Two threads run through the work and career of Gary Burlingame PhDopens in new window, CGP, AGPA-DF, psychology department chair and professor at Brigham Young University (BYU) in Provo, Utah—measuring the progress and outcomes of various therapeutic strategies, and identifying elements that contribute to effective group therapy.
Burlingame trained primarily in counseling psychology and joined BYU's clinical psychology program in 1983. With Michael Lambert PhDopens in new window, a fellow BYU professor, in the early 1990s, he created the OQ®(Outcome Questionnaire) Measure, a 45-item patient survey, now one of a widely used set of tools their company, OQ®Measuresopens in new window, offers to gauge therapeutic progress and success for adults, children, and groups.
"We call it mental health vital signs," Burlingame says.
He and Lambert have been pioneers in patient-reported outcome measurement (PDF, 423KB)opens in new window (PROM) in mental health, the regular assessment of progress, from patients’ point of view, of their functioning, symptom severity, and well-being over the course of treatment. One benefit has been that therapists can immediately address problems that may be more likely to show up in a written assessment than in therapy itself, like suicidal thoughtsopens in new window or the state of the allianceopens in new window between the patient and the therapist, Burlingame says.
"We showed therapists the clinical and the scientific value of using a measure on a session-to-session basis," he says.
Burlingame is a clinician, and he supervises and trains clinicians and consults extensively. He teaches both graduates and undergraduates at BYU and has authored or co-authored dozens of books, including Handbook of Group Therapyopens in new window, and additional chapters, and has published 160 peer-reviewed articles on group therapy and more than 50 articles on outcome questionnaires. He has been an APA Group Psychologist of the Year and was honored by the American Group Psychotherapy Associationopens in new window (AGPA) as a distinguished fellow for his “outstanding contributions in group psychotherapy.”
Research on group therapy
For decades, Burlingame has studied group therapy, the practice of treating a number of patients at the same time. Group therapy offers what psychiatrist Irvin Yalom, MD, identified as the "curative" or therapeutic factorsopens in new window—altruism, cohesion, universality, interpersonal learning input and output, guidance, catharsis, identification, family re-enactment, self-understanding, instillation of hope, and existential factors. These interpersonal conditions or mechanisms of change are particular to the group therapy experience.
Group therapy can give participants the comfort of realizing that no matter what problems they’re dealing with, they're not alone, Burlingame says. Another therapeutic factor that occurs uniquely in group is "vicarious learning," in which a person acquires a new skill by watching peers do it, he says.
Burlingame is a fellow and past president of APA Division 49 (Society for Group Psychology and Group Psychotherapy) and is also the current president of the AGPA. He believes group therapy, which achieved APA specialty status in 2018, could go a long way toward easing the present shortage of mental health services for both adults and children. Burlingame's team showed in 2016, in a meta-analysisopens in new window of 46 randomized clinical trials, that in terms of outcomes, there was "zero difference between individual and group therapy across multiple disorders," he says. Group therapy costs less than individual therapy, amplifies providers' services, offers some benefits individual therapy does not, and has been shown to work well for all ages and across ethnic groups, he says.
The average group therapist presently treats eight patients, Burlingame says. If, in a single treatment hour, "I'm treating eight patients rather than one, all of a sudden, I'm solving my problem of getting patients access to treatment," he says.
Some therapy groups work on a specific condition, like depression, anxiety, schizophrenia, or substance abuse disorder, while in others, patients address a range of issues. People who experience illness or loss can join a therapy group with others who are dealing with the same type of experience. Some patients combine individual and group therapy.
Not every patient is suitable for every group, or any group, for that matter, and Burlingame's OQ® Measures has a 19-item group readiness questionnaireopens in new window for practitioners to help patients find their best therapy option.
Pandemic normalizes online group therapy
A "silver lining" of the pandemic has been the normalizing of online therapy, bringing treatment to people who might not otherwise have access to mental health services. While the jury is still out on whether online therapy works as well as the face-to-face type, Burlingame’s team has recently found that online group therapy can be just as effective as online individual therapy, he says.
Given the abundanceopens in new window of researchopens in new window showing equal outcomesopens in new window for in-person individual and group therapy, Burlingame says, "it's no longer acceptable not to treat patients in a group."
Training providers does still represent a hurdle, though, he says. The AGPA sponsors programs for psychologists and students interested in becoming certified in group therapy, and Division 49 offers training opportunities and other resources as well. However, only about a quarter of psychology students in APA-approved programs ever receive training in group psychology, Burlingame says, because the class is often presented as an elective, and because some professionals still see group therapy as not that different from individual therapy. Prospective practitioners can—and should, Burlingame says—acquire the specialized skill set of group therapy through classwork and practicums that lead to certification.
Group therapy website
Burlingame is also involved in the creation of an evidence-based group treatment website for both clinicians and the public, along the lines of APA Division 12's (Society of Clinical Psychology) "research-supported psychological treatments"opens in new window section. Funding for the new group therapy website, which will address 12 common adult psychiatric disorders, will come from Division 49, the AGPA and the German Health Ministry. Burlingame says he’s in touch with psychologists all over the world who specialize in group psychology. "If there's good evidence for treatment, I want it on the website," he says.
Burlingame says he has been interested in groups ever since he watched the Chicago Democratic Convention on television in 1968 as a boy. He saw then the power a group could have, he says. As a college student studying group dynamic principles with a teacher who was also a social psychologist, he participated in classroom demonstrations but was determined not to succumb to the power of the group. He did, though, he recalls. "Groups affect you, whether you want them to or not," he says.
