GROUP PSYCHOTHERAPY

Despite the fact that we have already touched on elements and exercises of group therapy in various sections, it is so popular that it deserves a detailed self-review. Therefore, we apologize for some repetitions. In addition, it is useful for readers to familiarize themselves with the various definitions and approaches to group psychotherapy of the most well-known theorists and practitioners.

Group psychotherapy is currently very popular and has many definitions.

It is important to distinguish group psychotherapy as a form of training and psychocorrectional occupations in many other areas of psychotherapy ( behavioral therapy, psychodrama, gestalt, psychosynthesis, etc. ) from group psychotherapy as an independent psychotherapeutic direction in which elements of other types of psychotherapy can be used, but which are fundamentally different the fact that in it the main work and responsibility for it is transferred from the psychotherapist to the group itself and its individual members.

These ideas of group psychotherapy are especially close to the approaches of humanistic psychology and psychotherapy, although the beginning of these approaches can be seen in the ideas of Adler.

For the first time the term “group psychotherapy” was used by Jacob Moreno in 1932, denoting by this simply psychotherapy, conducted not individually, but in groups. In the future, many representatives of both medical and non-medical psychotherapy gave their definitions of this form and method.

In addition, each focused on one important aspect of this method. S.Krachotvil (1978) pointed out that during group therapy, the process of group dynamics of relationships and interaction both vertically (clients and the therapist) and horizontally (clients among themselves) is well used. Although it must be said that the concepts of “vertical” and “horizontal” are not used here as in management (the head is subordinate), since most of the approaches to group therapy imply creating an atmosphere of client relationships with the therapist, which Adler called an equal partnership.

Most authors ( N.K. Lipgard et al., 1978, S.Ledar , 1990, and many others) point out that the main merit of this method is to create an atmosphere of joint activity and creative unity of both clients with the psychotherapist and clients with each other.

Sometimes you can find the use of the terms group psychotherapy and collective psychotherapy . Such well-known specialists as Liebig (1974), Velvovsky (1986) and others consider these terms identical. However, there are other opinions.

Some authors believe that the concept of collective psychotherapy emphasizes only the collective form of occupation, the content of which does not necessarily profess the principles of the reinforcing (self-healing) effect of using the internal reserves of the group - the “dynamics of the group process” (K. Rogers), while group therapy is built on this effect.

V.T.Kondrashenko, V.I.Donskoy (1997) and many other authors believe that collective therapy most likely refers to mass therapy, which is by no means identical to group therapy, mainly due to insufficient activation and use of intragroup self-help reserves.

However, VM Bekhterev believed that “a group cannot be called a random gathering of persons in a given period of time in a certain place”. In his opinion, this should be a group of people united by some common goal, mood, task, etc. Although this definition may well be attributed to almost any psychotherapeutic group.

To these disputes should be added the fact that in our politicized pedagogical and psychological literature for decades the team was treated as a higher type group, united by value-orientation unity and a socially significant goal. It seems that such a definition, derived from the works of A.S. Makarenko and developed in Soviet psychology under the guidance of A.V. Petrovsky and others, has the right to exist in modern scientific literature.

However, today, since we have entered an open society, then for a better understanding with colleagues it is very important to know precisely the differences that we put into the interpretation of the same terms. We understand the team as the most highly organized, united, active, positively socially oriented group, and in Western psychology, the word collective often refers to the gathering of people who need a certain association and the inclusion of group dynamics processes to be characterized as a group .

Some opponents cite irrefutable facts of increasing the therapeutic effect (mainly, directive therapy, self-suggestion, suggestion, hypnosis ) even among spontaneously gathered or unfamiliar (and not aspiring to) people. Indeed, VM Bekhtereva and others can find many examples of mental infection during mass hypnosis or in such phenomena as panic and even mass epidemics of mental diseases . However, despite the external community of increasing the effectiveness of interaction, mass, collective and group therapy has a fundamental difference.

With a massive, collective suggestion, or mental infection, this process occurs spontaneously, often out of control and brings not healing, but, on the contrary, aggravating consequences. (This does not exclude the possibility of competent use of collective hypnosis and other types of therapeutic suggestion.)

This is what concerns the Western use (however, very rare) of the concept of collective therapy . However, as already mentioned, during the years of Soviet power, we are accustomed to the opposite interpretation of the term collective , meaning not just a group, but its highest form in terms of the unity of socially significant values ​​and the ways to achieve it.

Of course, in this understanding, the collective acquires many features that distinguish it from the usual psychocorrectional group, and can have a very peculiar (and not only amplifying, but also inhibiting the individual development of the personality) effect.

In this social sense, the concepts of collective and collective therapy that are still used by some of our specialists have certain achievements, original theoretical and practical approaches that can even claim to be an independent direction. However, we believe that they should be considered separately, since they do not fit into the traditional understanding of group therapy.

As for group therapy (in the strict scientific interpretation of this term), the process is organized here (although it does not have strict regulation) and is aimed at jointly solving very specific psychological problems or their accessible stages, which we will discuss in more detail.

Group psychotherapy is not a spontaneous, but rather well-established (although not rigidly constructed) process, which has many different types and forms of implementation and use in various combinations with almost all classical areas of modern psychotherapy.

As with every psychotherapeutic area, in group therapy there is a set of already established concepts and terms.

Let's start with such a thing as a psycho-correction group.

A psycho-correction group is a small (up to 20 people) therapeutic group consisting of people who have voluntarily joined together to study together and solve common psychological problems, both personal and interpersonal.

The group works mainly according to the “here and now” principle, that is, transferring all of their experiences and attempts to study and resolve them from the past to the present.

Two types of psychocorrectional groups are most popular:

- skill training groups;

- encounter-group (group of meetings - collisions).

Skills training groups are usually centered on the psychotherapist, that is, his leadership is felt quite clearly.

Encounter groups (see above) transfer the main work and responsibility to themselves, that is, to all members of the group.

It is believed that the first effect of the positive influence of the group on the process of recovery of patients was noticed by an American doctor J.Pratt in the treatment of patients with tuberculosis. In the process of treatment, he included explanatory conversations about hygienic rules of behavior, during which he tried to strengthen the faith of the patients in the final recovery. At first he conducted these conversations individually, and then, in order to save time, began to conduct them with a group of patients.

After some time, such conversations began to be spontaneously supplemented by conversations of patients with each other, an atmosphere of mutual support. This form of communication was liked by the patient himself and began to have a significant psychotherapeutic effect, although it could not be called group psychotherapy in the modern sense of the term.

It should be noted that the effect of increased interaction of people on each other in groups and masses was noted by many sociologists, psychologists, psychotherapists and psychiatrists (Lebon, Freud, Bekhterev, Moskovichi and others), but this was more a matter of spontaneous influence (infection) or strengthening of directive (direct a) suggestions (including hypnosis). As for the use of the psychotherapeutic effect of the interaction of group members in non-directive psychotherapy, we can say that Freud's students A. Adler, L. Wender, and others began to use it. Freud himself was very critical about the possibility of conducting psychoanalysis in the group, considering that the influence and even the very presence of the group can distort the information produced by the client.

However, nowadays many psychoanalysts use the group method not only to save time, but also considering it more effective (with the right group selection).

And yet, the author of group psychotherapy as the direction and method is considered to be Jacob Moreno, who published a journal in 1931, which was called “Group Psychotherapy”.

In the future, one of the most prominent representatives of group psychotherapy was Carl Rogers, who introduced a lot of new things into it. His main merit is considered to be the development of a humanistic, or anti-authoritarian, direction, that is, therapy, centered on the client. He introduced the already mentioned notion of encounter groups.

K.Rodzhers, in turn, notes the significant contribution of Kurt Levin (and first of all his field theory) to the development of theory and group psychotherapy. After all, it was Kurt Levin who, long before the emergence of this method, group psychotherapy argued that it is easier to change individuals in a group than individually. The main ideas and methods of K.Rodzhers are set forth in the book “Theoretical and Methodological Problems of Socio-Psychological Training” by L.A. Petrovskaya (M., 1982), where the author cites his own interesting views on this area.

The book by S. Kratokhvila “Group psychotherapy of neurosis” (1978), many of which can be successfully adapted to non-medical psychotherapy, has become a good tool for the application of group psychotherapy in medical practice.

The group psychotherapy (1990), as well as the works of S.S. Liebig, A.L. Groysman, N.V.Ivanov, A.I. Zakharov are of considerable interest in this direction. and other works.

The following classification of psycho-correction groups is most often used:

- problem solving teams;

- groups of training in interpersonal relationships (usually these are groups of business people, politicians, various kinds of leaders);

- growth groups (self-improvement);

- therapeutic groups.

Most clearly summarized the main characteristics of psycho-correction groups Lakin. In his work, published in 1972, he lists the following features of the atmosphere in which the group psychotherapy process takes place:

- relief of the expression of emotions;

- the emergence of a sense of belonging;

- self-disclosure duty;

- testing of new behavioral skills;

- group sanctioned interpersonal communication (interpersonal comparisons);

- separation with the formal leader of responsibility for managing the group.

Currently, many group psychotherapy practitioners use the well-systematized handbook by K. Rudestam "Group Psychotherapy" (1990).

In addition to the already noted reinforcing psychological effects on the individual, the group allows you to simulate (play) various social situations that the client would like to learn to cope with. And since the group usually selects people with similar problems or peculiarities (except for heterogeneous groups), there is a common interest here: helping others, helping themselves. That is, all members of the group are not just spectators, but personally interested participants.

We have already described many aspects of the formation and activity of psycho-correction groups in the “Behaviorist (Behavioral) Therapy” section. Therefore, we recall only the main points.

So, groups are divided into types : groups of formation of skills and encounter-groups. Groups also differ in the form and content of the upcoming therapeutic activity. And, finally, groups can unite to solve any narrow but important task for each member of this group: fear of an exam, public speaking, unreasonable fear of a particular person.

It should be remembered that group therapy is not favorable for all people and not for all cases. This is where the experience of the psychotherapist is required to determine indications or, on the contrary, contraindications to the use of group psychotherapy.

I must say that group therapy has a fairly wide range of applications. However, the style and methods of work in such groups can vary significantly depending on the differences in tasks and problems.

It is believed that in order to overcome ordinary life difficulties, in many cases it is enough to use the so-called conversational therapy , giving the client the opportunity to fully satisfy his ability to share his problems with understanding companions, to be accepted and listened to with sympathy and attention.

Despite the well-deserved reputation of an independent psychotherapeutic area, group therapy is successfully friends with other therapeutic areas and methods. So, for example, in case of violations of the characterological type, most specialists use methods of gestalt therapy. as well as psychodrama. Behavioral psychotherapy is well used in skill training groups and in the psycho-correction of certain phobias (obsessive fears). Non-directive group psychotherapy is often used in the prevention and treatment of alcoholism and other addictions, etc.

It is not recommended to take in therapeutic groups of persons suffering from various kinds of psychosis and characterized by low intelligence. Persons with reduced intelligence do not fit well into the discussion of problems, constantly clarifying details that are clear to others.

They force other members of the group to be distracted by explaining things obvious to other things, that is, they prevent the formation of a group of like-minded people.

Persons suffering from psychosis, tend to periodically bring dissonance into a group atmosphere, which should be as secure and comfortable as possible for each member of the group, allowing him to overcome fears and embarrassment and enter into normal communication.

It is necessary to think carefully before including in groups of people with severe psychopathic disabilities (especially epileptoid), as well as people with severe physical disabilities - will they not greatly interfere with the formation of unity and homogeneity of the group, distracting attention (even if the most sympathetic) from the main direction of work on the unifying all problem.

Therapeutic groups can vary quite significantly in the number of participants: from 3-5 to 20 people. Some therapists even work with groups of up to 30 people, but such a number of participants, as well as too small (3 people), should be justified by the task of work and the composition of the group, otherwise certain difficulties are inevitable.

In too small groups, the effect of one of the main ideas of group therapy, interpersonal support, is significantly reduced. And in too large groups, the tendency of spontaneous internal disintegration of one large group into several small ones is often observed, which largely turns off their participants from the purposeful work of the whole group.

Most agree that the optimal number of participants in a psycho-correction group should range from 8 to 12 people.

What are the signs to choose a group?

Usually groups are completed on one or more of the following characteristics:

1. Problem signs (general psychological problems and neurosis).

2. Personal attributes (general features of interests, level of intelligence, type of character).

3. Demographic characteristics (national and ethical community, age, gender).

Some authors (Bennis, Sheppard) believe that it is useful to complete the so-called heterogeneous (that is, heterogeneous in composition) groups, as they are closer to the real model of society, for which we are preparing our clients for successful functioning. In such groups, natural disagreements and even conflicts often arise, which, on the one hand, simulates real situations in society, but, on the other hand, delays the establishment of a process of mutual understanding and creating an atmosphere of personal security and comfort.

This is where a fundamental dispute arises: whether to create a psychological climate in groups that is more favorable, "greenhouse" than real conditions, or work in more typical conditions for a normal society, but at the expense of comfort and a sense of security of group members.

Каждый из подходов имеет свои плюсы и свои минусы.

В гетерогенные (различные по составу) группы иногда специально (но, разумеется, при внимательном контроле терапевта) включают конфликтных, раздражительных людей для проверки устойчивости отрабатываемых моделей поведения и способности к контролю как своих эмоций, так и эмоций членов группы, воспринимающих их. К сожалению, такие группы не всегда способствуют раскрытию людей, принятию других и себя. Нередко они распадаются уже на первых этапах, несмотря на опыт психотерапевта и его периодические разъяснительные беседы в пользу групп именно такого типа.

Гомогенные (однородно подобранные) группы быстрее создают благоприятную атмосферу и начинают совместно решать общие психологические проблемы. Однако, как показывает многолетняя практика, очень часто успешные модели общения, уверенности в себе, публичного выступления и т.п. в таких группах так и остаются лабораторными моделями, и клиенты плохо переносят отработанные приемы в реальную жизнь.

Но здесь, на мой взгляд, часто упускается еще один важный фактор гомогенных групп - они становятся терапевтичными самой своей атмосферой, в которой люди находят так нехватающее им в жизни общение и понимание. Недаром многие подобные группы существуют (в первую очередь в США, да и в других странах) годами и превратились в необходимые для этих людей (как правило, одиноких или непонимаемых близкими) чуть ли не во вторые семьи.

При этом первая задача - избавится от какой-то привычки или состояния - уже давно отошла на второй план, главным стал сам процесс общения.

Перед началом занятий психотерапевт проводит с участниками только что сформированной группы установочную беседу. В зависимости от типа групп он излагает основные условия и правила групповой работы.

Основными правилами (требованиями к участникам) практически для всех типов психокоррекционных групп являются:

- искренность и открытость в общении участников;

- преобладание эмоциональной спонтанности (первичного естественного реагирования) над рациональностью (размышлениями);

- принцип «здесь и теперь».

Usually group therapy classes are held 3-4 times a week. Each session lasts for 1-1.5 hours. However, these are only guidelines that may vary to a certain degree by the psychotherapist depending on the conditions and tasks of the work.