Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

TABLE 29-5. Twenty Therapeutic Factors in Group Psychotherapy ( continued ) Factor Definition Imitation The conscious emulation or modeling of one’s behavior after that of another (also called role modeling ); also known as spectator therapy, as one patient learns from another

Insight

Conscious awareness and understanding of one’s own psychodynamics and symptoms of maladapting behavior. Most therapists distinguish two types: (1) intellectual insight—knowledge and awareness without any changes in mal adaptive behavior and (2) emotional insight—awareness and understanding leading to positive changes in personality and behavior. The process of imparting a sense of optimism to group members; the ability to recognize that one has the capacity to overcome problems; also known as instillation of hope The free and open exchange of ideas and feelings among group members; effective interaction is emotionally charged. The process during which the group leader formulates the meaning or signif icance of a patient’s resistance, defenses, and symbols; the result is that the patient has a cognitive framework within which to understand their behavior. Patients acquire knowledge about new areas, such as social skills and sexual behavior; they receive advice, obtain guidance, and attempt to influence and are influenced by other group members. Ability of the person to evaluate objectively the world outside the self; includes the capacity to perceive oneself and other group members accu rately. See also consensual validation. Projection of feelings, thoughts, and wishes onto the therapist, who has come to represent an object from the patient’s past. Such reactions, while perhaps appropriate for the condition prevailing in the patient’s earlier life, are inap propriate and anachronistic when applied to the therapist in the present. Pa tients in the group may also direct such feelings toward one another, a process called multiple transferences. The awareness of the patient that they are not alone in having problems; others share similar complaints or difficulties in learning; the patient is not unique. The expression of suppressed feelings, ideas, or events to other group mem bers; the sharing of personal secrets that ameliorate a sense of sin or guilt (also referred to as self-disclosure )

Inspiration

Interaction

Interpretation

Learning

Reality testing

Transference

Universalization

Ventilation

Groups tend to meet one to two times a week, usually for 1½ hours. They may be homogeneous or heterogeneous, depending on the diagnosis. Examples of homogeneous groups include those for patients attempting to lose weight or stop smoking, and groups whose members share the same medical or psychiatric problem (eg, AIDS, PTSD, substance use disorders). There are many factors to consider when forming groups, and certain types of patients do not do well in certain types of groups. Patients with psychosis, who require structure and clear direction, do not do well in insight-oriented groups. Patients with paranoid disorder, antisocial personalities, and patients with substance use disorders can benefit from group therapy but do not do well

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