Group Therapy for Psychoses

Ivan Urlić, Manuel Gonzalez De Chavez

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781315522593
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Group therapy for patients with psychotic experiences is one of the least known of the group therapies; it is also one of the most diverse. This collection presents a range of methods, models and settings for group therapy for psychoses, as well as exploring the context for this type of treatment.

Group Therapy for Psychoses offers an international perspective on the current range of practice in the field, in multiple care situations, contexts and institutions; from acute units to therapeutic communities, rehabilitation groups, self-help, and groups of those who hear voices. Presented in two parts, the first covers the history, evaluation and research methodologies of group therapy, while the second explores specific examples of groups and settings. The book tackles misconceptions about the treatment of psychoses and emphasises the healing effects of group therapy. It underscores the importance of training for selecting and conducting groups of patients suffering from psychoses and suggests possible formats, approaches and perspectives.

The book's wide, reflexive and practical collection of chapters together demonstrate how group therapies can effectively help patients with psychotic experiences to overcome their difficulties on their way to recovery. The book will be of great use to clinicians working with people suffering from psychosis, including psychiatrists, psychotherapists, psychoanalysts, psychologists, physicians and social workers. It will also appeal to group analysts, family therapists and CBT practitioners, as well as to all researchers in these fields.

Part I

Overview of group psychotherapies for people suffering from psychoses

Chapter 1

History of group psychotherapy for patients with psychoses

Manuel González de Chávez

Groups are potentially dangerous places and therefore unsuitable for therapeutic purposes.

(letter from Freud to Trigant Burrow: Pertegato and Pertegato, 2013: p. xxxiii)

First you will get the sociologists, then the social psychologists, then the general practitioners, then the plain people, but you will never live to see the day when psychiatrists will accept group psychotherapy.

(William Alanson White to Jacob L. Moreno: Moreno, 1989)

The beginnings of group psychotherapy were not exempt from encountering many resistances, as shown by the attitude of Freud and the observation of William Alanson White on the psychiatrists of their times. With the exception of some group and theater–therapeutic experiences in the nineteenth century in some psychiatric asylums, such as those of Glasgow (Hunter and Macalpine, 1963), Kiev or St Petersburg (Blatner, 2000), it was during the first decades of the twentieth century when social interest regarding knowledge of groups, their dynamics and possible functionality, began to develop (Strodtbeck and Hare, 1954).

The history of group psychotherapy in the psychoses is therefore connected to that of sociological and psychosocial research of the groups in addition to that of the history of group therapy in general and to the more extensive history of the psychotherapy of the psychoses. Three stages in the history of group psycho- therapy in the psychoses can be differentiated: (1) a first stage of initiation of these therapies, which would correspond to the first half of the twentieth century; (2) a second stage of expansion of the group therapies in psychoses, which took place from the 1950s to the 1990s; and (3) a third stage of consolidation of these therapies during the last 30 years.

Initiation

In the first decades of the twentieth century, the groups that were started in the hospital setting with psychotic patients were either didactic, with lectures, illustrative cases and other pedagogical procedures, or recreational and ludic, with social activities to promote interaction of the patients. The first publication on group therapy of dementia precox was by Edward W. Lazell (1921), who described the experience that occurred in one of the most advanced American hospitals of the time, Saint Elizabeth’s Hospital of Washington, directed by William Allanson White. In that hospital, individual psychotherapy of the psychoses had already begun with Edward J. Kempf, a pioneer and precursor of Harry S. Sullivan, who worked in the same centre years later. Lazell had already carried out individual didactic therapeutic interventions in the style of Kempf and made the proposal to W.A. White of organising some wards with selected patients to add the ‘group method’ to therapeutic activities, obtaining ‘rewarding results’. The groups included conferences, lectures or cases, followed by group discussion. In those times, homosexuality was in the origin of dementia precox: an aggressive homosexuality derived from the hebephrenics, and a sumissive one from the paranoids. The group method made it possible for the patients to speak about their lives and to channel their sexuality towards heterosexual objectives. Lazell was an enthusiastic sponsor during the entire first half of the twentieth century of didactic group psychotherapies tackling important problems and difficulties (Lazell, 1945).

Later, in the third decade of the twentieth century, group therapies with psycho- analytic approaches and concepts began in the US (Kaplan and Sadock, 1972), although Alfred Adler had initiated group experiences years earlier in Europe. At this time, group therapies with psychotic patients were conducted in the most advanced American centres (Abrahan and Varon, 1953; Frank, 1952; Standish, et al., 1952).

The pioneers of group therapies with schizophrenic patients faced all the uncertainties and lack of knowledge regarding these disorders, together with those of the new context of the group therapies. Many were enthusiastic young people without experience or bibliographic references, who did not fully know how to act with these patients gathered into a group. They wondered about the objectives and priorities of group therapy. Socialisation of the patients? Lifting them out of isolation? Helping them to verbalise their experiences? Regarding the size of the groups: the entire ward, or small, homogeneous, mixed, acute or chronic groups? They discussed how the institution affected the groups and the groups the insti- tution. Obviously, they also questioned their own role as therapists: teaching, mobilising or listening? Passive or directive? Allowing the patients to speak freely? Giving priority to each patient or to the global functioning of the group? They were interested in achieving an environment where the patients listened to each other. Was it necessary to speak in the group only about the ‘healthy aspects’ of each individual or also to include the psychotic experiences? Only about the ‘here and now’ or also about the ‘there and then’? They were concerned about how to handle aggressivity or passivity of the patients, hyperactivity and verboseness of some of them, and silences and autism of others. How to cope with fear, distrust, hopelessness and suicidal ideas in the group? What to do with the verbalisation of the psychotic experiences – minimise them, ignore them, listen to them, interpret them, or try to understand them?

Around the mid-twentieth century, many group initiatives with psychotic patients had been performed: didactic and psychoeducation groups, psychodramas, groups with puppet theaters, music therapy, dance therapy, groups with recreational and rehabilitation activities, psychoanalytic, interpersonal or psychosocial groups, hospital and outpatient groups, for acute or chronic patients, family groups, and homogeneous or mixed groups with neurotic patients. The first observations of group dynamics and processes had already been made with these patients, as well as short-term results and evaluations, and some of the combined therapies and comparative studies of group and individual therapies, or patients treated with or without group therapy (see Meiers, 1945; Stotsky and Zolik, 1965).

The study of the groups, from sociology or social psychology perspectives, also advanced from decision making or interpersonal influence to becoming interested in other subjects, such as structure and group environment (Lewin, 1947). Nonetheless, it is an extra issue of Sociometry (entitled ‘Group psychotherapy: A symposium’, 1945), the journal founded by J.L. Moreno, which offers us the best view of the state of the group therapies as a whole in the mid-twentieth century. This issue also includes a series of articles from American and English military psychiatrists and presents some of the keys to the subsequent expansion of group dynamics, when they were accepted and incorporated with enthusiasm by these democratic armed forces. It was the military psychiatry of these countries, before, during and after the Second World War, that gave a decisive impulse to the group practices and therapies. In England, for example, the subsequent development of the therapeutic communities, social psychiatry or group analysis could not be understood without the military hospital of Northfield, where Rickman, Foulkes, Bion, Maxwell Jones, Joshua Bierer and many others coincided in group practice (Harrison, 2000).

Expansion

Publications on group therapy in general and applied to psychotic patients specifically, multiplied exponentially beginning with the Second World War (Corsini and Putzey, 1957), and continued to do so in subsequent decades. At the end of the 1980s, there were more than five thousand articles on group psychotherapy in the psychoses published in the English language alone (Lubin and Lubin, 1987) and it must be supposed that more existed in other languages. Two journals dedicated to group therapies – International Journal of Group Psychotherapy and Group Analysis – stand out for having collected articles dedicated to group psychotherapy in the psychoses.

The second half of the twentieth century was enormously productive for group therapies in general and also for those specifically dedicated to psychotic patients. The therapeutic contexts became diversified beyond the hospital setting, with the new care organisation advocated by community psychiatry. Groups were dedicated to rehabilitation, in its diverse aspects, performed in centres and day hospitals or in therapeutic communities, and the outpatient groups in mental health centres, which now assumed a new decisive role in care.

Many group therapy practices with psychotic patients were broadly developed: psychoeducation, psychodynamic, interpersonal, supportive, insight, social skills and problem solving, and other diverse models to which cognitive behavioural group therapies were incorporated in subsequent years. The first group psychotherapy manuals – by Klapman (1946), Corsini (1957) and Johnson (1963) – were published, and some had chapters dedicated to psychoses (Johnson, 1963), which would later become more common in major group psychotherapy manuals such as Kaplan and Sadock (1971). The first books on group psychotherapy for inpatients (Yalom, 1983; Rice and Rutan, 1987) and in children with psychotic problems (Speers and Lansing, 1965) were also published. Family therapies, which were expanded in these decades, also had their group equivalent with multi-family therapies. In addition, research in group therapies for patients with diverse diagnoses and also in schizophrenia proliferated, evaluating results for inpatients or out- patients, and comparing them with other therapeutic alternatives or in therapies combined with other psychosocial interventions (Parloff and Dies, 1977; González de Chávez, 2009).

All the individual, family group and institutional therapies with psychotic patients expanded in the second half of the twentieth century, and with them the interest for training of professionals and the indications of said therapies, in addition to their interactions, comparative studies, therapeutic procedures and the development of care programmes (see Alanen, Silver and González de Chávez, 2006).

Consolidation

The third and last stage of the history of group therapies in the psychoses began in the last decades of the last century and has continued up to the present. It began with the publication of the first books entirely dedicated to group psychotherapy in psychotic patients (Ascher-Svanun and Krause, 1991; Kanas, 1996; Schermer and Pines, 1999; Stone, 1996). This is a stage of maturity, consolidation, adaptation, integration and re-evaluation of these therapies. The need to integrate perspectives and models is suggested at this time, as simultaneously occurs in psychotherapies in general. Processes of adaptation take place: of adapting to the organisation of the public services and to the funding forms of the care; to new therapeutic contexts with psychotic patients, such as therapeutic communities; and to new strategies such as early intervention, and the concepts of empowerment and recovery for persons who have gone through psychotic experiences that make group dynamics the guiding force that carries them to their objectives. These final group experiences (self-help group, peer-support group, recovery group, etc.) are enriching group therapies with psychotic patients, especially those of persons who hear voices, and these networks are already extended in all the countries of the world.

The current stage of development of group therapies in general and in group therapy of psychoses specifically is also characterised by a special emphasis on: the evaluation of these therapies; the choice of the quality indicators; the methodology of the publications or trials, their statistical processing, sample sizes and control groups; and on all the investigation that refers to their efficacy, indications, processes or mechanisms of change and specific therapeutic factors. They are keys in the future development, implementation and differentiation of these therapies (Furhiman and Burlingame, 1994; Burlingame, Kircher and Taylor, 1994; Manor, 2009; Tost, Hernandez and González de Chávez, 2012).

What have we learned in one century of group psychotherapy of the psychoses?

The group psychotherapy of the psychoses has a century of history. It is practised worldwide, in institutions and organisations of all types, in many care programmes, with many modalities and approaches, and in a very heterogeneous wide range of persons with psychotic experiences, biographic evolutions and distinct characteristics. There are already tens of thousands of articles in scientific journals, and monographic books on this therapeutic practice continue to be published periodically (Radcliffe, et al., 2010; Lecomte, Leclerc and Wilkes, 2016). However, we must not get lost in the boundless forest of many local circumstances and characteristics of organisations, settings, formats, techniques, therapeutic training or styles. Rather, we should remember what this century of history of group psychotherapy in the psychoses has taught us. We could sum it up as follows:

• It is useful to perform group psychotherapies on patients with psychotic experiences wor...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Notes on contributors
• Foreword by Brian Martindale
• Foreword by Brian Koehler
• Preface
• Acknowledgements
• Part I Overview of group psychotherapies for people suffering from psychoses
• Part II Groups for psychoses: Different approaches and different settings
• Epilogue: The future of group psychotherapy for psychoses
• Name index
• Subject index