Abstract
In recent years, social functioning of patients has increasingly been used as a criterion for assessing the therapeutic efficacy of the group psychotherapy. The purpose of this preliminary study was to examine whether social functioning of patients with diagnosed psychotic disorders changes during their participation in psychodynamic group psychotherapy. The sample consisted of 30 patients involved in the psychodynamic group psychotherapy (PGP), and a comparative group of 30 patients treated only with antipsychotic medication therapy (treatment as usual; TAU). After two years of therapy, the instruments designed for this study (self-assessment and therapist-assessment questionnaire) were applied to examine changes in patient communication in their interpersonal relations, romantic and working functioning, and overall social functioning. The research also included data as to whom patients turned to for help, and the number of hospitalisations in the observed period. The majority of patients from both groups assessed their social functioning as improved, with significant differences found only in the area of romantic relations: more patients in the TAU group assessed their functioning as worsened. Nevertheless, a significantly higher number of patients in the PGP group were assessed by their therapists to have improved social functioning in all dimensions, except in the area of romantic relations, where there was no statistically significant difference between the groups. In comparison with the TAU group, twice as many patients in the PGP group turned to their psychiatrist for help and had four times fewer hospitalisations. Considering the limitations of this preliminary study, it can be concluded that the findings are promising, although further research is required to determine whether a psychodynamic approach to group psychotherapy truly leads to improved social functioning of patients with psychotic disorders.
I introduce an approach to group that has remained undeveloped in the literature, but represents an essence of relationally oriented group psychotherapy. Evolving from the verbalizations and enactments through which the group symbolizes and becomes known - a nuclear idea takes shape. It emerges from the nucleus of the group process: co-created from intersubjective forces and locations that cannot be fully specified, yet may be possible to observe, name, and utilize clinically. Groups organize themselves by developing nuclear ideas, with the therapist’s active participation. They are vehicles through which a group comes to think about its thinking: not only what it thinks, but also how it thinks, or chooses not to think, and when and why. Developing the nuclear idea provides a framework for how the therapist-and the group itself-goes about the task of containing. With its emphasis on meaning and the development of meaning as transformational, the concept of the nuclear idea supplements the whole group, interpersonal, and intrapsychic lenses through which the therapist comes to understand group experience and base interventions. Clinical vignettes illustrate how the therapist may develop nuclear ideas thematically, conceptualize further, and negotiate meaning with the co-participation of other group members.
The Imago group was developed in 2010 as a step-down group for members of the Winterbourne Therapeutic Community (TC) who had completed their treatment. This paper aims to review the usefulness of the group by reflecting on service user and staff feedback. Design/methodology/approach – An opportunity sample of all current and ex-members of the Imago group (n=17) were approached and a mixed methods design was used to gain a wide collection of data. A self-report questionnaire was designed to access the opinions of members and staff about the Imago group. In total, 71 per cent of Imago members and 90 per cent of staff responded. Findings – Results show that “staff being familiar”, “reconnecting with fellow ex-TC members” and alternating days were the top three most helpful aspects of the group, whereas “having at least 4 weeks away from the TC before attending the Imago Group”, “style of session” and “venue” were found to be the least helpful aspects. Research limitations/implications – Limitations of the study centre round data collection. There were comprehension problems with the instructions for completing the quantitative scale and a small sample size meant that interpretations were tentative. Originality/value – The Imago group is deemed a valuable part of the service for many of the service users (and staff), helping to aid recovery and re-integration into life after therapy. Elements of the group which were rated as least helpful require more thinking about.
Group therapies are routinely provided for patients with severe mental illness. The factors important to the group experience of patients are still poorly understood and are rarely measured. To support further research and practice, we aimed to develop a questionnaire that captures how patients experience groups within a community mental health context. An initial pool of 39 items was conceptually generated to assess different aspects of group experiences. Items were completed by 166 patients with severe mental illness attending group therapies in community mental health services in Italy. Patients with different psychiatric diagnoses who attended at least 5 group sessions were included. An exploratory factor analysis was used to identify different dimensions of group experiences and to reduce the number of items for each dimension. The resulting questionnaire has five subscales: 1) sharing of emotions and experiences, 2) cognitive improvement, 3) group learning, 4) difficulties in open expression and 5) relationships. Each subscale has 4 items. The scale and sub-scales have good internal consistency. The Ferrara Group Experiences Scale is conceptually derived and assesses dimensions of group experience that are theoretically and practically relevant. It is brief, easy to use and has good psychometric properties. After further validation, the scale may be used for research into patient experiences across different group therapy modalities and for evaluation in routine care.
Trainees may experience greater effectiveness as therapists by conceptualizing group therapy interactions as occurring at different levels of functioning. We teach group therapy trainees to be aware of and flexibly direct their interventions to three levels of the group: (a) the intraindividual level, (b) the interpersonal level, and (3) the group-as-a-whole level. Within this conceptualization, we also encourage trainees to reinforce the group structure especially related to safety and secure base and to help group members to self-reflect about their interactions within the group. In this clinical process commentary, we describe a process of pregroup assessment and preparation that includes evaluating individual core relational patterns (CRPs) and how these patterns might express themselves in the three levels of group functioning. A running case presentation provides examples of a CRP formulation, levels of group functioning, and therapist interventions that are specific to each level. Making use of each group level within every session may allow the novice group therapist to sort the complex information they receive in a meaningful way. A therapist who can flexibly attend to and work within each group level will optimize the effectiveness of their interventions.
We examine the work of icap, a clinic for Irish people in Britain, to describe an (Irish) idea of ‘home’ within a psychoanalytic/group-analytic discourse, and some aspects of its clinical significance in providing culturally-sensitive psychotherapy. Our work weaves through four axes of trauma: the dislocation embedded in all migration, irrespective of the social or economic circumstances of the migrant; the long domination of Ireland by England, and some of the resulting complexities in Irish migration to Britain; childhood abuse, within the ‘home’ and within the Church-run institutions sanctioned by the Irish state; and childhood neglect and deprivation. In clinical practice these levels interpenetrate and interact with each other. Early trauma followed by migration impacts on the patient’s internalized ‘home’; culturally-specific loss and yearning are then central to the creation and maintenance of identity, and linked to narratives of ‘home’. In trauma ‘home’ can become frozen in an idealized and/or terrorized state, whereas the creation of a healthy internalized ‘home’ depends on a creative fluidity, a need intensified when actual departure from the home country requires identity adjustment. We touch on the significance of the physical body and external ‘home’. Composite case studies illustrate these clinical themes.
In this opinion piece, I explore some of the social and cultural factors that contribute to the creation of feelings of shame in those members of society who are vulnerable or disadvantaged in various ways. I suggest that a ‘blame and shame’ attitude has become pervasive in today’s political culture, reassuring the comfortable and privileged that they deserve their own success and allowing them to blame the disadvantaged for their own misfortune. Those who feel that they must become invulnerable in order to succeed therefore project their own vulnerable child onto the vulnerable in our society and attack and condemn in others what they most fear in themselves.
In this paper, I draw on Freudian and Lacanian psychoanalytic theory to consider the notion of perversion and fetishisation within the context of contemporary UK public mental health services which have been subject to New Public Management restructuring. Offering an organisational case example based on clinical experience within an expanded NHS mental health service, I explore how services that are subject to neo-liberal regulatory and performance management systems sponsor a perverse organisational solution to the anxieties and difficulties of dealing with psychologically distressed patients. I conclude that theorising the unconscious dynamics of perversion and fetishism may provide an opportunity to rethink governmentality, offering a potentially fruitful means of addressing recent political concerns about the negative impact of a ‘target culture’ on public sector health services.
There is growing concern about how people respond to a fast-changing world in the context of economic decline. Symptoms of distress such as depression and anxiety are reaching epidemic proportions alongside the breakdown of family stability. This paper considers how psychoanalysis can enter the debate about these concerns and whether psychoanalytic theory and practice in the UK has concentrated too much on the individual to the exclusion of the wider family and the community.
Psychologically Informed Planned Environments (PIPEs) are an additional stage in the Offender Management Personality Disorder Pathway. The author describes the context, the impact of the work on both offenders and staff, and discusses the importance of paying close attention to the psychological process level from both a service and an organisational perspective. It is argued that the group analytic understanding of group and individual process is an important element of the psychological containment within PIPE for both offenders and staff. The group analytic focus on the here and now relational level linking to the historical context and the unconscious group and individual process provides a structure and concept for understanding the intrapersonal, interpersonal, group process, psychosocial process and the organisational context and its impact. Reference is made to the necessity of addressing the environment offender’s move onto following their PIPE experience.