PS521 Unit 6 Group Versus Individual Paper Example

Is the Group Room Worth It?: A PS521 Unit 6 Paper Weighing Group Against Individual Treatment for an Intensive Outpatient Program's Budget

[Student Name]

Purdue University Global

PS521: Group Counseling

Unit 6 Group Versus Individual Treatment Paper

[Instructor Name]

[Date]

The writer, the program, the hospital's figures and every detail of the proposal are composite and illustrative; the sources cited are real.

The Question

Our program runs three evening groups a week for each cohort, with individual sessions every other week. A member of the hospital's finance committee, who had read that personalized care is the future, asked the program director in October whether members would do better with more individual counseling and fewer group nights. The director asked me to summarize the research for the committee. This paper is that summary and the recommendation that followed.

Comparing Formats Directly

The most useful evidence comes from studies that compared group and individual formats within the same trial. Burlingame et al. (2016) found 67 such studies published over 25 years. In the 46 studies that compared identical treatments, patients and doses, the two formats produced equivalent outcomes on primary measures, with an effect size difference near zero and little variability across studies. In 21 studies comparing different treatments, the formats were again equivalent overall, although researchers' allegiance to one format influenced results. There were no differences between formats in treatment acceptance, dropout, remission or improvement, and outcomes did not differ by diagnosis. Substance use disorders were among the diagnoses with the largest improvements from before to after treatment in both formats.

For the committee's question, this is the central finding: when the content and dose are the same, people do about as well in groups as in individual sessions.

Group Treatment for Substance Use Specifically

A 2019 meta-analysis gathered 33 randomized trials of group therapy for adults with substance use disorders (Lo Coco et al., 2019). Group therapy produced small but significant effects on abstinence when compared with no treatment, with individual therapy and with other treatments that used no specific psychotherapeutic techniques. Effects on how often people used substances and on disorder symptoms were not significant. Group therapy did show moderate effects on symptoms of anxiety and depression, and attrition did not differ between group and other conditions.

Weiss et al. (2004), reviewing 24 earlier studies, reached a similar conclusion: outcomes in group and individual formats generally did not differ, and no single type of group reliably did better than another. Both reviews note that group research is hard to do well, because members influence each other and group processes are difficult to standardize.

The research does not say groups are better than individual counseling; it says they are about as good, which is a strong argument when one counselor can see nine people at once.

Applying the Evidence to the Program

Our program has two full-time counselors and one intern. Each cohort of nine members currently receives nine hours of group per week, three nights of three hours, plus a fifty-minute individual session every two weeks. Replacing two group nights with weekly individual sessions would require each counselor to add about seven individual hours a week for one cohort alone, while cutting each member's total treatment time from nine hours a week to about four.

Burlingame and colleagues' finding of equivalence applies when the dose is the same. The proposed change would not hold dose constant; it would cut it by more than half. Intensive outpatient programs are defined in part by the number of treatment hours per week, and reducing those hours would change what the program is, not just its format.

The change would also affect the waitlist. Our program currently has eleven people waiting for a cohort. The group format lets two counselors serve eighteen members across two cohorts. A mostly individual format would serve fewer people, and the waitlist would grow.

What Groups Add That Is Hard to Measure

Some benefits of group work do not appear clearly in outcome trials. Members in our cohort have described the relief of hearing others tell the same stories, the hope they draw from a peer volunteer who completed the program a year earlier, and the practice they get in handling conflict and feedback in the room. The 2019 meta-analysis's finding of moderate effects on anxiety and depression may reflect some of these processes. These are not reasons to ignore the evidence, but they help explain why equivalent outcomes can still favor groups in practice.

What Individual Sessions Add

Individual sessions remain important for some members and some tasks: assessing safety, discussing matters a member is not ready to raise in group, such as abuse or legal problems, and planning medication or referrals. Our biweekly individual sessions serve those purposes. A member who struggles in group, such as someone with severe social anxiety or a recent trauma, may need more individual time, and that decision should be made person by person.

Questions the Committee Raised

The finance committee asked two follow-up questions. The first was whether members who drop out of groups would have stayed in individual counseling. Burlingame and colleagues found no difference between formats in dropout, which answers the question at the level of research, though not for any particular member. The second was whether groups are cheaper only because they are lower quality. The evidence of equivalent outcomes in matched comparisons argues against that, but the committee was right to ask for local data, which is why the recommendation includes a dashboard.

Recommendation

I recommended keeping the three group nights and biweekly individual sessions, with two additions: a quick screening at intake for members who may need more individual care, and a simple outcome dashboard tracking attendance, abstinence by urine test and depression scores so the committee can see results directly. The director presented the summary to the committee, which agreed to keep the current format and review the dashboard in six months.

Limits

Both meta-analyses include studies from many settings, and few match an intensive outpatient program in a small city exactly. Allegiance effects in Burlingame and colleagues' analysis suggest that researchers' preferences can shape results. Our own dashboard will not prove that groups cause better outcomes, but it will show whether the program is doing what the research suggests it should.

Conclusion

The research on group versus individual treatment points to equivalence when content and dose are matched, and to small benefits of group therapy for abstinence in substance use disorders. Applied to our program, that evidence supports keeping the group format, because the proposed change would cut treatment dose, shrink capacity and lose benefits members describe, while offering no evidence of better outcomes.

References

Burlingame, G. M., Seebeck, J. D., Janis, R. A., Whitcomb, K. E., Barkowski, S., Rosendahl, J., & Strauss, B. (2016). Outcome differences between individual and group formats when identical and nonidentical treatments, patients, and doses are compared: A 25-year meta-analytic perspective. Psychotherapy, 53(4), 446-461. https://doi.org/10.1037/pst0000090

Lo Coco, G., Melchiori, F., Oieni, V., Infurna, M. R., Strauss, B., Schwartze, D., Rosendahl, J., & Gullo, S. (2019). Group treatment for substance use disorder in adults: A systematic review and meta-analysis of randomized-controlled trials. Journal of Substance Abuse Treatment, 99, 104-116. https://doi.org/10.1016/j.jsat.2019.01.016

Weiss, R. D., Jaffee, W. B., de Menil, V. P., & Cogley, C. B. (2004). Group therapy for substance use disorders: What do we know? Harvard Review of Psychiatry, 12(6), 339-350. https://doi.org/10.1080/10673220490905723