuse who have a somatoform disorder.     

The family environment of married male pathological gamblers,alcoholics, and dually addicted gamblers

The family environments of married pathological gamblers, alcoholics, and alcoholic gamblers were measured with the Family Environment Scale (FES), a measure of 10 characteristics of family life. The total sample consists of 193 hospitalized patients, which includes 73 male alcoholics, 53 female alcoholics, and 67 male pathological gamblers, of whom 34 were alcoholics and 33 were not. All four treatment groups had a significantly lower degree of cohesion than normal controls. Male alcoholic gamblers reported significantly more conflict and less personal independence than controls, while male gamblers (nonalcoholics) reported less independence and intellectual-cultural orientation. Male alcoholics (nongamblers) reported more conflict, less independence, intellectual-cultural orientation, and active-recreational orientation than normals. Female alcoholics (nongamblers) also reported less intellectual-cultural orientation and active-recreational orientation than normals. Except for one comparison, treatment groups did not differ from each other. The implications of these findings for models of addiction are discussed as well as their contribution to understanding family issues for pathological gamblers.     

Accurately depicting pathological gamblers: Policy and treatment implications

This paper describes results from a 3-year study of pathological gambling in the general population. Two distinct groups of pathological gamblers, based on income, were distinguished in the general population. These two groups varied considerably on several dimensions, including their demographic characteristics, gambling involvement and problematic gambling-related behaviors. These results contradict widely-accepted beliefs about the characteristics and behaviors of pathological gamblers and suggest that efforts in outreach, education and program development must be expanded to include types of pathological gamblers beyond those currently in treatment.This work was funded by Research Grant MH44295 from the Violence & Traumatic Stress Research Branch of the National Institute of Mental Health.     

The gambling market in the Federal Republic of Germany and the helpseeking of pathological gamblers

The development of the gambling market in the Federal Republic of Germany since the middle of the seventies and data on pathological gamblers seeking help are described. The continuously increasing supply, together with increases in turnover, was followed-with some temporal delay-by an increase in the number of gamblers who sought advice and treatment. Preliminary measures taken by the health authorities as well as some consequences of pathological gambling are discussed.This article is a translation of a German article published in: Deutsche Hauptstelle gegen die Suchtgefahren (1990): Jahrbuch '91 zur Frage der Suchtgefahren. Hamburg: Neuland-Verlag.     

Examining the relationship between spousal involvement in Gam-Anon and relapse behaviors in pathological gamblers

The present investigation focused on Gamblers Anonymous (GA) members in Ohio to ascertain whether or not spousal participation in Gam-Anon, the companion support group, decreased the gambler's relapse into gambling behavior. A cross-sectional survey of 43 GA members was conducted using a self-administered questionnaire. While no significant difference was found in the relapse of those gamblers with or without a spouse in Gam-Anon, the degree to which the gambler had engaged in other addictive-like behaviors in the past did appear to be related to relapse. Those gamblers who had not relapsed reported significantly more engagement in past addictive-like behaviors (excessive overeating, drinking, and using drugs) than those who had relapsed. Additionally, their spouses had also engaged in addictive-like behaviors in the past. Discussion suggests possible explanations for the findings. Implications are drawn for both outcome measures and research with self-help groups.     

Clinical work with adolescents and their parents during family transitions: Transference and countertransference issues

This paper describes specific transference and counter-transference issues that commonly emerge in therapeutic work with adolescents and parents who are in the midst of family transitions such as divorce and remarriage. Psychoanalytic understanding and definitions of transference and countertransference are applied to short-term family-centered cases in which the parent-adolescent relationship is at particular risk. Case vignettes are presented in order to illustrate how transference and countertransference may guide or interfere with clinical interventions that are especially indicated with adolescents whose family structure has changed. Such interventions as well as the use of consultation are briefly described.At the time this paper was prepared, Ms. Springer was Associate Director and a senior clinician at the Center for the Family in Transition in Corte Madera, California. Funds for the research and clinical work that provided the basis for this paper were supplied by grants from the San Francisco Foudation. An earlier version of this paper was presented at the 66th Annual Meeting of the American Orthopsychiatry Association, New York City, March 31–April 4, 1989.     

Potential and probable pathological gamblers: Where do the differences lie?

A large proportion of adolescents engage in gambling activities and the prevalence of pathological gambling is high. This study presents a factor analysis of responses from 122 college students who obtained a score of 3 or greater on the South Oaks Gambling Screen (SOGS), the most widely used instrument to identify probable and potential pathological gamblers. The analysis showed five dimensions: Illegal Behaviors, Heavy Gambling, Eating Disorders, Parentally Modelled/Less Impulsive, and Worry. Analyses revealed that except for the Eating Disorders factor, all factors clearly differentiated the probable from potential pathological gamblers, as identified by the SOGS. Results raise important questions about the relationship of pathological gambling to other psychopathological or antisocial behaviors. Thus the probable pathological gambler category represents a wide-ranging behavioral profile that goes beyond gambling per se. Avenues for future research as well as clinical implications are discussed.This research was partially supported by grants from Le Fonds Richelieu, le Conseil Québécois de la Recherche Sociale and the Social Sciences and Humanities Research Council of Canada.     

Family,marital, and occupational satisfaction for recovering pathological gamblers

This paper describes the efforts of a private gambling treatment program to conduct a retrospective study of pathological gamblers treated in a publicly supported residential program. The Johns Hopkins Center for Pathological Gambling treated approximately 100 pathological gamblers nationwide from 1979 to 1983 in its residential component. Twenty-six gamblers were assessed regarding their recovery status with specific focus on family, marital status and occupational satisfaction. It was hypothesized that the more satisfied patients would display lower frequencies of gambling and that gambling frequency was dependent upon the level of satisfaction. Thirty-one percent of these gamblers reported abstinence. Regression analyses indicated that the recovery of pathological gamblers as measured by frequency of gambling is significantly influenced by job satisfaction, and moderately influenced by marital status and family life satisfaction. Consequently, these factors should be addressed by mental health professionals in research and treatment of pathological gambling.     

Comorbid mood and adjustment disorders among pathological gamblers seeking treatment in Hong Kong

Research findings on comorbidity and pathological gambling are non–existent in Chinese communities. The objectives of this study were to: (a) determine the prevalence of comorbid mood and adjustment disorders among pathological gamblers seeking treatment in Hong Kong; (b) compare demographic profiles and clinical features in pathological gamblers with and without comorbid mood and adjustment disorders; and (c) explore the association and temporal relationship between pathological gambling and comorbid mood and adjustment disorders. Assessment instruments included demographic data, BSI, SCID-I, ASI and LIFE-RIFT. Results showed that about two-thirds (63.7%; n = 128) of 201 participants reported lifetime comorbid psychiatric disorders. Most common comorbid disorders were mood disorders (29.4%; n = 59) and adjustment disorders (20.9%; n = 42). Pathological gamblers with comorbid mood or adjustment disorders showed more severe levels of psychopathology, impairment in psychosocial functioning and gambling problems. This study is important because it is the first scientific comorbidity study among pathological gamblers in a Chinese context.