精神科住院患者团体心理治疗准备性会谈与治疗后访谈初探

精神科住院患者团体心理治疗较门诊患者团体心理治疗存在临床情境的特殊性,本研究探索将准备性会谈与治疗后访谈纳入治疗计划,治疗前向患者普及住院治疗、心理治疗的知识,澄清团体心理治疗的形式、目标、内容,了解患者对团体心理治疗的疑问、期望,允许患者做出是否参加治疗的决定,并在治疗后的访谈中强化疗效因子。     

Creative Group Living in a Children's Institution Edited by Susanne Schulze

Psychoanalytic psychotherapy is not well developed in Japan (Kotani, 1996). Until recently, group psychotherapy in particular has not been well received by patients or clinicians. Cultural difficulties in using group psychotherapy with Japanese patients have now been overcome and a theory of systematic intervention techniques has been developed. The basic dynamic factors of group psychotherapy such as culturally embedded aspects of social and personality structure are analyzed in this article. Culture-bound psychodynamic characteristics of Japanese patients as activated and worked through in the group process are first described with case illustrations. A systemic hypothesis linking cultural and psychodynamic structure is then delineated and the focal points of interventions are explained in terms of the field dynamics of social structure and boundary dynamics of personality structure.     

Concurrent group and individual psychotherapy in a psychiatric day hospital for depressed elderly

Concurrent psychotherapy is used in various settings for patients of different diagnoses and ages. The concurrent group and individual psychotherapy of older adults with depressive disorders in a psychiatric day hospital is described, emphasizing phases of treatment and transference and countertransference themes uniquely relevant to working with depressed elderly patients in a day hospital. Case examples are offered to illustrate these issues. The special technical considerations that need to be utilized when multiple therapists and settings are present are described. The model employs the use of an integrative, interactive group therapy, along with various other group treatments and antidepressant medication, with individual therapy serving a subordinate but organizing role.     

Complications in group psychotherapy with AIDS patients

AIDS has a unique set of characteristics that makes group psychotherapy more complex than with other populations: (1) the threat of an early death, (2) a highly variable course of illness, and (3) stigma related to the illness and to the preexisting lifestyles of most patients. The specific ways in which the three factors seriously interfere with establishing and maintaining group cohesion are discussed, and clinical guidelines are suggested. In addition, a model for understanding and working with these and other issues in group psychotherapy, based on Erik Erikson's interpersonal theory of development, is presented. Finally, particular countertransferential difficulties are discussed in relation to the heightened emotionality common to AIDS psychotherapy groups.     

An integrated model of group psychotherapy for patients with fibromyalgia

This study examined the effectiveness of an integrated model of brief group psychotherapy for treatment of fibromyalgia syndrome, using cognitive behavioral and supportive expressive techniques. In the context of an outpatient, multidisciplinary fibromyalgia treatment program, group psychotherapy was provided to 35 patients with 21 control patients. Pre-post treatment measures of depression, anxiety, fibromyalgia impact, pain, fatigue, and morning tiredness were obtained. Using a quasi-experimental design with validated psychometric instruments, the results showed a significant decrease in pre-versus post treatment measures of depression, fibromyalgia impact, fatigue, and pain for the treatment patients, suggesting that an integrated model of group psychotherapy may have beneficial psychological and functional effects for some patients with fibromyalgia.     

The Object Relations Technique by Herbert Phillipson

AIDS has a unique set of characteristics that makes group psychotherapy more complex than with other populations: (1) the threat of an early death, (2) a highly variable course of illness, and (3) stigma related to the illness and to the preexisting lifestyles of most patients. The specific ways in which the three factors seriously interfere with establishing and maintaining group cohesion are discussed, and clinical guidelines are suggested. In addition, a model for understanding and working with these and other issues in group psychotherapy, based on Erik Erikson's interpersonal theory of development, is presented. Finally, particular countertransferential difficulties are discussed in relation to the heightened emotionality common to AIDS psychotherapy groups.     

Great Men: Psychoanalytic Studies by Edward Hitschmann. Foreword by Ernest Jones

Abstract

This study examined the effectiveness of an integrated model of brief group psychotherapy for treatment of fibromyalgia syndrome, using cognitive behavioral and supportive expressive techniques. In the context of an outpatient, multidisciplinary fibromyalgia treatment program, group psychotherapy was provided to 35 patients with 21 control patients. Pre–post treatment measures of depression, anxiety, fibromyalgia impact, pain, fatigue, and morning tiredness were obtained. Using a quasi–experimental design with validated psychometric instruments, the results showed a significant decrease in pre-versus post treatment measures of depression, fibromyalgia impact, fatigue, and pain for the treatment patients, suggesting that an integrated model of group psychotherapy may have beneficial psychological and functional effects for some patients with fibromyalgia.     

Voices from the Inaudible: The Patients Speak by Theodor Reik

Fifty-one inpatients, hospitalized on average for 21 days, were studied by means of discharge debriefing interviews. An unstructured, mandatory, and functionally heterogeneous psychotherapy group was compared with a structured, voluntary, and functionally homogeneous psychotherapy group. Statistical analysis of the patients' valuation of the group psychotherapy experiences and of their rankings of traditional group psychotherapy curative factors were performed. Results demonstrated that group psychotherapy was a highly valued component of the overall inpatient treatment. Structural modifications aimed at increasing the here and now, and interpersonal focus of the group meetings, such as the use of patient agendas and group rehashes, significantly affected the patients' group experiences. A comparison of both types of inpatient groups with an outpatient group psychotherapy sample suggests certain guidelines for the goal setting and conduct of inpatient group psychotherapy, recognizing the specific and heterogeneous needs and capacities of the patients treated.     

Unerwünschte und schädliche Wirkungen von Psychotherapie

Unwanted effects or even damage due to psychotherapy are largely neglected issues within psychotherapy research as compared to other fields. On the other hand, it is reasonable to assume that unwanted effects of a treatment which intends to influence patients into a positive direction are very likely. The rate of negative effects of psychotherapy (the deterioration effect according to Bergin) is consistently estimated to be 10% of all cases and shows this same rate in a variety of studies. This review highlights side effects of psychotherapy both on the part of the patients and of the therapists. It reports unwanted effects related to different psychotherapeutic methods, i.e. psychoanalysis, cognitive behaviour therapy, client-centered psychotherapy and – beyond these basic orientations – group psychotherapy. The paper also reports on negative effects of psychotherapy on an untreated partner. Finally, some proposals are given on how negative effects of psychotherapy could be diminished. The authors especially highlight the possibilities of changing the therapist, the treatment technique, or the theoretical treatment approach as a way to reduce negative effects.     

Inherent moral practice in group psychotherapy

The large amount and variety of group psychotherapy practiced today enjoins us to determine its morality, that is, its rightness or wrongness. In this essay group therapy and morality are briefly defined. Using the writings of both philosophers and psychologists, evidence of morality is sought in the intentions and actions of both the patients and therapist and in the group process itself. Paying attention to "personal valuative acts," which are moral in nature and in outcome, group psychotherapy results in the good of the patient, of the therapist, and of the art or practice of group psychotherapy itself.     

The Preoedipal Development of the Critical Superego and Its Manifestations in Psychoanalytic Group Psychotherapy

Alexithymia is a psychic dysfunction in which symbolic thinking and fantasy are reduced, somatization is common, feelings are poorly communicated, empathy is impaired, and intimate interpersonal relations are difficult to maintain. Individuals with significant alexithymia may have a variety of psychiatric disorders but their psychotherapy should always be informed by an awareness of their alexithymia. This paper reviews the concept and details the most efficient means of psychotherapy for alexithymic patients. Ideal treatment for such patients maximizes their opportunities to learn while protecting their self-esteem and minimizing nonproductive stress. Such treatment involves concurrent individual and group psychotherapy. Clinical material is presented and specific therapeutic maneuvers are explored.     

Therapist gender and the same-sex puberty age psychotherapy group

Puberty is considered to be the most difficult developmental period to conduct psychotherapy. Group psychotherapy has special appeal for pubescents because of the anxiety experienced in individual psychotherapy with adults, and the mutual identification and support experienced with groups of same-sex peers. Although pubescents readily form cohesive groups, the emotional stress for the group therapists is intense and many therapists are reluctant to take on such groups. Close attention to the principles of developmental ego psychology suggests that pubescent groups will be more effective if conducted by group therapists of the same sex as the patients.     

Time-Limited Dynamic Psychotherapy as a Model for Short-Term Inpatient Groups

The present article proposes a method, practiced by the author, to adapt time-limited dynamic psychotherapy (TLDP), a short-term individual psychodynamic therapy, for use with inpatient psychotherapy groups. Characteristics of TLDP which suggest the usefulness of such an adaptation, including short-term duration, specific treatment focus, rapid conceptualizations and broad selection of patients, and emphasis on the here-and-now in therapy, are discussed. The general approach to treatment, a supportive stance that involves an identification of maladaptive interpersonal issues, and then working on these issues without directly confronting the patients, is described. Specific therapeutic techniques for common inpatient group situations are also discussed.     

Amelioration of transference resistance: substitute therapists in milieu group psychotherapy

Building upon Wolf's (1949) notion of the use of an alternate session in group psychotherapy, this paper suggests that an alternate therapist substituting for an absent regular therapist in milieu group psychotherapy can facilitate similar therapeutic benefits. The mechanism of this process of overcoming transference resistance is seen as twofold: (1) sessions with a substitute therapist allow patients to confront the infantilization often present in a milieu setting and experiment with more autonomous ego functioning. (2) Sessions with a substitute therapist create conditions which are apart from the ongoing process of the therapy group, thereby allowing for a therapeutic splitting process to develop wherein transference feelings about the regular therapist can be expressed to his or her "alter ego." Several case vignettes are presented in order to illustrate the clinical utility of a substitute therapist.     

The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder

Treatment studies and particularly psychotherapeutic treatment studies of patients suffering from an adjustment disorder are very scarce, leading to insufficient evidence regarding the efficacy of treatment in this population. Whereas timely psychotherapy is known to be of benefit in the treatment of adjustment disorders, the ideal duration of psychotherapeutic interventions is not known. This study examined whether a brief 12-session focused psychodynamic psychotherapy may be as efficient as a longer intermediate-term (1?year) psychodynamic psychotherapy in treating patients suffering from an adjustment disorder. Subjects (n?=?66) were randomly assigned to either brief or intermediate psychotherapy. They were assessed by self-report measures and clinician’s evaluation at baseline, end of therapy, and 9?months after therapy was terminated. The results showed a good overall improvement in the whole group. Furthermore, brief psychotherapy was found to be as good as intermediate psychotherapy both at the end of treatment and at follow-up. Although our study was not designed to confirm the efficacy of dynamic psychotherapy in the treatment of adjustment disorders, our results suggest that brief interventions may be good enough in adjustment disorder, thus allowing treatment of a greater number of patients without compromising for the quality and suitability of treatment.     

Premature termination: A risk in eating disorder groups

This study examines the influence of combined vs. conjoint psychotherapy on the phenomenon of premature termination in eating disorder groups. Thirty-eight women with a diagnosis of anorexia nervosa or bulimia enrolled in group psychotherapy were designated as group completers or premature terminators using individually defined treatment objectives. Those eating disorder patients in combined group and individual psychotherapy showed a lower frequency of premature termination than patients in conjoint group and individual psychotherapy.     

Psychoanalytic Psychotherapy with People in Abusive Relationships

Summary

Psychoanalytic perspectives on violence between partners is describedand forms a foundation for an approach to group and individual psychotherapy of men and women in relationships in which there is physical violence between partners. The empirical results of a study of the outcome of psychoanalytically oriented psychotherapy are described. Nineteen men and 16 women completed research measures before beginning psychotherapy and after completing 16 sessions of group psychotherapy. Twelve people who completed group psychotherapy continued in individual psychotherapy and completed measures again after 16 sessions of individual psychotherapy, and nine people completed measures again after the 16 sessions of group and 32 sessions of individual psychotherapy. Statistical analyses addressed outcomes in terms of verbal and physical aggression and dysphoric affects and anger. Both research and clinical outcomes are discussed.     

Confronting death: Group psychotherapy with terminally ill individuals

A model for group psychotherapy with terminally ill patients is proposed, one in which the group is homogeneous and open-ended. Cancer and HIV infection are used as examples of chronic, terminal illnesses, and the relevant literature on group psychotherapy with these conditions is reviewed. Treatment with both sets of patients has been characterized by considerable variation in the structure, composition, and duration of the group. Being diagnosed with a terminal illness is traumatic and leads to denial, which may be adaptive or maladaptive depending upon its behavioral manifestations. The homogeneous, open-ended group encourages adaptive denial, which fuels hope and the will to live. The mechanism through which this occurs involves the unconscious identification with the group as an entity. This causes the emergence of a fantasy of a mother-infant dyad, within which can occur reworking of the depressive position. Scheidlinger, Turquet and Anzieu are cited to demonstrate this unconscious function of the group. Finally, clinical implications of such a model are highlighted.     

The problem of reinterpretive distortions in group psychotherapy with borderline patients

Group psychotherapy with borderline patients is challenging work. A group in which the core of patients falls within this nosological category is described. The phrase reinterpretive distortion is used to characterize an aspect of these patients' communication style which makes their effective treatment quite difficult. Examples of the phenomenon are offered, as is an explanation of the dynamics which give rise to it and the functions it seems to serve. Effective ways to deal with reinterpretive distortions in the group psychotherapy context are suggested.