Working together: An investigation of the impact of working alliance and cohesion on group psychotherapy attendance

Abstract

Objectives Group psychotherapy holds considerable potential for cost‐effective treatment delivery. However, issues with client attendance can compromise the efficacy of such treatments. To date, client specific factors are amongst the most researched predictors of attendance in psychotherapy, with much less of a focus given to process factors, particularly in the group therapy context. This study aimed to determine which process factors influenced attendance in the context of a group therapy programme for adults with anxiety. It was hypothesized that (1) the working alliance and group cohesion would be moderately correlated, (2) both the working alliance and group cohesion would explain unique variance in session attendance, and (3) the working alliance would act as a moderator for attendance, when group cohesion was low. Design The study utilized a within participants design. Methods Participants were 91 adults (aged 18–74 years) who took part in a 9‐week, transdiagnostic cognitive behavioural group therapy programme for the treatment of anxiety disorders. Results Working alliance and group cohesion were significantly, but only moderately correlated (rs ranging .41 to .55). Together, working alliance and group cohesion significantly predicted total session attendance (17.70% variance explained). Working alliance did not moderate the relationship between group cohesion and session attendance. Conclusions The importance of individual and group processes in influencing group therapy engagement is highlighted, including the role of fostering bonds within the group and between clients and therapists. Practitioner points A complex array of process factors has been argued to influence treatment outcomes in group therapy The quality of the relationship between group therapy clients, as well as the relationship between a client and the therapist, predict session attendance. The quality of the relationship between the client and the therapist may be the most important predictor of session attendance. Therapists should foster positive relationships between each client and the therapist in group therapy, as well as assisting each client to foster positive relationships with other group members.

Implementation of a brief online skills group of dialectical behaviour therapy for emotional dysregulation in Latinx: a withdrawal experimental single-case design

“…Group cohesion was high throughout the treatment and was not different between placebo versus treatment, suggesting that any difference in the scores of one module versus another was not due to improvements in cohesion. These findings support our hypothesis that emotional dysregulation lessened due to skills taught in DBT group sessions rather than simply group cohesion effects, to which research in group therapy has attributed a good amount of responsibility (Clough et al ., 2021).…”

Group Therapy with Peer Support Provider Participation in an Acute Psychiatric Ward: 1-Year Analysis

“…In self-report studies on Yalom's therapeutic factors, "cohesion" is considered the main therapeutic factor which facilitates the other therapeutic factors [29]. More recent authors have confirmed that "cohesion" can represent one of the prevalent therapeutic factors in a group [18,32,33].…”

“…The group therapist in a hospital setting has to adopt an active posture working to facilitate some small changes within the group, using the technique of "here and now". He performs the important function of guardian in regulating the impact of potentially negative extra-group factors, such as the extreme variability of patients sometimes discharged before their participation in the group or the devaluation of the therapeutic group within the ward, and has the duty to address these issues, ensuring that they do not permeate within the group and diminish the experience [9,13,17,18]. A meta-analytic review highlighted that beneficial effects were found for inpatient group therapy, with different effectiveness related to different psychiatric disorders [19].…”

Intake procedures for child–parent relationship therapy: Moving toward an evidence-based process.

“…However, upon further exploration, Reed determined that when group members’ scores were considered as a collective, the measures of cohesion in a group were correlated with higher measures of success related to the reduction of child problem behaviors. Though group therapy may not be the focus of CPRT, research has found a strong relationship between group cohesion, attendance, satisfaction with group, and treatment outcomes (Clough et al, 2022; Tucker et al, 2020) indicating selection and success in group may be enhanced with intake and recruitment protocols in CPRT. Further, when members do not feel comfortable with all members of the group, they are less likely to feel safe in engaging (Kinsworthy & Garza, 2010).…”