Robert L. Gleave

Group climate, cohesion, alliance, and empathy in group psychotherapy : Multilevel structural equation models

This study examined the definitional and statistical overlap among 4 key group therapeutic relationship constructs—group climate, cohesion, alliance, and empathy—across member–member, member–group, and member–leader relationships. Three multilevel structural equation models were tested using selfreport measures completed by 662 participants from 111 counseling center and personal growth groups. As hypothesized, almost all measures of therapeutic relationship were significantly correlated. Hypothesized 1-factor, 2-factor (Working and Bonding factors), and 3-factor (Member, Leader, and Group factors) models did not fit the data adequately. An exploratory model with Bonding, Working, and Negative factors provided the best fit to the data. Group members distinguished among relationships primarily according to relationship quality rather than the status or role of others (i.e., leader, member, or whole group).

The Group Questionnaire: A clinical and empirically derived measure of group relationship

Abstract The Group Questionnaire (GQ) is a recently developed self-report measure of the therapeutic relationship based on Johnson and colleagues (2005) three-factor model; Positive Bonding, Positive Working, and Negative Relationship. This study validated Johnsons model with a new and extended sample and created a shorter 40-item trial version. SEM analysis of the GQ tested whether it produced the same three-factor structure found in three earlier studies with 486 participants from three populations—outpatient university counseling center, non-patient AGPA process groups, and inpatient state hospital. Results of further SEM refinements demonstrated that a final 30-item version had good fit to the three-factor model although distinct differences in response pattern were found between the three populations. Implications for future utility and clinical relevance of the GQ are discussed.

Youth Psychotherapy Change Trajectories and Early Warning System Accuracy in a Managed Care Setting

OBJECTIVES To examine change trajectories in routine outpatient mental health services for children and adolescents in a managed care setting, and to use these trajectories to test the accuracy of two variations of an early warning system designed to identify cases at risk for deterioration. METHOD Multilevel modeling procedures were used to examine longitudinal Youth Outcome Questionnaire (YOQ) data for 16,091 youth aged 4-17 years (39% female, mean age 10.5) referred for treatment in a managed care system. RESULTS Clients with more frequent YOQ administrations had slightly lower baselines and faster rates of change. Both the traditional and simplified versions of the early warning system demonstrated good accuracy in identifying clients who deteriorated, with a sensitivity of .63, specificity of .83, and hit rate of .81. CONCLUSIONS Results provide further evidence that patient-focused early warning systems can accurately identify most youth who are at risk for negative outcomes in routine mental health services.

Exploring Interactions of Improvers and Deteriorators in the Group Therapy Process: A Qualitative Analysis

Abstract This study examined the interactions of individuals who showed symptom improvement and those who showed deterioration during the course of short-term group psychotherapy. A qualitative hermeneutic analysis was used to identify and describe themes from the group interactions. Both broad group themes, as well as themes specific to improvers and deteriorators, were found. Findings suggest that the differences in group behavior between those who get worse and those who improve are subtle and thus difficult for group leaders to detect. Although the differences were not immediately apparent, a deeper examination of group process did reveal distinct patterns for deteriorators that were different from those of improvers. These patterns of interaction are discussed as well as variables related to client, leader, and group as a whole that may have contributed to the outcome of group members.

Differential effectiveness of group, individual, and conjoint treatments: An archival analysis of OQ-45 change trajectories

Abstract Objective: While empirically-supported treatment (EST) choices are continually expanding, choices regarding formats for delivery (individual only, group only, or conjoint [simultaneous individual & group]) are often determined by agency resources or clinician preference. Studies comparing individual and group formats have produced mixed results, while recent meta-analytic reviews support format equivalence. Method: We employed a multilevel model to test for outcome differences using the OQ-45 on an outpatient archival data set of clients receiving individual-only (n = 11,764), group-only (n = 152) or conjoint (n = 1557). Results: Individual and group outcomes were equivalent with some analyses showing conjoint trailing. Moderators of change included initial distress, treatment duration, intra-group dependency, and format. Conclusions: Results support meta-analytic findings of format equivalence in a naturalistic setting for group and individual. Referral practices and future results are discussed.

The effects of relationship and progress feedback in group psychotherapy using the Group Questionnaire and Outcome Questionnaire–45: A randomized clinical trial.

Routine outcome monitoring (ROM) systems that identify clients at-risk for treatment failure using outcome and therapeutic process measures are a recognized evidence-based practice. However, only 3 empirical studies have tested ROMs in group therapy, producing mixed results. This randomized clinical trial tested the Outcome Questionnaire System, the ROM system with the most empirical support for individual therapy patients, with 430 group therapy patients who were randomly assigned to 2 experimental arms (Group Questionnaire [GQ] + Outcome Questionnaire–45 [OQ-45] vs. OQ-45). Given the strong evidence for progress feedback, the primary purpose of this study was to ascertain if therapeutic relationship feedback using the GQ reduced rates of relationship deterioration and failure when progress feedback was held constant. Group leaders simultaneously ran pairs of groups that were randomly assigned to the 2 conditions. Of the 430 patients enrolled in 58 groups, 374 attended more than 4 sessions. Results showed that therapeutic relationship predicted improvement in outcome and that feedback reversed the course of relationship deterioration and reduced rates of relationship failure. Although there were no effects on attendance and dropout for feedback, the 2 experimental arms produced mixed results for the OQ-45 not-on-track cases. The combined relationship and progress feedback (GQ/OQ-45) was associated with fewer outcome deterioration cases, while the progress feedback condition (OQ-45) showed higher outcome improvement cases. Findings are discussed with respect to previous group ROM studies, clinical implications, and future research.

Practice-based evidence can help! Using the Group Questionnaire to enhance clinical practice.

Practice-based evidence (Burlingame & Beecher, 2008) is an approach to evidence-based practice that addresses treatment efficacy to remediate clinicians’ inability to predict treatment response (Chapman et al., 2012; Hannan et al., 2005). The Group Questionnaire (GQ; Bormann, Burlingame, & Straub, 2011; Johnson, Burlingame, Olsen, Davies, & Gleave, 2005) is one practice-based evidence measure that supports clinical judgment to enhance psychotherapy outcomes by measuring 3 important group constructs: Positive Bond, Positive Work, and Negative Relationship. A clinical example of how one group leader used GQ data provided by group members regarding their weekly group experiences to support her interventions in a process-oriented therapy group for adults includes verbatim clinical exchanges among group members and the leader. The example also includes a GQ report with explanations of the group members’ scores and numerical and graphical data. The authors detail how the leader used the data from the measure to promote curiosity about group cohesion and movement toward treatment goals, to reframe perceptions of group interaction, and to gauge outcomes of shared group experience. The group leader’s examination of the GQ data outside the group allowed her to use this information for positive impact inside the group to guide interventions and explore content and process, warranting additional attention. The authors encourage curiosity about other interactions among other group members reflected in the GQ report and how this information could be used to positively impact the group in other ways.