Rene Weideman

Group composition and group therapy for complicated grief.

This prospective study investigated the impact of group composition on the outcome of 2 forms of time-limited, short-term group therapy (interpretive, supportive) with 110 outpatients from 18 therapy groups, who presented with complicated grief. The composition variable was based on the patients level of quality of object relations. The higher the percentage of patients in a therapy group who had a history of relatively mature relationships, the better the outcome for all patients in the group, regardless of the form of therapy or the individual patients quality of object relations score. The findings have direct clinical implications for composing short-term therapy groups for outpatients with complicated grief and possibly for other types of group therapies and patient problems.

Differentiating Symptoms of Complicated Grief and Depression Among Psychiatric Outpatients

Objective: This study examined whether dimensions of complicated grief (CG) could be distinguished from dimensions of depression and whether these dimensions were differentially affected by group psychotherapy for CG. Method: A total of 398 psychiatric outpatients who had experienced one or more significant death losses provided ratings on standard measures of grief and depression. Factor analysis of the 56 items from these measures was used to explore the possibility that grief and depression symptoms would form separate dimensions of distress. Subsamples of the patients also participated in 1 of 2 forms of short-term group therapy for CG. Repeated-measures analysis of variance and calculation of effect sizes were performed to examine changes in the dimensions following treatment. Results: The grief items formed 3 distinct clusters representing different dimensions of CG. None of the depression items loaded highly on these grief dimensions. The depression items formed 2 distinct clusters. Two of the grief dimensions demonstrated the most improvement following group therapy that addressed CG. There was also evidence for differential effectiveness of the 2 forms of group therapy. Conclusions: When assessing psychiatric patients who have death losses, clinicians should consider different types of grief reactions. Different types of grief reactions may be responsive to different treatments. In the absence of depressive symptoms, clinicians should not assume the absence of CG.

A Comparison of cognitive and skills training strategies in the treatment of unassertive clients

Cognitive behavior modification and traditonal behavioral skills training procedures were compared as treatment interventions for unassertive individuals and found to be equivalent in therapeutic efficacy. Results are discussed with reference to Banduras model of self-efficacy.

Short-term group therapies for complicated grief : two research-based models

Although a certain amount of grief is expected and normal following the loss of a loved one, many people experience particularly intense and/or long-lasting grief, or complicated grief (CG). Up to 20% of acutely bereaved individuals and 33% of psychiatric outpatients suffer from CG. Furthermore, as the baby boom generation ages, the number of people experiencing CG will likely increase. One of the most cost-effective, research-supported treatments for CG is short-term group therapy. This approach not only treats more patients with fewer resources, but also capitalizes on the unique and powerful therapeutic factors associated with group therapy. Over the past 22 years, William Piper and colleagues have developed and tested two models for treating CG with short-term group therapy. Extensive randomized, controlled clinical trials have demonstrated significantly higher effect sizes for the model treatments than other CG treatments, including individual therapy approaches. This book begins with a meticulous, comprehensive review of research related to CG, including prevalence, risk factors, effects of patient characteristics and group composition on therapeutic outcome, and mechanisms of change in group therapies for CG. The chapters also describe how the two models were developed and tested. Finally, the book explains how to administer the models, including assessing patients, forming groups, preparing group members for treatment, and running and terminating the group. This book is essential reading for all clinicians and researchers interested in CG, group therapy, and short-term therapy, as well as administrators and managers responsible for the delivery of healthcare services.

Ambivalence and Other Relationship Predictors of Grief in Psychiatric Outpatients

Ambivalence has been viewed as an important causal agent in the development of complicated grief. However, examination of studies commonly cited as supporting this belief reveals basic limitations in their methodology and conclusions. The current study examined associations between several relationship predictors (ambivalence, affiliation, and dependence) and both grief-specific symptoms and depression in two samples of psychiatric outpatients who had experienced loss of significant others. Findings from the first sample (N = 138) were used to test for evidence of cross-validation in the second sample (N = 139). Contrary to traditional belief, ambivalence was inversely related to severity of grief symptoms. In contrast, affiliation and dependence were directly related to severity of grief symptoms. None of the predictors provided evidence of cross-validation in the case of depression. Explanations for the findings and clinical implications are considered.

Screening for Complicated Grief: When Less May Provide More

Objective: This study aimed to discover screening questions for initial assessments of psychiatric outpatients to identify which patients are likely experiencing complicated grief (CG). Method: We examined the responses of 235 outpatients to questionnaire items. One set came from the Texas Revised Inventory of Grief (TRIG). This set represented events cited in clinical literature as indicators or risk factors for CG. Another set came from a factor analysis of items that define CG. We determined relations between items and CG, analyzed sensitivity and specificity, and compared the 2 sets of items. Results: The factor analysis items were superior. The 2 best items correctly identified nearly 90% of patients with and without CG. Conclusion: The items can be transformed into screening questions to be used in initial interviews.

Therapists' Perspectives on Optimal Treatment for Pathological Narcissism.

This study used Q methodology to explore clinicians’ perspectives regarding optimal psychotherapy process in the treatment of pathological narcissism, a syndrome of impaired self-regulation. Participants were 34 psychotherapists of various disciplines and theoretical orientations who reviewed 3 clinical vignettes portraying hypothetical cases of grandiose narcissism, vulnerable narcissism, and panic disorder without pathological narcissism. Participants then used the Psychotherapy Process Q set, a 100-item Q-sort instrument, to indicate their views regarding optimal therapy process for each hypothetical case. By-person principal components analysis with varimax rotation was conducted on all 102 Q-sorts, revealing 4 components representing clinicians’ perspectives on ideal therapy processes for narcissistic and non-narcissistic patients. These perspectives were then analyzed regarding their relationship to established therapy models. The first component represented an introspective, relationally oriented therapy process and was strongly correlated with established psychodynamic treatments. The second component, most frequently endorsed for the panic disorder vignette, consisted of a cognitive and alliance-building approach that correlated strongly with expert-rated cognitive–behavioral therapy. The third and fourth components involved therapy processes focused on the challenging interpersonal behaviors associated with narcissistic vulnerability and grandiosity, respectively. The perspectives on therapy processes that emerged in this study reflect different points of emphasis in the treatment of pathological narcissism, and may serve as prototypes of therapist-generated approaches to patients suffering from this issue. The findings suggest several areas for further empirical inquiry regarding psychotherapy with this population.

Short-Term Group Therapy for Complicated Grief: The Relationship Between Patients’ In-Session Reflection and Outcome

Objective: The objective of the present study was to examine the nature of patients’ work in two types of short-term group psychotherapy. The study sought to investigate the relationship between patients’ psychodynamic work versus supportive work in group psychotherapy and treatment outcome at termination and at 6-month follow-up. Psychodynamic work refers to reflection regarding intrapsychic motivations, defenses, and relational patterns, and supportive work refers to practical problem solving. Method: Participants were 110 patients who completed two forms of group therapy for complicated grief: interpretive therapy and supportive therapy. Two types of patients’ in-session activity—psychodynamic work and supportive work—were rated by group therapists in both treatments. Pre-post and follow-up outcome domains included general symptoms, grief symptoms, and life dissatisfaction/severity of target objectives. Results: There was no significant difference in the nature of patients’ therapeutic work between interpretive and supportive groups. Psychodynamic work was associated with pre-post improvement in grief symptoms. Psychodynamic work was also associated with further improvement in grief symptoms at 6-month follow-up, along with improvement in broader symptom domains. Supportive work was not associated with any pre-post or follow-up benefit. Conclusion: The findings provide evidence that psychodynamic work—focused on the development of insight and self-reflection—in group psychotherapy can contribute to further benefit after the completion of treatment. This finding cut across two approaches to short-term group therapy for complicated grief, suggesting that it may reflect a general curative mechanism of group treatments.