Group psychotherapy

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Group psychotherapy uses the special group phenomena (group dynamics, transference , countertransference ) that occur in a group for psychotherapy by treating several patients in the group.

history

The term "group psychotherapy" was first used in the early 1940s by Jacob Levy Moreno , the founder of psychodrama . The term "Group Analysis" ( German  , group analysis ' ) comes from Trigant Burrow .

In 1905 Josef H. Pratt worked with groups in a tuberculosis ward, and in the 1920s the analysts Paul Schilder , Alfred Adler , August Aichhorn , Siegfried Bernfeld , Lazell , Marsh and Wender made experiments with groups. 1921 developed Moreno in Vienna impromptu game , and Freud wrote Group Psychology and the Analysis of the Ego . For cost reasons, they worked with groups of 30 to 200 participants. From 1923 to 1926 Burrow published on collective phenomena in groups. The motives behind this development were the desire to understand the influence of the group and society on the patient and the need to treat many patients at the same time.

Jacob Levy Moreno and Samuel Slavson in New York , Wilfred Bion and SH Foulkes at Northfield Military Hospital in England formally and institutionally established group psychotherapy in the years of World War II .

In the 1960s to 1980s it was developed by Michael Balint in London, Raymond Battegay in Basel, Raoul Schindler in Vienna, Fritz Perls and Carl Rogers in New York, Josef Rattner in Berlin, Alice Ricciardi in Rome, and Horst Eberhard Richter in Gießen and Annelise Heigl-Evers in Göttingen.

Representatives of group analysis in the German-speaking area today are - in Austria - Friedl Kubelka , Felix de Mendelssohn , Alfred Pritz , Josef Shaked and Elisabeth Vykoukal and - in Germany - Mohammad Ebrahim Ardjomandi , Angelika Berghaus , Rolf Haubl , Michael Hayne , Margarethe Seidl , Volker Tschuschke and Ursula Volz .

Categories

The following group therapies can be roughly distinguished:

Methodology and impact

Depending on the school, three perspectives have a particular focus and complement each other:

  1. The therapy of the individual in the group, the participants are observers
  2. The therapy of the individual by the group, the participants are co-therapists, the group is a therapeutic element
  3. The therapy of the group, the group itself, is the goal of observation and change

The group should act as a reflection of the society and the family of origin of each participant. The basis is always a depth psychological concept, supplemented with findings from social psychology and group dynamics. No topic is given to the group. The participants talk about what is bothering them and share ideas and fantasies as freely as possible. The therapist is benevolent, neutral and abstinent . This creates an unstructured situation in which participants can relive relationship experiences from their childhood and the feelings associated with them ( transference ). In a conflict, forbidden wishes and internalized cultural and parental taboos should be made clear and resistance should be reduced. The released, defended moods and energies should be used in a new and helpful manner.

The most important effective factors are (in this order): catharsis (as an expression of feelings), emotional cohesion in the group and mutual interpersonal learning. Participants who establish relationships with others in the group , open themselves to others, give feedback to others and receive and accept feedback themselves are seen as successful .

For the therapist, the complexity of the transference and countertransference between the participants, on the leader and vice versa, is a great professional and personal challenge. He works by uncovering the repressed and psychological resistance, using the means of analyzing transference and countertransference. Insight and self-strengthening in the encounter with others should enable new emotional experiences, direct relationships and a new view of the world .

Group size, setting

Usually a group size of seven to twelve people is considered ideal. Four participants are considered a minimum. The group members sit in a circle - without a table - so that everyone can look each other in the eye. There are also one or sometimes two therapists. In training groups there is occasionally an observer who does not take part in the group events.

Each meeting lasts one and a half to two hours. Usually there is no program or pre-formulated goal. The group members initiate and determine the course of the conversation through their contributions. Depending on the group leader, either one participant is in the center of attention over several sessions, all the others learn through observation learning and participatory observation , or a topic is discussed multifocally. In analytical group psychotherapy, the free association of the participants is important on the one hand , and the therapist's power of interpretation on the other . The therapist can adopt a largely passive posture, but can also actively intervene in what is happening. Its most important task is to observe and interpret the unconscious communication between the members and the resistance of the individuals to change. Its role and its reactions also depend on the underlying form of therapy ( see below : The different schools).

Large group therapy

In large groups, patients are treated in groups of up to 200 participants, but mostly 30 to 80. The sessions should be led by an experienced therapist. Large group therapy was originally developed because too few therapists were available for too many patients. However, it has occasionally been able to establish itself in the clinical setting , also for the treatment of severe disorders such as psychoses and personality disorders , on the other hand it was able to gain reputation - as a (serious) alternative - within the scope of the wave of self-awareness after 1968. Work is done either in the classic way according to Bion and Foulkes or according to Alfred Adler , for whom the formation of a sense of community was essential as the basis for solving the life's tasks of work - love - community.

Important large group leaders in the German-speaking area today are Felix de Mendelssohn and Josef Shaked ; both live in Vienna and also work in the international working group for group analysis . Well known were the late Friedrich Liebling (Zurich) and Josef Rattner (Berlin), who now lives in seclusion and no longer leads any groups.

Open group, closed group

In the closed group, the composition of the participants remains the same from the first to the last meeting. Closed groups are mainly offered as part of training weeks. This group then meets three to four times a day.

In the - more widespread - open group, vacancies are filled with new participants. As a rule, attendance is mandatory so as not to disrupt the therapeutic process.

The different schools

A number of psychotherapy schools deal with group work. In addition to the directions described in detail here, these are also:

Dynamic group psychotherapy

The development of the dynamic group psychotherapy (DG) method is closely linked to Raoul Schindler . His interest was the study of group dynamics of family structures and social forms with regard to disease-causing or health-promoting effects. In his clinical work with psychotic patients, Schindler developed bifocal group and family therapy (1952) and the model of rank dynamics (1956). From this combination of social and depth psychological theories, an independent, interpersonal psychotherapeutic process emerged, dynamic group psychotherapy. The content is related to other psychodynamically, interactively oriented group methods.

Psychodrama

Jacob Levy Moreno developed psychodrama as "therapy in the group with the group for the group" and combined group psychotherapy with sociometry and impromptu play . The client (protagonist), as the main actor of the psychodramatic game in the " here and now " of a psychodrama stage, creates his therapeutic theme. Well-known elements are doubling , sharing and feedback . The aim of psychodrama is to activate spontaneity, creativity and integration. Through constructive and spontaneous action, the protagonist should find a new, appropriate reaction to a new or already known situation.

Group analysis

Psychoanalysis in the group

Samuel Slavson analyzed the individual in the group. A “social hunger” can therefore only be satisfied in a group. His goal was to strengthen the " I " against the "id" and the "superego". He used the unstructured group situation to awaken traumatic memories through interpretation and to experience compassion through their expression ( catharsis ) in the presence of third parties . The analyst is the decisive factor.

Classic group analysis

Wilfred Bion developed a socio-technical system approach of a “leaderless group” ( see also: group dynamics ). Everyone is seen as a member of a group who can only realize their abilities in the group . He regards the therapeutic “group as a unit”, like an individual as a whole . The “analytical diad ” does not consist of therapist and client, but of therapist and group. The group analyst, as a "non-member", is the central object for the participants' transmissions . As an “advocate of reality”, he always directs his interpretations towards the group as a whole and especially towards the attitudes towards dependency, struggle, flight and pair formation. These attitudes are seen as desires that shape the course and ability of a group to work. The “here-and-now” is always considered. The goal is the "ability to work", i.e. reference to reality, reference to time, understanding of the context, cooperative action and conscious conversation. For this purpose, the attempt is made to strengthen the cohesion in the group and to reduce the defense against original fears and a dependence on an ideal leader.

Analytical group therapy

Foulkes sees the group as a network of relationships . The group analyst is a group member with a special role. He defines people by the group in which they live and by the community to which they belong. All forces in a group form a “group matrix ”. The group is therefore more than the sum of its members. According to Foulkes, mental disorders are rooted in a disruption of communication , alienation from the community, and are always an expression of a disorder in the family of origin. In the therapeutic group, the individual tries to restore precisely this disturbed situation ( compulsion to repeat as resistance to knowledge and change). The group should counteract this defense mechanism through analysis and confrontation . Via a path from the symptom to the conflict to conflict resolution , “I training in the group” is intended to allow the individual to attain his “true identity”. The participant should share with others his deepest concerns and by others as in the same situation as he learned by his isolation has to resolve and that he should secure feel. As in a mirror , he should recognize his situation in that of the others and learn to understand himself and the others. The stronger the group cohesion , the easier it is to go deeper and deeper and to resolve conflicts with one another. This should create a great deal of trust and personal strength. The main work should be done by the group members themselves, the therapist sees himself as a conductor . He intervenes when the group (in his opinion) does not develop further and interprets the life story of the individual and also the processes in the group , which are understood as the staging of collective fantasies.

Göttingen model

Heigl and Heigl-Evers developed the Göttingen model for ego-weak , severely disturbed patients. The group process should give the individual insight into his conflict structure in three stages.

  1. Psychoanalytical- interactional therapy: The therapist assumes a positive relationship offer. The work in the here-and-now is supported, the client receives no interpretations and little confrontation. First of all, its goal is to create trust.
  2. Psychoanalytically oriented therapy: works with less structuring, a little more confrontation and abstinently supportive. Early childhood dependencies on parents should be reduced.
  3. Analytical therapy: the therapist behaves abstinently and thereby promotes regression , the ego deficits are clarified through interpretations and autonomy is to be made possible through maturation .

Gestalt therapy

Fritz Perls developed the gestalt group from the "individual work in front of the group" for the purpose of demonstration . The group is used as an energy amplifier and the relationship dynamics of the participants with one another is made a topic. Well-known elements are the hot seat and the feedback . Contact disorder, awareness , the principle of dialog and dealing with aggression are key elements. A session ends with a sharing in which the participants give each other feedback. The aim is to establish contact through awareness of oneself and of others.

Casriel group

Daniel Casriel developed the cathartic Casriel therapy named after him . Through the experience of emotional openness, combined with physical closeness to another person, early injuries should be reactivated and the associated feelings, negative attitudes, physical blockages and destructive behavioral patterns worked through and resolved.

Therapeutic community

A combination of different types of group therapy is intended to promote mutual learning, social responsibility and spiritual growth and, in addition to the self-organization of everyday life, serve as a learning and practice area in order to change emotional patterns as well as thought and behavioral patterns in a protected setting through new emotional experiences . Living together in a community should create a safe atmosphere that encourages change. This includes the exchange among those affected about found solutions, as well as reacting to the other, taking one's own perceptions and emotional reactions to their behavior seriously and communicating them to the other, and thus supporting each other in the recovery process. You meet yourself in the eyes and hearts of your fellow human beings to find us in the mirror of our neighbor. Clear structures and binding agreements and rules are essential . The therapeutic community meets several times a week for so-called committees and a general assembly.

The therapeutic community should provide a system of mutual support in the clinic and is an essential part of the concept of milieu and sociotherapeutic work . The participation of the patients in the organization and the design of the processes in the clinic also promotes the ability to cope with practical tasks. The therapeutic community is widespread in psychosomatic clinics and addiction clinics.

Related groups

The following groups are not counted as part of classic group psychotherapy, although some of them have smooth transitions.

  • Self-awareness groups and encounter groups should enable learning about one's own behavior in the group. Mental stability is a prerequisite for participation.
  • The T-Groups of group dynamics often have a therapeutic character, as do the large groups of the organization laboratory.
  • An analytical group technique developed by Enrique Pichón-Rivière for young people is called Grupo Operativo . He gave them the opportunity to look after themselves.
  • Those affected also support one another in self-help groups . A-groups according to the twelve-step program are sometimes used as a preparatory, accompanying and aftercare- stabilizing parallel to therapy.
  • Psychoeducation means training the mentally ill , often together with relatives, so that they better understand the illness and treatment. Exchanging experiences and helping people to help themselves are essential contents.
  • Training and exercise groups for coping with stress or anxiety, for communication and self-confidence training, often follow a predetermined sequence with clearly structured behavioral exercises based on a manual .
  • Group supervision and analytical Balint groups deal with the relationships of therapists, educators and other psychosocial professions with clients and patients. They are centered on professional competence . However, they almost always take place without the involvement of the patient.
  • Indication groups have a clear objective - for example coping with depression or smoking cessation - or limit the circle of possible participants - based on age or to a certain clinical picture. They are mostly behavior therapy oriented.

Training of group therapists

Each school has its own training concept. The entry requirements differ depending on the country and psychotherapy law . In some countries, prior training in a one-to-one therapeutic procedure is required. What they all have in common is intense self-awareness in the group, work as a co-therapist and as a therapist under supervision .

In Austria - for entry in the list of psychotherapists of the Federal Ministry of Health - the following is required:

  • the psychotherapeutic propaedeutic course (765 hours of theory, 480 hours of practical training, 20 hours of supervision and 50 hours of self-awareness), and then afterwards
  • the subject matter with 300 hours of theory, at least 200 hours of self-experience, 550 hours of internship with 30 hours of practical supervision, a further 100 hours depending on the focus of the method and the following
  • Practice: 600 hours of therapeutic work and 120 hours of supervision.

A certificate from the International Working Group for Group Analysis can be obtained after having participated ten times in the ten-day training workshop - four times as a participant, three times as an observer, three times as co-leader. In addition, two theoretical presentations and two supervision cases must be presented in the first phase of the study, as well as two admissions interviews.

For the training of group psychotherapists, supervisors and group dynamics, participation in self-awareness is an admission requirement. In self-awareness groups there are always flowing transitions to the various forms of group psychotherapy (analytical, client-centered, gestalt therapeutic, group dynamic).

literature

current
classic
Trade journals
  • Group psychotherapy and group dynamics , since 1968 4x / year, ISSN  0017-4947 , Vandenhoeck & Ruprecht
  • Yearbook for group analysis and its applications , ed. Mohammed Ebrahim Ardjomandi
  • Austrian Yearbook for Group Analysis , ed. by Wolfgang Martin Roth and Josef Shaked

Associations

See also

Individual evidence

  1. ^ Trigant Burrow: The Basis of Group-Analysis , 1928
  2. ↑ Tschuschke: effective factors of group psychotherapy , in: Praxis der Gruppenpsychotherapie, 2001.
  3. ↑ Hansjörg Hemminger : Salvation lies in the group (archive version) ( Memento from September 28, 2007 in the Internet Archive )
  4. ↑ Maria Majce-Egger: Dynamic group psychotherapy . Ed .: www.gddg.at. 2014.