Robert H. Klein

Some principles of short-term group therapy.

ABSTRACTThis paper reviews the burgeoning literature on short-term group therapy, primarily focusing on outpatient groups, and formulates a set of general principles for conducting such groups. Short-term group therapy is defined, and technical characteristics shared by most short-term treatment approaches are summarized. Clinical applications and common group goals are identified. Although few empirical studies have been reported, the efficacy of short-term approaches is shown to be comparable to that of longer-term treatment interventions. The implications of a short-term format are highlighted with regard to patient selection and preparation, group composition, and the nature of the contract. Detailed consideration is given to the therapists role, and a comprehensive, supportively oriented approach is described.

Patient characteristics and attendance patterns in outpatient group psychotherapy.

A study of over 700 referrals for group therapy within a large university hospital setting revealed that such services were primarily provided for moderately to severely disturbed patients, mostly ...

Large-group processes and the patient-staff community meeting.

ABSTRACTThis paper assesses the impact of large-group processes and dynamics upon the patient-staff community meeting in hospital treatment. It focuses upon the therapeutic values and limitations of the large-group format by examining, from an integrated general systems and object relations perspective, how size, structure, patient population, staff training, and leadership variables reciprocally affect the process and content of the community meeting. The special problems associated with selecting an appropriate format for the meeting and the intense pull of regressive group forces upon the large-group leader are discussed.

Benzodiazepine use and risk of mortality among patients with schizophrenia: a retrospective longitudinal study.

OBJECTIVEnThis study examined the association between benzodiazepine use alone or in combination with antipsychotics and risk of mortality in patients with schizophrenia.nnnMETHODSnA retrospective longitudinal analysis was performed using Medicaid claims data merged with death certificate data for 18,953 patients (aged 18-58 years) with ICD-9-diagnosed schizophrenia followed from July 1, 2006, to December 31, 2013. Cox proportional hazard analyses were used to estimate the risk of all-cause mortality associated with benzodiazepine use; adjustment was made for a wide array of fixed and time-varying confounders, including demographics, psychiatric and medical comorbidities, and other psychotropic medications.nnnRESULTSnOf the 18,953 patients diagnosed with schizophrenia, 13,741 (72.5%) were not prescribed a benzodiazepine, 3,476 (18.3%) were prescribed benzodiazepines in the absence of antipsychotic medication, and 1,736 (9.2%) were prescribed benzodiazepines in combination with antipsychotics. Controlling for a wide array of demographic and clinical variables, the hazard of mortality was 208% higher for patients prescribed benzodiazepines without an antipsychotic (HR = 3.08; 95% CI, 2.63-3.61; P < .001) and 48% higher for patients prescribed benzodiazepines in combination with antipsychotics (HR = 1.48; 95% CI, 1.15-1.91; P = .002). Benzodiazepine-prescribed patients were at greater risk of death by suicide and accidental poisoning as well as from natural causes.nnnCONCLUSIONSnBenzodiazepine use is associated with increased mortality risk in patients with schizophrenia after adjusting for a wide range of potential confounders. Given unproven efficacy, physicians should exercise caution in prescribing benzodiazepines to schizophrenic patients.

Termination in group psychotherapy from the perspectives of contemporary object relations theory and self psychology.

Throughout the development of object relations theory and self psychology, the importance of attachments, availability, absences, limitations, and endings have been factors that have informed theory and practice. This article examines the multiple meanings and impacts of terminations in group psychotherapy at the intrapsychic, interpersonal, and group-as-a-whole levels, from the perspective of contemporary object relations theory and self psychology. Emphasis is placed on the initiation of a mourning process, with the dynamics of guilt, shame, and aggression toward objects who are separate or inaccessible, and the experience of a shortcoming or absence, associated with a loss of self-object oneness, soothing, and idealization from the narcissistic sector of the personality. Therapeutic opportunities afforded by terminations and the importance of resolving countertransference reactions are highlighted.

Countertransference Issues in Group Psychotherapy with HIV-Positive and AIDS Patients

Mental health professionals are increasingly aware of the special difficulties encountered by therapists working with HIV-positive and AIDS patients. In this report, countertransference issues experienced by therapists leading a psychotherapy group for heterosexual, drug-using HIV-positive and AIDS patients in an inner city hospital are explored. Countertransference is discussed under the headings of helplessness, death anxiety, and anger.

The Axis II group: treating severely characterologically disturbed patients.

Treating the chronically mentally ill involves not only working with patients suffering from schizophrenia and other prolonged or recurrent psychotic illnesses, it also means providing treatment for patients with severe personality disorders. Many of these patients are also active substance abusers. This article examines the therapeutic and management issues raised for outpatient clinicians who work with these patients. Consideration is devoted to the special problems in treating the dual diagnosis patient, issues of patient and therapist safety, limit setting, splitting dynamics, and countertransference reactions. A set of recommendations is offered for conducting outpatient group therapy, specifying what is needed from both the clinicians and the facility in which this type of treatment is provided.

The relationship between psychological distress and knowledge of disease among hemophilia patients and their families: A pilot study

As part of a large scale, comprehensive study of the psychosocial functioning of hemophilic patients and their families, 12 pilot families were assessed using objective measures of psychiatric symptomatology and general knowledge of hemophilia. Although the small number of subjects in this pilot study precludes any detailed statistical analyses, some preliminary findings are presented concerning the level of psychological distress reported by patients and their family members and the subjects level of general knowledge about hemophilia. Of most interest was the presence of significant negative correlations between knowledge of hemophilia and extent of self-reported psychological distress for mothers and patients under 15 yr of age. Maintenance of this relationship with a larger sample would have important implications for patient and family education.

Toward Understanding and Treating Violence in America: Some Contributions From Group Dynamic and Group Therapy Perspectives: Introduction to Part I

Abstract The co-editors introduce a two-part Special Section of the Journal devoted to understanding and treating violence in America. They examine the relevance of clinical experience for contributions that can be made by group therapists and group dynamic thinkers to the growing national dialogue about this problem. The pervasive nature, causes, and different forms of violence in the United States are compared with those found in other countries. Underlying sociocultural values and myths, historical and current cultural contexts are considered breeding grounds for potential violence. How therapists can promote healthy change in their groups and in the broader society is explored. The articles contained in part one are reviewed against this backdrop.

Toward the establishment of evidence-based practices in group psychotherapy.

It is a pleasure both personally and on behalf of the American Group Psychotherapy Association (AGPA) to be asked to coordinate and introduce this special issue of the Journal, which is devoted to evidence–based practices in group psychotherapy and group intervention strategies. This issue consists of four parts: (1) a brief historical introduction that identifies the salient professional challenges; (2) a newly developed set of comprehensive clinical practice guidelines applicable to a broad variety of group approaches; (3) a series of commentaries from leading experts in the field of evidence–based practices who address the inherent issues raised by the practice guidelines; and (4) a research review of recent publications that explore the dilemmas and possibilities of the clinician taking on the dual roles of psychotherapist and researcher. This format was selected to permit the reader to put into context and begin to evaluate AGPA’s attempt to establish a set of clinical practice guidelines for group psychotherapy. Our hope is to highlight the relevance and importance of the central questions and challenges facing our field in connection with evidence–based practices.