SUMMARY
Lilianna Engel : Effectiveness of outpatient individual and group psychotherapy
– an integrated approach
Aims. The aims of the study were, firstly, to assess effectiveness of the integrated
individual and group psychotherapy of outpatients with neurotic and stress-related
disorders. Secondly, outcome stability and delayed effects of psychotherapy were
assessed
at
1-year
follow-up.
Moreover,
the
mechanisms
underpinning
psychotherapeutic interventions were investigated. An answer was sought to the
question whether therapy outcomes in patients receiving individual therapy were
mainly intrapsychic (i.e. related to personality change), while in those receiving
group therapy – predominantly associated with improvement in social functioning.
Participants. The study sample consisted of 100 patients referred by a consulting
psychiatrist to the Outpatient Clinic, Institute of Psychiatry and Neurology for
psychotherapy. There were 51 men and 49 women aged 20-59 (mean age 33 years,
SD = 11.85), diagnosed by the ICD-10 criteria with neurotic, stress-related and
somatoform disorders (F-40 to F-48), dysthymia (F-34), or personality disorders (F60 to F-69). Patients receiving therapy were divided into two groups with regard to
the form of therapy: individual (N = 33) and group psychotherapy (N = 33). There
was also a waiting-list control group (N = 34). In both treatment groups
psychotherapy was conducted by the same therapist using the integrated approach.
Irrespective of the form of psychotherapy, the treatment was provided to each patient
for 1 year, totaling 50 sessions held once a week. Group therapy was conducted in 2hour sessions, in three therapeutic groups, while individual sessions took 1 hour.
The following variables were measured on three occasions: at baseline (pretreatment), on the treatment completion (post-treatment) and at 1-year follow up:
1. Symptom severity (using The Symptom Checklist „O”, developed at the
Psychotherapy Chair, Collegium Medicum, Jagiellonian University in Cracow);
2. Neurotic personality traits (measured with The Neurotic Personality Questionnaire
KON 2006, the Psychotherapy Chair, Collegium Medicum, Jagiellonian University
in Cracow),
3. Social functioning level, with social competences assessed in three dimensions - of
intimacy, social exposure and assertiveness (using The Social Competences
Questionnaire (KKS - A (D)) by Anna Matczak, Psychological Testing Laboratory of
the Polish Psychological Association),
4. General personality traits (the Adjective Check List by H. B. Gough, A. B.
Heilbrun),
5. Clinical picture based on the Medical History Questionnaire, including
sociodemographic data and difficult situations in life as reported by the patients;
6. Solving Problem Life Situations - a tool developed by the author on the grounds of
the former questionnaire, with the following 6 categories of difficult life problems:
joblessness, lack of job satisfaction, loneliness –lack of a stable relationship,
conflicts in relationships, avoiding important decision-making in life, unfinished
education.
Results and conclusions
1. The integrated approach (including dynamic, cognitive-behavioral and systemic
components) applied in outpatient individual and group psychotherapy turned out to
be effective. A significant symptom relief was attained post-treatment, together with
reduced levels of neurotic personality traits, as well as enhanced social competences
and increased solvability of difficult situations in life. These changes were generally
stable at the 1-year follow-up. Moreover, some delayed effects of therapy were
noted.
2. Qualitative differences concerning changes in neurotic personality traits, social
competences, and solvability of difficult life situations suggest that the mechanisms
underpinning symptom amelioration were different in patients undergoing either
group or individual psychotherapy, both post-treatment and at 1-year follow-up. A
qualitative analysis of outcomes attained in the two forms of psychotherapy indicates
that individual psychotherapy leads mostly to intrapsychic (personality) changes,
while group psychotherapy results in interpsychic (social functioning) changes.
The effect of the patients’ negative self-appraisal improvement on symptom
amelioration was confirmed post-treatment in both groups receiving either individual
or group psychotherapy. At the 1-year follow-up symptom relief in both groups was
associated with an improvement in negative self-appraisal, and besides, with two
other positive changes: after group psychotherapy - in exaltation, and after individual
psychotherapy – in the lack of vitality.
3. No relationship was found between symptom amelioration and the patients’
general personality traits measured at the baseline using the ACL. However, their
2
baseline general personality traits (ACL) were significantly related to changes in the
remaining variables under study (i.e. neurotic personality traits, social functioning,
and solving difficult life problems).
4. Symptom amelioration was unrelated to the patients’ sociodemographic
characteristics.
3