None of the items more characteristic of cognitive therapy
were negative; however, several of the items more character-
istic of supportive therapy were negative. For example, sup-
portive group members appeared more aloof or resisted
participation, and the therapist was more likely to be de-
scribed as condescending or disingenuous. In the larger treat-
ment study, members of the cognitive group beneﬁted more
than members of the supportive group. While this may be
attributed to speciﬁc factors, there also appear to be some
common factor differences. Mainly, the characteristics of the
cognitive group appear to be more positive than the charac-
teristics of the supportive group. Therefore, it may be that the
more positive attitude and the higher levels of motivation
observed in the cognitive group may contribute to the greater
beneﬁt of this group. At the same time, the speciﬁc cognitive
group activities are likely to contribute to the group differ-
ences. It is easier to be actively involved in a group consisting
of structured activities. While not examined in this study,
there may be differences among individual therapists that
could affect the differences between the groups; however,
there were no differences among therapists in terms of treat-
ment ﬁdelity. Clients from both groups showed added beneﬁt
from the groups. Therefore, being part of a group based on
common factors of therapy also led to improvement over
pretreatment status. The addition of a no group condition
would allow for the comparison of the common factors
supportive group to no treatment to determine the beneﬁt
from the supportive group.
This study was an initial attempt to describe additional
characteristics of treatment of individuals with chronic men-
tal illness. Although we have described the group process, we
cannot make causal statements regarding which elements
were responsible for the superior outcome of the cognitive
modality. It appears that therapists in both groups exhibited
good therapeutic skills; however, cognitive group members
appeared more motivated and active in group activities than
those in the supportive group. Additionally, therapist factors
such as therapist responsiveness to clients were not speciﬁ-
cally studied here. Future research should explore the rela-
tionship between treatment process and outcome for various
cognitive training approaches. For example, it may be that a
treatment based on speciﬁc factors invokes superiority on
common factors as well; therefore, it is unclear whether the
superiority of one treatment over another is driven by com-
mon factors, speciﬁc factors, or their combination. Addition-
ally, this study illustrates the feasibility of examining process
questions within standard treatments for individuals with
chronic mental illness.
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