group analytic poster presentation final

ABUHB Presentation 2015

Poster presentation to Aneurin

Bevan University

Health Board

An Evaluation of a 3 year Group Analytic Therapy intervention with service users (of secondary

mental health care) in the welsh valleys

[email protected] June

23rd, 2015


What is Analytic Group Psychotherapy ?

• Group analysis combines a psychoanalytic and social approach to groups.

• It considers the group to be the ideal medium for therapeutic change based on the reciprocal relationship between the individual and the group

• “Group analysis is a form of psychotherapy by the group and of the group including it’s conductor

• It aims to achieve a healthier integration of the individual in their network of relationships” Institute of Group Analysis 2015


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Literature Review 1• Review of 74 studies indicated that Group

therapy is as effective as individual therapy (Toseland & Siporin 1986).

• Comprehensive reviews by Dies 1993, Piper 1993, McRoberts 1998 indicated group therapy compares favourably to individual therapy. McRoberts was a meta analysis of 23 outcome studies comparing individual to group therapy.

• Group therapy is equally effective as individual for depression and personality disorder (Robinson 1990). Supported by meta analyses by Tyllitski(1990), Budman 1998.


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Literature Review 2• McDermut 2001 reviewed 48 studies showing

statistically significant reductions in depressive symtoms following group psychotherapy.

• Cogan and Porcerelli (2003) found that group therapy decreases aggression and dysthymia in clients

• Terlidhou 2004 found an overall reduction for symptoms for clients as follows : less concern with their illness, lower conversion of psychological conflicts into physiological concerns, less anti social behavior, less paranoia, less bizarre behaviours exhibited.


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Literature 3• Burlingame, in another meta study found that group

psychotherapy offered significant benefits to depressed clients (2003), in 71% of cases he found that client diagnoses indicated demonstrable improvement

• De Chavez (2000) found that group therapy increases hope, cohesiveness and altruism of clients who have schizophrenia

• Burlingame (2011) found that group ‘cohesion’ was reliably (r 0.25) associated with improvements in outcome for clients in groups defined as reductions in their symptoms and improvements in interpersonal functioning

• Regular attendance has also been found to be a marker of cohesion (Fallon 1981, Yucksel et al 2000).

• In 2011 Burlingame began to identify what he termed as ‘positive therapeutic interventions’ : these include promoting interaction, encouraging patient communications, promoting insight and explaining the rationale for interventions


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Attendance At Case Study Group


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Attendance0

10

20

30

40

50

60

70

80

90

Year 1

Year 2

Year 3


Composition of Case study group• Group sized 8 : 4 men and 4 women• Duration 3 years, patients advised a minimum 2 year stay• 131 sessions held on a weekly basis between September 2011 to September 2014

Attendance• 79% overall average Year 3 • 85% overall average Year 2 • 80% overall average Year 1 • 2 out of 8 in paid employment• 2 out of 8 in voluntary work (rising to 4 out of 8 in year 3)


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Attendance & Retention In Case Study Group By

GenderSessions attended

Men % Women % 131 sessions in total over 3 years

Year 1 87 75Year 2 91 79Year 3 84 71

Year 1 100 100Year 2 100 100Year 3 100 50


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Case Study Group Mental Health Issues

Group Issues 8=100%Previous Suicide attempts 7 out of 8DSH 5 out of 8Self reported depression 8 out of 8Personality disorder 6 out of 8Addiction/substance misuse 5 out of 8Domestic violence 7 out of 8Psychosis 2 out of 8Reported Child abuse (physical/sexual) 4 out of 8


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Benefits of Group & Individual therapy


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Breaks isolationDiversity of perspectiveSees the problems enactedLoosening of fixed viewsMembers give & receiveImproves communication skills & effectivenessAllows time to build trustOffers a BenchmarkDevelops toleranceObserves, bears witness & learns from peers

Possibility of a more intense attachmentMore individual attentionMore in depth workLess exposingPotentially SaferFewer risksGuaranteed to get heard

Ben

efits

of G

RO

UP

Psy

chot

hera

pyB

enefits of IND

IVID

UA

L psychotherapy


Research Cycle


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Year 1 therapy

1st year focus group

Year 2 Therapy

2nd year focus group

Year 3 Therapy

3rd year focus group


Emergent Group Themes

Emergent themes


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Emergent Group Themes

Shadow themes


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Evolving Roles of group participants


23rd, 2015ABUHB Presentation 2015

Exile/ Isolate

(Impartial maybe

ambivalent)

Observerreflecting

back to you, feeding back,

observing self

WitnessBroadening perspective,

dev-ing tolerance

MemberGives & receives

support/empathy

Identification

ActorDiscloser, opens up,

takes risks, relaxes

Experimenter

(Uses group as testing ground for external change)


• “Life is still hard but analytic group therapy can provide a

stable base from which people with (mild, moderate and

severe) mental health issues can build up trust, break out of

their isolation and more positively reconnect with themselves,

each other and with their community”

Risks

• The group can replay distressing themes for members. As the work gets deeper, those in

more ambivalent/co dependent relationships may find continued membership of the group

more challenging to their status quo (at home). This can increase the risk of premature

departures for some members or scapegoating for others.


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Moderation of treatment

However risks can be moderated by

• Highly skilled facilitation,

• Considering support for member’s families,

• Ensuring good supervision is in place for therapists

• For the model to consider the possibility of 2 facilitators for groups where there is a predominance of severe mental health problems.


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Some Limitations Of Focus Group Research With

The Case Study Group• Absence of some members of the group in each year of the evaluation.

• The presence of the same ‘social dynamic’ operating in the focus group, as in the therapy group, even though each had a different facilitator.

• The writer of this holds the dual role of therapist and analyser/reporter of the outcome (though not the focus group facilitator).

• Had different methodology been used, then different data may have surfaced.

• This was one group, led by one therapist, two supervisors and one focus group facilitator over three years. However the length of the study and the consistency of the group and of those holding facilitative roles probably lends some coherence to these findings.


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Recommendations① Service users unanimously requested that the health board

consider including a rolling analytic group as part of the repertoire of therapeutic services offered by the local Health Board.

② At the assessment process, establish levels of family support for the intervention. Consider ways of involving, enhancing or engaging families in supporting clients in their therapy.

③ To ensure that an appropriately qualified therapist facilitates the group and has access to regular appropriate supervision.

④ To continue to regularly evaluate the experience of service users across the range of interventions.

⑤ Service users valued and felt valued by the research process. They were pleased to be asked about their views and consulted about their treatment. This, in itself, may have been additionally therapeutic.

[email protected] June 23rd, 2015

mailto:[email protected]

mailto:[email protected]


Final Poster

•Final poster


23rd, 2015

group analytic poster presentation final

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