Molyn Leszcz | University of Toronto (original) (raw)
Papers by Molyn Leszcz
American journal of psychotherapy, 2014
Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treati... more Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treating mental disorders mostly lie dormant in consensus-treatment guidelines. Broadly disseminating these psychotherapies by training trainers and front-line health workers could close the gap between mental health needs and access to care. Research in continuing medical education and knowledge translation can inform the design of educational interventions to build capacity for providing psychotherapy to those who need it. This paper summarizes psychotherapy training recommendations that: adapt treatments to cultural and health organizational contexts; consider implementation barriers, including opportunity costs and mental health stigma; and engage local opinion leaders to use longitudinal, interactive, case-based teaching with reflection, skills-coaching, simulations, auditing and feedback. Community-based training projects in Northern Ontario, Canada and Ethiopia illustrate how best-educa...
American Journal of Psychotherapy, 2020
This article aims to review the expanding role of group psychotherapy in the treatment of individ... more This article aims to review the expanding role of group psychotherapy in the treatment of individuals with medical illnesses, an area that has expanded dramatically during the past 30 years. The fundamental principles of adaptation of group therapies for specialized clinical populations are articulated. Clarity of goals and thoughtful alignment with patient interests and needs are at the heart of building a strong therapeutic alliance and potentiate the effectiveness of group therapy. This article also discusses the conceptual underpinnings of group therapies and the ways in which group therapeutic factors gain expression with these clinical populations. This article also focuses on breast cancer, in light of its clinical prominence and the development of group therapies for individuals with the disease. These therapies address clinical concerns for women along the continuum of the disease, including familial and genetic predisposition, primary breast cancer, adaptation to illness and its treatment, metastatic disease, and dealing with mortal illness.
Canadian Journal of Public Health, 2008
We describe an evidence-based approach to enhancing the resilience of healthcare workers in prepa... more We describe an evidence-based approach to enhancing the resilience of healthcare workers in preparation for an influenza pandemic, based on evidence about the stress associated with working in healthcare during the SARS outbreak. SARS was associated with significant long-term stress in healthcare workers, but not with increased mental illness. Reducing pandemic-related stress may best be accomplished through interventions designed to enhance resilience in psychologically healthy people. Applicable models to improve adaptation in individuals include Folkman and Greer's framework for stress appraisal and coping along with psychological first aid. Resilience is supported at an organizational level by effective training and support, development of material and relational reserves, effective leadership, the effects of the characteristics of "magnet hospitals," and a culture of organizational justice. Evidence supports the goal of developing and maintaining an organizational culture of resilience in order to reduce the expected stress of an influenza pandemic on healthcare workers. This recommendation goes well beyond the provision of adequate training and counseling. Although the severity of a pandemic is unpredictable, this effort is not likely to be wasted because it will also support the health of both patients and staff in normal times.
American Journal of Psychotherapy, 2007
PLOS ONE, 2017
Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable po... more Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable population. The Coordinated Access to Care from Hospital EDs (CATCH-ED) study examined the effectiveness of a brief case management intervention in reducing ED use and improving health outcomes among frequent ED users with mental health or addiction challenges in a large urban centre. Adults (!18 years of age) who had five or more ED visits in the past 12-months, with at least one visit for mental health or addictions problems were randomized to either brief case management (N = 83) or usual care (N = 83) and followed for 12 months. The primary outcome of effectiveness was the frequency of ED visits during 12 months after study enrolment. Secondary outcomes included days in hospital, mental health and addiction symptom severity and health-related quality of life, measured by the SF-12. Compared to usual care, CATCH-ED participants saw a 14% reduction in frequency of ED visits during the 12-month post-randomization period [rate ratio (RR) = 0.86, 95% CI 0.64-1.15)], however, this finding did not reach statistical significance. There were also no statistically significant differences between the groups at 12 months in the number of days spent in hospital (RR = 1.16, 95% CI 0.59-2.29), physical (1.50, 95% CI-2.15-5.15) or mental (-3.97, 95% CI-8.13-0.19) component scores of the SF-12, severity of psychiatric symptoms (-0.41, 95% CI-2.30-1.49), alcohol (0.053 95%-0.017-0.12) or drug (-0.0027, 95% CI-0.0028-0.023) use. Compared to usual care, a brief case management intervention did not result in significantly reduced ED use or improved health outcomes among frequent ED users with mental health or addictions challenges in a large urban centre in Canada. Future studies need to evaluate the availability and accessibility of community-based resources for individuals with frequent ED use.
International Journal of Group Psychotherapy, 1994
International Journal of Group Psychotherapy, 2015
The opportunity to be a discussant of Dr. Billow’s article is very much welcomed and appreciated.... more The opportunity to be a discussant of Dr. Billow’s article is very much welcomed and appreciated. We are indebted to Dr. Billow for his willingness to publish clear, articulate, and thoughtful clinical illustrations of his work and then engage review and discussion. I have been invited to comment through the editorial process. In doing so, I hold in mind the contributions from another discipline, that of surgery, as articulated by Atul Gawande, who notes that in order for us to advance our expertise, we have to be willing to expose our work to the scrutiny of other colleagues. Dr. Gawande has done this within the operating room, and Dr. Billow and others do this within the context of their clinical consulting room. To extend the analogy, the surgeon is guided by anatomy and surgical technique, and the group therapist is guided by theory and therapeutic practice. As our field moves more and more towards a focus on competencybased training and we strengthen and deepen our investment in training, it also reminds us of the need to be less private and more transparent in demonstrating clinical work so that we in fact can use live observation, detailed transcripts, and video sessions to advance our understanding and clinical work. The best work in psychotherapy
International Journal of Group Psychotherapy, 1989
A broad range of characterologically difficult patients present for treatment in psychotherapy gr... more A broad range of characterologically difficult patients present for treatment in psychotherapy groups. Despite different clinical presentations, including features of the schizoid, borderline, and narcissistic personality disorders, these patients share a common developmental failing. Specifically, these individuals have failed to attain object constancy and the associated stable internalization of tolerably ambivalent representations of the self, and of the other, in relationship with one another. Splitting mechanisms predominate over integrative ones, as primitive defenses are utilized to deal with the individual's powerful needs and fears related to engagement and intimacy. These maladaptive interpersonal styles are clearly illuminated in group therapy, but often to the exclusion of the latent, intrapsychic derivatives of this behavior, with detrimental effects. This paper examines the group therapy of such patients from the perspective of object relations and self psychology theories, models that provide the essential link between the interpersonal and the intrapsychic worlds.
The Canadian Journal of Psychiatry, 1999
The 7 main objectives of this paper are as follows: • To comprehensively detail the efficacy ofth... more The 7 main objectives of this paper are as follows: • To comprehensively detail the efficacy ofthe psychotherapies. • To detail why skills in the psychotherapies are essential to the effective and competent functioning of contemporary psychiatrists. • To establish a balance between the practice and use ofboth short-term and long-term therapies. • To establish definitively that the psychotherapies must be included as a central component of core psychiatric servIces .
PloS one, 2016
This study aimed to explore the service needs and preferences of frequent emergency department us... more This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention. We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care. Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical need...
Standards and Guidelines for the Psychotherapies, 1998
BMC health services research, Aug 24, 2016
Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable po... more Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable population. This article describes the rationale for a brief case management intervention for frequent ED users with mental health and/or addiction challenges and the design of a randomized trial assessing its effectiveness. Eligible participants are adults in a large urban centre with five or more ED visits in the past year, with at least one prior visit for a mental health or addictions reason. Participants (N = 166) will be randomized to either 4 to 6 months of brief case management or usual care, and interviewed every 3 months for 1 year. Consent will be sought to access administrative health records. A subset of participants (N = 20) and service providers (N = 13) will participate in qualitative data collection. Addressing the needs of frequent ED users is a priority in many jurisdictions. This study will provide evidence on the effectiveness of brief case management, compared to usua...
BMC health services research, Apr 27, 2016
Addressing the needs of frequent users of emergency departments (EDs) is a health system priority... more Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre. Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experien...
General Hospital Psychiatry, 2016
This study explored service user and provider perspectives on barriers and facilitators of contin... more This study explored service user and provider perspectives on barriers and facilitators of continuity of care for frequent users of emergency departments (ED) participating in a brief intensive case management intervention. Method: We conducted semistructured interviews with 20 frequent ED users with mental health and addiction challenges participating in a brief intensive case management intervention, eliciting experiences of care and care continuity. We interviewed 13 service providers working with this population. We used thematic analysis to determine shared and unique barriers and facilitators to continuity of care, and we gave priority to themes reported by both service users and providers. Results: Within fragmented systems of care, strong working relationships between service users and providers, timely access to coordinated services and seamless transitions to needed supports increased perceived care continuity. Barriers to continuity of care included difficulties engaging this population, short intervention duration and the lack of a single accountable service provider to address health and social needs. Conclusion: Although brief intensive case management interventions have the potential to improve continuity of care for frequent ED users, continuity of care, especially for people with complex health and social needs, may be compromised by program and personal characteristics as well as lack of broader system integration.
On Becoming a Psychotherapist, 2010
The Wiley‐Blackwell Handbook of Group Psychotherapy, 2011
The interpersonal model of group psychotherapy, predicated on the early work of Harry Stack Sulli... more The interpersonal model of group psychotherapy, predicated on the early work of Harry Stack Sullivan and subsequently developed into a comprehensive model of group psychotherapy by Irvin Yalom, is described in this article. Using the common clinical illustration and descriptions of group members, the authors address the theoretical underpinnings of the interpersonal model of group psychotherapy; ways of maximizing patient engagement; group leadership principles; and the group leader's responsibility to facilitate the group effectively within the here-and-now. Core elements that will be addressed include the group leader's role in fostering group cohesion; receptive and expressive aspects of empathy; and interpersonal feedback and therapeutic metacommunication. All group therapists have had the experience of realizing their group is off track, along with the recognition that the group leader, whether novice or experienced, may have contributed to the group quandary. During these instances, our theory guides us through the maze of confusion that often accompanies such occurrences. It is crucial that the group leader have a reliable theory to help the group operate as a healing therapeutic entity. Interpersonal group theory will provide the theoretical framework for this article. We appreciate the opportunity to articulate the theory and technique of the interpersonal model of group psychotherapy using the brief clinical illustration created by our colleague, Dr. Joseph Shay.
Psychotherapeut, 2004
Zusammenfassung Der Brustkrebs erzwingt geradezu unsere Aufmerksamkeit mit seiner hohen Prävalenz... more Zusammenfassung Der Brustkrebs erzwingt geradezu unsere Aufmerksamkeit mit seiner hohen Prävalenz—30% aller Krebsneuerkrankungen bei nordamerikanischen Frauen sind Brustkrebs—, und er ist die zweithäufigste Todesursache bei Frauen in Nordamerika. Weiße nordamerikanische Frauen haben ein Risiko von 1:9, im Laufe ihres Lebens an Brustkrebs zu erkranken. Es gibt zahlreiche Anknüpfungspunkte, darunter genetische und familiäre Prädisposition, primäre Krebserkrankung/Langzeitüberleben und rezidivierende oder metastasierende Krankheit.
Psychiatric Rehabilitation Journal, 2006
The stress associated with managing a first episode of schizophrenia and the secondary psychologi... more The stress associated with managing a first episode of schizophrenia and the secondary psychological sequelae may predispose young people to the phenomenon of illness engulfment, whereby personal identity is lost and replaced with a sense of self defined entirely by the illness. The overall objective of this pilot project was to provide an initial evaluation of the impact of a novel group intervention targeting improvement of self-concept (engulfment) and overall quality of life for young adults recovering from a first episode of schizophrenia. Fifty-two young adults diagnosed with a DSM-IV schizophrenia spectrum disorder were sequentially assigned to either a 12-week group intervention that provided members with opportunities to attain healthy self-concepts or a control group that received high quality treatment as usual. The two groups were compared on pretreatment, post-treatment, and 3-month post-treatment measures of engulfment, quality of life, and psychiatric symptoms. Allowing for dropouts, 26 subjects remained in the treatment group and 14 subjects in the control group after the 3-month follow-up. Participants in the treatment group demonstrated significant improvement in engulfment, quality of life (intrapsychic subscale) and symptoms, while the comparison group did not change. These preliminary results provide support for the benefits of a group intervention designed to enhance self-concept and to minimize the engulfing effects of illness.
American journal of psychotherapy, 2014
Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treati... more Psychotherapies, such as Interpersonal Psychotherapy (IPT), that have proven effective for treating mental disorders mostly lie dormant in consensus-treatment guidelines. Broadly disseminating these psychotherapies by training trainers and front-line health workers could close the gap between mental health needs and access to care. Research in continuing medical education and knowledge translation can inform the design of educational interventions to build capacity for providing psychotherapy to those who need it. This paper summarizes psychotherapy training recommendations that: adapt treatments to cultural and health organizational contexts; consider implementation barriers, including opportunity costs and mental health stigma; and engage local opinion leaders to use longitudinal, interactive, case-based teaching with reflection, skills-coaching, simulations, auditing and feedback. Community-based training projects in Northern Ontario, Canada and Ethiopia illustrate how best-educa...
American Journal of Psychotherapy, 2020
This article aims to review the expanding role of group psychotherapy in the treatment of individ... more This article aims to review the expanding role of group psychotherapy in the treatment of individuals with medical illnesses, an area that has expanded dramatically during the past 30 years. The fundamental principles of adaptation of group therapies for specialized clinical populations are articulated. Clarity of goals and thoughtful alignment with patient interests and needs are at the heart of building a strong therapeutic alliance and potentiate the effectiveness of group therapy. This article also discusses the conceptual underpinnings of group therapies and the ways in which group therapeutic factors gain expression with these clinical populations. This article also focuses on breast cancer, in light of its clinical prominence and the development of group therapies for individuals with the disease. These therapies address clinical concerns for women along the continuum of the disease, including familial and genetic predisposition, primary breast cancer, adaptation to illness and its treatment, metastatic disease, and dealing with mortal illness.
Canadian Journal of Public Health, 2008
We describe an evidence-based approach to enhancing the resilience of healthcare workers in prepa... more We describe an evidence-based approach to enhancing the resilience of healthcare workers in preparation for an influenza pandemic, based on evidence about the stress associated with working in healthcare during the SARS outbreak. SARS was associated with significant long-term stress in healthcare workers, but not with increased mental illness. Reducing pandemic-related stress may best be accomplished through interventions designed to enhance resilience in psychologically healthy people. Applicable models to improve adaptation in individuals include Folkman and Greer's framework for stress appraisal and coping along with psychological first aid. Resilience is supported at an organizational level by effective training and support, development of material and relational reserves, effective leadership, the effects of the characteristics of "magnet hospitals," and a culture of organizational justice. Evidence supports the goal of developing and maintaining an organizational culture of resilience in order to reduce the expected stress of an influenza pandemic on healthcare workers. This recommendation goes well beyond the provision of adequate training and counseling. Although the severity of a pandemic is unpredictable, this effort is not likely to be wasted because it will also support the health of both patients and staff in normal times.
American Journal of Psychotherapy, 2007
PLOS ONE, 2017
Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable po... more Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable population. The Coordinated Access to Care from Hospital EDs (CATCH-ED) study examined the effectiveness of a brief case management intervention in reducing ED use and improving health outcomes among frequent ED users with mental health or addiction challenges in a large urban centre. Adults (!18 years of age) who had five or more ED visits in the past 12-months, with at least one visit for mental health or addictions problems were randomized to either brief case management (N = 83) or usual care (N = 83) and followed for 12 months. The primary outcome of effectiveness was the frequency of ED visits during 12 months after study enrolment. Secondary outcomes included days in hospital, mental health and addiction symptom severity and health-related quality of life, measured by the SF-12. Compared to usual care, CATCH-ED participants saw a 14% reduction in frequency of ED visits during the 12-month post-randomization period [rate ratio (RR) = 0.86, 95% CI 0.64-1.15)], however, this finding did not reach statistical significance. There were also no statistically significant differences between the groups at 12 months in the number of days spent in hospital (RR = 1.16, 95% CI 0.59-2.29), physical (1.50, 95% CI-2.15-5.15) or mental (-3.97, 95% CI-8.13-0.19) component scores of the SF-12, severity of psychiatric symptoms (-0.41, 95% CI-2.30-1.49), alcohol (0.053 95%-0.017-0.12) or drug (-0.0027, 95% CI-0.0028-0.023) use. Compared to usual care, a brief case management intervention did not result in significantly reduced ED use or improved health outcomes among frequent ED users with mental health or addictions challenges in a large urban centre in Canada. Future studies need to evaluate the availability and accessibility of community-based resources for individuals with frequent ED use.
International Journal of Group Psychotherapy, 1994
International Journal of Group Psychotherapy, 2015
The opportunity to be a discussant of Dr. Billow’s article is very much welcomed and appreciated.... more The opportunity to be a discussant of Dr. Billow’s article is very much welcomed and appreciated. We are indebted to Dr. Billow for his willingness to publish clear, articulate, and thoughtful clinical illustrations of his work and then engage review and discussion. I have been invited to comment through the editorial process. In doing so, I hold in mind the contributions from another discipline, that of surgery, as articulated by Atul Gawande, who notes that in order for us to advance our expertise, we have to be willing to expose our work to the scrutiny of other colleagues. Dr. Gawande has done this within the operating room, and Dr. Billow and others do this within the context of their clinical consulting room. To extend the analogy, the surgeon is guided by anatomy and surgical technique, and the group therapist is guided by theory and therapeutic practice. As our field moves more and more towards a focus on competencybased training and we strengthen and deepen our investment in training, it also reminds us of the need to be less private and more transparent in demonstrating clinical work so that we in fact can use live observation, detailed transcripts, and video sessions to advance our understanding and clinical work. The best work in psychotherapy
International Journal of Group Psychotherapy, 1989
A broad range of characterologically difficult patients present for treatment in psychotherapy gr... more A broad range of characterologically difficult patients present for treatment in psychotherapy groups. Despite different clinical presentations, including features of the schizoid, borderline, and narcissistic personality disorders, these patients share a common developmental failing. Specifically, these individuals have failed to attain object constancy and the associated stable internalization of tolerably ambivalent representations of the self, and of the other, in relationship with one another. Splitting mechanisms predominate over integrative ones, as primitive defenses are utilized to deal with the individual's powerful needs and fears related to engagement and intimacy. These maladaptive interpersonal styles are clearly illuminated in group therapy, but often to the exclusion of the latent, intrapsychic derivatives of this behavior, with detrimental effects. This paper examines the group therapy of such patients from the perspective of object relations and self psychology theories, models that provide the essential link between the interpersonal and the intrapsychic worlds.
The Canadian Journal of Psychiatry, 1999
The 7 main objectives of this paper are as follows: • To comprehensively detail the efficacy ofth... more The 7 main objectives of this paper are as follows: • To comprehensively detail the efficacy ofthe psychotherapies. • To detail why skills in the psychotherapies are essential to the effective and competent functioning of contemporary psychiatrists. • To establish a balance between the practice and use ofboth short-term and long-term therapies. • To establish definitively that the psychotherapies must be included as a central component of core psychiatric servIces .
PloS one, 2016
This study aimed to explore the service needs and preferences of frequent emergency department us... more This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention. We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care. Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical need...
Standards and Guidelines for the Psychotherapies, 1998
BMC health services research, Aug 24, 2016
Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable po... more Frequent users of hospital emergency departments (EDs) are a medically and socially vulnerable population. This article describes the rationale for a brief case management intervention for frequent ED users with mental health and/or addiction challenges and the design of a randomized trial assessing its effectiveness. Eligible participants are adults in a large urban centre with five or more ED visits in the past year, with at least one prior visit for a mental health or addictions reason. Participants (N = 166) will be randomized to either 4 to 6 months of brief case management or usual care, and interviewed every 3 months for 1 year. Consent will be sought to access administrative health records. A subset of participants (N = 20) and service providers (N = 13) will participate in qualitative data collection. Addressing the needs of frequent ED users is a priority in many jurisdictions. This study will provide evidence on the effectiveness of brief case management, compared to usua...
BMC health services research, Apr 27, 2016
Addressing the needs of frequent users of emergency departments (EDs) is a health system priority... more Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre. Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experien...
General Hospital Psychiatry, 2016
This study explored service user and provider perspectives on barriers and facilitators of contin... more This study explored service user and provider perspectives on barriers and facilitators of continuity of care for frequent users of emergency departments (ED) participating in a brief intensive case management intervention. Method: We conducted semistructured interviews with 20 frequent ED users with mental health and addiction challenges participating in a brief intensive case management intervention, eliciting experiences of care and care continuity. We interviewed 13 service providers working with this population. We used thematic analysis to determine shared and unique barriers and facilitators to continuity of care, and we gave priority to themes reported by both service users and providers. Results: Within fragmented systems of care, strong working relationships between service users and providers, timely access to coordinated services and seamless transitions to needed supports increased perceived care continuity. Barriers to continuity of care included difficulties engaging this population, short intervention duration and the lack of a single accountable service provider to address health and social needs. Conclusion: Although brief intensive case management interventions have the potential to improve continuity of care for frequent ED users, continuity of care, especially for people with complex health and social needs, may be compromised by program and personal characteristics as well as lack of broader system integration.
On Becoming a Psychotherapist, 2010
The Wiley‐Blackwell Handbook of Group Psychotherapy, 2011
The interpersonal model of group psychotherapy, predicated on the early work of Harry Stack Sulli... more The interpersonal model of group psychotherapy, predicated on the early work of Harry Stack Sullivan and subsequently developed into a comprehensive model of group psychotherapy by Irvin Yalom, is described in this article. Using the common clinical illustration and descriptions of group members, the authors address the theoretical underpinnings of the interpersonal model of group psychotherapy; ways of maximizing patient engagement; group leadership principles; and the group leader's responsibility to facilitate the group effectively within the here-and-now. Core elements that will be addressed include the group leader's role in fostering group cohesion; receptive and expressive aspects of empathy; and interpersonal feedback and therapeutic metacommunication. All group therapists have had the experience of realizing their group is off track, along with the recognition that the group leader, whether novice or experienced, may have contributed to the group quandary. During these instances, our theory guides us through the maze of confusion that often accompanies such occurrences. It is crucial that the group leader have a reliable theory to help the group operate as a healing therapeutic entity. Interpersonal group theory will provide the theoretical framework for this article. We appreciate the opportunity to articulate the theory and technique of the interpersonal model of group psychotherapy using the brief clinical illustration created by our colleague, Dr. Joseph Shay.
Psychotherapeut, 2004
Zusammenfassung Der Brustkrebs erzwingt geradezu unsere Aufmerksamkeit mit seiner hohen Prävalenz... more Zusammenfassung Der Brustkrebs erzwingt geradezu unsere Aufmerksamkeit mit seiner hohen Prävalenz—30% aller Krebsneuerkrankungen bei nordamerikanischen Frauen sind Brustkrebs—, und er ist die zweithäufigste Todesursache bei Frauen in Nordamerika. Weiße nordamerikanische Frauen haben ein Risiko von 1:9, im Laufe ihres Lebens an Brustkrebs zu erkranken. Es gibt zahlreiche Anknüpfungspunkte, darunter genetische und familiäre Prädisposition, primäre Krebserkrankung/Langzeitüberleben und rezidivierende oder metastasierende Krankheit.
Psychiatric Rehabilitation Journal, 2006
The stress associated with managing a first episode of schizophrenia and the secondary psychologi... more The stress associated with managing a first episode of schizophrenia and the secondary psychological sequelae may predispose young people to the phenomenon of illness engulfment, whereby personal identity is lost and replaced with a sense of self defined entirely by the illness. The overall objective of this pilot project was to provide an initial evaluation of the impact of a novel group intervention targeting improvement of self-concept (engulfment) and overall quality of life for young adults recovering from a first episode of schizophrenia. Fifty-two young adults diagnosed with a DSM-IV schizophrenia spectrum disorder were sequentially assigned to either a 12-week group intervention that provided members with opportunities to attain healthy self-concepts or a control group that received high quality treatment as usual. The two groups were compared on pretreatment, post-treatment, and 3-month post-treatment measures of engulfment, quality of life, and psychiatric symptoms. Allowing for dropouts, 26 subjects remained in the treatment group and 14 subjects in the control group after the 3-month follow-up. Participants in the treatment group demonstrated significant improvement in engulfment, quality of life (intrapsychic subscale) and symptoms, while the comparison group did not change. These preliminary results provide support for the benefits of a group intervention designed to enhance self-concept and to minimize the engulfing effects of illness.