Little research has been done on therapeutic alliance in group psychotherapy, especially the impact of treatment duration and therapist professional characteristics.
Therapeutic alliance was rated by patients on the Working Alliance Inventory-Short Form at three time points (sessions 3, 10 and 17) in a randomized controlled trial of short-term and long-term psychodynamic group psychotherapy. As predictors we selected therapist clinical experience and length of didactic training, which have demonstrated ambiguous results in previous research. Linear latent variable growth curve models (structural equation modeling) were developed for the three Working Alliance Inventory-Short Form subscales bond, task and goal.
We found a significant variance in individual growth curves (intercepts and slopes) but no differential development due to group length. Longer therapist formal training had a negative impact on early values of subscale task in both treatments. There was an interaction between length of the therapists' clinical experience and group length on early bond, task and goal: therapists with longer clinical experience were rated lower on initial bond in the long-term group but less so in the short-term group. Longer clinical experience influenced initial task and goal positively in the short-term group but was unimportant for task or significantly negative for goal in the long-term group.
There was no mean development of alliance, and group length did not differentially impact the alliance during 6 months. Early ratings of the three Working Alliance Inventory-Short Form subscales partly reflected different preparations of patients in the two group formats, partly therapist characteristics, but more research is needed to see how these aspects impact alliance development and outcome. Therapists should pay attention to all three aspects of the alliance, when they prepare patients for group therapy.
In psychodynamic groups, length of therapy does not differentiate the overall level or the development of member-leader alliance. Within psychodynamic groups, each individual appear to have their unique perception of the member-leader alliance. Therapists with longer formal psychotherapy training may be less successful in establishing early agreement with patients on the tasks of psychodynamic group psychotherapy. Patients perceive a somewhat lower degree of early emotional bonding with the more clinically experienced therapists in long-term psychodynamics groups. Therapists with more clinical experience may contribute to a stronger degree of initial agreement with patients on the tasks and goals of short-term group psychotherapy.
We present here a qualitative study of nine time-limited therapies with children. Time-limited psychotherapy with children is a structured therapeutic method, where the objectives and contents are individual for each child. The number of hours for the therapy is contracted together with the child and the parents. The goal of the therapy is formulated as a shared focus based on the needs of the individual child. The focus is expressed metaphorically and is decided upon together with the child and parents before the therapy is commenced. The therapist's task is to connect the material that the child brings in to the sessions to the agreed focus. The study showed that a clear framework gave the children and the families the necessary security during the therapy process. Attunement to the children's experiences within this framework invited the children to communicate their experiences. Parents, teachers and therapists reported in all cases a positive change after the therapies had been concluded.
The relationship between level of alcohol dependence and treatment outcome was examined by comparing the success rates of severely dependent and not severely dependent males treated briefly in Toronto and Brazil. Treatment involved three 1-hour sessions of training in methods for achieving abstinence or moderate drinking. During the year following treatment, the severely dependent clients were more frequently rated as "successful"--56% of them achieved abstinence or moderate drinking, compared to about 30% of those who were not severely dependent. Although this difference is not statistically significant, the finding is clearly of clinical relevance.
The present article describes experience with admissions for observation for limited periods in the Psyciatric Hospital for Children in Risskov. Admissions of this type were introduced in 1984 in Risskov and this is hitherto the only place in Denmark where this is done. The case records of 75 children admitted during the period 1.1.1984-31.12.1986 were reviewed as regards the pattern of referral, the problems on admission and placing on discharge. The durations of these admissions were 4-5 weeks and the structure of these admissions for limited periods is described in this article. The value of this form of hospitalization is emphasized. Maintenance of the child's relationships to the home and school, efficiency of the working routine and improved sorting out of children for long-term hospitalization are emphasized as important arguments. Finally, it is recommended that all departments for child psychiatry with residential units should have the possibility of admitting children for limited periods as part of extended outpatient investigation.
The aim of this study was to identify significant predictors of length of time spent in treatment. In a convenience sample of 439 Danish survivors of child sexual abuse, predictors of time spent in treatment were examined. Assessments were conducted on a 6-month basis over a period of 18 months. A multinomial logistic regression analysis revealed that the experience of neglect in childhood and having experienced rape at any life stage were associated with less time in treatment. Higher educational attainment and being male were associated with staying in treatment for longer periods of time. These factors may be important for identifying those at risk of terminating treatment prematurely. It is hoped that a better understanding of the factors that predict time spent in treatment will help to improve treatment outcomes for individuals who are at risk of dropping out of treatment at an early stage.