D. Martin Kivlighan

Evidence-based treatments for depression and anxiety versus treatment-as-usual: A meta-analysis of direct comparisons☆

OBJECTIVE The aim of this study was to examine the relative efficacy of evidence-based treatments (EBTs) versus treatment-as-usual (TAU) in routine care for anxiety and depression in adults. METHOD A computerized search of studies that directly compared an EBT with a TAU was conducted. Meta-analytic methods were used to estimate effectiveness of EBTs relative to TAU and to model how various confounding variables impacted the results of this comparative research. RESULTS A total of 14 studies were included in the final meta-analysis. There was significant heterogeneity in the TAU conditions, which ranged from unknown and/or minimal mental health treatment to psychotherapeutic interventions provided by trained professionals. Although the effect for EBT vs. TAU was significantly greater than zero, the effect for EBT vs. TAUs that were psychotherapeutic interventions was not statistically different from zero. CONCLUSIONS Heterogeneity of TAU conditions in this meta-analysis highlight the importance of clarifying the research questions being asked when investigating and drawing conclusions from EBT-TAU comparisons. Researchers need to clarify if they are comparing an EBT to psychotherapeutic services in routine care or to minimal mental health services. Extant research on EBT versus TAU reveals that there is insufficient evidence to recommend the transportation of EBTs for anxiety and depression to routine care, particularly when the routine care involves psychotherapeutic services.

The enduring effects of psychodynamic treatments vis-à-vis alternative treatments: A multilevel longitudinal meta-analysis

Although evidence suggests that the benefits of psychodynamic treatments are sustained over time, presently it is unclear whether these sustained benefits are superior to non-psychodynamic treatments. Additionally, the extant literature comparing the sustained benefits of psychodynamic treatments compared to alternative treatments is limited with methodological shortcomings. The purpose of the current study was to conduct a rigorous test of the growth of the benefits of psychodynamic treatments relative to alternative treatments across distinct domains of change (i.e., all outcome measures, targeted outcome measures, non-targeted outcome measures, and personality outcome measures). To do so, the study employed strict inclusion criteria to identify randomized clinical trials that directly compared at least one bona fide psychodynamic treatment and one bona fide non-psychodynamic treatment. Hierarchical linear modeling (Raudenbush, Bryk, Cheong, Congdon, & du Toit, 2011) was used to longitudinally model the impact of psychodynamic treatments compared to non-psychodynamic treatments at post-treatment and to compare the growth (i.e., slope) of effects beyond treatment completion. Findings from the present meta-analysis indicated that psychodynamic treatments and non-psychodynamic treatments were equally efficacious at post-treatment and at follow-up for combined outcomes (k=20), targeted outcomes (k=19), non-targeted outcomes (k=17), and personality outcomes (k=6). Clinical implications, directions for future research, and limitations are discussed.

The Group's Absence Norm and Commitment to the Group as Predictors of Group Member Absence in the Next Session: An Actor-Partner Analysis.

The groups absence norm, a construct from the applied psychology literature, was used to examine session absences in personal growth groups. Rather than examining the absence norm statically, we modeled it dynamically as a time-varying covariate (Tasca et al., 2010). We also examined moderation by modeling the interaction of the absence norm and the group members commitment to the group in predicting the group members absence in the next group session. Session absences in 1,722 group sessions for 66 group members in 9 interpersonal growth groups were modeled using Kenny, Mannetti, Pierro, Livi, and Kashys (2002) adaptation of the Actor-Partner Interdependence model. Specifically, a 3-level model (sessions within group members within groups) examined the relationship of the groups absence norm (average previous absences of the other group members), commitment to the group (previous absences of the group member), and the interaction of the groups absence norm and commitment to the group on absence in the next session. As we hypothesized, (a) a greater number of previous individual absences (low commitment) increased the probability of a member being absent the next session, (b) the higher the groups absences norm, the greater the probability that an individual group member would be absent the next session, and (c) individual group members who were more committed to the group were more influenced by the groups absences norm than were group members less committed to the group. Implications for research and practice are discussed.

Are Group Leader Knowledge Structures Related to Member Satisfaction With the Leader

Knowledge structures are people’s ways of organizing the concepts in a domain. Educational effectiveness can be documented by examining changes in novices’ knowledge structures. Studies show that group counseling trainees begin to structure their knowledge of group members and group leader interventions in a manner similar to the knowledge structure of experienced group counselors. This research assumes that trainees with knowledge structures more similar to experienced practitioners will be more effective group leaders. We tested this assumption and found that group members were more satisfied when the trainee’s knowledge structure of group counseling leader interventions converged with the knowledge structure of experienced group therapists.

Group Climate Research: Where Do We Go From Here?

Abstract We review the articles by Bakali, Wilberg, Klungsøyr, and Lorentzen (this issue) and Bonsaksen, Borge, and Hoffart (this issue) that examine different aspects of group Climate using the Group Climate Questionnaire. Both articles build on the previous group climate literature and both provide important new insights into the relationship between individual group members’ perceptions of group climate and their treatment outcome (Bonsaksen et al., 2013) and the development of group climate across time. Our comments focus on how these two areas of research can be extended. Specifically, we recommend that group development researchers use new statistical techniques that describe patterns in how group climate changes across time. In addition, we encourage researchers examining the relationship between group climate and outcome to use the Actor Partner Interdependence Model to include other groups members’ perceptions of group climate as a predictor of an individual group member’s treatment outcome.

If You Get Better, Will I? An Actor-Partner Analysis of the Mutual Influence of Group Therapy Outcomes

The effectiveness of group psychotherapy has been empirically studied and supported over several decades; however, there remains much to understand regarding the specific factors contributing to effective group psychotherapy. The current study uses Kashy and Kennys (2000) actor-partner interdependence model (APIM) to examine the relationship between an individual group members outcome and the outcomes of the other group members. This is the first study to examine the effects of the outcomes of other therapy group members on those of individual members. Specifically, we examined the relationship between an individual group members presymptom score, the aggregated presymptom scores of the other group members, and the aggregated pre- to postsymptom change of the other group members on an individual group members pre- to postsymptom change. We analyzed the change in pre-post posttraumatic stress disorder (PTSD) symptoms of 105 women in 16 trauma-informed groups in a womens correctional facility. As hypothesized, an individuals presymptom measure (actor effect) and the aggregated presymptom measures of the other group members (partner effect) were positively related to the individuals change in PTSD symptoms. Contrary to our hypothesis, the aggregated pre-post change in PTSD symptom measures of the other group members (partner effect) was negatively associated with the pre-post change in PTSD symptom measures of an individual group member. Social comparison theory is discussed as an explanation for why a group member would report lowered amounts of change when in a group with others who are reporting a higher amount of change. Implications for research and practice are discussed.

The Effects of a Social and Talent Development Intervention for High Ability Youth with Social Skill Difficulties.

Abstract Contemporary models highlight the need to cultivate cognitive and psychosocial factors in developing domain-specific talent. This model was the basis for the current study where high ability youth with self-reported social difficulties (n = 28, 12 with a coexisting disability) participated in a social skills and talent development intervention over the course of a two-week summer enrichment program. Compared to high ability youth not in the social skills intervention (n = 9), participants reported positive changes in friendship qualities (help), indicating a treatment effect. Among all participants, positive changes were reported in friendship companionship and security, suggesting the talent development program alone had significant impact on psychosocial factors (friendship qualities). For those in the social skills group, higher scores on performance approach goal orientations were related to lower change scores in friendship closeness, suggesting if one is driven academically to outperform peers, this may negatively affect their ability to form close ties with peers.

A Social Network Analysis of International Collaboration in Counseling Psychology

Over the past two decades, counseling psychology has emerged as an international discipline. Despite efforts to internationalize counseling psychology and increase cross-cultural relationships, few studies have considered international collaboration on scientific scholarship as a metric or factor of internationalization. Therefore, using social network analyses, we tested the occurrence and patterns of collaborations between authors from different countries on published studies in the Journal of Counseling Psychology and The Counseling Psychologist from 2005 to 2015. Results indicated that a small proportion of possible international collaborations existed, as measured by network density, and the majority of collaborations involved authors affiliated with institutions in the United States. However, international collaboration significantly increased over time, as measured by the density of the network. Our findings are consistent with previous research suggesting a lack of cross-national scholarship in counseling psychology and identify global areas for further cross-cultural development.

Construction and validation of the Multicultural Orientation Inventory—Group Version.

Given the continued racial/ethnic diversification of the United States, it is not uncommon for therapy groups to consist of members with diverse racial/ethnic backgrounds and various cultural identities. Scholars have underscored how this cultural diversity can directly impact many processes and outcomes of group-based interventions (Chen, Kakkad, & Balzano, 2008). However, there is presently a paucity of empirical research testing the relationship between cultural processes of therapy groups and members’ outcomes. Moreover, no psychometrically sound measure of the cultural process that unfolds in group therapy currently exists. As such, this study sought to adapt the Multicultural Orientation Inventory to develop and validate the Multicultural Orientation Inventory—Group Version (MCO-G), a measure assessing the cultural humility, cultural comfort, and cultural missed opportunities in therapy groups. Data for this validation study consisted of 208 members of 49 therapy groups across 10 university counseling centers. Confirmatory factor analyses supported a 3-factor structure of the MCO-G Inventory, wherein the 3 factors corresponded with the underlying constructs of cultural humility, cultural comfort, and cultural missed opportunities. This study provides initial evidence for the estimated internal and convergent validity of the MCO-G, as measured by clients’ perceptions of a higher-order group therapeutic factor and improvement in therapy. Results provide initial support for the psychometric properties of the MCO-G. Moreover, groups’ cultural humility and cultural missed opportunities were related to members’ improvement in therapy. Clinical implications and future research are discussed.

Are belongingness and hope essential features of academic enhancement groups? A psychosociocultural perspective.

Despite evidence of the effectiveness of postsecondary academic enhancement interventions, presently there is a paucity of research examining the effective processes of such programs. Informed by the psychosociocultural model, this study tested the relationship between the growth in hope and belongingness, as well as academic achievement for undergraduates on academic probation participating in academic enhancement groups. Longitudinal ratings of hope and belongingness from 167 undergraduates enrolled in 22 academic enhancement groups were modeled as predictors of changes in their grade-point average (GPA). Results indicated that the growth in students’ hope and belongingness were significantly associated with changes in their GPA. Additionally, gender significantly moderated the relationship between hope and academic achievement, such that women who had small or large increases in their hope during the intervention and men who had large increases in hope during the intervention had significant and large improvements in their GPAs; men who had small increases in hope during the intervention had significant but small improvements in their GPAs. Our findings suggest the importance of group processes of belongingness and hope for academic enhancement groups.