¿Qué es el grupoanálisis? / What is group analysis?

En este trabajo exponemos las características de lo que para nosotros es el grupoanálisis, diferenciándolo de otras formas de psicoterapia de grupo. Es el resultado de nuestros años de experiencia y aprendizaje. Explicamos también los criterios formativos emanados de la European Group Analytic Training Institutions Network (EGATIN), que son los que se siguen en los cursos formativos de los que formamos parte. (AU)

In this paper we expose the characteristics of what group analysis is for us, differentiating it from other forms of group psychotherapy. This is derived from our clinical experience and training process. We also explain the training criteria decided by the European Group Analytic Training Institutions Network (EGATIN), which are the ones we follow in the training courses we lead. (AU)

La formación del psicoterapeuta grupal / Training in group psychotherapy

En los servicios de salud mental de nuestro país se da un escaso desarrollo de la psicoterapia en general, y de la psicoterapia de grupo, en particular. Estas carencias generan la necesidad de mejorar la formación en psicoterapia de grupo de nuestros psiquiatras y psicólogos, que ha de ser realizada siempre con metodologías grupales. La psicoterapia de grupo es el instrumento terapéutico que posibilita elaborar el sufrimiento de la población que atendemos, además de producir cambios subjetivos. Por ello, ha de ser la estrategia de elección en las psicopatologías leves y moderadas, y en las graves, combinada con psicoterapia, ya que, además, es la única estrategia terapéutica capaz de resolver el alto número de personas que acuden a las consultas de la red de salud mental. Finalmente, señalamos cuáles han de ser los pilares de la formación y, para resolver las carencias en la formación de nuestros profesionales, proponemos un programa de formación en psicoterapia de grupo para los futuros especialistas, psiquiatras y psicólogos

There is a lack of development in psychotherapy, particularly in group psychotherapy, in mental health services in Spain. The training of our psychiatrists and psychologists in group psychotherapy is of great importance, since it is a first-line treatment choice in the case of mild and moderate psychopathology, and also in the severe one, combined with psychotherapy. On the other hand, it allows to deal quickly and effectively with the subjective suffering of the population we serve, and is the only therapeutic strategy capable of meeting the needs of the large number of people that seek our help. We propose a training program in group psychotherapy, using group methodologies in both supervision and training, and formulate a series of proposals to improve the training of our professionals

Can education and training improve the adoption of a psychosocial group treatment by dementia services?

OBJECTIVE: Cognitive stimulation therapy (CST) is a psychosocial group treatment for people with dementia. The aims of this project were to (a) evaluate the effectiveness of a one-day training workshop; (b) measure the uptake of CST following the workshops; and (c) explore the barriers of implementing CST. METHOD: Ten workshops were conducted. Attendees completed a self-evaluation at the end of the training day and were later invited to complete an online survey enquiring about implementation. RESULTS: Two hundred and fourteen workshop attendees completed the self-evaluation. The mean self-rated knowledge and skills for conducting and facilitating CST (1 = No skills, 5 = Very good skills) was 2.3 (SD = 1.2) and 4.3 (SD = 0.7) before and after the workshop, respectively (p = 0.000). The mean self-rated confidence for applying learning to conducting and facilitating CST was 4.2 (SD = 0.7) (1 = Not confident, 5 = Very confident). There were 11 CST programmes started after the workshops and another 10 sites were in the process of starting CST programmes. The main barriers of implementation were lack of staff time/funding and problems of finding suitable participants with dementia. CONCLUSIONS: The one-day training workshop is an effective method to disseminate CST. Addressing the barriers identified could improve the adoption of CST in practice.

Multimethod Formative Research to Improve the Training and Delivery of Tobacco-cessation Interventions in Behavioral Health Settings.

INTRODUCTION: Despite progress in reducing tobacco use within the general population, high prevalence of tobacco use continues in individuals with mental health and substance use disorders ("clients"). Tobacco use persists as the leading cause of premature mortality in this population. While behavioral health providers have frequent contacts with this population, they lack training in tobacco cessation counseling. METHODS: We conducted multimethod formative data collection consisting of key informant interviews with providers, field observations at clinical sites, and structured group interviews with behavioral health providers, and, separately, clients. Activities were conducted at 4 behavioral health agencies with 9 behavioral health clinic sites in southern Arizona. Recurring phrases and level of repetition were quantified to identify themes. These themes were then used to adapt the method of training delivery and revise the curriculum content for providers at the participating sites. RESULTS: Results indicated that providers had "training fatigue" and low satisfaction with multiple, online trainings. Further, providers noted issues including time constraints, competing clinical priorities, and low access to tobacco-cessation materials. Clients demonstrated high self-awareness around the importance of quitting smoking and professed frustration at being unable to quit, despite multiple attempts. Finally, both providers and clients agreed that a personal, supportive approach to cessation counseling was preferred. CONCLUSIONS: Using results from this formative research to revise delivery and content of existing smoking-cessation training for behavioral health providers may address barriers to assisting clients with smoking cessation. Additional research to determine the efficacy of the adapted training is needed.

A statewide initiative to train behavioral health providers in smoking cessation.

Individuals with mental health and substance use disorders smoke at rates two to four times higher than the general population and account for over half of smoking-related deaths. Building capacity of behavioral health providers to provide smoking cessation treatment may decrease smoking prevalence in these groups. The present study evaluated a statewide rollout of a capacity building training program to teach behavioral health providers to deliver a manualized smoking cessation group intervention for patients with mental health and substance use disorders. Behavioral health treatment providers (N = 333) participated in a day-long training. Pretraining and posttraining evaluations were conducted on the day of training to assess changes in confidence, attitudes, and knowledge regarding smoking cessation and possible barriers to implementing the smoking cessation curriculum in treatment programs. These constructs were reassessed in follow-up surveys conducted online 2 and 6 months posttraining. A subset of providers participated in follow-up telephone calls to discuss implementation of smoking cessation programming. Posttraining evaluations indicated that trainees' confidence, attitudes, and knowledge of smoking interventions improved. Follow-up surveys indicated that these gains decreased but were maintained above baseline. Over one-half of survey respondents reported taking at least one implementation step. Interviewees reported that agency and staff-level barriers such as difficulty coordinating a group, staff turnover, and inadequate time with clients precluded more widespread implementation. Training for behavioral health providers is effective in improving confidence, attitudes, and knowledge regarding smoking cessation interventions. Consistent implementation requires ongoing support and agency problem solving to address common barriers.

Training clinicians to deliver group CBT to manage anxiety in youth with ASD: Results of a multisite trial.

OBJECTIVE: Few guidelines are available regarding optimal training models for practitioners delivering cognitive-behavioral therapy (CBT) for anxiety in youth with autism spectrum disorder (ASD). The present study systematically compared 3 instructional conditions for delivering the Facing Your Fears program (FYF) to children with ASD and anxiety. METHOD: Thirty-four clinicians (Mage = 34 years; 94% women, 88% Caucasian) and an intent-to-treat sample of 91 children with ASD and anxiety (Mage = 11; 84% male 53% Caucasian) met eligibility criteria across 4 sites. A 3-group parallel design via a Latin square procedure was used to randomize 9 teams of clinicians to 1 of 3 training conditions: Manual, Workshop, Workshop-Plus. The effectiveness of instructional condition was assessed via implementation (CBT knowledge, treatment fidelity) and treatment outcomes (reductions in anxiety as measured by the Anxiety Disorders Interview Schedule-Parent (ADIS-P). RESULTS: Clinicians in both Workshop conditions significantly increased CBT knowledge postworkshop, F(1, 18) = 19.8, p < .001. Excellent treatment fidelity was obtained across conditions (above 89%), although clinicians in the Workshop conditions obtained significantly higher fidelity ratings and delivered FYF with greater quality than the Manual condition. Children with ASD demonstrated significant reductions in anxiety symptoms for three of the four anxiety diagnoses, with no differences noted across instructional condition. Rates of improvement were lower than those obtained in a previous controlled trial. CONCLUSIONS: Results suggest that although there may be some advantage to participating in a Workshop, clinicians in all conditions could deliver FYF with excellent fidelity and yield positive treatment outcomes. Lack of a no-treatment comparison group limits interpretation of findings. (PsycINFO Database Record

Innovative Clinical Training Site for Psychiatric Mental Health Nurse Practitioner Students: Elementary School-Based Group Therapy (Manuscript ID UMHN-2017-0143).

The aim of this clinical training site innovation is to develop accessible pediatric mental health clinical training sites for psychiatric mental health nurse practitioner (PMHNP) students. Mental health services in school settings provide treatment in the child's community and create opportunities for innovation and collaboration with teachers, school counselors, and school psychologists. School settings provide opportunities for early recognition of anxiety symptoms and accessible treatment that can help close the gap in clinical training sites for this population. Mild and moderate symptoms of anxiety often go untreated and may affect academic performance negatively. Cognitive behavioral play therapy is an effective treatment modality provided by PMHNP students and supports the roles of school personnel.

The development and efficacy of a group intervention program for individuals with serious mental illness in jail.

Providing cost-effective means to treat the influx of individuals with serious mental illness entering the correctional system is a major challenge. Failure to provide appropriate mental health treatment may lead to poor outcomes, including recidivism and suicide. Group intervention is an effective and cost efficient way to provide mental health treatment. However, it has been understudied in jail settings. To meet the needs of jail-inmates with serious mental illness, an eight-week group-based module curriculum was developed and studied through analyses of perceived usefulness, retention of key material, and associations with cognitive ability, improvement in psychiatric symptoms, and level of motivation. One week after the completion of a group session, the participants remembered the group topic and at least one key point from the group the majority of the time. Better recall of group material was associated with better overall cognitive ability and motivation at discharge. Participants found the groups to be somewhat to extremely useful 88.4% of the time. Higher levels of usefulness were associated with reduced psychopathology and psychiatric improvement, as well as higher motivation at discharge. The findings provide support for the group intervention and implementation in a jail setting. Further implications are discussed.

Process-oriented dynamic group psychotherapy for depression as a teaching modality in a family medicine residency program- A pilot study.

Background and Objectives This pilot study provides a description and evaluation of process-oriented dynamic group psychotherapy for depression as a teaching modality for family medicine residents. The main purpose of using this modality was to teach family medicine residents a variety of psychological clinical skills. A secondary benefit of this modality was to provide in-house, primary care treatment to depressed patients, although the efficacy of this was not evaluated in the present study. Methods A 10-item, self-report, Likert-type questionnaire was administered to a convenience sample of family medicine residents who had participated in the program. Results Completed questionnaires were received from 100% of the family medicine resident participants. Responses to the questionnaires indicate that the residents felt they acquired a variety of clinical skills from the training modality, to include developing active listening and interviewing skills; methods to improve the doctor-patient relationship; increased skills in empathy, intuitive processes, and emotional support; a depth understanding of how intra-psychic conflicts and interpersonal problems contribute to depression; how to give effective feedback that promotes behavioral change; and how to place interventions at the appropriate level of change. Eighty-eight percent of residents indicated they would recommend this learning modality to a family medicine physician colleague. Conclusions The family medicine residents' responses to the questionnaires indicate that they perceived process-oriented dynamic group psychotherapy for depression as a constructive and beneficial modality for both patient care and learning a variety of clinical skills.

Using Psychoeducation and Role Induction to Improve Completion Rates in Cognitive Behavioural Therapy.

BACKGROUND: Pre-treatment role induction interventions have been suggested to potentially enhance attendance and clinical outcomes in psychotherapy. AIMS: This study aimed to evaluate the effects of a programme of three transdiagnostic seminars (TDS) for patients with common mental disorders accessing cognitive behavioural therapy (CBT) in primary care. TDS included CBT psychoeducation and role induction. METHOD: A random sample of patients (n = 49) participated in TDS followed by CBT (TDS+CBT) and they were compared with matched controls (n = 49) accessing usual CBT. TDS participants rated the relevance and quality of this intervention using an acceptability questionnaire (AQ). Treatment completion (vs dropout) rates were compared across groups using chi-square tests. Post-treatment changes in depression (PHQ-9) and anxiety (GAD-7) symptoms were compared between groups using analysis of covariance controlling for potential confounders. Analyses were based on intention-to-treat principles. RESULTS: Mean AQ ratings of the TDS intervention were comparable across diagnostic groups (p = .05). Treatment completion rates were significantly higher (p = .02) in the TDS+CBT group (87.8%) by comparison with usual CBT (68.8%). However, no significant differences in post-treatment symptom changes were found for depression (p = .34) or anxiety measures (p = .71). CONCLUSIONS: Incorporating a psychoeducational role induction prior to CBT significantly improved treatment retention, but not overall symptom reductions.

Feasibility and effectiveness of a combined individual and psychoeducational group intervention in psychiatric residential facilities: A controlled, non-randomized study.

This controlled, non-randomized study explored the feasibility of introducing a Combined Individual and Group Intervention (CIGI) for users with mental disorders in residential facilities, and tested whether users who received the CIGI had better functioning than users who received the Treatment-As-Usual (TAU), at two-year follow up. In the CIGI, a structured cognitivebehavioral approach called VADO (in English, Skills Assessment and Definition of Goals) was used to set specific goals with each user, while Falloon's psychoeducational treatment was applied with the users as a group. Thirty-one professionals attended a training course in CIGI, open to users' voluntary participation, and applied it for two years with all users living in 8 residential facilities of the Mental Health Department of Modena, Italy. In the same department, 5 other residential facilities providing TAU were used as controls. ANOVA for repeated measures showed a significant interaction effect between users' functioning at baseline and follow up assessments, and the intervention. In particular, change in global functioning was higher in the 55 CIGI users than in the 44 TAU users. These results suggest that CIGI can be successfully introduced in residential facilities and may be useful to improve functioning in users with severe mental disorders.

Impacto de una intervención grupal psicoeducativa para pacientes con depresión leve/moderada en las consultas de atención primaria / Impact of a psychoeducational group intervention for patients with mild/moderate depression in primary care

Objetivo. Analizar el impacto de los grupos psicoeducativos para pacientes con depresión leve/moderada en relación con la frecuentación de las consultas de Atención Primaria, el consumo de ansiolíticos y antidepresivos y el número de días de incapacidad temporal de los pacientes que realizaron la intervención grupal frente a aquellos que no la realizaron. Método. Ensayo aleatorio controlado, longitudinal, prospectivo de dos cohortes en 13 Equipos de Atención Primaria de Barcelona ciudad. 232 pacientes: 120 del grupo intervención y 112 del grupo control. Las variables del estudio fueron: sexo, edad, estado civil, nacionalidad, nivel de estudios, situación laboral, consumo de ansiolíticos y/o antidepresivos, número de días de baja laboral, sintomatología depresiva, calidad de vida, comorbilidad asociada y frecuentación de las consultas de médico y enfermera de Atención Primaria. Resultados. El 69.7 % de la muestra total eran personas sanas. La frecuentación del grupo control y del grupo intervención en las consultas de enfermería representó una reducción de 2 puntos en la media de visitas realizadas durante el año previo a la intervención y el año posterior a la intervención. Esta frecuentación no quedó afectada en el grupo control ni en las visitas al médico de familia. Se observó una reducción en el número de bajas de aquellas personas que han realizado la intervención grupal. Conclusiones. La intervención grupal psicoeducativa para pacientes con depresión leve/moderada disminuye la frecuentación de los pacientes en las consultas de enfermería y reduce el número de personas que solicita una baja laboral después de la intervención (AU)

Objective. To analyze the impact of psycho-educational groups for patients with mild/moderate depression in relation to attendance in primary care consultations, the consumption of anxiolytics and antidepressants and the number of days of temporary disability of patients who performed the intervention group versus those not performed. Method. Controlled, longitudinal, prospective cohorts in 13 primary care teams of Barcelona city randomized trial. 232 patients, 120 intervention group and 112 in the control group. The study variables were: sex, age, marital status, nationality, education level, employment status, consumption of anxiolytics and/or antidepressants, number of working days, depressive symptoms, quality of life, co-morbidity and attendance in consulting physician and primary care nurse . Results. 69.7 % of the total sample were healthy persons frequenting the control group and intervention in the nursing represented a reduction of 2 points in the average number of visits made during the pre-intervention year and the year after the intervention. This was not affected attendance in the control group and in visits to the family doctor. A reduction was observed in the number of casualties of those who have made the group intervention. Conclusions. The psychoeducational group intervention for patients with mild/moderate depression makes decrease the assistance frequency of the patients to nurse consultory. Patients who have assisted to psychoeducational group intervention tend to apply less for the medical leave (AU)

Group Psychotherapy in Italy.

This article describes the history and the prevailing orientations of group psychotherapy in Italy (psychoanalytically oriented, psychodrama, CBT groups) and particularly group analysis. Provided free of charge by the Italian health system, group psychotherapy is growing, but its expansion is patchy. The main pathways of Italian training in the different group psychotherapy orientations are also presented. Clinical-theoretical elaboration on self development, psychopathology related to group experiences, and the methodological attention paid to objectives and methods in different clinical groups are issues related to group therapy in Italy. Difficulties in the relationship between research and clinical practice are discussed, as well as the empirical research network that tries to bridge the gap between research and clinical work in group psychotherapy. The economic crisis in Italy has led to massive cuts in health care and to an increasing demand for some forms of psychological treatment. For these reasons, and because of its positive cost-benefit ratio, group psychotherapy is now considered an important tool in the national health care system to expand the clinical response to different forms of psychological distress.

Group Psychotherapy in Finland.

This article describes the development of group psychotherapy in Finland as a treatment in the 1950s, 1960s, and 1970s. Different theoretical preferences split the training programs into two; both are now trying to survive in a psychotherapeutically changing landscape. All training programs have been transferred to the universities, but a lack of interest in, and knowledge about, group psychotherapy has resulted in fewer students choosing this program. This may result, in the future, in even less knowledge of, and research in, group dynamics in Finland.

Group Psychotherapy in Denmark.

This is a short article on the history and training standards in the Institute of Group Analysis in Copenhagen (IGA-CPH). We describe theoretical orientations and influences in the long-term training program and new initiatives, like courses in mentalization-based group treatment and a dynamic short-term group therapy course, as well as research in group psychotherapy in Denmark. Some group analytic initiatives in relation to social issues and social welfare are presented, as well as initiatives concerning the school system and unemployment.

Group Psychotherapy in the United Kingdom.

In the United Kingdom (U.K.), group therapy is one of the most widely practiced methods, with a broad range of applications and an extensive literature. The terminology used here is based on the author's chapter in The New Oxford Textbook of Psychiatry (Schlapobersky & Pines, 2008). We used two factors-therapeutic goals and group leadership-to provide a classification of different models and applications. We described group therapy as a method, group analysis (for example) as a model, and an in-patient or weekly group as an application of a model.

Group Psychotherapy in Canada.

Canada is a relatively young country, spanning a vast geographical area; yet, it has matured quickly, becoming a diverse, prosperous, and proud nation. The development of group psychotherapy in this country has followed a similar path: its roots can be traced back to fairly recent times, but it has given rise to a rich fabric of practice, teaching, and research traditions. This article provides a brief synopsis of how group therapy is provided, taught, and studied in Canada. Given the growing emphasis on providing group therapy, we recommend that Canadian mental health services invest in continuing education in group therapy; accrediting bodies require that foundational knowledge in group principles be taught to all trainees; and institutions encourage researchers to engage clinicians in practice-based research.

Group Psychotherapy in Egypt: Past, Present, and Future.

Egypt has a central position in Africa and the Middle East. Events in the last few years have brought Egypt to the forefront of the world's interest in politics, sociology, and group psychology. This paper explores the evolution, development, and current status of group psychotherapy and group processes in Egypt. Starting from times of old in Pharaonic, Islamic, and Christian cultures, the paper discusses the theoretical orientation of contemporary group psychotherapy in the country, its status in the health care system, its training and research opportunities, and its current and future challenges.

Working at the Periphery: A View of Group Psychotherapy in Australia.

Australia is a vast country with a relatively small population living in cities separated by long distances. It is a wealthy country with a highly developed mental health system in which psychotherapy has a limited, but recognized, place. Group psychotherapists are a small but active community within that mental health world. Limitations in numbers, influence, and authority have left group psychotherapy on the margins of universities and major mental health organizations. A commitment to thoughtful clinical work, a willingness to reach out to vulnerable people, and some signs of flexibility in clinical approaches promise a strengthening of the role of group psychotherapy in Australia.

Group Therapy Graduate Seminar: A Developmental Perspective.

Teaching group therapy is an essential aspect of graduate studies within the helping professions. Existing models discuss four basic elements required for such training: experience, observation, supervised practice, and theory. The present paper offers a model for a group therapy seminar based on these four elements and organized along developmental concepts. Clinical observations of 120 psychology students who participated in the seminar were gathered over a five-year period. Teaching techniques included supervised observation, fish-bowl, one-way mirror, and a final paper integrating theory and practice. The seminar enabled students to practice and to theorize about group processes, both as participants and as co-leaders. Seminar outcomes and conclusions are discussed.