Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 28: Psychotherapies

Table 28.3-3 Twenty Therapeutic Factors in Group Psychotherapy

Factor

Definition

Abreaction A process by which repressed material, particularly a painful experience or conflict, is brought back to consciousness. In the process, the person not only recalls but relives the material, which is accompanied by the appropriate emotional response; insight usually results from the experience. The feeling of being accepted by other members of the group; differences of opinion are tolerated, and there is an absence of censure. The act of one member helping another; putting another person’s need before one’s own and learning that there is value in giving to others. The term was originated by Auguste Comte (1798–1857), and Sigmund Freud believed it was a major factor in establishing group cohesion and community feeling. The expression of ideas, thoughts, and suppressed material that is accompanied by an emotional response that produces a state of relief in the patient. The sense that the group is working together toward a common goal; also referred to as a sense of “we-ness”; believed to be the most important factor related to positive therapeutic effects. Confirmation of reality by comparing one’s own conceptualizations with those of other group members; interpersonal distortions are thereby corrected. The term was introduced by Harry Stack Sullivan; Trigant Burrow had used the phrase “consensual observation” to refer to the same phenomenon. The process in which the expression of emotion by one member stimulates the awareness of a similar emotion in another member. The group re-creates the family of origin for some members who can work through original conflicts psychologically through group interaction (e.g., sibling rivalry, anger toward parents). The capacity of a group member to put himself or herself into the psychological frame of reference of another group member and thereby understand his or her thinking, feeling, or behavior. An unconscious defense mechanism in which the person incorporates the characteristics and the qualities of another person or object into his or her ego system. 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. Conscious awareness and understanding of one’s own psychodynamics and symptoms of maladaptive behavior. Most therapists distinguish two types: (1) intellectual insight—knowledge and awareness without any changes in maladaptive behavior; (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 problem; 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 significance of a patient’s resistance, defenses, and symbols; the result is that the patient has a cognitive framework within which to understand his or her 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 accurately. 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 prevaling in the patient’s earlier life, are inappropriate and anachronistic when applied to the therapist in the present. Patients in the group may also direct such feelings toward one another, a process called multiple transferences. Universalization The awareness of the patient that he or she is not alone in having problems; others share similar complaints or difficulties in learning; the patient is not unique. Ventilation The expression of suppressed feelings, ideas, or events to other group members; the sharing of personal secrets that ameliorate a sense of sin or guilt (also referred to as self-disclosure ). Acceptance Altruism Catharsis Cohesion Consensual validation Contagion Corrective familial experience Empathy Identification Imitation Insight Inspiration Interaction Interpretation Learning Reality testing Transference

problems than they are for providing insight-oriented therapy, which is the province of the small-group therapy meeting.

of themselves through their interactions with the other group members, who provide feedback about their behavior; to pro- vide patients with improved interpersonal and social skills; to help the members adapt to an inpatient setting; and to improve communication between patients and staff. In addition, one type of group meeting is attended only by inpatient hospital staff and is meant to improve communication among the staff mem- bers and to provide mutual support and encouragement in their day-to-day work with patients. Community meetings and team meetings are more helpful for dealing with patient treatment

Group Composition Two key factors of inpatient groups common to all short- term therapies are the heterogeneity of the members and the rapid turnover of patients. Outside the hospital, therapists have large caseloads from which to select patients for group therapy. On the ward, therapists have a limited number of