Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 28: Psychotherapies

Table 28.3-1 Comparison of Types of Group Psychotherapy

Supportive Group Therapy

Analytically Oriented Group Therapy One to three times a week Anxiety disorders, borderline states, personality disorders 1 to 3 + years

Psychoanalysis of Groups

Transactional Group Therapy One to three times a week

Behavioral Group Therapy One to three times a week Up to 6 months Phobias, passivity, sexual problems

Parameters

Frequency

Once a week

One to five times a week

1 to 3 + years

Duration Primary

Up to 6 months Psychotic and anxiety disorders

1 to 3 years Anxiety and

Anxiety disorders, personality disorders

indications

psychotic disorders

Individual

Usually

Always

Always

Usually

Usually

screening interview

Communication content

Primarily

Present and past life situations, intragroup and extragroup relationships

Primarily past life experiences, intragroup relationships

Primarily intragroup relationships; rarely, history; here and now stressed Positive relationships fostered, negative feelings analyzed

Specific symptoms without focus on causality

environmental factors

Transference

Positive

Positive and negative transference evoked and analyzed

Transference

Positive relationships fostered, no examination of transference

transference encouraged to promote improved functioning

neurosis evoked and analyzed

Dreams

Not analyzed

Analyzed frequently Always analyzed and encouraged

Analyzed rarely

Not used

Dependence

Intragroup

Intragroup

Intragroup

Intragroup

Intragroup

dependence encouraged; members rely on leader to great extent

dependence encouraged;

dependence not encouraged; dependence on leader variable

dependence encouraged; dependence on leader not encouraged

dependence not encouraged; reliance on leader is high Create new defenses, active and directive

dependence on leader variable

Therapist activity

Strengthen existing defenses,

Challenge defenses, active, give advice or personal response

Challenge defense, passive, give no advice or personal response

Challenge defenses, active, give personal response, rather than advice

active, give advice

Interpretation No interpretation of unconscious conflict

Interpretation of unconscious conflict

Interpretation of unconscious

Interpretation of

Not used

current behavioral patterns in the here and now

conflict extensive

Major group processes

Universalization, reality testing

Cohesion,

Transference, ventilation,

Abreaction, reality testing

Cohesion,

transference, reality testing

reinforcement, conditioning

catharsis, reality testing

Socialization outside of group

Encouraged

Generally

Discouraged

Variable

Discouraged

discouraged

Goals

Improved

Moderate

Extensive

Alteration of

Relief of specific psychiatric symptoms

adaptation to environment

reconstruction of personality dynamics

reconstruction of personality dynamics

behavior through mechanism of conscious control

Table 28.3-2 Therapist’s Role in Group Therapy

Diagnosis The diagnosis of patients’ disorders is important in determin- ing the best therapeutic approach and in evaluating patients’ motivations for treatment, capacities for change, and personal- ity structure strengths and weaknesses. Few contraindications exist to group therapy. Antisocial patients generally do poorly in a heterogeneous group setting because they cannot adhere to group standards; but if the group is composed of other antiso- cial patients, they may respond better to peers than to perceived

1. Size of group 2. Frequency of sessions 3. Patient composition 4. Confidentiality 5. Goals 6. Preparation of patients 7. Determine group processes