Cohesion, Alliance and Outcome in Group Psychotherapy

Abstract

Cohesiveness has been viewed as the group psychotherapy equivalent of the therapeutic alliance in individual treatment. Although researchers have attempted to study the concept of cohesion in group treatment, understanding of this so-called "curative" group factor remains quite primitive. In this study of 12 time-limited psychotherapy groups, with a total of 90 nonpsychotic outpatients, we explore the relationships between cohesion, alliance and treatment outcome. Our cohesion measure is a new instrument, the Harvard Community Health Plan Group Cohesiveness Scale, developed for use with group therapy videotapes. To measure alliance we have modified the Penn Helping Alliance Scale (Group Alliance Scale) to be scored from videotapes of group sessions. Both of these instruments use trained observers to make ratings for the group-as-a-whole. The outcome battery for patients in these groups included a widely varied set of measures, enabling us to view change from a number of perspectives. Our findings indicate that cohesion and alliance as measured here are related concepts. We also find that both cohesion and alliance appear to have strong relationships with improved self-esteem and reduced symptomatology for patients in these groups. In addition, it appears that outcome is most related to cohesion in the first 30 minutes of a group session. Implications of these and other findings are discussed.

Scale development of a measure to assess community‐based and clinical intervention group environments

“…In one study, examining members' appraisals of self-help groups (i.e., Multiple Sclerosis, Compassionate Friends, and Overeaters Anonymous groups), members who perceived that their group was well organized and had a proficient leader reported greater satisfaction with the group, higher levels of selfγesteem, and lower levels of depression (Maton, 1988). Similar findings have been obtained in other studies, which have shown that primary group outcomes are related to several features of group environments, including perceived levels of group cohesion (Budman, Soldz, Demby, Feldstein, Springer & Davis, 1989;Meredith, 1987), disruptive group dynamics (Faris & Brown, 2003), group leadership and implementation (Kulic, Horne, & Dagley, 2004), and perceived group climate (Choi, Price, & Vinokur, 2003;MacKenzie, Dies, Coché, Rutan, & Stone, 1987).…”

“…As the use of group-level interventions increases in both research and applied settings, it is very important to document the possible moderators to individuals' change as a result of participating in an intervention group (Stefanek, 2004). As previous research has shown, features of group environments play an important role in determining the effectiveness of a group-level intervention (Budman et al, 1989;Choi et al, 2003;MacKenzie et al, 1987;Maton, 1988;Meredith, 1987). Thus, researchers and practitioners utilizing interventions groups may benefit from routinely asking: "How do participants' perceptions of the group environment affect their individual progress, and progress for the intervention as a whole?"…”

“…Indeed research has suggested that the way a group intervention is developed, implemented, and managed impacts the way participants view the group's atmosphere and productivity (Kulic et al, 2004). It should be noted that group cohesiveness, which has been long understood to be the most salient factor in determining the effectiveness of psychotherapeutic group interventions (Budman et al, 1989;Yalom, 1985), was the factor that explained the least variance in items making up the Intervention GES. Nonetheless, the cohesiveness subscale was significantly correlated with both the implementation and preparedness and counterproductive activity subscales.…”

Modeling cohesion change in group psychotherapy: the influence of group leader behaviors and client characteristics

“…They found that group-level cohesion, as rated by an independent observer of both membermember and member-leader interactions, was related to client improvement. They also noted that cohesion within the first 30 minutes of a session had the strongest relationship to outcomes (Budman et al, 1989). Other researchers have noted the importance of therapist ratings of group cohesion.…”

“…conflictual) and working stages of a psychotherapy group. As such, there is strong theoretical evidence for the examination of cohesion in group psychotherapy process and outcomes (Budman et al, 1989;Kivlighan & Lilly, 1997).…”