Therapeutic use of a soap opera discussion group with psychiatric in-patients

The paper analyzes the therapeutic use of a soap opera discussion group with psychiatric in-patients. Through the use of media, patients are allowed to distance their concerns. The techniques are similar to play therapy with children or to projective testing. Individual themes and programs are discussed. The paper relates media to the collective unconscious and mythology. Although the research for this article was done with in-patients, the observations could be applied to other therapeutic groups.I would like to express special thanks to Ann Armour, a mental health worker at Framingham Union Hospital, who has worked with me on the soap opera discussion group.     

Family Sculpting: A Pilot Program for a Schizophrenic Group*

Verbal group therapy is a conventional treatment for schizophrenic patients. This report describes a pilot program of brief group therapy which utilized nonverbal sculpting techniques as the central therapeutic modality. Family sculpting provided a structured format for the patients to organize perceptions of self and family within specific contexts, to experience these perceptions in action, and employ them in resolving family conflicts.     

What was that Secret? Framing Forced Disclosures from Teen Mothers

Although previous research has examined the micropractices of therapeutic interaction, few studies have focused on the expression of power in group therapy. This ethnographic study examines a therapeutic program for teen mothers to explore how self‐disclosure occurs, focusing on the therapist's techniques for soliciting disclosure and subsequent responses. These techniques include the therapist's own disclosures, presentation of commands, and revelation of information, which then evoke the disclosure. Individuals respond with immediate compliance, delayed compliance, or sustained resistance. Although the therapist attempts to mask this imbalance, her strategies reinforce the power differences between herself and the teen mothers. The interactions observed here illustrate how clients may find therapeutic environments less about psychological unburdening and healing and more about the negotiation of power in an institutional setting. A more effective therapy might focus on disclosure of clients' successes rather than primarily on the revelation of discrediting information.     

Supervision in Family Therapy: A Developmental Perspective

A group model of supervision of family therapy was implemented by a team of three supervisors with doctoral students in counseling psychology. It was believed that such an approach would provide students with more opportunity to work as therapists with families and to observe a greater variety of families, therapists, and therapeutic styles than in other models. Interchange in supervisory sessions focused on co-therapy issues, observation skills, family dynamics, differing therapeutic techniques and approaches, and planning and goal setting in therapy. This experience contributed to the professional and personal growth and development of students.     

Group Therapy with Couples in Conflict

This article describes a psychoanalytically based time limited model of couples group therapy, using live clinical material to illustrate the process and flow of therapy. Because of the pre-therapy clear agreement regarding number of sessions, it is important that the contract be adhered to by all parties, underscoring issues of reliability regarding commitment and fostering completion. Critical themes such as dependence and independence rapidly become focal issues in treatment. Mirroring, reflecting, confronting, supporting and interpreting are among the treatment techniques utilized. A heterosexual co-therapy team is recommended as the optimal therapeutic pair for group leadership.     

Family Constellation — A Therapy Beyond Words

Family Constellation, a psychotherapeutic approach associated with the name Bert Hellinger, has become a popular yet also controversial form of systemic therapy in the German‐speaking therapy community. ‘Family Constellation’ (Familienstellen) means the individual client's physical‐emotional positioning and re‐positioning of substitute family members in relation to each other, with help of a therapeutic group. Family Constellation is a one‐session approach that addresses family‐of‐origin issues. The therapeutic process is highly experiential, utilising multiple sensory modalities. Hellinger locates his model within phenomenology, and his practice has roots in several therapy schools. His model offers complementary therapeutic techniques in our ‘languaged’ world of family therapy.     

The Treatment of Adult Male Child Molesters Through Group Family Intervention

Abstract

This paper explores the effectiveness of treating the child molester in multiple contexts as opposed to in-group therapy alone. Research indicates that sexual abuse may stem from a combination of family dysfunction (Hanson et al., 1994) and further, that family members' decisions impact the therapeutic process (Lipovsky, 1991). These and other findings suggest that effective counseling of sexual offenders should include not only the perpetrator, but the family members as well. This paper outlines a current treatment program utilizing a group process of relapse prevention and cognitive behavioral therapy techniques in concert with a companion group for partners and a therapeutic nursery for preschool-aged children. Using archival data, this paper addresses the effectiveness of the program and highlights the usefulness of involving family members in the process.     

Single-case Design: The Neglected Alternative for the Evaluation of Family Therapy*

Family therapy (as with other treatment forms) needs to demonstrate its efficacy, but a major obstacle to the development and evaluation of therapeutic techniques in family therapy in particular, has been the almost total reliance on what is called classical group comparisons (e.g., treatment versus no-treatment groups). The focus on group comparisons, however, has meant a complete disregard for a methodology that is also highly appropriate; single-case design (or intrasubject replication) where the sample size is N = 1. In recent times, there has been an increasing disenchantment with classical group design for a number of reasons. For example, group comparisons are not always feasible in many clinical settings and tend to lack relevance for the practitioner's daily functioning. This paper elaborates these kinds of reasons and outlines the major advantages of using single-case design. There is little doubt that single-case methodology is becoming increasingly popular as an important research tool that can no longer be disregarded. Its specific applicability to evaluative research in family therapy is particularly appealing.     

Way of being and the therapeutic pyramid: Expanding the application of a common factors meta‐model

Common factors proponents have suggested the need for principle‐based meta‐models to explain how various factors interact with each other to produce change. The therapeutic pyramid is a common factors meta‐model that outlines how therapeutic skills and techniques, the therapeutic alliance, and a therapist's way of being interactive to produce therapeutic change. Skills and techniques occupy the smallest top portion of the pyramid, with the therapeutic alliance in the middle and a therapist's way of being forming the foundation of the pyramid. The success of any layer rests on the quality of the immediately underlying layer. This study illustrates the broad applicability of common factors meta‐models by applying the therapeutic pyramid to couples therapy, family therapy, training and supervision, and professional ethics.     

The Three Fallacies: Evaluating Three Problematic Trends in Clinical Practice

In an era of condensed treatment and managed care, three trends are gaining prevalence in some graduate training programs and in some circles of the practicing community, limiting clinicians from utilizing the therapeutic techniques needed to help a client achieve long-standing intrapsychic change, a precondition for maintaining therapeutic gains post treatment. The first trend, the equation of empathy with sympathy, hinders the therapeutic dyad from truly understanding a client’s internal experience and implicitly conveys the message that anxiety-provoking material is less welcome in the consulting room. The second trend, prizing cognition over affect, results in a primary focus on secondary thought process, discounting the affective experience that unconsciously steers behavior and thought. This trend is, in large part, due to the widespread dissemination of cognitive-behavioral therapy efficacy research and the belief by some individuals that psychodynamic forms of treatment lack empirical support. The last and most problematic trend, the rigid utilization of treatment manuals, tends to result in a reductionistic approach to treatment, limiting psychotherapy to a set of techniques while also overlooking salient aspects of treatment that can predict positive outcomes. Treatment manuals oversimplify the process of therapy; as a result, the therapeutic dyad is less likely to uncover and discover the multiple origins of one’s suffering, contributory factors that are not always readily available to conscious awareness. This paper discusses each trend and the therapeutic implications that result.     

The Therapeutic Pyramid: A Common Factors Synthesis of Techniques,Alliance, and Way of Being

Common factors in therapy such as the therapeutic alliance and client motivation have been found to account for more change than therapy models. But common factors have been critiqued as only lists of variables that provide little practical guidance. Some researchers have demonstrated that certain common elements (e.g., the therapeutic alliance) account for more variance than others (e.g., techniques), suggesting that some factors should be emphasized over others. Such findings suggest the need for alternatives to model‐based therapy, with one alternative being meta‐models, or “models of models,” that focus on how therapeutic factors interact with each other to produce change. The purpose of this article is to propose a meta‐model describing the relationship between two specific common factors—the therapeutic alliance and interventions. We also propose a new factor—a therapist's way of being—that we believe is foundational to effective therapy. The model is proposed in pyramid format, with techniques on top, the therapeutic alliance in the middle, and therapist way of being as the foundation. The hierarchical relationships between these three concepts are discussed, along with implications for training, research, and therapy.     

INTERMINABLE SEX THERAPY: A REPORT ON TEN CASES OF THERAPEUTIC GRIDLOCK

This paper reports on ten cases in which treatment began with conventional sex therapy and was later modified by incorporating techniques of psychodynamic couple therapy. While the modifications initially led to symptom reversal, the reversal of symptoms activated a recycling sequence of relapses and renewed symptom reversals, ultimately terminating in treatment failure. While the ten couples were heterogeneous in many respects, they did form a distinct clinical group. In common, they demonstrated a set of characteristics laced with hate, love and dependency, which interacted to create what the authors have called "therapeutic gridlock" and "interminable" sex therapy.     

Two is Better than One: Use of Behavioral Techniques within a Structural Family Therapy Model

This paper encourages the combination of behavioral and family therapeutic techniques within the family context. The approach discussed is most helpful during the beginning to intermediate stages of family therapy and serves to provide the therapist with the necessary leverage to allow for effective intervention and change. Three case histories are presented to illustrate the techniques discussed     

Ego Psychology and Self Psychology in social work practice

Ego Psychology and Self Psychology are compared by examining how each theory would imply different treatment techniques. These differences are discussed at both a theoretical level and in terms of their applications to the same case. At the level of theory, Mahler's and Kohut's views are compared along five dimensions: definition of the problem, motivation, conflict, the nature of the therapeutic process, and the therapist's role in that process. At the level of technique, specific attention is paid to when the differences aid or impede the therapeutic process.     

Politics and Power in Therapy; A Discussion on the Implications of Postmodern Ideas for Therapeutic Practices

In this paper, broad questions are posed about the impact of postmodern ideas on therapeutic practice. Therapists operating within postmodern perspectives are questioning the objectivity of theories of knowledge, and in that process are retreating from their expert positions. This paper discusses this controversial shift within the broader context of the questions of the power of therapeutic techniques and knowledge in general.     

Group Cohesion and Homework Adherence in Multi‐Family Group Therapy for Schizophrenia

This study examined the relationship between levels of group cohesion, defined as whole group relationships, and between‐session therapeutic homework adherence in a multi‐family group therapy (MFGT) for people with schizophrenia. Participants from 18 consenting families attending MFGT groups completed weekly homework adherence ratings, group cohesion and spontaneous between‐session activity measures. Levels of group cohesion at each session were compared with measures of scheduled and spontaneous homework adherence reported at the next session. It was hypothesised that higher levels of group cohesion would be related to homework adherence and other spontaneous between‐session therapeutic activity completed by group members. Results show higher levels of group cohesion were associated with higher rates of spontaneous between‐session therapeutic activity. However, contrary to expectations no significant relationship between cohesion and scheduled homework completion was found. The implications of the findings for group processes and homework adherence are discussed.     

BRINGING ADVENTURE INTO MARRIAGE AND FAMILY THEAPY: AN INNOVATIVE EXPERIENTIAL APPROACH

outdoor adventure experiences, traditionally associated with programs like Outward Bound and Project Adventure, have evolved into specific interventions for a number of therapeutic populations. Once used primarily with dysfunctional adolescents, a series of presentations and writings have emerged that apply these techniques to marriage and family populations. This article presents a brief history and overview of the documented use of adventure experiences in marriage and family therapy and enrichment. Illustrations of actual techniques and recommendations for guiding future studies are also offered.     

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.