Group psychoanalytic psychotherapy introductory remarks
In the last two decades, group psychotherapy has become increasingly important in the context of psychotherapeutic treatment both in outpatient and inpatient settings. In psychotherapeutic rehabilitation clinics, group psychotherapy is a central component of inpatient treatment.
Many patients are initially skeptical about group psychotherapy. After a thorough introduction and information about group psychotherapy, many participants learn to appreciate this form of treatment as extremely helpful. There is closed and half-open group psychotherapy.
1.1 Group Psychotherapy
Brief historical overview, at the beginning of the last century, tuberculosis patients were informed about their disease in leader-centered groups of doctors in sanatoriums and received encouragement and support in the patient group.
In 1931 in the USA psychosis patients were treated in groups, here the emphasis was more on the common experience of the group participants among each other (so-called peers) not so much on the behavior of the group leader, the group experience had a relieving effect for the participants. This model was successfully practiced worldwide in the self-help groups of Alcoholics Anonymous from 1935 onwards. It led to the development of further self-help groups after the Second World War.
Independently of this, Moreno developed a role-playing method, psychodrama, a specific form of group psychotherapy.
Since the 1930s, the concept of group psychotherapy as a treatment method has also been introduced in the field of deep psychologically oriented analytical psychotherapy (Slavson 1934). Educational treatments such as autogenic training have also existed since that time.
1.1.2 Psychoanalytic group therapy
The aim of analytical group therapy is to uncover and overcome the underlying causes of conflict, problem or unwanted behavior with the help of other group members and the therapist/doctor as the unconscious backgrounds. In analytical group therapy, it is assumed that a person’s relationship behavior is particularly influenced by the experiences he or she has had in childhood, especially with his or her close relatives. These early experiences are confirmed in the bonding behavior of the adult human being and are reflected in the way in which one can shape one’s interpersonal relationships in the unconscious. This can lead to feelings or ways of thinking being unconsciously transferred to the present relationships today in patterns of behavior that were experienced in an earlier phase of life. This pattern has then become such a self-evident part of the personality that it is usually difficult to recognize it as behavior that no longer fits in with the person and life situation today. The cultivation of relationships then turns out to be difficult because misguided behavior patterns have buried themselves in the personality and become a familiar companion in life.
In the group therapeutic situation, these old patterns and their roots can be brought into consciousness through interaction and reflection between the participants, so that relationships in everyday life can also be shaped differently.
1.1.3 Different approaches in group psychotherapy
There are very different approaches to group psychotherapy: Psychoeducativ-themed therapy groups – especially for physically ill clients
Social communicative self-help groups – groups to improve social perceptions and interaction
Behavioral training in groups – mainly within the framework of addiction prevention and addiction rehabilitation treatment
Art and music therapy groups – to improve emotional experience within the framework of multidimensional therapy in psychosomatic clinics
Body related group therapy offers – for the improvement of relaxation ability (functional relaxation therapy, PMR) and for the improvement of the body experience (concentrative movement therapy, body therapy and Feldenkrais). Large milieu therapy groups (so-called ward meetings) – to promote social competences, to improve the perception of others and oneself, to get to know role behavior, to promote communicative abilities (to learn to listen, to give and receive feedback).
1.1.4 Group Psychotherapy based on Depth Psychology
In the narrower sense, group psychotherapy based on depth psychology is offered in different settings:
Analytical group psychotherapy
Analytically oriented group psychotherapy
Depth psychology-based interactional group psychotherapy
Psychodramatic group psychotherapy
This specific group psychotherapy is offered both on an outpatient basis and as inpatient psychotherapeutic treatment in psychosomatic clinics. A distinction is made between two forms:
2. Closed and half-open group psychotherapy
In closed group psychotherapy the individual participants are selected in preliminary talks. The group psychotherapy starts at a fixed date, leaving group participants will not be replaced by new ones. This form of group psychotherapy mainly takes place in outpatient psychoanalytic groups.
In the case of inpatient treatment in psychosomatic clinics, half-open group psychotherapy is the most common form, i.e. new patients are admitted to an already existing group after group participants have left. They benefit from the already established positive and trustful therapeutic working atmosphere of the group. On the other hand, the group must always compensate and process the retirement and new entry of group members. Heterogeneous group psychotherapy, where men and women with different clinical pictures are treated together. This offers the advantage of getting to know multi-layered perspectives and experiencing a wider spectrum of mutual reaction patterns and feedback. One’s own behavioral and communication patterns also meet diverse reactions and in this way make new experiences and insights possible.
2.1 How does group psychotherapy work?
As an important stimulating impulse, the participants of a group psychotherapy group experience a renewed access to justified hope for a change in their individual situation, both on the part of the therapists and on the part of the group members themselves. The personal experience of hope is a decisive factor for the further process of change and recovery. In individual therapy, skepticism about a therapeutic change can last longer. The experience in group psychotherapy that other group members suffer from similar conflicts and complaints and that those affected are not alone with their fears and conflicts leads to a profound relief. The patients no longer feel isolated with their suffering, but can gain a new inner access to the social environment; if they previously lived in a stronger social isolation due to illness.
In addition to the exchange of information in the context of group psychotherapy, many clients experience again for the first time that they can be important and helpful for others. This experience contributes decisively to an improvement of self-esteem. Within the framework of group psychotherapy, many participants repeat experiences they knew from their families of origin, but can now gain new corrective experiences within the framework of psychotherapy in the here and now, which enable them to make contact and communicate with others outside the therapy. The development of new and positive behavior patterns in human interaction can be tested within the protected framework of group psychotherapy, so that social fears are reduced. In group activities, the participants clearly experience an extension of behavioral models compared to experiences from the primary family, both through the behavior of the therapists and through the behavior of group members. A very central aspect of group psychotherapy is interpersonal learning in the here and now in the group, which represents a social microcosm. Through corrective emotional experiences, all participants gain an improved perception of themselves and others and are able to contribute this to their social environment, family and career.
The feeling of belonging in group psychotherapy, after initial fears, represents an important and fundamental new experience for many participants far beyond the time of participation in group psychotherapy.
Univ. Prof. Dr. Andrawis