Abstract
The Search for Evidence — A Basic Assumption of Group Analysis?
Steinar Lorentzen presents a treatment manual for short- and long-term analytic groups, borne out of his assertion that most of the existing research in Europe has been focused on short-term groups, despite long-term groups being preferred. The manual has emerged from the research design for his randomized control trial study of the relative effectiveness of short- and long-term group analytic psychotherapy for affective, anxiety, and personality disorders.
From early on, the practice of group analysis has been intertwined with attempts to provide evidence for its effectiveness. The Northfield Experiments were early illustrations of this, demonstrating the value of the group analytic approach. A question regarding what constitutes therapeutic progress arose, with Bion, Foulkes, Main and others at odds with senior military personnel. From the start, this raised a fundamental debate about who research is for, and the differing agendas of various stakeholders.
In the current climate, providing evidence of clinical effectiveness is paramount in securing funding for services. Lorentzen has responded to this demand, providing evidence for group analytic psychotherapy (both short- and long-term), while also responding to the need for clarity of technique within the group analytic literature. As such, he has embodied the true values of the research endeavour—to provide evidence of effectiveness as well as to clarify technique and theory.
In setting up his research project, Lorentzen has also attempted to explore patient, therapy and therapist factors that may influence outcome, and to study potential mechanisms of change. The first part of his manual is devoted to long-term group psychotherapy: he provides a succinct summary of group analytic theory, the dynamic administration underpinning a long-term group, and a specific focus on therapist attitude. Lorentzen identifies ‘three essential methodological measures in group analysis’: a group analytic culture; the oscillation between the here and now, and the there and then; and balancing interpretation and translation. He goes on to discuss technique, providing an invaluable and coherent set of guidelines for interventions in long-term group analytic psychotherapy. The last chapter in the section on long-term analytic groups is devoted to clinical examples, where Lorentzen provides illustrations of analytic groups in action.
In the second part of the manual, Lorentzen focuses on short-term group analytic psychotherapy, highlighting the similarities and differences in relation to long-term analytic groups. He discusses the specific modifications to be made when conducting a short-term analytic group: the conductor needing to be more active; the treatment more focused and structured; and more focus on both working in the here and now, and also on maintaining an awareness of the termination phase. Lorentzen draws specific attention to the developmental stages in short-term analytic groups, stating that ‘each stage seems to confront the group, individual members and the therapist with characteristic challenges that have to be solved in order for the group to be able to move on’ (p49). Lorentzen concludes this section with a range of clinical examples, highlighting the dilemmas and specific techniques required in short-term group analytic therapy.
The third part of the manual is devoted to clinical research, with Lorentzen reporting on the research process. He starts off by discussing therapist adherence and competence in the study, describing the measures designed to assess therapist competency and adherence to a group analytic model. Next, the challenges in operationalising the project are discussed, concluding with some preliminary results. Lorentzen’s study showed a clinically significant change (‘ . . . the patient both improves significantly and . . . moves into the range of the normal population’) in a greater number of patients with personality disorders in the long-term group than in the short-term group. He interprets the clinical implication of this data in terms of the importance of the diagnosis of personality disorder before treatment length is agreed, drawing attention to the potential economic implications, but also the potential ‘destructive ruptures in therapeutic alliance and attachment to other group members’.
On a group process level, Lorentzen states that the findings of his study suggest that a greater focus on therapy goals and their associated therapeutic tasks, and more attention to the member–therapist relationship, would improve therapy outcome. In his closing comments, Lorentzen focuses briefly on the mechanisms of change in group therapy. His study has found a change in negative attributional style in the long-term group, and there are plans to investigate the role of self-understanding as a potential mechanism of change.
Steinar Lorentzen has provided us with an essential group analytic text for the times we live in and also for the times to come. His research and manual are a valuable asset in securing the future of group analysis within the current climate, and should be embraced by current and future group analysts wishing to promote and develop the discipline.