The current study represented a replication of previous research, addressing measures of interpersonal relatedness as predictors of outcome for dynamically oriented, short-term group (STG) psychotherapy for patients presenting with complicated grief. In an analysis of data from a comparative trial of two forms (interpretive, supportive) of STG therapy (n = 107), Ogrodniczuk, Piper, McCallum, Joyce and Rosie reported that three distinct indices of interpersonal relatedness-quality of object relations, current social functioning and attachment insecurity-each had significant relationships with measures of treatment outcome, with attachment insecurity emerging as the strongest predictor. The current study (n = 110) was based on data from a subsequent trial of the two therapy approaches that examined the effect of group composition on outcome, by Piper, Ogrodniczuk, Joyce, Weideman and Rosie. Predictor variables and outcome factors involved in the current analyses were similar or identical to those employed by Ogrodniczuk et al., and an identical analytic strategy was followed. Only the patient's attachment insecurity emerged as a strong predictor of psychotherapy outcome, providing a replication of the key finding from the previous study. The clinical implications and limitations of the results are discussed.

This study examined the effect of age on attending and completing different types of group therapy among psychiatric outpatients, and whether cohesion among group members mediates the effect of age on attendance. The sample consisted of 139 outpatients who began short-term interpretive or supportive group psychotherapy. Hierarchical regression analysis and Kaplan-Meier survival analysis were used to test the effect of age on attending and completing therapy. Mediation analysis was used to examine whether cohesion mediated the effect of age. Significant associations between age, session attendance, and termination status were found for patients receiving supportive group therapy. Age was directly related to attending and completing therapy. Quality of the relationships among patients (i.e., cohesion) was found to mediate the effect of age on attendance. Depending of the type of group therapy offered, younger patients may be at risk for poor treatment adherence. Difficulty forming positive relationships with other group members may contribute to this risk.

Alexithymia is a patient characteristic that reflects deficits in the cognitive processing and regulation of emotions. It is generally considered to have an adverse effect on the outcome of psychotherapy. Little is known about the processes through which alexithymia exerts this effect. One proposed mechanism suggests that patients with alexithymia trigger negative therapist reactions that contribute to poor outcome for such patients. This study examined whether therapist reactions to a patient mediate the relationship between alexithymia and outcome in group psychotherapy for complicated grief. Alexithymia was assessed with the Toronto Alexithymia Scale-20. Therapist reactions to a patient, reflecting the therapist's perceptions of a patient's positive qualities, personal compatibility, and significance as a group member, were assessed with a cohesion questionnaire. Outcome in several areas of functioning was measured. We found that alexithymia (specifically, greater difficulty in communicating feelings and greater tendency to engage in externally oriented thinking) was associated with less favorable outcome and that this relationship was mediated by therapist reactions to a patient. The mediation provided by therapist reactions to a patient accounted for approximately one third to one half of the direct effect of alexithymia on psychotherapy outcome. This suggests that therapist reactions to a patient represent a major mechanism through which alexithymia exerts its effect.

Extant pharmacological literature seems to indicate that antidepressants are the most effective treatment for depression. However, there are flaws in the traditional paradigm for evaluating the efficacy of antidepressants. The traditional paradigm in pharmacology has adopted a biologically monistic causal structure, suggesting that the efficacy of antidepressants resides exclusively in biological pathways. The current paradigm in pharmacology has ignored the potential impact of psychological factors associated with the efficacy of antidepressants. This has occurred because psychological effects are seen as being a “paradigmatic anomaly,” phenomena that are at odds with the traditional paradigm. Thus, the psychological factors associated with the administration of antidepressants have collectively been labeled as a “placebo effect” and discounted as a potential treatment pathway. However, empirical evidence suggests that the psychological factors, such as the formation of patient expectancies and a therapeutic alliance between physician and patient, increase the efficacy of antidepressants. Consequently, the current paper proposes the adoption of a transactional model that reflects the reciprocal interaction between psychological and biological factors associated with the efficacy of antidepressants.

Rates of patient-initiated premature termination in different forms of psychotherapy are consistently high. Patient-initiated premature termination is recognized as a significant obstacle to the effective and efficient use of psychotherapy. The literature describes many strategies for preventing premature termination, but lacks integration. This review attempts to provide a concise and comprehensive summary of the strategies that research or clinical experience have suggested may be useful for minimizing patient-initiated premature termination. A search was conducted on the MEDLINE, PsycINFO, and EMBASE databases for literature published between January 1970 and March 2004. Retrieved articles were published in English in peer-reviewed journals and focused on psychotherapy for adults. Thirty-nine publications that discussed strategies for preventing or reducing patient-initiated premature termination of psychotherapy were identified. Surprisingly, only 15 of these were research studies. Most of the retrieved literature consisted of clinical descriptions. The strategies can be assigned to nine categories: pretherapy preparation, patient selection, time-limited or short-term contracts, treatment negotiation, case management, appointment reminders, motivation enhancement, facilitation of a therapeutic alliance, and facilitation of affect expression. Research supports some of the strategies for reducing premature termination. However, methodologically sound studies of prevention strategies remain few in number.

This study investigated the relationships between initial level of alliance, pattern of alliance over sessions, and outcome in a sample of 107 patients who completed short-term group therapy for complicated grief. Both patient-rated alliance and therapist-rated alliance were studied. For patient-rated alliance, both the initial level of alliance and the linear pattern of alliance were directly and significantly related to favorable outcome. For therapist-rated alliance; no significant direct relationships with outcome were found. Instead, significant interaction effects were found. For patients with relatively high initial-alliance, the greater the increase in alliance over sessions, the better the outcome. For patients with relatively low initial alliance, the greater the decrease in alliance over sessions, the better the outcome. Explanations for the findings,are considered as well as possible clinical implications.

Background: Most investigations of residual symptoms have focused on partial responders to antidepressant medications. Comparatively few have examined residual symptoms among patients who achieved a more successful response to treatment. In addition, few studies have assessed residual symptoms among patients treated with psychotherapy. The purpose of the present study was to assess residual symptoms of depression among psychiatric outpatients who successfully responded to psychotherapy and determine their association with other important clinical outcomes. Methods: Sixty patients with major depression who participated in a randomized controlled trial of two forms of short-term, individual psychotherapy were studied. We examined the prevalence of residual symptoms among successful responders, as well as the relationships between residual symptoms, pre-therapy patient characteristics, relapse, and other outcomes. Results: Thirty-three (55%) of the 60 patients responded successfully to psychotherapy. Of those, 82% had residual symptoms. Residual symptoms predicted relapse at 6-month follow-up, and were associated with less favorable psychosocial functioning at post-therapy and at 6-month follow-up. Limitations: The study consisted of post-hoc analyses of existing data, the number of asymptomatic patients was small, and a proxy measure of relapse was used. Conclusions: Residual symptoms are prevalent among depressed patients who successfully respond to psychotherapy. Greater residual symptoms appear to increase the risk for relapse and are associated with poorer psychosocial functioning.

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work. The productivity and longevity of this psychiatric organization appear to derive from several strengths, including cooperation between leaders of the clinical and research programs; the institution of staff relations groups in the three clinical programs; the operation of the fully integrated evaluation and research program that serves to provide empirical support for the treatments offered; and a unifying ideology characterized by the valuing of both psychodynamic and group oriented work. Other important factors to the success of the PPS include the strengths of the founder of the service and financial and other support of the academic department in which it is housed. This paper describes the historical development and present structure and functioning of the PPS, the challenges it has been confronted with, and the responses to those challenges. We conclude with factors contributing to its survival and productivity and with thoughts about the future.

This study investigated whether the therapeutic alliance mediates between patient expectancy of improvement and the outcome of time-limited, short-term group psychotherapy. Data were drawn from a comparative trial of 2 forms (interpretive and supportive) of time-limited group therapy for complicated grief (W. E. Piper, M. McCallum, A. S. Joyce, J. S. Rosie, & J. S. Ogrodniczuk, 2001). Patients' outcome expectancy was based on individualized target objectives for treatment, and alliance was assessed from patient and therapist perspectives. The data were analyzed through the use of hierarchical linear modeling. Patient-rated alliance played a mediating role in the relationship between outcome expectancy and group benefit, suggesting that the expectancy-outcome association is expressed through the development of a collaborative relationship between the individual members and the group therapist.

This study explored the relative strength of two patient characteristics, psychological mindedness (PM) and alexithymia, as predictors of psychotherapy outcome. Data were provided by two comparative trials of interpretive versus supportive therapy. One involved short-term group therapy for 107 outpatients with complicated grief. The other involved short-term individual therapy for 144 outpatients of mixed diagnoses. Prior to beginning therapy, patients were assessed for PM using the Psychological Mindedness Assessment Procedure and for alexithymia using the 20-item Toronto Alexithymia Scale. For both trials, the association between PM and alexithymia was small and non-significant. The therapy approach (interpretive vs. supportive) did not differentially affect the relationship between either predictor variable and outcome. There were significant direct relationships between PM and favourable outcome, and between alexithymia and favourable outcome in both trials. There was an additive relationship between PM and alexithymia in predicting outcome. Implications of these results are discussed.

The relationships between patient personality variables and outcome for 107 psychiatric outpatients with complicated grief who completed either interpretive or supportive short-term group therapy were investigated. The personality variables were assessed prior to treatment with the NEO-Five Factor Inventory (NEO-FFI). For patients in both forms of therapy, extraversion, conscientiousness, and openness were directly associated with favorable treatment outcome. In contrast, neuroticism was inversely related to favorable outcome for patients in both forms of therapy. Agreeableness was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but not for those in supportive therapy. The results highlight the importance of assessing patient personality in order to predict response to short-term group therapy. Possible explanations and clinical implications of these findings are discussed.

In a recent study, the patient characteristic quality of object relations (QOR) was directly related to favorable outcome (reduction of grief symptoms) among a sample of 53 outpatients with complicated grief who completed treatment in 1 of 8 time-limited, interpretive therapy groups. Recent research literature has suggested that patient affect variables may mediate the relationship between QOR and outcome. In the present study, affect variables were investigated as potential mediating variables using the procedure developed by R. M. Baron and K. A. Kenny (1986). The balance of positive and negative affect expressed in therapy as rated by both patients and therapists emerged as a significant mediating variable. Explanations for how this variable works as a mediating variable and why it facilitates favorable outcome were offered. Clinical implications are also considered.

This study investigated changes in perceived social support after group therapy for patients who developed complicated grief reactions subsequent to a variety of death losses. Sixty-one psychiatric outpatients, who received either interpretive or supportive group therapy, rated their perceptions of social support from 3 sources (family, friends, a special person) before treatment onset, after treatment completion, and 6 months after treatment. For patients in both forms of therapy, perceived social support from all 3 sources changed significantly during the follow-up period, but not during the treatment period. Changes (pretherapy to 6-month follow-up) in depressive symptomatology were found to be associated with changes in perceived social support. The results suggest that perceived support improves after, but not during, psychiatric treatment of complicated grief, and that a reduction in depression severity is associated with improvement in perceived social support. Possible explanations and implications of these findings are discussed.

The authors investigated the hypothesis that the therapeutic alliance mediates the relationship between pretherapy expectancy of improvement and psychotherapy outcome. Data were drawn from a comparative trial of 2 forms of short-term, time-limited individual psychotherapy (W. E. Piper, A. S. Joyce, M. McCallum, & H. F. Azim, 1998). Measures of expectancy and outcome were based on an individualized assessment of target objectives; outcome was considered from 3 perspectives (patient, independent assessor, therapist). Using the R. M. Baron and D. A. Kenny (1986) procedure, the authors found evidence in support of the hypothesized mediation effect. The effect was evident when the alliance was rated from the perspective of either patient or therapist, and it accounted for one third of the direct impact of expectancy on outcome. Clinical implications and limitations of the study are discussed.

This study examined the relationships among patient affect (experienced and expressed), work, and outcome in two forms of time-limited, short-term group therapy for-complicated grief Work was defined as the degree to which the patient pursued the primary objectives of the two forms of therapy. Substantial evidence of direct relationships between the experience and expression of positive affect and favorable outcome was found. A direct relationship between work and favorable outcome was also found. Additive and interaction effects indicated that the combination of these two types of predictor variables (positive affect, work) had a stronger relationship to favorable outcome than either variable alone. Some evidence was found for an inverse relationship between the experience and expression of negative affect and favorable. outcome. The findings were consistent with a social functional theory of the impact of affect on others during bereavement. Clinical implications of the findings are considered.

Early group process variables were investigated as predictors of dropping out for patients who participated in short-term group psychotherapy for complicated grief. Constructs assessed included affect, cohesion, group climate, and therapeutic alliance. Using logistic regression analyses, the authors investigated differences between dropouts and remainers at Sessions 1 and 4. Results indicated that after the 1st therapy session, imminent dropouts reported experiencing less positive feelings than remainers. In addition, therapists' ratings of cohesion to the patients were significantly lower for the dropouts than for remainers. Clinical implications of these findings are discussed.

This study investigated the effect of perceived social support on the outcome of group therapy for patients who experienced complicated grief following a variety of death losses. One hundred and seven psychiatric outpatients, who received either interpretive or supportive group therapy, rated their perceptions of social support from three sources (family, friends, and a special person) prior to treatment onset. For patients in both forms of therapy, perceived social support from friends was directly associated with favorable treatment outcome. In contrast, perceived social support from family was inversely related to outcome for patients in both forms of therapy. Perceived social support from a special person was directly related to favorable improvement in grief symptomaology for patients in interpretive therapy, but unrelated for those in supportive therapy. The results highlight the importance of assessing the level of support patients perceive from their social networks. The findings also suggest that the effect of perceived social support may also depend on the source of the support. Possible explanations and clinical implications of these findings are discussed.

(2002). Introduction to the Special Section on Contemporary Group Therapy Research. International Journal of Group Psychotherapy: Vol. 52, No. 4, pp. 459-462.

Objective: A comparative trial of 2 forms (interpretive and supportive) of short-term, time-limited individual (STI) therapy provided data that were used to test the propositions of the Howard and others phase model of psychotherapy change. Method: Patients completed the Integra Outpatient Tracking Assessment Form on 5 occasions during the 20-session treatments. The measure assesses 3 dimensions: subjective well-being, current symptoms, and current life dysfunction. Howard and others regard these as dimensions that represent successive phases in the therapy change process (that is, well-being improves first, followed by resolution of symptoms, and finally by change in long-standing life dysfunction). We conducted a test of their model, using their approach to data analysis. Results: The comparative trial data provided no support for the phase model. Conclusions: Possible explanations for the absence of confirmatory findings are considered.

The present study considered three methods of using DSM Axis II information to examine the effect of personality disorder on outcome in two forms of short-term, individual psychotherapy (interpretive and supportive). The first method involved examining whether the presence of any personality disorder influenced treatment outcome. The second method involved examining the effect of the number of personality disorders on outcome. The third involved examining outcome for specific personality disorders. The study found that a diagnosis of any personality disorder did not influence the outcome of therapy. In contrast, the number of personality disorders was significantly related to outcome at post-therapy and at 12-month follow-up. The findings indicated that a greater number of personality disorders was associated with less favorable outcome across both forms of therapy. This supports the notion that personality pathology is more severe when it involves a greater number of personality disorders. In an exploratory set of analyses, the study also found some evidence of differences in outcome for specific personality disorders.