Group psychotherapy with mentally retarded adults: issues related to design, implementation, and evaluation.
Group therapy for dually diagnosed adults can start simple—blend behavioral drills with talk time and track mood each week.
01Research in Context
What this study did
Pfadt (1991) wrote a how-to guide, not a trial. The paper maps every step needed to run therapy groups for adults with both intellectual disability and mental health issues.
It mixes behavioral tools (token boards, social skills drills) with psychodynamic ideas (talking about feelings, group trust). It also tells agencies how to share staff, space, and data.
What they found
No numbers are given. The paper is a blueprint, not a scorecard. It lists what to measure—mood logs, attendance, staff stress—but does not report results.
How this fits with other research
Cox et al. (2015) later tested a pure CBT group program and saw big symptom drops. Their manual follows the same group rules Pfadt (1991) sketched—clear goals, weekly check-ins, role-play—but drops the psychodynamic parts.
Unwin et al. (2016) reviewed 11 tiny CBT studies and found weak effects. This seems to clash with Cox et al. (2015), but Gemma pooled mostly single-case designs while R used a larger quasi-experiment. The difference is study power, not therapy type.
Khokhar et al. (2025) add a wider lens: packages that blend several ABA tools beat one-tool plans for adult problem behavior. Pfadt (1991) was first to argue for blending; the new review shows the payoff.
Why it matters
You can lift the paper’s checklist today: pick a closed group of 6–8 adults, write a shared goal on the board, run a 45-minute session, and track mood with color cards. Start small, then add CBT or ABA modules as you see progress.
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02At a glance
03Original abstract
Although the mental health needs of mentally retarded persons are becoming increasingly acknowledged by service providers, psychotherapy is still neglected as a treatment modality. This paper provides a framework for considering issues related to the design, implementation, and evaluation of group psychotherapeutic endeavors to benefit dually diagnosed clients. A social systems approach to psychopathology is described to illustrate how a variety of potentially treatable aspects of dysfunctioning can be identified and selected as treatment goals for group psychotherapy with mentally retarded individuals. Treatment models are presented to assist in the pragmatic blending of behavioral and psychodynamic interventions that are relevant for conducting group psychotherapy with this population. Administrators and clinicians are provided with a prototype of how to establish and maintain cost-effective linkages between mental health and mental retardation agencies, so that dually diagnosed clients are not excluded from receiving services they need. Finally, process and outcome evaluation strategies are considered which might provide an empirical basis for documenting the effectiveness of group psychotherapy as a viable, nondrug approach to treating psychopathology in mentally retarded individuals.
Research in developmental disabilities, 1991 · doi:10.1016/0891-4222(91)90012-h