A mixed method Delphi study to determine professional consensus on the key elements of outpatient Psychodynamic Group Psychotherapy (PGP) for psychosis

Although psychodynamic group psychotherapy (PGP) has been offered to patients with psychosis for over a century there is little empirical evidence of its effectiveness. In part this has to do with the lack of a consistent and adequately robust definition of this intervention. The aims of this study were to develop a set of the core components of PGP for psychosis and to gain a deeper insight into the current methods of its delivery. A research design using a mixed methodology combining the Delphi method and the thematic analysis has been employed. 37 experts around the world were recruited to participate in three rounds to produce and rate statements that aimed to address the following areas in order to consolidate consensus of opinion: indications for treatment, the aims of therapy, therapy frame, therapeutic factors, assessment and preparatory sessions, the formulation of hypotheses, a general therapeutic approach throughout assessment and therapy, phase specific interventions and attitudes and qualities necessary for therapists conducting PGP for psychosis. 145 components were endorsed as important or essential for PGP for psychosis by more than 80% of the experts. The participants' comments on their rating decisions were then subjected to thematic analysis which highlighted further adaptations of PGP which should be applied to patients with psychosis: more active leadership, and more considered interpretation of unconscious dynamics and transference. Participants argued for the flexible application of PGP principles and stressed the importance of understanding psychosis as a response to overwhelming emotional experiences. Importantly, none of the participants considered PGP to be harmful to patients with psychosis, which warrants a review of the existing warnings against psychodynamic therapies for psychosis. The outcomes of this study could be of value to clinical practice, the training and dissemination of PGP for psychosis, the development of a competency framework as well as for future research into its effectiveness.