Group Analysis

This article describes the context for commissioning a systematic review into the effectiveness of group analytic and psychodynamic group therapies, and sets out an argument for supporting and promoting research within group analysis.

This article uses the contributions of one particular service user to highlight the value of seeking and using service user input into the design, delivery and evaluation of clinical services. The voices of patients have often gone unheard and unheeded on such issues. The Cassel Hospital, which is usually seen as a champion for listening to the views of patients, is used to exemplify the very real difficulties involved in true listening. It is seen to have been difficult and complicated for us in that institution to give up a more paternalistic omniscient stance. However the many values of true listening makes it easier, once started, to continue with seeking and using service user input to improve clinical services. Transference is seen to be robust. We end with a challenge to colleagues working in other psychotherapy service settings to seek to find the value for them in involving and listening to the views of service users.

Treatment manuals may have different purposes. In clinical work it may be to demonstrate the main feabtures and principles of a treatment method to trainees. In psychotherapy research it may be an attempt to ensure that all patients are influenced in a similar way, thus trying to increase the internal validity of the study. Measures taken to ensure internal validity (randomization, inclusion of patients with similar diagnosis, check of treatment fidelity etc.) often reduce the possibility of generalizing the results from such studies to a regular clinical context (external validity).

This article describes how treatment manuals for short- and long-term analytic group psychotherapies (20 and 80 weekly sessions, respectively) were developed. We wanted to study the significance of the treatment length, and potential moderators and mediators of differential change in the treatment of regular patients with mixed disorders (anxiety, affective, and mild to moderate personality disorders) who had been referred to outpatient services. The article presents reflections, choices, and dilemmas encountered in developing these manuals. Brief examples from the manuals are presented, highlighting differences between the two formats.

This article reports on a systematic review to assess the efficacy and clinical effectiveness of group analysis and analytic/dynamic (A/D) group psychotherapy. Systematic literature searches were undertaken; 34 primary studies and 19 reviews met the inclusion criteria and their data was extracted. Of the primary studies, the randomized controlled trials provided evidence for the efficacy and clinical effectiveness of group therapy approaches in a range of clinical problems, but not for specific benefits of any particular theoretical approach. The controlled studies and observational studies gave support for the use of group psychotherapy in a variety of conditions.

The review of reviews confirms that group therapies in general are more effective than wait list or standard care controls. Methodological challenges encountered and recommendations for further research are presented, along with a more detailed discussion of the implications of the review for the research community.

The systematic review undertaken for the Group Analytic Community by Sheffield University is an excellent piece of work ‘of its time’, but it may not speak to everybody in the field. Some of the reasons for this are the precise methodology of such reviews, concerned with an exclusively rationalist model for selecting and appraising evidence in a framework, which excludes other schools of thought (particularly the social sciences, including critical theory, anthropology and economics). As many of those who work in group analysis have backgrounds in these and allied disciplines, rather than biomedical science, there is a risk of excluding much useful and scholarly collaboration with adjacent disciplines unless we hold an open mind about such methodologies. As group analysts, we are in a strong position to observe and criticize the ‘evidence-based hegemony’ when it becomes closer to dogma than science.

This article is based on a talk given to a Group Analytic Society conference entitled ‘Can Group Therapy Survive NICE?’ held in London on 29 January 2010.

This article describes how four seasoned clinicians and group analysts working in public mental health services, experience their participation in a randomized trial of short-term versus long-term analytic group psychotherapy (20 or 80 sessions). The design makes it possible to integrate the research with regular clinical practice, and participation gives the institutions the opportunity to fulfil obligations of doing research, that are imposed on the Community Mental Health Centres. The experiences are mainly described from the clinicians’ position, but some comments from the research director are included. The collaboration across approximately five years is found to be interesting and rewarding. Based on the assumption that further steps are made to strengthen and develop the qualitative aspects of such projects, the clinicians recommend such collaboration as a feasible and useful way to build and maintain a bridge across the gap that too often seems to separate researchers and clinicians. This is assumed to be profitable for everyone involved, not least the patients.

This article describes the application of Compendium, a knowledge cartography software tool, for the recording of group process. As a hypertext tool, it enables analysts to visualize connections between people, ideas and information, establishing an evidence base within and across contexts (such as group sessions). After customizing its visual language, templates and keyword system, it has been piloted as a research tool for the measurement of group process. This would appear to hold the promise of providing a ‘digital substrate’ for recording, discussing and analysing long term group dynamics in new ways. While the project is in its early stages, early indications are that it is a useful tool, which can highlight group process and record change over time. In the longer term, it seems plausible that group processes such as multiple mirroring and identification, and such complex structures as the matrix, could be made visible and researchable through this methodology.

This article traces the fluctuating interest in research in group analysis since the 1970s and how resistance to evidence-based research was eventually overcome by threats posed by NHS commissioning, leading to the joint IGA/GAS commissioning of the systematic review of the effectiveness of group analysis and dynamic group psychotherapy. The findings and recommendations of the review appear to pose a strategic choice between accepting the rules of the ‘evidence game’ or setting our own standards for meaningful research. Both involve the need to ‘sell’ group analysis. Five steps are suggested as a combination of the two strategies.