Molyn Leszcz

The Rationale and Foundations Of Group Psychotherapy for Women with Metastatic Breast Cancer

Group psychotherapy has become an important modality of intervention in contemporary psychooncology. This article reviews and describes the rationale and foundations for group psychotherapy for women with metastatic breast cancer. It emerges from a replication study of an earlier study performed by Spiegel (Spiegel, Bloom, Kraemer & Gottheil, 1989), which demonstrated that participation in structured group psychotherapy resulted in improved psychosocial adjustment and a significant survival effect on women with metastatic breast cancer. Other intervention studies, psychosocial effects of psychosocial interventions, as well as psychosocial variables associated with the course of illness, are described. The contribution of existential considerations in psychotherapy is also articulated as a component of the group-supportive expressive intervention. Clinical illustrations, emerging from ongoing treatment groups, are used to demonstrate theoretical concepts.

Peer group mentoring of junior faculty.

ObjectiveThe purpose of this article is to document and evaluate the initiation of a mentoring model for junior faculty utilizing a peer group approach rather than the traditional dyadic model.MethodsJunior faculty members in an academic department of psychiatry at Sunnybrook Hospital, University of Toronto, were invited to take part in a peer mentoring program involving evening meetings every 2 months over a 1-year period from 2004–2005. Of the 12 invitees, 10 agreed to participate in the program. The group participants developed the program agenda collectively. Learning objectives as well as a list of topics of interest were established at the inaugural meeting. A focus group was held at the end of 12 months to provide a descriptive, qualitative evaluation. The focus group leader prepared a report based on observations and notes taken during the focus group.ResultsThe report prepared by the focus group leader identified six main themes that included: program development, knowledge gains, interpersonal gains, psychological/emotional gains, process of the program and future directions. The overall response was clearly favorable with a unanimous decision to maintain the group and continue meeting into the next year.ConclusionA peer group mentoring format for junior faculty in an academic department of psychiatry can be an effective model of mentoring.

Group interventions for patients with cancer and HIV disease. Part I: Effects on psychosocial and functional outcomes at different phases of illness

Abstract Group interventions for individuals facing cancer or HIV disease have drawn considerable attention among researchers and clinicians over the past 20 years. There is growing evidence that group services may be helpful, but which interventions are most effective for participants at which phases in the trajectory of disease has been less clear. Moreover, professionals working in different intervention settings (e.g., primary prevention vs. clinical care) and different disease sites (cancer vs. HIV disease) often have little awareness of relevant advances in other fields. Efforts to integrate findings in the literature may accelerate research and advance the standard of clinical care. The current article, the first in a series of four special reports, critically evaluates the efficacy of group interventions led by professional or trained facilitators for individuals confronted by cancer or HIV, across the spectrum of illness from elevated risk through advanced disease. We examine psychosocial and functional outcomes for different interventions directed toward different patient subgroups, trace common themes, highlight limitations, and offer recommendations for further research.

Lessons learned from enrollment in the BEST study—A multicenter, randomized trial of group psychosocial support in metastatic breast cancer

The BEST study, a multicenter randomized trial of group psychosocial support in metastatic breast cancer, had several unusual features that may have influenced recruitment, notably the group nature of the intervention and the need for close collaboration between medical and psychosocial investigators. The recruitment process was examined in light of these features. Establishment of study centers was facilitated by involvement of experienced medical investigators who had successfully collaborated in previous research projects. Systematic evaluation of potential subjects or direct recruitment by psychosocial investigators optimized recruitment; however, the group nature of the intervention prolonged recruitment. Overall, 652 women were approached and 237 (43.3% of those medically eligible) randomized. Using population-based estimates, 24.3% of women with metastatic breast cancer were assessed for the study and 8.7% randomized. A randomization ratio of 2:1 was required to form and maintain groups. Competing clinical trials were the greatest barrier to recruitment. Five lessons were learned during recruitment for this trial: (1) multicenter randomized trials of psychosocial interventions are feasible, even in very ill patients, (2) the use of a group intervention effectively increased the required sample size by 50%, (3) similarity of randomization rates suggests that generalizability of study results will probably be comparable to that of other randomized cancer trials, (4) multidisciplinary collaborations and involvement of experienced researchers facilitated enrollment, and (5) most challenges encountered in recruitment were similar to those seen in all clinical trials.

Randomized trial of group psychosocial support in metastatic breast cancer: the BEST study

An unexpected finding that a specific form of group therapy had a significant survival effect for women with metastatic breast cancer reported by Spiegel era/. (1) has generated considerable interest in the evaluation of related psychosocial interventions. The reported results of other group interventions have raised both enthusiasm and doubt about significant survival effects. Fawzy’s work (2, 3) has demonstrated a significant survival and quality-of-life effect as reflected in improved measures of coping as well as vigour, depression, confusion and fatigue. Other reports (4-61, in contrast, have failed to demonstrate a significant survival effect or quality-of-life impact. Further investigation, in particular attempts to replicate the Spiegel intervention, would help to resolve concerns regarding the efficacy of such interventions and might identify the factors that may mediate the therapy’s effects. This evaluation of psychosocial interventions should be undertaken with the same degree of applied rigour as any medical intervention study with attention to such factors as dosing and frequency of the interventon, structure and rationale of the intervention, social integration and group cohesion, acquisition of active coping skills, adherence to the intervention protocol and competent therapeutic leadership.

The interpersonal approach to group psychotherapy

The interpersonal model of group psychotherapy emphasizes the critical nature of peer interactions and consequent dynamic interpersonal learning. The author illustrates basic concepts of the model through a series of clinical vignettes. The central importance of the group as a social microcosm, cohesion and group process, here-and-now activation, and corrective emotional experience are documented, as is the role of the therapist in facilitating interpersonal feedback and effective therapeutic work.

Multi-family psycho-education group for assertive community treatment clients and families of culturally diverse background: a pilot study.

This study evaluates the incorporation of Multi-Family Psycho-education Group (MFPG) to an Assertive Community Treatment Team developed to serve culturally diverse clients who suffers from severe mental illness. Participants included Chinese and Tamil clients and their family members. Family members’ well-being, perceived burden, and acceptance of clients were assessed before and after the intervention. Focus group interviews with clinicians were conducted to qualitatively examine MFPG. Family members’ acceptance increased after MFPG. Regular attendance was associated with reduction in perceived family burden. Culturally competent delivery of MFPG enhanced family members’ understanding of mental illness and reduced stress levels and negative feelings towards clients.

Evidence‐based group psychotherapy: using AGPA's practice guidelines to enhance clinical effectiveness

Practice guidelines represent a useful approach to facilitate the delivery of evidence-based mental health care. In this article, we detail group psychotherapy practice guidelines developed by the American Group Psychotherapy Association (AGPA). Combining the research literature with expert consensus, the AGPA has created a resource that should prove useful for psychotherapists, administrators, and patients. We illustrate the guidelines through a series of clinical dilemmas and challenges.

Group interventions for patients with cancer and HIV disease: Part III. Moderating variables and mechanisms of action.

Abstract Growing evidence supports the value of group interventions for individuals who are at risk for or have developed cancer or HIV disease. However, information is more limited concerning how these services can be delivered in an optimal manner, and what processes contribute to their benefits. Parts I and II of this review examined the efficacy of different interventions for individuals at different phases of illness, ranging from primary prevention to late-stage disease, in both psychosocial and biological domains. The current paper examines some of the factors other than phase of illness that might influence group treatment effects (e.g., intervention parameters, participant characteristics), and explores mechanisms of action.

Towards an integrated model of group psychotherapy with the elderly

Three current approaches to the group therapy of the cognitively intact, depressed elderly are reviewed. Examination of the strengths and limitations of these three models--self psychology, developmental considerations such as reminiscing and life review, and cognitive-behavioral therapies--points in the direction of the usefulness of an integrated model. The main objectives of an integrated approach include: stabilization of the individuals sense of self, establishment of interpersonal competence, and enhanced mastery over the affects of depression and demoralization. Clinical illustrations are provided to demonstrate the practical considerations in this model of group therapy.