Social Work News Headlines

Updated on: Sun, 22 Jul 2018 06:00:33 GMT

Introduction to special issue: Feedback in group psychotherapy.
The current issue highlights the necessity of feedback in group psychotherapy—both monitoring group member feedback during treatment and providing feedback to group members before and during group therapy. Regardless of the orientation or type of group, collecting members’ perceptions and experiences influences how the group leader identifies members who are struggling in the group or are at risk of dropping out. Providing group members with feedback during the pregroup preparation and throughout the therapy process is also helpful to group members as they work to obtain their goals in the group. The author describes what types of measures are useful, how collecting this information impacts the treatment process such as repairing ruptures, and how feedback relates to treatment outcome. Group leaders will be able to apply these articles and feedback processes to their groups, and group researchers will be able to identify future studies that are needed to move the field forward. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Developing a therapeutic relationship monitoring system for group treatment.
The use of outcome monitoring systems to identify clients that are at-risk for treatment failure has now become part of daily clinical practice, shown in >25 empirical studies to improve client outcomes. These promising findings have led to outcome monitoring systems being recognized as evidence-based. Feedback systems based on client perception of therapeutic processes are recent additions to the monitoring literature, and the research suggests that these too lead to improved outcomes. Unfortunately, feedback systems and research have been primarily limited to individual therapy, creating a knowledge gap for multiperson treatment. This study reports on the development of a therapeutic relationship monitoring system for group treatment using results from 6 Group Questionnaire (GQ) studies conducted in 4 unique clinical populations: nonclinical process, counseling center, European inpatient, and seriously mentally ill inpatients. The GQ is a factor-analytically derived scale, which assesses a client’s perception of 3 relationship quality constructs (positive bond, positive work, and negative relationship) across 3 structural domains (member–member, member–leader, and member–group). The first goal of the present study was to replicate the previously established factor structure across each clinical population. The second goal was to establish normative values and relevant feedback alerts for the GQ subscales in each population. Findings support the GQ factor structure across clinical populations, indicating that the constructs measured by the GQ bear similar relationships in each population. Further, findings support the implementation of unique norms and feedback alerts in each clinical population, reflecting the reality of meaningful differences between clinical populations. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

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. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Do clinicians really use feedback-monitoring systems? A qualitative analysis of 16 group leaders.
The use of feedback based on outcome and process measures to inform treatment is gaining ground as one form of evidence-based treatment. However, little is known regarding how therapists actually use feedback, particularly from process measures, to affect treatment. This two-part qualitative study used session-by-session and treatment-episode narratives from group therapists to define how they acted on process feedback from a member-completed measure of the therapeutic relationship: the Group Questionnaire (GQ). Therapists’ responses in the first wave of data were also used to develop a therapist-completed measure to quantify how feedback affected treatment. Sixteen group leaders received weekly session feedback reports on group members’ responses to the GQ from the preceding group session. Leaders explained how they used that feedback in two ways: (a) with session-by-session written descriptions of feedback use and (b) with end-of-semester debrief interviews in which leaders described their experience with the feedback over the course of an entire group treatment episode. A content analysis of leader descriptions was undertaken by two independent pairs of raters to determine whether common patterns of use could be uncovered. Thirteen common use categories emerged across the two rater pairs. A 7-item questionnaire reflecting the most frequently used categories of use completed at the end of group treatment was shown to be highly correlated with session-by-session leader narrative. Implications of the common use patterns across therapists, variability between therapists, and the potential of the 7-item questionnaire are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

An item reduction analysis of the Group Questionnaire.
There is a constant tension between having measures short enough for daily practice and long enough to provide useful information. Although shorter measures are more convenient for clients, fewer items necessarily mean less information, a loss of psychometrics, and possible floor and ceiling effects. This study examined the effects of shortening the Group Questionnaire (GQ) on its clinical utility and psychometric integrity. Creation of a 12-item GQ (GQ-12) was done using archival data with 1,087 participants gathered from counseling centers, nonclinical process groups, outpatient psychiatric hospitals, and an inpatient state hospital. Testing of the loss of clinical utility was conducted using archival data from 432 group counseling center patients. Analysis for creation of the GQ-12 was done using multilevel structural equation modeling. Items were selected using clinical judgment and statistical judgment considering interitem correlation and factor loading. Model fit was analyzed in comparison with the standards in the literature and with the full-length GQ. Loss of clinical utility was analyzed by comparing alerts generated by the GQ-30 with alerts generated by the GQ-12. The GQ-12 has good model fit and acceptable reliability. A significant number of alerts were lost by reducing the items (status alerts: sensitivity 82–93%, specificity 97–99%; change alerts: sensitivity 52–67%, specificity 99–100%). This study suggests that although it is possible to create a psychometrically sound, shortened version of a feedback measure, clinicians should be aware that helpful information is lost. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Does progress feedback enhance the outcome of group psychotherapy?
There is evidence that progress feedback combined with a clinical support tool (CST) improves treatment outcome in individual psychotherapy. This study examined the effect of feedback in combination with a CST in outpatient group psychotherapy. A prospective cohort study was performed with patients meeting diagnostic criteria for a major depressive disorder or an anxiety disorder. Patients received cognitive-behavioral group therapy or interpersonal group therapy and completed the Outcome Questionnaire-45 on a session by session basis. In the control cohort (N = 132), no feedback was provided. In the feedback cohort (N = 137), patients and clinicians received feedback on the treatment progress based on the Outcome Questionnaire-45. If a patient was deteriorating as compared with the start of treatment or the previous session, the CST was offered. Both cohorts showed a significant decrease in symptoms during therapy, but no significant differences existed on treatment outcome. The number of sessions was significantly lower in the feedback cohort. The results suggest that feedback in outpatient group psychotherapy does not improve outcomes but that fewer sessions may be sufficient to obtain outcomes similar to treatment as usual. More research with the use of progress feedback in outpatient group therapy is needed, especially with CSTs. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

It’s complicated: Using group member process-feedback to improve group therapist effectiveness.
Experienced leaders of psychotherapy groups are surprisingly inaccurate in their judgments about their members’ perceptions of positive bonding relationships with the leader and other group members. The practical implication is worrisome: the lower the leader’s degree of accuracy, the worse the member therapeutic outcomes tend to be. A promising approach to improving leaders’ appraisals of their members’ perceptions of positive bonding relationships is to provide them, after each session, feedback about their own and their members’ bonding relationship perceptions. Profiling trajectories of leaders’ and members’ perceptions over time yields rich “stories” of relationship development, that if strategically packaged into brief, concise, and vivid reports, and delivered as a formal “group member feedback” intervention, would direct leaders’ attention to those emerging, but easily overlooked, countertherapeutic relationships, requiring immediate, well-informed targeted interventions. To increase the utility of such reports, training leaders use intuitively appealing, but structured heuristics (“interpersonal-fit-with-the-group” and “intrapersonal-split-relationships”), accelerate leaders’ recognition of patterns in perceptions as they change over time, and free up their cognitive resources for determining whether to intervene into the group process at the appropriate level: intraindividual, interpersonal, or group-as-a-whole. To illustrate the use of these heuristics, we present two hypothetical cases, with visual displays of congruent and discrepant perceptions of bonding relationship perceptions between members over time, and make tentative recommendations about where and when leaders might intervene to achieve optimal impact. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Reciprocal influence of distress and group therapeutic factors in day treatment for eating disorders: A progress and process monitoring study.
Eating disorders (EDs) are chronic mental illnesses with high levels of psychological, social, and health burden. Day treatment programs (DTP) are effective group-based partial hospital models that have been used to treat EDs for several decades. However, few studies have examined the factors associated with reduced distress in ED patients who participate in DTP groups. Related to this is whether change in distress is preceded by change in positive group processes, or vice versa. In this study, we examine the reciprocal relationship between growth of group therapeutic factors and change in distress in an ED sample. Participants were patients with an ED (n = 156) who took part in a 12-week DTP at a tertiary care hospital center. On a weekly basis, patients completed progress- and process-monitoring measures. We hypothesized: (a) positive changes in distress and in group therapeutic factors across weeks of DTP and (b) a bidirectional relationship between change in distress and group therapeutic factors. We found a significant growth of group therapeutic factors and decline in distress over the 12 weeks of DTP. We also found evidence for a reciprocal relationship between change in group therapeutic factors and change in distress. Group therapists working in DTPs for patients with EDs can enhance the benefits of treatment by focusing on group therapeutic processes, which in turn reduces distress, which then acts to enhance the ability of an individual to benefit from group interactions. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Specific formulation feedback in dynamic-relational group psychotherapy of perfectionism.
In this article, we describe how individualized feedback, in the form of a clinical formulation, is used in our dynamic-relational group treatment of perfectionism (Hewitt et al., 2015), a core vulnerability or transdiagnostic personality factor. The authors discuss briefly their conceptualization and assessment of perfectionism as well as other aspects of patients’ functioning, and the use of both psychodynamic and interpersonal models to derive, for individual patients, their unique formulation or idiosyncratic model of their perfectionistic and related behavior. Moreover, we describe the process of providing the formulation feedback to each patient in preparation for group psychotherapy and, finally, provide an illustrative case. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Innovations in group assessment: How focused brief group therapy integrates formal measures to enhance treatment preparation, process, and outcomes.
Focused brief group therapy (Whittingham, 2015) is an integrative interpersonal approach to brief group therapy that uses formal assessment to guide and inform treatment. By utilizing assessment as a key part of real-time clinical feedback throughout treatment, multiple therapeutic goals are enhanced. This article addresses 2 specific uses of assessment within focused brief group therapy—to focus treatment around interpersonal subtype distress and to inoculate clients against self-sabotage. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

Routine measurement and feedback in support groups for parents of children with autistic spectrum disorder.
Support groups for parents of children with Autistic Spectrum Disorders (ASD) are very common in public mental health settings. These groups have been found to be helpful in reducing parental stress and providing parents with professional knowledge as well as peer support. Clinical experience, as well as parents’ verbal feedback, often indicates that within these groups there are occasionally unmet needs that are not expressed during sessions. In this article we describe the benefits of using routine measurement and feedback as means to identify and address such needs. The article presents clinical examples of how routine measurement and feedback can assist group leaders in the delicate and often complex work of responding to both individual and group processes and in adapting group structure according to the specific needs of the individuals participating in the group. A demonstration of rupture and repair patterns, identified and facilitated by the use of feedback, is followed. Finally, we discuss the benefits of routine measurements in support groups that utilize a rolling group structure, as a means to accurately assess their effectiveness. We briefly conclude with the need for further studies on routine measurement of parents’ groups, aimed at gaining knowledge needed to provide a better adjustment for both parents and children coping with ASD challenges. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

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. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

The impact of providing group performance feedback on a large mental health system.
Over a 2-year period, quality measures were instituted in the behavioral health services of Mercy Health (Ohio and Kentucky), one of the largest not-for-profit health systems in the United States. More than 25,000 patients were seen during this period across two states, in inpatient, partial hospitalization and intensive outpatient units. The Outcome Questionnaire 30.2 (Lambert, Finch, Okiishi, & Burlingame, 2005) was used at admission and discharge for the purposes of quality improvement, and results were integrated into quality improvement processes such as group supervision, telepresence supervision, and site accountability. This article will discuss how measurement provided an essential foundation for continuous quality improvement processes, leading to enhanced outcomes for patients with severe and persistent mental illness and addictions. (PsycINFO Database Record (c) 2018 APA, all rights reserved)