Psychotherapeutic (psycho-correctional) groups are small temporary associations of people that exist and develop under the guidance of a leader (psychotherapist), with a common goal of interpersonal exploration, personal learning, growth and self-disclosure (Barrett-Lennard, 1975).

Among the psycho-correctional groups, groups of organizational development, or problem solving, can be distinguished; leadership training and interpersonal skills training groups; groups personal growth; therapeutic groups (Cohen & Smith, 1976).

K. Rudestam describes the following types of psycho-correctional groups: 1) T-groups; 2) meeting groups; 3) gestalt groups; 4) psychodrama; 5) body therapy groups; 6) dance therapy groups; 7) art therapy groups; 8) skills training groups; 9) groups of theme-centered interaction.

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Group psychotherapy

From the history of the development of therapeutic groups .. one of the first specialists who practiced therapy in groups was Boston .. one of the first who made a significant contribution to modern group psychotherapy was Jacob Moreno the creator of ..

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Advantages and disadvantages of group forms of psychotherapy
Advantages of group forms of psychotherapy The ability to model the processes occurring in social environment. Life is primarily social

Disadvantages of group forms of psychotherapy
• Each individual participant receives less attention in the group than in individual therapy. Difficulties in implementing an individual approach, standardization of psychotherapeutic

Universal psychotherapeutic factors
As the main psychotherapeutic factors in individual psychotherapy, the relationship between the psychotherapist and the client comes first: 1) acceptance of a person is a particularly positive

Therapeutic Factors in Group Psychotherapy
In group psychotherapy, therapeutic factors related to the relationship of group members come to the fore. 1) acceptance by other group members 2) self-disclosure

Psychocorrective processes in the group
Kelman identified three processes that are critical to any psycho-corrective group: compliance, identification, and appropriation. First, the members of the group decide to be subjected to

group dynamics
For the first time the term "group dynamics" was used by Kurt Lewin in 1939. According to K. Lewin's definition, group dynamics is a set of positive and negative

Group goals
The goals of the therapeutic group are the result of the group's work planned by the facilitator and / or group members. Obviously, goals can be explicit and hidden, long-term (strategist

Group norms
Norms are a set of rules of conduct that govern the actions of participants and allow sanctions to be applied to forms of behavior that are unacceptable for a given group [Rudestam, 37].

Group roles
A role is a set of functions and behaviors that are considered appropriate for a given individual and are implemented in a certain social context [Rudestam, 32]. Gr

Expert
The most traditional function of the leader-therapist can be considered the role of a permanent expert in the group. The manager always has the opportunity to comment on the processes taking place in the group

Sample
Finally, the team leader can play the role of a model member. Occupying a special position in the group, leaders often cannot do anything about the fact that others imitate them. However

Leadership styles
According to the style of leadership, the following leaders can be distinguished: authoritarian (directive, autocratic) democratic (collegiate) liberal (permissive, form

For and against authoritarianism
Bach (Bach, 1954) believes that organization contributes to earlier cooperation, reduces anxiety among the leader and other members of the group, weakens resistance to group influences, specifically

For and against liberalism
Lakin and Costanzo (1975) emphasize that it is important for the leader to overcome the desire of group members for dependence, inspire them with self-confidence and convince them of the need for self-reliance.

Group structure problem
The most important factor in choosing a group leadership style is the structure of the group. Depressed patients can work successfully in a programmed, structured group, and at the same time in a non-structural group.

group cohesion
Kurt Lewin defined cohesion as "a total field of forces that creates in the participants a sense of belonging to a group and a desire to remain in it" (Lewin, 1947, p. 30). In other words, cohesion - uh

group tension
The opposite of cohesion is tension. If cohesion is the result of the action of positive forces of mutual attraction, then tension is the result of negative forces of mutual repulsion.

Managing cohesion and tension in the group
Group cohesion factors Factors that increase cohesion Factors that decrease cohesion

Group Cohesion Management
To encourage cohesion To prevent cohesion 1. Make the group smaller 2. Encourage agreement with group goals 3. Stee

groupthink
Groupthinking - pressure exerted on the members of a group to force them to adapt to the norms of the group and incline towards consensus (unanimous decision)

Reasons for groupthink
· Desire to reach a consensus by all means. Accession of individual members of the group to the point of view of its most influential members, who enjoy authority, trust, stubbornly

Ways to prevent groupthink
Help fight against destructive action groupthink can freely express the will of the minority, the admission and encouragement of deviations from generally accepted views. Creating conditions for

Group development phases
Usually, there are three to four phases in the development of a psychotherapeutic group. Different authors often call these phases differently, but the content of these phases is the same.

First phase
In this phase, the group is anxious, anxious, dependent. Covertly and openly, members of the group are looking for a leader, waiting for an explanation of the goal, plans, and eager for activity. Group members seek advice on

Third and fourth phases
In the third phase, cohesion, interest, sincerity, and spontaneity develop. The group is operational. Healing properties develop (Rogers K.). quarter

Formation
Formation - the stage at which group members are selected according to their functional or technical experience in order to fulfill the goals of the group. Group members, team introducing

Number of participants
Group sessions can take place in groups large enough to make interaction possible, or small enough so that everyone is involved and feels involved.

Participant composition: homogeneity and heterogeneity
The next question is whether the group should be heterogeneous (diverse) or homogeneous (homogeneous) in composition. When talking about similarities or differences among participants, they usually mean the following:

Familiarity with the goals and norms of the group
Work on the formation of cohesion begins at the stage of selection and acquisition of the group. A way to increase the group's attractiveness to a potential member is to describe the group in a positive way.

Eligible and Unsuitable Participants
For most groups, the most successful candidates are mentally healthy people: those whose psychological defense is low, and whose ability to learn, unlike others, is high. Practically for teaching

Reasons for not joining the group
Participants can leave the group before it ends for various reasons. Rudestam cites a study by Yalom (Yalom, 1966) conducted at a university outpatient clinic. 35 out of 97 patients

Discussion
The discussion is described by the following parameters: Localization - place in the structure of the session Form - reflective self-report, thematic discussion Order - follower

Discussion Models
1. Directive model - the leader is active, can change the order of the discussion at any time, ask any questions to the participants, and in some cases even break the rules. 2. Liberal mo

Brief description of psycho-correctional groups
Groups Paradigm Key concepts Main goals of T-groups (training groups) cognition

T-groups
The emergence of T-groups was the result of the first conscious attempts to use meetings of a certain duration in groups of a certain composition and with a certain leader, in order to

Meeting groups
Encounter groups, or encounter groups, emerged at the forefront of the T-group movement under the influence of such prominent figures as William Schütz and Carl Rogers. Encounter groups caused more controversy

Gestalt groups
The process of emergence and development of Gestalt groups is closely related to the personality of their creator, Fritz Perls. This is one of the first approaches to working with psycho-correctional groups, in which no

Psychodrama
Psychodrama has long history, largely associated with the activities of Jacob Moreno, who is often considered the founder of group psychotherapy. Psychodrama is the first way of working with groups that

Body psychotherapy
Body psychotherapy includes a wide variety of group work methods. All these methods are based on the recognition of the existence of a close relationship between mental and physiological processes.

Art therapy and dance therapy
Art therapy and dance therapy are specialized group work methods that require appropriate training. Both of these methods arose on the basis of psychoanalysis and in the past with

Theme-centered interaction
The first topic-centered interaction groups (TCV groups) were organized by Ruth Kohn, who thereby made a great contribution to the development group work. This is another approach to working with psychoco

Transactional Analysis
Transactional analysis was developed by Eric Berne, who became disillusioned with the possibilities of traditional methods of group psychoanalysis. TA is a very popular, practical and promising method

Skill training groups
Finally, skills training groups represent the behavioral trend in psychotherapy, with their emphasis on observable behaviors and their refusal to explore emotions and consciousness.

1. The concept of psychotherapy. its specifics, goals and objectives.

2. general characteristics psychological models of psychotherapy.

3. Group psychotherapy. The concept of a psychotherapeutic group.

The concept of psychotherapy. its specifics, goals and objectives

Psychotherapy occupies a special place among the varieties of professional assistance to the individual. The question of the professional affiliation of psychotherapy is not an easy one. In the Soviet Union, psychotherapy was a medical specialty. In the West, psychotherapy has traditionally been a practical psychology. This dual understanding of the activity of the psychotherapist persists to this day. The activity of a psychotherapist is considered in accordance with his two professional roles:

o a medical specialist who treats a patient with the help of both psychological influence and specific medical means (medicines, hypnosis, etc.);

o a specialist psychologist, designed to help the individual survive in various life and social situations and focused on working with the client's deep meaningful life problems. In this case, he uses only psychological means of activity.

Of course, a specialist in practical psychology can carry out psychotherapy only in the second sense of this concept and has no right to use medical means. Therefore, we take the following assertion as the starting point. Psychotherapy is aimed at deep penetration into the personality and the implementation of progressive shifts in its interaction with the world through a change in self- and worldview and provides for the creation of conditions for the full development of the personality.

The purpose of psychotherapy is to assist in the development of a full-fledged personality, capable of taking an active and creative position in relation to himself and his life, coping with traumatic situations and experiences, making decisions and acting productively, unconventionally and with dignity in appropriate socio-cultural conditions.

It is customary to distinguish between group and individual psychotherapy.

Individual psychotherapy is a dialogue between a psychotherapist and a client with the aim of psychological help the last one.

In modern psychological literature, several approaches have developed that characterize the relationship between psychological counseling and psychotherapy:

1) psychotherapy and psychological counseling are activities that are different in content and tasks;

2) psychotherapy and psychological counseling are identical, have identical theoretical and practical foundations, but differ in details;

3) psychological counseling deals with interpersonal problems, and the psychotherapist deals with internally personal ones.

O.F. Bondarenko claims that the main differences psychological counseling from psychotherapy turn out to be regarding the interpretation of a person as an object of influence.

In the process of psychotherapy, people change along with their models of the world.

Today, about 100 different psychotechnics of psychotherapy are known. All of them not only find supporters, but also make it possible to effectively provide psychological assistance.

Each type of psychotherapy is designed to help clients operate successfully in the world.

General characteristics of psychological models of psychotherapy

An analysis of the psychotherapeutic literature allows us to state that today in this area of ​​practical psychology there is no single approach to identifying the main areas of psychotherapy. This is due to its consideration either as a method of treatment (more often this approach is found in foreign psychological literature), or as a type of psychological assistance to a client.

So, for example, Yu. G. Demyanov identifies such methods of psychotherapy used in practice:

o rational psychotherapy;

o psychoanalytic psychotherapy;

o cognitive-analytical psychotherapy;

o psychotherapy based on transactional analysis;

o person-oriented psychotherapy;

o gestalt therapy;

o autogenic training;

o emotional stress therapy;

o group psychotherapy;

o positive psychotherapy.

The classification of psychotherapy models as a variety of therapeutic actions is described by H. Remschmidt. He proposes a classification of psychotherapy models according to the following principles:

The theoretical concept that underlies psychotherapy (psychoanalysis, behavioral psychotherapy, cognitive therapy etc.);

Organizational forms of treatment (individual, group and family therapy);

The specificity of the corrected disorder (psychosis, autism syndrome, neurotic disorders, depressive states, fear syndrome, obsessiveness syndrome, etc.).

In the psychological literature, there is also no unanimity in identifying the main models of psychotherapy. So, in particular, G. Onishchenko, V. Panok distinguish three main models of psychotherapy:

o psychodynamic psychotherapy focused on psychoanalysis;

o humanistic psychotherapy and its main currents - Rogerian, existential, gestalt therapy;

o behavioral (behavioral) psychotherapy.

A somewhat different approach is presented by A.F. Bondarenko. He identifies four main theoretical approaches to psychotherapy:

1) psychodynamic;

2) humanistic;

3) cognitive;

4) behavioral or behavioristic.

Group psychotherapy. The concept of a psychotherapeutic group

Group psychotherapy was introduced into the practice of psychological assistance in 1932 by J. Moreno, and 10 years later there was already a journal on group psychotherapy and professional organization group psychotherapists.

Group psychotherapy is understood as a method of psychotherapy in which several clients are assisted at the same time. The emergence of group psychotherapy is due, according to Moreno, the lack of psychotherapists and significant time savings.

The first method of group psychotherapy was psychodrama.

In the 40s, T-groups appeared (K. Levin), which provide for the formation of interpersonal relationships and the study of processes in small groups and in their variety - the group of sensitivity.

Today, these groups have evolved into special skill groups and personal development or encounter groups.

Psychotherapeutic groups are small, temporary associations of people led by a psychologist or social worker that have a common goal of interpersonal exploration, personal growth, and self-discovery.

These are groups in which there is a holistic deep development of the personality and self-actualization of a healthy person, the process of his mental maturation is accelerated.

Depending on the overall goal, the group has a relatively clear hierarchical structure. One of the members of the psychotherapeutic group acts as a leader, the rest are in the role of subordinates. This structure may change depending on the goals of psychotherapy. Common goals, combined with the needs of individual members of the group, determine group norms, that is, the forms and style of behavior of all members of the group.

It is necessary, according to Lemkuhl, to distinguish group training and work with a group from group psychotherapy proper. Remschmidt explains it this way: "Group training is focused on overcoming certain behavioral disorders and requires high structuring (purposeful exercises, a rigid therapeutic plan), in group psychotherapy it is said to gain emotional experience and achieve intrapsychic changes, while the degree of structuring is small" .

All forms of group therapy use predominantly verbal methods, as well as action-oriented or behavioral methods. AT recent times activity-oriented approaches are becoming increasingly important. They contain therapeutic elements and the basic principles of both of the above methods, but differ from them in their emphasis on activity and group exercises.

The success of group psychocorrection and psychotherapy largely depends on the personality of the leader (coach of the group). The leader of the group performs, as a rule, four roles: expert, catalyst, conductor and exemplary participant. That is, he comments on group processes, helps participants to objectively assess their behavior and its impact on the situation; contributes to the development of events; equalizes the contributions of each participant in a group interaction; open and authentic.

Yalom I. Group Psychotherapy: Theory and Practice. Per. from English. - M .: April Press, Publishing House of the Institute of Psychotherapy, 2005

Chapter 1. Treatment Factors in Group Therapy — 1

Chapter 2 Interpersonal Influence — 12

Chapter 3 — 31

Chapter 4. Medical factors. Review — 47

Chapter 5 The Therapist: Tasks and Techniques — 74

Chapter 6 The Therapist: Transference and Transparency — 136

Chapter 7 Patient Selection — 156

Chapter 8 — 175

Chapter 9 — 193

Chapter 10 — 209

Chapter 11 — 230

Chapter 12 — 262

Chapter 13 — 291

Chapter 14 — 320

Chapter 15 — 354

Chapter 1. Treatment Factors in Group Therapy

How does group therapy work? If we can answer this “simple” question with sufficient precision and definitiveness, we will have at our disposal the key to the most exciting and controversial problems in psychotherapy. By highlighting those factors that are critical in the process of therapy, it can give therapists rational basis to develop their own tactics and strategy.

I believe that therapeutic changes are in the highest degree complex process and that it occurs through a complex interaction of various components of a person's life experience, which I will refer to as "healing factors". As you know, the complex consists of the simple, and the holistic phenomenon consists of the processes that make it up, so I will start by describing and discussing these fundamental factors.

From my point of view, healing factors fall into eleven basic categories:
1. Instilling hope.
2. Versatility.
3. Communication of information.
4. Altruism.
5. Corrective analysis of the influence of the parental family.
6. Development of socializing techniques.
7. Imitation behavior.
8. Interpersonal influence.
9. Group cohesion.
10. Catharsis.
11. Existential factors.

In this chapter, we will discuss the first seven factors. The factors "interpersonal influence" and "group cohesion" are so important and complex that we will consider them separately. About "existential factors" will be discussed in the fourth chapter, in the context of the presentation of the relevant material. Since "catharsis" is inextricably linked with other healing factors, it will also be covered in the fourth chapter. It must be borne in mind that, although we consider all these factors separately, they are interconnected with each other: none of them exists and does not act on its own.
Some of these factors are related to the treatment process itself, while others may be considered as conditions of it. Although individual therapeutic factors act in therapeutic groups of all types, their interaction in different groups may proceed in different ways; factors that are secondary or hidden in some groups may be paramount or open to observation in others. In addition, patients in the same groups may be affected by completely different sets of therapeutic factors. Essentially, therapy touches the realm of deep human experience and therefore can be done in an infinite number of ways (I write more about this in Chapter 4).

The list of treatment factors I have proposed is based on my clinical practice, on the experience of other therapists, on the impressions of patients who successfully completed the course of treatment in the group, on relevant systemic studies. At the same time, it must be admitted that none of these grounds can be considered indisputable, and the testimonies of the leaders of the group and its members are sufficiently objective, just as one cannot consider our research methodology perfect and applicable in all cases.

Group therapists offer varied and self-contradictory lists of healing factors (see Chapter 4). Without any doubt, they can be considered disinterested and unbiased observers. All of them have spent time and effort to achieve certain therapeutic results, and their opinions on this or that issue are largely determined by their own experience. Even among therapists who share the same beliefs and use the same terms, there may be disagreement about why patients improve. Recently, my colleagues and I, in studying encounter groups, have noticed that many successful group leaders attribute success to factors that have nothing to do with the therapeutic process; for example, the hot chair technique, or non-verbal exercises, or the direct influence of one's personality (see chapter 14). But this does not surprise us - the history of psychotherapy is replete with doctors who could effectively treat, but could not explain the reasons for this. Sometimes we, as therapists, "give up," so acutely we feel that we have reached a dead end. Who among us has not had a patient who, in a completely inexplicable way, had a general improvement in his condition?

By interviewing group therapy patients at the end of a course of treatment, we can obtain data on which treatment factors, from their point of view, had the most positive effect on them, and which the least; in addition, during the course of treatment itself, patients can report to us at each session about those points that seemed to them the most important. To obtain this information, you can use the interview method or any other data collection method. But keep in mind that patient ratings are subjective ratings. Won't patients note the factors that lie on the surface, and naturally ignore the essential factors of treatment that are beyond their understanding? Won't their responses be influenced by factors beyond our control? For example, the information he communicates may bear the stamp of a personal relationship to the therapist or to the group. (Studies have shown that four years after the end of treatment, former patients were able to reason more soberly about the negative aspects of their stay in the group than when interviewed immediately after the end of the course.)

The search for therapeutic factors that could become universally recognized is further complicated by the fact that the experiences that the patient experiences in the group are very personal character; studies have shown that the same events occurring in a group different people perceive and experience very differently. An experience can be important and useful for some members of the group, but at the same time useless and even harmful for others.

Despite this, patient reports represent a rich and relatively undeveloped source of information. In the end, this experience belongs to them and only to them, and the further we move away from the experiences of the patient, the more emasculated our conclusions will be. Yes, there are factors that undoubtedly affect the patient's treatment process, which he is not able to know, but it does not follow that we should not take into account what patients say. I know from experience that the information content and accuracy of a patient's report depends largely on how they are asked. The deeper the questioner is able to go into inner world experiences of the patient, the more clear and meaningful becomes his (the patient's) message. The more the questioner is able to “forget” about his research interest for a while, the more confidence he will achieve in the patient and will be able, more than anyone else, to understand his inner world.

In addition to the therapist's opinion and the patient's reports, there is a third important approach to identifying treatment factors: the method of systematic research. The usual research strategy is to correlate a series of variables introduced into therapy and what happens to the patient "output". By establishing correlations between the variables introduced into therapy and a successful outcome, causal relationships can be shown and treatment factors can begin to be described. But be that as it may, the research approach is not perfect. It has many problems of its own: the measurement of what happens “at the end” does not have clear criteria, the selection and measurement of variable factors introduced into therapy is equally problematic (usually the measurement accuracy is directly proportional to the triviality of the variable factor).

I have used all of these methods to determine the healing factors discussed in this book. I do not present these factors as definitive; rather, I offer them as some kind of blanks, some kind of guidelines that can be tested and developed by other researchers. For my part, I am satisfied that I have deduced them from the best evidence at my disposal and created the basis for an effective approach to the therapeutic process.

instilling hope

The instillation and strengthening of hope is a decisive curative factor in all psychotherapeutic systems; not only because it allows the patient to be kept in the group and therefore treated, but also because the very belief in healing can be therapeutically effective. Studies have shown that the more the patient hopes that he will be helped, the more effective the therapy. A wealth of documented evidence suggests that the effectiveness of treatment is directly related to the patient's hope for healing and his conviction that he will be helped.

In every therapy group there are people at different stages on the road to recovery. Patients have long-term contact with group members who have improved. They also often encounter patients who have similar problems and who have made great strides in overcoming them. Hadden, in his description of working with a group of homosexuals, argues that the group must necessarily include people who are at different stages of recovery. I have often heard patients who have completed a course of treatment talk about how important it was for them to see improvements in others. Group therapists should by no means miss the opportunity to build on this factor, periodically drawing the attention of patients to the improvements that have occurred in other members of the group. It often happens that members of a therapy group themselves begin to testify to new members about the benefits of classes.

Some of the group therapists specifically emphasize the moment of instilling hope. Much of the meetings of the Society for Rehabilitation and Alcoholics Anonymous is dedicated to the testimonies of their members. Members of the Rehabilitation Society report on cases where they managed to avoid nervous strain in stressful situations by applying the methods developed in this community. Successful members of Alcoholics Anonymous tell stories of their fall and their salvation at every meeting. A very strong factor in the society of Alcoholics Anonymous is the fact that all of its leaders are former alcoholics. Synanon also maintains the hope of its patients by enlisting the guidance of those who have overcome their addiction to drugs. Patients develop the belief that they can only be understood by someone who has walked the same path and was able to find their way back.

Versatility

Many patients come to the therapist very disturbed by the thought that no one else suffers as much as they do, that they alone are experiencing fears, suffering from problems and unacceptable thoughts, impulses and fantasies. There is, of course, some truth in this, since many patients have their own "sets" of stressors that affect them and what is hidden in their subconscious. Their sense of their own uniqueness is closely connected with social isolation, with the difficulties experienced in interpersonal communication, with the unattainability of sincerity and emancipation in intimate relationships. In group therapy, especially in the early stages, dissuading the patient of the uniqueness of his problems is a powerful factor that can improve his condition. After the patient listens to the other members of the group and discovers that he is not alone in his suffering, he opens himself to the world around him, and a process begins that can be called "Welcome to the people", or "We are all in the same boat", or - more clinically, "Misery loves company."

No action, no thought can be completely inaccessible to the experience of other people. I have heard members of the group confess to acts such as incest, theft, embezzlement, murder, attempted suicide, and even worse things. But I saw that the rest of the group did not renounce it. Freud also noted that persistent taboos (against parricide and incest) were created precisely because such impulses are inherent in the deep nature of man.

This helping factor is not limited to group therapy. Universality also plays a role in individual therapy, even though there is less scope for consensus. I once discussed with a patient his six hundred hour experience of individual analysis with another therapist. When I asked him about the most important event during this time, he recalled an episode when he was deeply upset by his feelings towards his mother. Despite the opposition of strong positive feelings, he was haunted by an obsessive desire for her death, since in this case he received a very large inheritance. His analyst commented simply, "It looks like this is what we've created." Such a statement not only brought significant relief to the patient, but in the future gave him the opportunity to use his ambivalence for creativity.

Despite the complexity of human problems, certain common denominators undoubtedly exist, and members of the therapeutic group quickly find "comrades in misfortune." To illustrate this with an example, for many years I have invited members of T-groups (see Chapter 14) to engage them in the task of "top secrecy." Group members were asked to write anonymously on a piece of paper their main secret, - something that they absolutely would not want to share with the group. The secrets turned out to be strikingly similar to each other: they all belonged to one of the two dominant themes. The most common secret is a deep conviction of one's inadequacy, the feeling that if others knew the author of the secret for real, then his incompetence and intellectual inconsistency would be revealed to them. Slightly less common is a deep sense of alienation, with people reporting that they cannot truly care for or love other people. In third place, among the most popular secrets, are various kinds of sexual secrets, such as fear of homosexual inclinations. The same picture is observed in those who belong to the category of patients. Almost always, patients' experiences are associated with deep anxiety about self-esteem and interpersonal relationships.

Versatility, like other healing factors, cannot be considered on its own. Because patients recognize their similarity to others and share their deepest experiences, they benefit from their support and experience catharsis (see Chapter 3, "Group Cohesion").

Communication of information

In this section, I have included didactic training regarding mental health, mental illness, and general psychodynamics from therapists, as well as advice, suggestions, and help with life problems offered by both the therapist and other patients. In general, when therapists or patients look back on the path they have traveled in the therapy group, they do not appreciate this healing factor very much.

Most patients, by the end of a successful course of interactional group therapy, have learned a great deal about the functioning of the psyche, the meaning of symptoms, interpersonal and group dynamics, and the process of psychotherapy itself. Nevertheless, such education is a rather hidden process. Most group therapists do not incorporate directed didactic learning into the process of interactional group therapy. But there are several areas of group therapy in which education as such is an important part of the program. For example, Maxwell Jones, in his early work with large groups, devoted three hours a week to lectures in which he informed patients about the structure and function of the central nervous system and how this relates to psychiatric symptoms and disorders. Clapman developed a form of didactic group therapy for patients who completed their course of treatment, in which he used lectures and textbooks. Marsh created classes based on therapy groups and introduced a learning atmosphere into them by lecturing, assigning homework and transferring patients from class to class.

The Rehabilitation Society was originally created in accordance with the educational divisions. This independent organization was founded in 1937 by the late Abraham Low, M.D., and by the early 1970s included over 1,000 active groups with over 12,000 regular attendance. Membership in this organization is completely voluntary, people come there complaining of all sorts of psychological problems. Leaders are drawn from among the members of the groups, and although this organization formally lacks professional leadership, Dr. Low has established a tradition of holding meetings at which passages from his textbook To Mental Health Through Will Training are read and discussed aloud. Mental illness is explained in terms of a few simple principles that members of such groups should remember. For example, neurotic symptoms cause suffering, but they are not dangerous; nervous tension intensifies and perpetuates the symptoms, so it must be avoided; with the help of free will, the patient gets rid of the problems associated with nervous system etc.

Malamud and Mahover report creating a great, innovative learning-based approach. They organized "self-understanding workshops" consisting of an average of twelve patients, recruited from among psychiatric patients awaiting discharge. The main purpose of the workshops was to prepare patients for group psychotherapy. The course consisted of fifteen two-hour meetings, during which, in accordance with a detailed plan, the causes of psychological disorders were explained, which was a kind of self-knowledge method. The technique was so successful that not only were patients prepared for follow-up treatment, but many of them did not require any further treatment.

Groups in prenatal clinics and groups in Peace Corps training centers also use didactic training. Expectant mothers are explained the psychological basis of their physical and psychological changes, they explain how childbirth goes, they try to dispel irrational fears and prejudices and show that they are causeless. Peace Corps T-groups often use the "anticipatory guidance" method, where the likely stresses and conflicts that group members will have to deal with in a new culture for them are predicted and worked out in advance. In my work with the Peace Corps, I have found it useful to include in the staff a representative of the country to which the trip is being prepared. He, using didactic means, gave real information about the culture of the country and showed the volunteers of the training all the groundlessness of their fears.

My colleagues and I used a similar type of anticipatory guidance for psychiatric patients when preparing them to enter " new culture- in the group of psychotherapy. By anticipating the fears of patients, forming the necessary cognitive structures in them, we helped them to more effectively deal with the initial “culture shock”. (This procedure is described in detail in the ninth chapter).
Thus, didactic learning is used in various types of group therapy: to convey information, to structure groups, to explain how the disease proceeds. Often, didactic training serves as a factor in the initial unification of people in a group, until other healing factors are “turned on”. In particular, explanation and clarification act as full and effective healing powers. Man has always suffered from uncertainty and in all ages has tried to streamline his world, giving explanations, primarily religious or scientific. Explaining a phenomenon is the first step to controlling it. If a volcanic eruption is caused by the volcano god's displeasure, then there are methods to appease him and ultimately bring him under control. Frieda Fromm-Reichman emphasizes the role that uncertainty plays in anxiety. She notes that a person's self-awareness that he is not subject to himself, that his perception and behavior are under the control of irrational forces, is an important cause of anxiety. Jerome Frank, studying the American response to an unknown disease (schistosomiasis) originating in the southern part of Pacific Ocean, shows that secondary anxiety, arising from the state of the unknown, is often more harmful than the primary disease. The situation is similar with psychiatric patients: fear and anxiety, growing out of nowhere, the significance and severity of psychiatric symptoms can complicate the overall picture so much that effective research becomes extremely difficult. Thus, didactic education, providing a structural understanding of the phenomenon and explanation, has a value in itself and occupies a worthy place in the list of therapy tools (see the fifth chapter, which provides a more complete discussion on this issue).

In contrast to the explicit didactic teaching (which a therapist may give) in any therapy group without exception, its members give their own advice. In the dynamics of interactional group therapy, this circumstance is so invariably present at the early stage of the group's existence that it can be used to determine its age. If I watch or listen to recordings of a group in which patients regularly say, “I think you should…” or “What you are doing is…” or “Why would you…,” I can be sure is it a young band or is it senior group, which has encountered certain difficulties in its development and is experiencing a temporary regression. Despite the fact that advice is characteristic of an early stage in the development of an interaction therapy group, I can think of several instances where some advice on certain problems has been helpful to patients. Be that as it may, when patients advise each other - no matter what - they have a mutual interest and concern, this serves to achieve the goal. In other words, it is not the advice itself that is important, but the fact that it was given is important.

This behavior of actively giving or asking for advice is often an important clue to understanding the pathology of interpersonal relationships. For example, the patient who constantly takes advice from others only to reject it and upset others in the process is well known to group therapists as the "help-rejecting whiner" or "yes...but" patient (see Chapter 12). Other patients may ask for advice on problems that are basically unresolvable or have already been resolved. Still others absorb advice with an insatiable greed, but never respond to similar problems in others. Some members of the group, while claiming to maintain their high role status in the group or maintaining a mask of cold self-sufficiency, never directly ask for help; some are intemperate in expressing their gratitude; others never open the gift right away, but drag it home like a bone to chew on it alone.

Other types of groups, which are not openly and effectively oriented towards interactivity, use advice and guidance. For example, in groups where patients are preparing for hospital discharge, the Rehabilitation Society and Alcoholics Anonymous prefer to give direct advice. Discharge preparation groups may discuss possible trials awaiting them at home and how best to handle these situations. Alcoholics Anonymous uses special advice and short catchy slogans, such as asking patients to keep their withdrawal symptoms for the next twenty-four hours, for one day only. The Rehabilitation Society teaches its members how to "note the symptoms," how to "correct and track," "repeat and reverse," how to use willpower effectively.

Altruism

There is an ancient Hasidic story about a Rabbi who conversed with the Lord about heaven and hell. “I will show you hell,” the Lord said, and led the Rabbi into a room in the middle of which stood a very large round table. The people at the table were hungry to the point of despair. There was a large pot of stew in the middle of the table, enough to feed everyone. The meat smelled very delicious, and the Rabbi's mouth watered. People sitting at the table were holding spoons with very long handles. Each of them could reach the pot with a spoon and scoop up the meat, but since the handle of the spoon was longer than a human hand, no one could put this meat in their mouth. The Rabbi saw that the suffering of these people was terrible. “Now I will show you heaven,” the Lord said, and they went into the next room, exactly the same as the first. There was the same large round table with the same pot of meat. The people sitting at the table had the same long-handled spoons, but they were full and well-fed, they laughed and talked. At first, the Rabbi did not understand. "It's simple, but it requires a certain skill, - said the Lord - As you can see, they learned to feed each other."

In therapeutic groups, the same thing happens - patients receive by giving, not only in the process of direct exchange, but also from the act of "giving" itself. Psychiatric patients who are just starting a course of treatment are demoralized and deeply convinced that they have nothing of value to offer others. For a long time, they have considered themselves a burden, and when they discover that they can do something important for others, it restores and maintains their self-esteem.

Undoubtedly, patients in the process of group therapy bring each other great benefits. Often they are more willing to listen and remember something from another patient than from a group therapist. For many, the therapist remains just someone who is paid for his professional services, but other members of the group seem to be more suitable for spontaneous and sincere communication, for expressing support. When the patient looks back on the course of therapy, he always appreciates the other members of the group as those who did a lot to improve his condition - if not in the role of friends and advisers, then at least those who allowed the patient to know his inner self. the world through their relationship to themselves.

This healing factor has also been used in other psychotherapeutic systems. In primitive cultures, for example, the patient was given the task of preparing a meal or doing something else for the community. Altruism is an important part of the healing process in Catholic churches and holy places such as Lourdes, where the patient prays not only for himself but also for others. Warden Duffy is said to have stated: The best way helping a person is giving him the opportunity to help you. People need to feel needed. I have known former alcoholics who continued their contact with Alcoholics Anonymous years after their recovery; one worker reported that he told the story of his fall and subsequent rehabilitation at least a thousand times.

Patients may not immediately appreciate this source of help. Quite the opposite. Many of them resist the group's therapeutic influence by asking the question, "How can the blind lead the blind?" Or they ask: “What can I get from others who are as confused as I am? We will drown each other." Research shows that the patient in these cases is actually saying, "What do I have to offer this to anyone?" The reason for this opposition to the impact of group therapy lies in the critical self-assessment of the patient.

There is another, more subtle, benefit in the altruistic act. Many patients are mired in morbid self-blame, which takes the form of obsessive introspection or gnashing of teeth attempts to "realize" themselves. But self-realization or the meaning of life cannot be found within oneself, one's self-consciousness. I, like Frankl, believe that these qualities appear as a result of a person going beyond his limits, when we forget ourselves and give ourselves to someone or something outside of us. In therapeutic groups, this is gently taught and counter-solipsistic perspectives are opened up to its participants.

Corrective analysis of the influence of the parental family

Without exception, all patients come to group therapy with a history of highly negative experiences in their first and most important group, their family of origin. The group resembles a family in many ways, and many groups are led by a male/female duo to bring the group's configuration even closer to that of the parent family. Being dependent on their artificially created world (formed mainly in the parental family), members of the group interact with its leaders and other participants in the same way as they once interacted with parents and other relatives. There are countless variants of interaction patterns: patients can be hopelessly dependent on leaders, whom they endow with super knowledge and power; they can fight leaders at every turn, claiming that they hinder their growth or deprive them of their individuality; they may try to split the co-therapists by provoking disputes or disagreements between them; they may compete fiercely with other participants in an attempt to focus all of the therapists' attention and care on themselves. They may be looking for allies to try and "dump" therapists; they may give up their own interests, ostensibly unselfishly caring for other members of the group.

Obviously, the same principle is at work in individual therapy. The only difference is that the group provides much more opportunities for analysis. In one of my groups, there was a patient who silently pouted for two sessions, frustrated at not having received one-on-one therapy. The group was unable to meet her needs and she found it impossible for herself to talk in class, asking to be taken into account that she could only speak freely with a therapist or in private with a member of the group. Having yielded to my demands, the patient explained her anger by the fact that in a recent session another member of the group returned from the holidays and was very warmly welcomed by everyone. She also recently returned from vacation, but the group did not welcome her with the same warmth as the other member of the group.

After this incident, one patient received praise for offering an interpretation that was important to one of the group members, and the patient, about whom in question, made a similar statement a few weeks ago, and it went unnoticed. After a while, she also noticed that she was growing resentful about the distribution of time in the group: she could not patiently wait for her turn to speak and became irritated when attention shifted to others. All these experiences obviously had a long history and were rooted in her early relationships with loved ones. All these circumstances cannot be evidence against the method of group therapy, quite the contrary: the conditions of the group turned out to be especially useful for the patient, since they made it possible to make visible her envy and passionate desire to attract attention to herself. In individual therapy, these specific conflicts appear very sluggishly, if at all, because all the time of the therapist in this case belongs entirely to one and only patient.

It is important not only to analyze children's family conflicts but also correctly free the patient from their influence. Family relationships should not be allowed to become more and more restrained, otherwise they will turn into a rigid, impenetrable system, so characteristic of many families. Former stereotypes of behavior must be constantly questioned from the point of view of their correspondence to reality, they must be replaced in time with new stereotypes corresponding to reality. For many patients, working through their problems with therapists and other group members has a lot to do with past unfinished business and relationships. (To what extent work with the past should be represented in group psychotherapy is a complex and controversial issue, which we will deal with in chapter five).

Development of socializing techniques

Social learning - the development of basic communication skills - is a healing factor that operates in all therapeutic groups, although exactly what kind of communication is explicated depends on the type of therapeutic group.

In some groups, such as those preparing for discharge of those who have spent a long time in the hospital, as well as in youth groups, there may be a clear emphasis on the development of communication skills. Roles are played - how to approach a future employer about work, how to invite a girl to dance. In dynamic therapy groups, together with the basic rules of behavior, patients can receive important information about unacceptable behavior in society. For example, they may become aware of their disorienting habit of not making eye contact with the person they are talking to; or they learn about the impression that arrogance, the "royal attitude" makes on those around them, as well as many other social habits that, if not known, undermine their social relationships. For people who lack intimate relationships, the group provides the first opportunity to enter into full-fledged interpersonal communication. For example, one patient who constantly included endless, momentary, irrelevant details in his conversations, once in a therapy group, understood what was happening to him the first time. For many years, he saw only that other people either avoided him, or in every possible way reduced their contacts with him. Clearly, therapy involves much more than simply recognizing and generating changes in social behavior, but as we will show in chapter 3, they are very useful and crucial in initiating the healing phases.

It is often noted that more experienced participants in therapy groups are very good at communication skills. They are attuned (see Chapter 5) to help other people, they are proficient in conflict resolution, they are not disposed to judge, but they are much more empathetic and empathetic. These skills will be useful to them in future social interactions.

Simulation behavior

Pipe-smoking therapists often breed pipe-smoking patients. Patients during psychotherapy can sit, walk, talk, and even think in the same way as their therapists do. In a group, imitation processes are more blurred, since patients can take an example not only from the therapist, but also from other members of the group. The importance of imitative behavior in the therapeutic process cannot be overestimated, but recent social psychological research showed that we still underestimate their significance. Bandura, who had long argued that social learning could not be adequately explained in terms of direct reinforcement, demonstrated experimentally that imitation is an effective therapeutic force. For example, he successfully cured many people who were afraid of snakes simply by asking them to watch his therapist holding a snake. In group therapy, it is natural for a patient to benefit from observing the treatment of another patient with a similar set of problems, a phenomenon called "replacement" therapy, or "observation" therapy. Even if the specific imitative behavior stops shortly, it can help the person to "unfreeze" by experimenting with new behaviors. The point is that it is normal for patients to try on something from other people in therapy and then discard it as what causes the disease. This process can be highly therapeutic and facilitate the transition from understanding that we are imperfect to discovering who we really are.

Participation in the group will be especially useful for you,
if you remember these rules more often :

• Be focused ). Think about what you want from the group more often. Before each group meeting, take the time to ask yourself what you expect from this meeting.
• Be flexible (oh). Even having a clear idea of ​​​​what you expect from this meeting, be ready (a) to accept what is not included in your plans.
• Be "greedy" for work . The success of the group depends on your desire to work for their own benefit. If you constantly wait for “your turn” or try to figure out how much time in class you are entitled to, suppress your spontaneity, you will soon see with disappointment that your the time never comes.
• Remind yourself of feelings . It's important to share thoughts, but it's even more important to talk about feelings. Less often start with the words "in my opinion ...", "I think ...", and more often - "I feel."
• Express yourself more . Often we do not dare to express our thoughts and feelings because we are afraid of appearing stupid. However, we should not forget that the group is the perfect place to see what happens when you express what you feel. If you feel anything about the group or some of the members, be sure to express it. There is a big difference between thinking to yourself and speaking out loud.
• Do not wait. The longer you put off actively participating in a group, the harder it will be to get started.
• Do not be silent. The silent person(s) are much less likely to get important information about themselves from other participants, in addition, they often think that you are only observing and evaluating them. By your silence you deprive others of the opportunity to learn from you,
• Experiment . The group is a place where you can freely and safely show yourself in many ways. Having tried here, you can then transfer something to life.
• Don't expect things to change all of a sudden . Give yourself time to change yourself and your life in the right direction. Nothing happens right away.
• Avoid advice and asking questions . Your thoughts and feelings expressed to another are more valuable than any advice. It is necessary to ask in such a way that the interlocutor opens up, and does not become isolated or forced to defend himself.
• contact directly. Don't talk about others in the group in the third person. Always contact everyone directly.
• Don't rush to help . If someone is talking about their painful problems, do not rush to interrupt and console him. A person improves by experiencing pain - let him do it sometimes.
• react. If someone says something about you, react - no matter if your reaction is positive or negative. This builds trust in the group.
• Be open to the reactions of others . Accept any reactions of others to you, not just pleasant ones for you. However, do not rush too quickly to agree with everything or immediately reject everything.
• Respond to therapist(s) ). By doing this, you can better understand your reactions to authorities in general.
• Don't label yourself or others . Respond immediately if someone looks at you too one-sidedly.
• Decide for yourself how open .
• Leverage group experience . Try to apply in life what you learned and what you learned in the group.