Psychotherapy with schizophrenics in team groups: a systems model

Article Abstract:

Inpatient psychiatry usually includes some form of group treatment. When the unit is an acute one, or designed for short stay, there are often a variety of levels of illness and functioning to be found among patients, making the implementation of group therapy difficult. Controversy exists as to whether patients with similar diagnoses or levels of functioning should be grouped together (homogeneous groups) or whether all patients on the unit should be in the same group (heterogeneous groups). One suggestion is that patients be offered a two-tiered group approach, consisting of a heterogeneous group followed by a homogeneous one. The workings of the heterogeneous group, or the 'Team group', is discussed. One of the biggest concerns with Team groups is that lower functioning patients, such as schizophrenics, will not be able to tolerate the anxiety raised by such a group. Group theory holds that schizophrenics, because of their lower level of defensiveness, are more attuned to the emotional state of the group. If group members feel anxious, but do not show it, the schizophrenic, who is usually more fragile, will reveal the anxiety for the group. It follows that they will also be more likely to display effects of tensions and anxiety that the group manifests than nonschizophrenic peers. Using a schizophrenic's keen sense of the emotional state of the group as an insight into the therapeutic process of the group can give the therapist needed information. Acknowledgement of the value of this information can give the schizophrenic a sense of usefulness and acceptance by others, perhaps for the first time. To maximize the potential benefits to the schizophrenic, the therapist must use an appropriate technique and style; must have an understanding of the schizophrenic psychopathology; and must understand group dynamics. These areas are discussed in detail. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Schizophrenics, Group psychotherapy, Group counseling

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Treating the iatrogenically infantilized patient

Article Abstract:

There are relatively healthy patients who continuously seek psychotherapy. They tend to use therapy as a means to avoid other commitments, so that treatment rarely leads to sustained improvement. These patients present their emotional life and functional ability in a very negative manner and insist that they would fall apart without help. If their wish for continuous therapy is granted, the result is an iatrogenically (treatment-induced) infantilized patient. The case study is presented of a 24-year-old college student who was assessed as an iatrogenically infantilized patient when he applied for psychotherapy at a school counseling facility. During his initial appointment, he outlined his life in detail and effectively communicated that he was a mental mess requiring long-term treatment. He had been receiving psychological treatment since age 13. Although he focused on his problems and shortcomings, he was doing well academically despite the fact that he found it difficult to concentrate. The school therapist enlisted the aid of a co-therapist. Together they told the student that they usually worked with patients who could benefit from short-term therapy. He was asked to think about whether he was sufficiently motivated to benefit from this type of therapy. The co-therapists then worked out a treatment regimen in which the focus would be on behavior in the here-and-now; obtaining overall insight or insight about the past was not a primary goal. The aim of therapy would be to discourage dependency and regression while increasing confidence and developing a good self-image and independence. The treatment ended successfully, confirming the argument that when working with dependent infantilized patients, traditional therapeutic processes foster regression and intense attachment, which prevents the patients from developing mastery over their lives. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Case studies, Psychotherapy, Iatrogenic diseases

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The question of medical psychotherapy

Article Abstract:

In the early days of psychoanalysis, psychotherapeutic practice conducted by anyone other than a fully trained physician was punishable by law. Only in 1926, with Freud's 'The Question of Lay Analysis,' did Freud posit that neurotics, for whose illness medical science could find no organic cause, were not like other 'patients.' In the same sense, analysts, who underwent a different sort of training, were not exactly like other doctors. In fact, medical training generally omits instruction in the areas required to carry out successful analysis. More than 60 years later, the question of who is best equipped to treat the neurotic patient remains unresolved. Modern psychiatry has at times embraced Freud's theories, and at others claimed that the layperson is unqualified to treat mental patients. An opposing view claims that, as scientists, physicians are by their very approach to the problem, incapable of treating these patients. Thus, it must be recognized that as psychiatric patients are indeed different from others, it follows that the physicians who treat them must also undergo a different sort of training. In defining the nature of the problem, the author points to the difficulties of theorization and the stigma that still attaches to both psychiatric patients and therapists who treat them. (Consumer Summary produced by Reliance Medical Information, Inc.)

Training, Study and teaching, Psychoanalysts, Psychiatrists, Psychiatry

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