Welcome to the AGPA Practice Resource for Evidence-Based Practice in Group Psychotherapy!
The term “evidence-based practice” is widely used across health disciplines, but what does it mean for practitioners and consumers of group therapy services?
The purpose of this section is to:
• Explain how the material in this section of the website is organized
and how it can be useful to you as a practitioner or consumer of group
therapy services
• Define “evidence-based practice” in the context of providing and
accessing group therapy services
• Provide a brief summary of the evidence regarding the efficacy and
effectiveness of problem or disorder-focused therapy groups
• Provide a brief summary and definition of multicultural competence in
group practice
• Provide group practitioners and consumers with general references for
further learning
How is this section organized?
The material presented in this section is organized by problem or disorder-specific groups and the evidence to support the helpfulness of these group treatments when compared to another (or no) treatment. Of course, group therapy practice does not always occur through matching a particular disorder or diagnosis with a particular group that has been organized specifically to treat members with that problem. Despite this, research most often has examined questions about particular diagnoses or problems and whether a group intervention helps those facing that problem. Because most clinical practice is conducted with clients who have different diagnoses in the same group, i.e., groups that are heterogeneous rather than homogenous with regard to diagnosis, sometimes makes it more difficult to directly apply findings based upon the most rigorous research. However, most of the research included here has accounted for many of the real-world complexities (such as group members who have more than one diagnosis) that occur in groups.
Practitioners and Consumers: How do I know if my group is evidence-based?
There are several different perspectives on what “evidence-based practice” means in the context of providing or accessing group therapy services. One approach has to do with matching the treatment to the specific problem, and thus using treatments that have been tested in randomized clinical trials (the so-called “gold standard” of research) and shown to be efficacious in treating that problem. Another perspective defines “evidence-based practice” as using the best available research, combined with clinical judgment and client preferences. This is the perspective taken by the AGPA Science to Service Task Force as articulated in the Clinical Practice Guidelines (2008). Becoming familiar with the research presented in this section of the AGPA website is one important part of the process of engaging in evidence-based practice.
What are some barriers to understanding “the evidence base”?
There are many ways to determine whether a small group treatment is helpful for participants. An important way is through systematic, rigorous research design and testing. However, what makes group therapy a rich, exciting, and rewarding experience also makes it complicated to study. A group therapy experience involves many dynamic, interacting variables and relationships, over time, and at multiple levels. Variables include the pre-group characteristics of each group member (i.e., personality, attachment style, cultural background, level of functioning, motivation, etc.); characteristics of the group therapist or therapists; characteristics of the particular treatment; the fit between the type of group and the goals of the group member; the type and quality of the relationship between group co-facilitators; the relationship between a facilitator and each group member; the relationship of each group member to the other members, and to the group-as-a-whole; and the characteristics (the content and the process) of a particular session (Miles & Paquin, 2013).
How do I know if I can trust the group research found here on AGPA’s website?
A multi-level conceptualization of individual and group level processes, as well as sophisticated tools for gathering and understanding group data, are required in order to account for the inherent complexity that characterizes group therapy in clinical practice. For example, quantitative data from small groups are inherently interdependent, and thus they violate many assumptions of most traditional statistical tests. Why does this matter? If this interdependence is not accounted for in the research design and analysis of group therapy data, faulty conclusions can be made about the helpfulness of the treatment. In a study by Baldwin, Murray, & Shaddish (2005) the researchers found that among the 33 studies of empirically supported group treatments, none accounted for non-independence of the data. The researchers re-analyzed the data from these studies and found that a much smaller proportion of the studies that were reported as significant actually were significant. Group research since then, including most of the group research presented in this section, addresses these issues, therefore making conclusions about the effectiveness of group therapy more reliable.
Another challenge to understanding the usefulness of research findings (and one that is inherent to all kinds of treatment research) involves being able to determine whether changes observed in clients are due to the treatment or to other variables. Specifically, in studies that are designed to test how well a particular kind of group treatment works when compared with no treatment or another kind of treatment, confounding variables (variables that are difficult or impossible to prevent or control) exist and can include just about anything that a group member does outside of the group session. For instance, a group member who accesses other types of treatment in addition to participating in group therapy can make it difficult or impossible to determine the extent to which any improvements are due to the treatment of interest and not some other variable.
“Efficacy vs. Effectiveness” – what is the difference?
The more controlled a study is in the research laboratory, the more confidently we can conclude that significant results are due to the treatment. This type of study is likely to be testing the “efficacy” of a treatment. However, how a treatment is implemented in a controlled, laboratory setting may look very different from how that treatment is implemented out in the field or “real world” setting, and may produce different results. Studies designed to test how a treatment works in the field can be considered to be “effectiveness” studies. Because both effectiveness and efficacy studies are essential to understanding “what works” in group intervention, both types of studies are included in this section of AGPA’s website.
What is “practice-based evidence?”
Another way of determining whether a therapy group is helpful to its participants involves tracking client and group-as-a-whole progress. Practice-based evidence refers to a process of information gathering about how the group and its particular members are faring, and can be done in several ways. The CORE-R Battery Revised (Burlingame et al., 2006) is one comprehensive resource designed to assist practitioners in tracking client progress, including selection, process, and outcome measures.
What are some things I can do to be an evidence-based group practitioner?
Evidence-based practice refers to basing one’s clinical practice on a combination of factors. Here are the resources an evidence-based group practitioner accesses when developing and delivering evidence-based group therapy services:
• Empirically supported treatments
• Best available empirical research
• Client preferences, values, and/or expectations regarding treatment
• Gathering practice-based evidence that your group processes are helping its members
• Clinical practice guidelines and other sources for working with diverse populations
Furthermore, an evidence-based group practitioner pays attention to the ingredients of change that appear to be present in successful therapy groups across problems, populations, treatment approaches, and settings (Burlingame, et al., 2013). These include:
• One’s formal theory of change
• Knowledge of group dynamics and basic social processes
• Imposed structure (e.g., member selection, pre-group preparation, etc.)
• Emergent structure (e.g., group development, group norms, etc.)
• Emergent processes (e.g., therapeutic factors, the group’s climate or cohesion,
leader
interventions, etc.)
• Individual characteristics of the group member and the group practitioner
• Knowledge, skills, and awareness related to working with culturally diverse clients in groups.
What is the evidence-base for multicultural competence in group practice?
One of the difficulties in establishing an evidence-base for group treatments for diverse populations is that historically, most treatment research has been conducted with samples of White, western (and in the case of disorder-specific research) men. More recently, researchers have begun examining specific treatment questions regarding the efficacy or effectiveness of a particular group treatment approach with traditionally underserved populations, in particular settings, with a group practitioner who engages in a particular set of behaviors or demonstrates a specific set of competencies (Miles & Paquin, 2014).
At present, it is not uncommon for group practitioners to encounter a lack of research about group treatments when working with a historically underrepresented population. This underscores the need for continued research to better understand how to develop, implement, and/or modify existing treatments to be maximally beneficial to historically underserved groups. Meanwhile, to compensate for this lack of empirical knowledge about how a particular treatment approach works with an understudied population, Chen and colleagues (2008) encourage group practitioners to become “local clinical scientists” and to gather practice-based evidence (see above) about how their clients are responding to the group intervention. Additionally, every group can be considered “multicultural” and therefore effective group practice requires multicultural competence (Chen, et al., 2008).
How do I become a multiculturally competent group therapist?
Multicultural competence has been noted to have three components: Awareness, knowledge, and skills (Sue, Arredondo, & McDavis, 1992):
• Awareness of beliefs and attitudes (e.g., awareness of one’s own cultural identities, values, and
biases)
• Knowledge (e.g., culture-specific knowledge about various cultural groups including sociopolitical
and historical knowledge)
• Skills (e.g., ability to respond verbally and nonverbally in manners appropriate to the culture of
one’s clients)
Becoming a multiculturally competent group therapist is an ongoing process. This process can include the following markers or tasks:
• Developing a framework for understanding oneself and others as “cultured beings”
• Being able to evaluate the cultural appropriateness of a group intervention
• Developing knowledge and awareness of how power, privilege, and oppression operate in the lives
of group members as well as in the group
Lastly, Chen and colleagues (2008) point out that the diversity that exists in group therapy will be unique to the particular group, as each therapy group is wholly unique. Furthermore, diversity in a group setting is a dynamic, relational process determined by the particular identities of therapist(s), members of the group, and the temporal context (time and place) in which the group is taking place (Chen, et al., 2008). Clinical practice guidelines in your discipline for working with diverse populations can provide further guidance on developing multicultural competence (e.g., APA, 2003).
We encourage citation of this page.
Full authorship reference is as follows: Barlow, S., Burlingame, G.M., Greene, L.R., Joyce, A., Kaklauskas, F., Kinley, J., Klein, R.H., Kobos, J.C., Leszcz, M., MacNair-Semands, R., Paquin, J.D., Tasca, G.A., Whittingham, M., & Feirman, D. (2015). Evidence-based practice in group psychotherapy [American Group Psychotherapy Association Science to Service Task Force web document]. Retrieved from http://www.agpa.org/home/practice-resources/evidence-based-practice-in-group-psychotherapy
Shortened version for citation is as follows: Barlow, S., Burlingame, G.M., Greene, LR,., Joyce, A., Kaklauskas, F., Kinley, J., ... & Feirman, D. (2015).Evidence-based practice in group psychotherapy [American Group Psychotherapy Association Science to Service Task Force web document]. Retrieved from http://www.agpa.org/home/practice-resources/evidence-based-practice-in-group-psychotherapy.
References
American Psychological Association (2003). Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists. The American psychologist, 58(5), 377. DOI: 10.1037/0003-066X.58.5.377
APA Presidential Task Force on Evidence-Based Practice (2006). Evidence-based practice in psychology. The American psychologist, 61(4), 271. DOI: 10.1037/0003-066X.61.4.271
Baldwin, S. A., Murray, D. M., & Shadish, W. R. (2005). Empirically supported treatments or type I errors? Problems with the analysis of data from group-administered treatments. Journal of consulting and clinical psychology, 73(5), 924. http://dx.doi.org/10.1037/0022-006X.73.5.924
Bernard, H., Burlingame, G., Flores, P., Greene, L, Joyce, A., Kobos, J., Leszcz, M., MacNair-Semands, R., Piper, W., McEneaney, A., & Feirman, D. (2008). Clinical practice guidelines for group psychotherapy. International Journal of Group Psychotherapy, 455-542. doi: 10.1521/ijgp.2008.58.4.455
Burlingame, G.M., Strauss, B; Joyce, A; MacNair-Semands, R; MacKenzie, KR; Ogrodniczuk, J; Taylor, S. (2006). CORE Battery-Revised: An assessment tool kit for promoting optimal group selection, process, and outcome. American Group Psychotherapy Association, New York, NY.
Burlingame, G., Strauss, B. & Joyce, A (2013). Change mechanisms and effectiveness of small group treatments, In M. J. Lambert (Ed.), Bergin & Garfield’s Handbook of psychotherapy and behavior change, 6th Ed. (pp. 640-689). New York: Wiley & Sons.
Chen, E. C., Kakkad, D., & Balzano, J. (2008). Multicultural competence and evidence‐based practice in group therapy. Journal of Clinical Psychology, 64(11), 1261-1278. DOI: 10.1002/jclp.20533
DeLucia-Waack, J. L., Donigian, J., & Hernandez, T. (2004). The practice of multicultural group work: Visions and perspectives from the field. Belmont, CA: Thomson/Brooks/Cole.
Miles, J.R. & Paquin, J.D. (2014). “Teaching at the intersection of evidence-based practice and multicultural competence in group training." Symposium presented at the American Psychological Association national meeting, Washington, DC.
Miles, J. R. & Paquin, J. D. (2013). Best practices in group counseling and psychotherapy research, In J. DeLucia-Waack, C. Kalodner, & M. Riva (Eds.) Handbook of group counseling and psychotherapy (2nd Ed) (pp. 178-192). New York: Sage Publications. DOI:http://dx.doi.org/10.4135/9781452229683.n10.
Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling & Development, 70(4), 477-486. DOI: 10.1002/j.1556-6676.