Lecture
Plan
one.
Family psychotherapy is traditionally understood as a set of psychotherapeutic techniques and methods aimed at treating a patient in the family and with the help of the family, as well as at optimizing family relationships.
The family is considered as a complete system. The family strives to preserve the existing connections between the elements and to their evolution. In the system is formed and maintained due to the effect of energy and matter exchange in non-equilibrium conditions, the oscillations help to achieve a new level of complexity, differentiation. The family exchanges information and energy with the external environment. Internal and external vibrations are accompanied by a reaction that returns the system to its steady state. When the fluctuations intensify, a crisis may occur in the family, the transformation of which will bring the system to a new level of functioning. The task of the psychotherapist is to connect to the system, capture its oscillations, strengthen them to give an impulse to change and call frustration for a therapeutic purpose. The family throughout its existence goes through natural development crises: marriage, separation from the parental family, mother’s pregnancy, childbirth, child enrollment in preschool and school institutions, adolescence, leaving school and choosing one’s own way, breaking up with parents, caring for retirement. It is at these stages that the family is unable to solve new problems using the old methods; this makes it necessary to complicate adaptive responses.
The family performs its functions through certain mechanisms - the structure of family roles, subsystems, and the boundaries between them. The structure of family roles prescribes family members what, how, when and in what sequence they should do when entering into relationships with each other. Repeating interactions lead to the establishment of certain standards - “standards of interactions”, which determine with whom and how to interact. In normal families, the structure of family roles is holistic, dynamic and alternative. If it is not possible to meet the needs within the framework of the established structure, family members undertake a search for alternative versions of family roles. Pathological family roles are those that, by virtue of their structure and content, have a traumatic effect on family members.
Family subsystems are a more differentiated set of family roles, which allows you to selectively perform certain family functions, to ensure the functioning of the family. A family member can be a member of several subsystems — the parent, spouse, child, male, female, etc. Simultaneous functioning in several subsystems is usually ineffective. In case of family quarrels between mother and child, she appears in 2 subsystems: married and parental, but the father and child can unite to protect against her. The boundaries between systems are rules that define who and how performs family functions. In normal families, they are clearly delineated and permeable. With hard boundaries, communication between subsystems is difficult, information is not exchanged, and with blurry ones, the stress experienced in some subsystems easily radiates to others.
The main principles of the work of the family research institute are:
1) the promotion of therapeutic hypotheses;
2) circularity;
3) neutrality;
4) a positive interpretation of the symptoms or problems of the patient and his family.
Prior to the 1st family session, psychotherapists in the therapeutic group, after listening to family members, put forward a number of hypotheses about the paradox of family relationships leading to the formation of symptoms of one of its members. Circularity is understood both in the etiopathogenetic (“principles of circular causality”) and in practical terms. Participants of psychotherapy are interviewed in a circle, figuring out the feelings of family members in quarrels. The psychotherapist maintains a neutral attitude towards all family members. Patient symptomatology is considered as a way of adaptation, the task of the therapist is to find other ways of adaptation for the patient. Based on this, the following stages can be distinguished in family psychotherapy:
1. Association of the psychotherapist with his family, joining him to the role structure presented by her: 1) establishing a constructive distance - free location of family members; 2) joining through the synchronization of breathing to the family member who claims the problem; 3) “mimesis” techniques, direct and indirect reflection of posture, facial expressions and gestures of participants in psychotherapy; 4) connection by prosodic speech characteristics to the applicant of the problem, the identified patient (speed, volume, voice intonation); 5) the use of predicates by the psychotherapist in his speech, reflecting the dominant representative system of the problem applicant and other family members; 6) tracking the oculomotor reactions of participants in psychotherapy in order to verify compliance of the verbally presented problem with deep-seated experiences; 7) preservation of the marital status quo, i.e. the structure of family roles demonstrated by the psychotherapist. In this case, there may be a clear leader who is the initiator of the appeal and the applicant of the problem; he can hide behind the silence and non-verbally let someone in the family know that he played the role of a “translator” who speaks on behalf of the family. In each of these cases, the psychotherapist, carrying out the connection, retains the shown structure of roles until its completion.
2. Formation of a therapeutic request: 1) the initiator of the appeal makes a manipulative request to the psychotherapist about the existence of the problem and its resolution. Such formulations allow the initiator to dissociate from a conscious or unconscious feeling of guilt, to disclaim responsibility for what is happening in the family and transfer it to another member and psychotherapist; 2) metamodelling techniques and psychotherapeutic metaphors help translate a request from a superficial, manipulative level to a level of awareness of parents as ineffective in their parental role; 3) the study by family members of themselves as ineffective parents contributes to the realization of their inefficiency as spouses; 4) in parallel with the formulation of the request, the psychotherapist examines the resource states of family members and them as a system: “Was there a moment in your life when you achieved success together? How did you do that? ”E.G. Eidemiller developed the technology of formulating a therapeutic request: XR-UR-ZR, where X is the level of manipulative inquiry, U is the level of self-awareness as ineffective parents, Z is the level of awareness of their incompetence as spouses, R is the resource state of family members. At the stage of forming a therapeutic request, it is important to study the goals that are set by each family member and which they want to achieve in the process of psychotherapy. At this point, it is necessary to transfer psychotherapeutic work from the plane of studying the past to the plane "here and now." An excursion into the past is carried out to discover the resource states of family members. The formulation of the goals of each family member leads to the formation of the goal of the family as a single, integral organism.
3. Reconstruction of family relations: 1) the work of a psychotherapist corresponds to the establishment of boundaries between subsystems, strengthening the functioning of some and the associated weakening of the functioning of other subsystems. Previously, spouses unconsciously mixed parental and marital contexts, which led to dissatisfaction with marriage and the appearance of problems or symptoms in a child. Separation of the marital and parental context in the process of psychotherapy contributes to their effectiveness and competence as spouses and parents. Parents learn to recognize the boundaries of their subsystem, the quality of its functioning, and the motives by which they inconsistently crossed the internal boundaries; 2) in therapy, there is a balance throughout the study of negative and positive experiences, two-level feedback, psychosculpting, family psychodrama.
4. Completion of psychotherapy and disconnection: 1) a signal to the end of psychotherapy is the achievement of the stated goals; 2) compliance with the agreed temporary contact. After the stage of joining, psychotherapy participants discuss the time required to achieve therapeutic changes. The minimum time for the reconstruction of family relationships is 6 hours (4 sessions), the maximum treatment time is 16 hours (8 sessions); 3) environmental verification - the creation by family members of an image of their future. At the last lesson, family members are invited to present themselves in a number of situations in the future: their interaction, what happens and what doesn't. The following discussion allows us to determine the most effective ways to use resource states.
2
The psychotherapeutic method, the specificity of which lies in the purposeful use of group dynamics, i.e. the entire set of relationships and interactions arising between the participants of the group, including the group psychotherapist, for therapeutic purposes.
Fundamentally, group psychotherapy is not an independent direction in psychotherapy, but is only a specific method, using which the main tool of psychotherapeutic influence is a group of patients, unlike individual psychotherapy, where such a tool is only a psychotherapist. Along with other psychotherapeutic methods, group psychotherapy (just like the individual form) is used within various theoretical orientations, which determine its originality and specificity: specific goals and objectives, the content side and intensity of the process, psychotherapist tactics, psychotherapeutic targets, choice methodological techniques, etc. All these variables are also largely due to the nosological affiliation of the cohort of patients participating in the psychotherapeutic group. Group psychotherapy acts as an independent direction in psychotherapy only in the sense that it considers the patient in a socio-psychological sense, in the context of his relationships and interactions with others, thereby pushing the boundaries of the psychotherapeutic process and focusing not only on the individual and his intrapersonal problems, and on the individual in the aggregate of his real relationships and interactions with the outside world. Relationships and interactions in which the patient enters into a group largely reflect his true relationships, since the group acts as a model of real life, where the patient exhibits the same attitudes, attitudes, values, the same methods of emotional response and the same behavioral responses. The use of group dynamics is aimed at ensuring that each participant has the opportunity to express himself, as well as the creation of an effective feedback system in the group, allowing the patient to more adequately and more deeply understand himself, see his own inappropriate relationships and attitudes, emotional and behavioral stereotypes that manifest themselves in interpersonal interaction, and change them in an atmosphere of goodwill and mutual acceptance.
Group psychotherapy is distinguished from group therapy, group psychotherapy, and collective psychotherapy. The latter essentially imply the use of any psychotherapeutic method in a group of patients (hypnosis, autogenic training, persuasion, persuasion, etc.). In this case, the psychotherapist acts by psychological means on a large number of patients at the same time, but does not systematically use situations, relationships and interactions between patients for therapeutic purposes. The history of the development of group psychotherapy is a movement from group therapy to group psychotherapy, that is, to the understanding and use of group effects for psychotherapeutic purposes. Since the beginning of the existence of medicine, healers have applied methods of psychological influence to assist the sick, making wide use of the group for this purpose. The expectations, orientations, emotions, feelings of hope, faith in the competence of the healer and the effectiveness of the procedures applied in the groups increased the state of affective tension, which increases with the participants' emotional contagion, and contributed to the patient's ability to influence and influence it. The impact was, first of all, in the suggestion, which turned to the emotional sphere of the patient and, bypassing his rational, critical thinking, had a beneficial effect on his well-being and psycho-physiological state and, as a result, on social functioning. An example of a group of positive effects on mental health can serve as the experiences of the Austrian psychiatrist Mesler (Mesmer F. A.), who is sometimes called the "creator of the theory and practice of psychotherapy, including group therapy." In the future, many eminent scientists and doctors used various psychotherapeutic methods in the group of patients, justifying the expediency and effectiveness of this approach. The first who drew attention to the therapeutic possibilities of using group interaction was the American doctor Pratt J., who in 1905 first organized psychotherapeutic groups for patients with tuberculosis. Initially, Pratt considered the group as an economically more convenient way of informing patients about health and illness, lifestyle and relationships that promote healing, and did not isolate its own therapeutic possibilities. Later he came to the conclusion that in psychotherapy the main role belongs to the group, the impact of which lies in the effective influence of one person on another, in the mutual understanding and solidarity arising in the group, contributing to overcoming pessimism and a sense of isolation.
Virtually all psychotherapeutic areas of the XX century. one way or another they used group forms and hung a certain contribution to the development of group psychotherapy. A special place in this series belongs to the psychoanalytic and humanistic areas. So, Adler (Adler A.) drew attention to the importance of the social environment and the manifestation of violations in patients. He believed that the group provides an appropriate context for the identification of emotional disorders and their correction. Believing that the source of the conflicts and difficulties of the patient and the wrong system of their values and life goals, he argued that the group can not only shape the views and judgments, but also helps to modify them. Working with a group of patients, Adler sought to achieve an understanding of the genesis of their violation by patients, as well as to transform their positions. The development of psychoanalytically oriented group psychotherapy was promoted by Slavson SR, Sehilcler P., Wolf A., and others. The founder of psychodrama Moreno (Mohepo) made a significant contribution to the development of group psychotherapy. term group psychotherapy. Among the representatives of the humanistic direction, Rogers occupies a special place (Rogers S. R.). Highlighting empathy, unconditional positive acceptance and authenticity as the main variables of the psychotherapeutic process, Rogers attached great importance to group forms, considering that the psychotherapist in them is a model for the participants, thereby contributing to the elimination of anxiety and the development of self-disclosure, that the relations between the participants of the group, can create optimal conditions for therapeutic change. The work of Levin (K. Lewin) and the field of group dynamics, who believed that most effective changes occur in a group rather than in an individual context, had a great influence on the development of group psychotherapy. Levin and his followers viewed personality disorders as the result and manifestation of disturbed relationships with other people and the social environment. They saw in the group a tool for correcting disturbed interactions, since such a correction occurs in the process of social learning. This process is facilitated and accelerated, in particular, due to the early detection and group context of typical for individual participants of non-adaptive interpersonal behavior. The main content of the work of the groups is the analysis of typical interaction patterns, the comparison of behavior in the current situation “here and now” with its nature and consequences in the past. Thanks to the tactful participation of the psychotherapist who encourages and guides the discussion, contributing to the emergence of an atmosphere of goodwill and cooperation, this analytical work facilitates the experience of corrective emotional experience that is inevitable for the learning process.It is also necessary to indicate such prominent theorists and practitioners and the field of group psychotherapy, such as Heck (Hock K.), Leder (Lecler S.), Kratochvil (Kratochvil S.), who, working in Eastern Europe, had a great influence on the development of Group psychotherapy in Russia.
The goals and objectives of group psychotherapy as a method focused on personality changes, to a certain extent, differ depending on the theoretical ideas about the personality and the nature of its violation, but reliance on group dynamics significantly brings together positions. In the most general form, the goals of group psychotherapy are defined as the disclosure, analysis, awareness and processing of the patient's problems, his intrapersonal and interpersonal conflicts and the correction of inadequate relationships, attitudes, emotional and behavioral stereotypes based on the analysis and interpersonal interaction. Considering the three planes of expected changes (cognitive, emotional, and behavioral), more specific tasks of group psychotherapy can be formulated as follows: 1. The cognitive sphere (cognitive aspect, intellectual awareness).Group psychotherapy should help ensure that the patient realizes: 1) the relationship between psychogenic factors and the occurrence, development and preservation of their disease; 2) what situations in the group and in real life cause tension, anxiety, fear, and other negative emotions that provoke the appearance, fixation and intensification of symptoms; 3) the relationship between negative emotions and the appearance, fixation and amplification of symptoms; 4) features of their behavior and emotional response; 5) how he looks from the outside, how his behavior is perceived by others, how the surrounding particular features of behavior and emotional response are evaluated, how they respond, what consequences this behavior has; 6) the existing disagreement between one's own image of Self and the perception of oneself by others; 7) own motives, needs, aspirations,attitudes, attitudes, behaviors and emotional responses, as well as their degree of adequacy, realism and constructiveness; 8) characteristic defense mechanisms; 9) internal psychological problems and conflicts; 10) features of interpersonal interaction, interpersonal conflicts and their causes; 11) deeper causes of experiences, methods of reaction, starting from childhood, as well as the conditions and features of the formation of a system of relationships; 12) his own role, the measure of his participation in the occurrence and preservation of conflict and psycho-healing situations, and also the way in which they could be avoided in the future. In general, the tasks of intellectual awareness are reduced to the following three aspects: awareness of the “personality – situation – illness” connections,awareness of the interpersonal context of the self and awareness of the genetic (historical) plan.
2. Emotional sphere. Group psychotherapy should help the patient: 1) to receive emotional support from the group and the psychotherapist, which leads to a sense of self-worth, weakening of defense mechanisms, increased openness, activity and spontaneity; 2) to experience in the group the feelings that he often feels in real life, to reproduce those emotional situations that he had in reality and with which he previously could not cope; 3) to experience the inadequacy of some of their emotional reactions; 4) learn sincerity in relation to yourself and other people; 5) to become more free in expressing one’s own negative and positive feelings; 6) learn to more accurately understand and verbalize their feelings; 7) to reveal their problems with their respective experiences (often previously hidden from themselves or distorted);8) modify the way of experiencing, emotional response, perception of oneself and one's relations with others; 9) to make an emotional correction of their relationship. In general, tasks in the emotional sphere cover the following main aspects: obtaining emotional support and the formation of a more favorable attitude towards oneself, immediate experience and awareness of the new experience in the group and oneself; accurate recognition I verbalize my own emotions; experiencing anew and awareness of past emotional experiences and getting a new emotional experience in a group.obtaining emotional support and the formation of a more favorable attitude towards oneself, direct experience and awareness of a new experience in the group and oneself; accurate recognition I verbalize my own emotions; experiencing anew and awareness of past emotional experiences and getting a new emotional experience in a group.obtaining emotional support and the formation of a more favorable attitude towards oneself, direct experience and awareness of a new experience in the group and oneself; accurate recognition I verbalize my own emotions; experiencing anew and awareness of past emotional experiences and getting a new emotional experience in a group.
3. Behavioral sphere. Group psychotherapy should help the patient: 1) to see their own inappropriate behavioral stereotypes; 2) acquire the skills of more sincere, deep and free communication; 3) to overcome inadequate forms of behavior, manifested in the group, including those related to the avoidance of subjectively difficult situations; 4) develop forms of behavior related to cooperation, mutual assistance, responsibility and autonomy; 5) to consolidate new forms of behavior, in particular those that will facilitate adequate adaptation and functioning in real life; 6) to develop and consolidate adequate forms of behavior and response on the basis of achievements in the cognitive and emotional spheres. In general, the tasks of group psychotherapy in the behavioral sphere can be defined as the formation of effective self-regulation.
Thus, the tasks of group psychotherapy focus on the three components of self-awareness: self-understanding (cognitive aspect), attitude to oneself (emotional aspect), and self-regulation (behavioral aspect), which allows defining the general goal of group psychotherapy as an extension of the patient’s self-consciousness. In principle, the objectives of any psychotherapeutic system, focused on personal change, can be formulated in this way. However, in group psychotherapy, the psychotherapeutic group acts as the main tool of therapeutic effect, which allows to reach an understanding and correction of the patient’s problems through interpersonal interaction, group dynamics. Group dynamics is a set of group actions and interactions resulting from the relationship and interaction of group members,their activities and the influence of the external environment, and represents the development, or movement, group in time. In general, group dynamics are determined by the goals, objectives and norms of the group, its structure, leadership structure, group roles, group cohesion, group stress, actualization of previous emotional experience, the formation of subgroups, the main types of verbal communication in the group. All elements of group dynamics are discussed in the course of work, since they most clearly express the specifics of the system of relationships, attitudes, behavioral patterns, etc., and can be viewed as the main topics of group discussion.group cohesion, group stress, actualization of previous emotional experience, the formation of subgroups, the main types of verbal communication in the group. All elements of group dynamics are discussed in the course of work, since they most clearly express the specifics of the system of relationships, attitudes, behavioral patterns, etc., and can be viewed as the main topics of group discussion.group cohesion, group stress, actualization of previous emotional experience, the formation of subgroups, the main types of verbal communication in the group. All elements of group dynamics are discussed in the course of work, since they most clearly express the specifics of the system of relationships, attitudes, behavioral patterns, etc., and can be viewed as the main topics of group discussion.
Reliance on group dynamics and interpersonal interaction, which is the focus of the group’s work on the “here and now” process, sometimes forms the point of view according to which group psychotherapy is aimed at reworking conflicts in the field of interpersonal interaction, while the individual - on the disclosure and processing of deep-seated , intrapersonal conflict. However, group psychotherapy in the framework of a particular psychotherapeutic tension solves the same tasks as an individual, but with the help of its own means. If psychotherapy has as its goal the disclosure and reworking of an internal psychological conflict and the correction of inadequate, disturbed personality relations, which have led to its emergence and subjective unsolvability, then this goal is common for both individual psychotherapy and group psychotherapy.Difficulties in the field of interpersonal interaction, interpersonal conflicts are largely the result of deep-seated collisions and disturbed personality relations. In interpersonal conflicts, hidden and unconscious psychological problems are highlighted. Exposure only at the interpersonal level is more like behavioral training, since the tasks of psychotherapy are more complex and deeper. The difference between individual psychotherapy and group psychotherapy, if there are common tasks, is that group psychotherapy focuses more on the interpersonal aspect, and individual - on the genetic aspect. However, only to a greater extent, and not exclusively.In group psychotherapy, internal psychological conflict and disturbed personality relationships are revealed through their direct reflection in the patient's real behavior in the group. At the same time, group psychotherapy, despite the dominant interactional orientation, is not limited to the actual situation “here and now”. Adequate correction of the disturbed personality relationships can be carried out by the patient only if the whole complex of psychological characteristics, manifested in the process of group interaction, correlates with his real situation and problems outside the group, allows him to reconstruct the peculiarities of interrelations in situations “there and then”. The regular repeatability, the stereotype of conflict situations, behavioral patterns and emotional responses in and outside the group,in the present and in the past, the content of the feedback received in the group is made more visible and convincing to the patient. This contributes to the creation of sustainable motivation to self-research and correction of their relationships, allows you to isolate what is behind the behavior in various situations. The consequence of the idea that the process of group psychotherapy should be limited to the situation “here and now” can only be a decrease in the effectiveness of psychotherapeutic influence. One of the most important mechanisms of therapeutic action of group psychotherapy - the patient’s emergence and experience in the group of those emotional situations that he had in real life in the past and were subjectively unsolvable and unresponsive - involves the reworking of past negative experiences, manifested in the actual emotional situation in the group,without which it is impossible to achieve positive, sufficiently deep personal changes. An adequate self-understanding also cannot be achieved outside the general context of the formation and development of the patient’s personality. As group psychotherapy is not limited to the interpersonal level, so individual psychotherapy is not limited only to awareness through genetic analysis. In individual psychotherapy, as well as in group, and real emotional interaction (in a group or psychotherapeutic dyad), and the patient's story about himself, his life, his past, to a certain extent, meet the principle of "here and now." First, the patient's verbal activity (or inactivity) is due to his actual interaction with the psychotherapist (group): trust or distrust, feeling of danger or security, desire to cause sympathy,find understanding, contact, collaborate or transfer all responsibility for treatment to a psychotherapist. Secondly, the story of his past, memories often also cause strong emotions, comparable to those that occurred in a real situation. However, a story about the past can not only provoke strong actual experiences, but also contribute to their adequate and accurate verbalization and awareness. Therefore, the restriction of the psychotherapeutic process in an individual psychotherapy only to the genetic plan, and in the group one only to the interpersonal one, as well as the extremely narrow understanding of the term “here and now”, seems unreasonable.which arose in a real situation. However, a story about the past can not only provoke strong actual experiences, but also contribute to their adequate and accurate verbalization and awareness. Therefore, the restriction of the psychotherapeutic process in an individual psychotherapy only to the genetic plan, and in the group one only to the interpersonal one, as well as the extremely narrow understanding of the term “here and now”, seems unreasonable.which arose in a real situation. However, a story about the past can not only provoke strong actual experiences, but also contribute to their adequate and accurate verbalization and awareness. Therefore, the restriction of the psychotherapeutic process in an individual psychotherapy only to the genetic plan, and in the group one only to the interpersonal one, as well as the extremely narrow understanding of the term “here and now”, seems unreasonable.seems unreasonable.seems unreasonable.
Most of the researchers in the process of group psychotherapy, as well as practices in this area, describe certain patterns in the development of the psychotherapeutic process in a group and the presence of its clearly defined phases. This process begins with the stage of dependent and exploratory behavior, goes through a period of occurrence, aggravation and resolution of intra-group conflicts and moves forward to the formation of group cohesion and effective problem solving. The presence of various schemes is determined both by different theoretical orientations and by different parameters, the study of which served as the basis for identifying certain phases of the group psychotherapeutic process. However, at a descriptive level, there are much more similarities than differences.The first phase of group psychotherapy is characterized by the passivity of patients and a high level of tension, mainly due to the discrepancy between expectations and the real group situation and the position of the psychotherapist. For the second phase, there is also a high level of tension (the specificity of which lies, as a rule, in the presence of negative emotions towards the psychotherapist) in combination with a higher activity of the patients. Constructive resolution of this crisis stage can be considered the open expression by patients of their feelings and group discussion of problems related to authorities, dependence, search for support, lack of autonomy and responsibility, and uncertainty. The third phase is characterized by the process of structuring a group, the development of a group culture, the development of group norms, goals, values,the formation of cohesion, mutual aid and mutual support. The fourth phase is the “working” one - the phase of an actively and purposefully working psychotherapeutic group. The cohesion, sincerity, spontaneity, interest, and a sense of security that emerged in the previous phase create the necessary conditions for the actual psychotherapeutic process in the group.
When considering the therapeutic effect of group psychotherapy, various mechanisms or factors of therapeutic action are distinguished, which are located in 3 main planes: emotional experience, self-understanding and behavior regulation. Depending on the theoretical orientation, representatives of different areas attach more or less importance to each of them, while emphasizing the specific role of the other two. Corrective emotional experience, confrontation and learning can be considered as the main mechanisms of the therapeutic action of group psychotherapy.
An important role in group psychotherapy is played by the behavior of a group psychotherapist, which is largely determined by theoretical orientation, but in general, his position can be characterized as non-directive. The main tasks of a group psychotherapist can be formulated as follows: 1) encouraging group members to manifest relationships, attitudes, behaviors, emotional reactions and discuss and analyze them, as well as to analyze the proposed topics; 2) creation in the group of conditions for the patients to fully disclose their problems and emotions in an atmosphere of mutual acceptance, security, support and protection; 3) development and maintenance of certain norms in the group, flexibility in the choice of directive and non-directive impact techniques. The means used by the group psychotherapist can be divided into 2 types: verbal and non-verbal.Verbalization includes the structuring of the course of classes (one of the most important functions of the psychotherapist), information gathering, interpretation (reflection of emotions, clarification, confrontation, interpretation itself), persuasion and persuasion, provision of information, setting tasks. In this case, it is not so much about the activity of a psychotherapist, but rather about stimulating members of a group to a certain type of activity. By non-verbal means include facial expressions, gestures, intonation. Preferred in terms of leadership of the psychotherapeutic group is the presence of two psychotherapists in it, which allows each of them to receive feedback regarding their behavior in the group.In this case, psychotherapists professionally control each other and can pay attention to their own distortions in the understanding of the group process and possible countertransference. A less experienced, novice group psychotherapist, who participates in work, gains experience in the field of group psychotherapy often acts as a therapist. Group management by psychotherapists who are at the same professional level is also common. The most preferable is the option of work in the psychotherapeutic group of 2 psychotherapists: a doctor and a psychologist, a man and a woman.also common. The most preferable is the option of work in the psychotherapeutic group of 2 psychotherapists: a doctor and a psychologist, a man and a woman.also common. The most preferable is the option of work in the psychotherapeutic group of 2 psychotherapists: a doctor and a psychologist, a man and a woman.
Methods of group psychotherapy are conditionally divided into basic and auxiliary. The main one is the group discussion, which has 3 main orientations - interactional, biographical and thematic. The auxiliary methods include psychodrama (playing role situations), psycho-gymnastics (non-verbal interpersonal interaction), music therapy (in active and receptive forms), projective drawing (drawing on a specific topic). Each of these methods can be used as an auxiliary device, but in this case we are talking about a complex used in working with one psychotherapeutic group. The basic form of group psychotherapy is group discussion, and auxiliary methods can be used as an additional device during the discussion and as a separate lesson.The combination of group discussion with various verbal and non-verbal auxiliary techniques is determined by the specific group situation and the phase of development of the group. Depending on this, the specific weight of different verbal and non-verbal methods, as well as the content and structure of occupations may vary. For example, in the initial phase of group psychotherapy, when there is a pronounced distance between patients and the fear of overcoming it, when patient behavior is characterized by tension and uncertainty, it is useful to increase the amount of non-verbal techniques, in particular psycho-gymnastics. Sometimes at the beginning of the work of the group, psychodramatic techniques are mainly used (conversation with a significant person, “social atom”, etc.). Auxiliary verbal and non-verbal methods are often used in a group to resolve difficult situations.Their use during the group discussion allows you to draw the attention of the group and individual patients to the characteristics and ways of behavior, reveal the existing relationships and make them more visual, revitalize the interaction process, give additional material for analyzing the problems of the group as a whole and each patient individually.
The duration of a group psychotherapy course depends on the theoretical orientation, nosological affiliation and type of medical institution. On average, it is 40 sessions of 1.5 hours each. The psychotherapeutic group consists of 8–12 people and, as a rule, is homogeneous on a nosological basis and heterogeneous with respect to other characteristics (gender, age, education, psychological characteristics, the specifics of psychological conflict, etc.).
Group psychotherapy is used in complex treatment of a wide variety of patient groups (neurosis, alcoholism and drug addiction, psychosis, psychosomatic disorders, chronic somatic diseases, etc.). The use of group psychotherapy is determined primarily by the role of psychogenic factors in the etiopathogenesis of the disease and its social and psychological consequences. This information is given in the relevant articles on psychotherapy in various fields of medicine.
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The basics of psychotherapy
Terms: The basics of psychotherapy