Alliance Rupture Detection and Repair in Group Therapy: Using the Group Questionnaire--GQ

Burlingame, Gary M.; Alldredge, Cameron T.; Arnold, Rachel A.

doi:10.1080/00207284.2020.1844010

Cited by 13 publications

(17 citation statements)

References 54 publications

(76 reference statements)

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“…Cohesion, on the other hand, refers to a general sense of a group’s unity of purpose in which members encourage and support one another (Forsyth, 2021; Yalom & Leszcz, 2020). While previous research produced mixed results of the relative contributions of the group alliance and cohesion in predicting outcomes (Bisseling et al, 2019; Burlingame et al, 2021; Norton & Kazantzis, 2016), our findings suggest that future research should disentangle the specific constructs related to member-group relationships (i.e., group alliance and cohesion), given their potential overlap (Bakali et al, 2009; Johnson et al, 2005) and to specify the structural relationships involved (member–member, member–therapist, member-group). Moreover, further research is necessary to refine the measurement of both group alliance and cohesion within the structural context of the group, and to evaluate their differential impact on patient outcomes (Burlingame & Strauss, 2021).…”

Section: Discussionmentioning

confidence: 55%

“…Future research is needed to provide a more rigorous theory-driven conceptualization of the alliance in groups that reflects its complexity relative to the alliance in individual therapies. For example, Burlingame et al (2021) Group Questionnaire allows for the assessment of bonding and work that taps into the structural relationships possible in groups. Although in the present study, we analyzed independent group data by a three-level multivariate meta-analysis, we were not able to assess within- versus between-group variance in the effect sizes.…”

Section: Discussionmentioning

confidence: 99%

“…Kivlighan (2021) also reported that not only the patient–therapist dyadic relationship but also the group-level relationships affect patient outcomes. This is likely by virtue of the simultaneous presence of intraindividual, interpersonal, and a group as a whole levels of interaction (Burlingame et al, 2021; Tasca et al, 2014). These different structural levels are embedded in both the group alliance and cohesion constructs.…”

Section: The Alliance Concept In Group Therapymentioning

confidence: 99%

See 2 more Smart Citations

The alliance-outcome association in group interventions: A multilevel meta-analysis.

Coco¹,

Gullo²,

Albano³

et al. 2022

Journal of Consulting and Clinical Psychology

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Objective: The therapeutic alliance has been studied in group interventions, but its relationship to patient outcome is still controversial. This study systematically reviewed the association of both the member-leader and membergroup alliance with patient outcomes, and assessed the effects of several theoretically informed moderators. Method: A three-level meta-analysis was conducted on 57 studies to disentangle within-and between-study variability in the alliance-outcome association. Results: The overall effect size of the unconditional model was r = −.259 (95% CI: −.302, -.214; p < .001), whereas the correlation between alliance and outcome based on the three-level meta-analytic model was r = −.215 (95% CI: −.252, −.178; p < .001) indicating a medium effect. Meta-regressions of moderators showed that the alliance-outcome correlation was higher when patients reported on their alliance with the group/other members compared with when they rated the alliance with the leader. Outcome type, rating perspective, theoretical orientation, treatment length, and year of publication were significant moderators of the relationship between alliance and outcome. Conclusions: The current meta-analysis highlighted that the therapeutic alliance, especially with other group members, is a significant predictor of outcomes in group therapies even after controlling for several moderators and adopting more conservative statistical modeling. What is the public health significance of this article?Prior research has established that member-leader alliance is a predictor of outcome in group psychotherapy with a small effect. This meta-analysis provides a comprehensive analysis of the complex role of the alliance in group therapy, suggesting that the alliance with other group members or the group as a whole has a significantly larger association with outcome. This study provides support for the importance of the group context on the alliance-outcome relationship.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: The Alliance Concept In Group Therapymentioning

confidence: 99%

See 1 more Smart Citation

The alliance-outcome association in group interventions: A multilevel meta-analysis.

Coco¹,

Gullo²,

Albano³

et al. 2022

Journal of Consulting and Clinical Psychology

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“…Eubanks et al (in press) explored how ruptures occur within supervision groups, and how one can rely on an observational system to identify and study ruptures in groups. Burlingame et al (in press) described the use of the Group Questionnaire (GQ) after sessions to detect ruptures so as to address them in group therapy.…”

Section: Ruptures and Repairs: The Special Issue Of The International...mentioning

confidence: 99%

Ruptures and repairs in group psychotherapy: Introduction to the special issue.

Marmarosh¹

2021

Group Dynamics: Theory, Research, and Practice

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Objectives: All relationships experience tensions and ruptures, but not all ruptures are acknowledged and repaired. Individual therapy researchers have shown that repairing ruptures in the therapy relationship is associated with an increased alliance, decreased dropout, and positive treatment outcome. Until recently, there has been less attention paid to ruptures in group psychotherapy. The current special issue is devoted to theory, assessment, research, and practice regarding ruptures and repairs in group treatment. Methods: Group researchers applied self-report and observational assessment methods to identify and study ruptures in group psychotherapy and group supervision. Designs of the studies included longitudinal analysis, case studies, meta-analysis, and a practice review. Results: Studies in this special issue identified that the alliance is related to outcomes and that different types of alliance ruptures, including microaggressions, occur in group therapy. Alliance ruptures manifest themselves at different levels of group interactions (member to member, member to leader, and member to group), which reflects the complex nature of this multiperson therapeutic context. Conclusions: The implications for practice are addressed as well as a call for future research to examine different types of ruptures in group therapy. Group member and leader factors influence the nature of the ruptures. The complexity of the group context suggests that repair processes that take into account levels of interactions in groups. Findings from these studies lay the foundation for future research needed to understand the impact of ruptures in groups. Highlights and Implications• Ruptures and repairs in group therapy can be measured using self-report assessments and through observer coding of group therapy sessions.• Ruptures in group therapy are more complex than in individual therapy given the multiple relationships within a group. Ruptures can occur between leaders and members, between members and members, and between members and the group-as-a-whole. They can also occur between coleaders.• Research is needed to understand the group, member, and leader factors that influence the process of rupture and repair. The type of group, stage of development, level of cohesion, and climate are group factors that will likely influence rupture repairs.• The level of experience, empathy, personality, and attachment style of the leader will likely influence the leader's capacity to identify ruptures and strategies for repair.

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“…So far, the GQ has been used to monitor the course of therapy and help therapists to detect and attend to problems when group relationships worsen or patients deteriorate, and studies show that such feedback improves outcomes and reduces attritions from therapy in more heterogeneous patient samples (Burlingame, Whitcomb, Woodland et al, 2018). More recent papers demonstrate how central therapeutic alliance that mostly has been studied in individual psychotherapy, also is for group therapy (Alldredge, Burlingame, Olsen et al, 2020) and how ruptured alliances are detected and coupled with the therapists repair attempts in group therapy, using the GQ (Burlingame, Allredge, & Arnold, 2021).…”

Section: Development Of the Group Questionnairementioning

confidence: 99%

The Group Questionnaire (GQ)—Psychometric properties among outpatients with personality disorders.

Pedersen¹,

Kvarstein²,

Wilberg³

et al. 2023

Group Dynamics: Theory, Research, and Practice

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Objective: Relational and emotional vulnerability represent essential problems among patients with personality disorder (PD). Group psychotherapy is a central component of evidence-based PD treatments. Generally, patient and therapist interrelationships predict improvement in therapy.However, although treatment of patients with PD is a more complex process, group processes are poorly elaborated in PD research. Documentation of the psychometric quality of group process measures in PD samples is an important precursor of such research. The Group Questionnaire-GQ is based on concepts of group cohesion and climate, empathy, and alliance and aims to capture the quality of member-member, member-group and member-leader relationships in group therapy. A 3-latent factor structure (positive bond, positive work and negative relationship) has generally been supported.This study aimed to perform a psychometric analysis of GQ administered in a clinical population of patients with PD.Method: The study included 369 patients with PDs attending group psychotherapy in 14 outpatient treatment units on a specialist mental health service level within the Norwegian Network of Personality Disorders in the period 2017-2020. Psychometric analyses included 3-latent factors and 8 sub-facets.Results: The 3-latent factors, positive bond, positive work and negative relationship were replicated. Psychometric integrity of the tripartite relationship structure-member-member, membergroup and member-leader, with 8 sub-facets, was supported.Conclusions: The GQ with 3-latent factors and 8 sub-facets can be recommended for future research and clinical practice in patient populations with PD. Highlights and Implications The study highlights that GQ can satisfactorily capture the group psychotherapy process for patients with personality disorder in its current form with three latent factors and eight sub facets  Results replicate former research on the psychometric qualities of GQ  Results implicate that the GQ can be useful in further research on PD treatment processes and mechanisms and mediators of change

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Alliance Rupture Detection and Repair in Group Therapy: Using the Group Questionnaire--GQ

Cited by 13 publications

References 54 publications

The alliance-outcome association in group interventions: A multilevel meta-analysis.

The alliance-outcome association in group interventions: A multilevel meta-analysis.

Ruptures and repairs in group psychotherapy: Introduction to the special issue.

The Group Questionnaire (GQ)—Psychometric properties among outpatients with personality disorders.

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