[ Pobierz całość w formacie PDF ]
.There has been a heavy emphasis on writtenmaterials that is not found in individual IPT, with patients provided not only with asummary of their interpersonal goals, but also with a four-page summary of the interac-tions and personal implications of each session before the next session starts.CAT has been adapted to group formats by Maple and Simpson (1995).The methodsdescribed in Chapter 6 for individual treatments were modified in ways which, in theretention of some individual sessions, resemble the IPT approach.Group CAT beganwith reformulation over four preparatory individual sessions, prior to patients joining agroup for the subsequent treatment phase.The group then lasts for 12 sessions, every-body starting and finishing together.The therapists have prior knowledge of every-body s formulation (ideally, having been the therapists who agreed these with eachfuture group member).All formulations then become group property, shared betweenthe members.Members collaborate on helping each other recognize and revise theirprocedures within their formulations. GROUPS AND INTEGRATION IN PSYCHOTHERAPY | 79In both IPT-G and group CAT, therefore, an agenda worked out individually withthe therapist is worked through in the group situation.This parallels techniques foundin the earliest days of psychoanalytic group psychotherapy a phase in which itremained psychoanalysis in a group, rather than group analysis proper.This couldsuggest both IPT-G and group CAT have some way to travel before becoming truegroup therapies.Maple and Simpson do describe a further step on that path, in theshape of group reformulation of dynamic patterns which impede the work of thegroup as a whole.However, the use by integrative therapists of focused preparatorysessions is consistent with one of the more robust findings in the group-outcomeresearch literature: the association of positive outcome with some prior experience ofindividual therapy (Malan 1976).Groups with integrative aimsThe question of whether some forms of practice are more integrative than others in theiraims is a delicate one.Hinshelwood (1988) has upheld a principle of integration as theethic of all psychotherapeutic activity.His philosophically informed discussions alsoillustrate the difficulties of suggesting that some practices might be more likely to realizethis aim than others.If one is agnostic on the question of success, and simply askswhether some approaches are more consciously concerned with integration as a goal, aparadox emerges having integrative aims is not invariably associated with integrativemethods.For instance, despite the emphasis on systemic thinking as a formal model oftherapy (i.e.one that can be set alongside psychoanalytic and cognitive behavioural par-adigms), systemic practice in groups is potentially more integrative than workinformed by other models.The reason is not that systemic therapists are often adept atmaking implicit use of analytic and cognitive understandings in what they do.It isbecause integration is a more explicit objective of the therapeutic work in a systemicgroup.Convergence between positive changes in the process of the group and in mem-bers own adjustment has been recognized by non-systemic therapists as a marker ofsuccess.Malcolm Pines (1998) account of coherence in groups is a masterly example ofthis in an analytic context.In the systemic group, personal integration is achieved nei-ther through retrospective analysis nor cognitive restructuring.It follows total individualparticipation in a process in which conflicts are identified using oppositions between sub-groups within the group.These are first highlighted, populated, and articulated beforeresolution is invited through a cathartic understanding of the partiality of both sub-groups perspectives.Intragroup and intrapsychic boundaries are simultaneouslyredrafted and realigned.A new equilibrium is achieved, until the flow of tensions in thegroup, inevitably, draws attention to subgrouping elsewhere.In all this, the conductor isa ringmaster rather than a co-ordinator of ceremonies, staging a series of set pieces in away that can nevertheless feel surprisingly natural. 80 | CHRIS MACEThe fluidity of systemic work of this type can make it seem elusive.Its principles havebeen set out by Agazarian (1998).They might be best illustrated from familiar ground.An impasse was reached in Dick s group at point [A] (cf.page 00).To see how this mightbe addressed by a systemic group therapist, assume that the members of the group havesome working familiarity with systemic ideas, and the group is now led by a systemictherapist, Diane.Diane turns to Kevin, and suggests he feels intensely uncomfortable about being inthe group.She asks if he has a strong urge to do anything.He says he does.He wantsto leave the room.She turns to the other members, asking if anybody else is feelingthis urge and inviting them to join Kevin s subsystem.Both Otto and Mary, sitting oneither side of Kevin, say they are.Diane invites them each to describe their urge toleave.Otto says he s afraid of hitting someone.Mary says she feels everybody is aboutto turn on her and that she d better leave to prevent this.Diane asks if anybody elsewould like to join this leaving subsystem.When no one volunteers, she identifieseverybody else as members of the staying subsystem, and asks what they are feeling.When Larry says he doesn t see why members of Kevin s subsystem should feel theyhave to go, Diane remarks that what he has said is not a feeling.Larry obliges by say-ing he wants everyone to calm down.When he is challenged again, he admits he isfeeling frightened and actually he did want them to go but was afraid of saying so.Norman admits he felt the same and is ashamed now.From the leavers subsystem,Mary says that she is now feeling less like leaving.Diane suggests Mary checks outwith Kevin how he is feeling now [ Pobierz całość w formacie PDF ]
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.There has been a heavy emphasis on writtenmaterials that is not found in individual IPT, with patients provided not only with asummary of their interpersonal goals, but also with a four-page summary of the interac-tions and personal implications of each session before the next session starts.CAT has been adapted to group formats by Maple and Simpson (1995).The methodsdescribed in Chapter 6 for individual treatments were modified in ways which, in theretention of some individual sessions, resemble the IPT approach.Group CAT beganwith reformulation over four preparatory individual sessions, prior to patients joining agroup for the subsequent treatment phase.The group then lasts for 12 sessions, every-body starting and finishing together.The therapists have prior knowledge of every-body s formulation (ideally, having been the therapists who agreed these with eachfuture group member).All formulations then become group property, shared betweenthe members.Members collaborate on helping each other recognize and revise theirprocedures within their formulations. GROUPS AND INTEGRATION IN PSYCHOTHERAPY | 79In both IPT-G and group CAT, therefore, an agenda worked out individually withthe therapist is worked through in the group situation.This parallels techniques foundin the earliest days of psychoanalytic group psychotherapy a phase in which itremained psychoanalysis in a group, rather than group analysis proper.This couldsuggest both IPT-G and group CAT have some way to travel before becoming truegroup therapies.Maple and Simpson do describe a further step on that path, in theshape of group reformulation of dynamic patterns which impede the work of thegroup as a whole.However, the use by integrative therapists of focused preparatorysessions is consistent with one of the more robust findings in the group-outcomeresearch literature: the association of positive outcome with some prior experience ofindividual therapy (Malan 1976).Groups with integrative aimsThe question of whether some forms of practice are more integrative than others in theiraims is a delicate one.Hinshelwood (1988) has upheld a principle of integration as theethic of all psychotherapeutic activity.His philosophically informed discussions alsoillustrate the difficulties of suggesting that some practices might be more likely to realizethis aim than others.If one is agnostic on the question of success, and simply askswhether some approaches are more consciously concerned with integration as a goal, aparadox emerges having integrative aims is not invariably associated with integrativemethods.For instance, despite the emphasis on systemic thinking as a formal model oftherapy (i.e.one that can be set alongside psychoanalytic and cognitive behavioural par-adigms), systemic practice in groups is potentially more integrative than workinformed by other models.The reason is not that systemic therapists are often adept atmaking implicit use of analytic and cognitive understandings in what they do.It isbecause integration is a more explicit objective of the therapeutic work in a systemicgroup.Convergence between positive changes in the process of the group and in mem-bers own adjustment has been recognized by non-systemic therapists as a marker ofsuccess.Malcolm Pines (1998) account of coherence in groups is a masterly example ofthis in an analytic context.In the systemic group, personal integration is achieved nei-ther through retrospective analysis nor cognitive restructuring.It follows total individualparticipation in a process in which conflicts are identified using oppositions between sub-groups within the group.These are first highlighted, populated, and articulated beforeresolution is invited through a cathartic understanding of the partiality of both sub-groups perspectives.Intragroup and intrapsychic boundaries are simultaneouslyredrafted and realigned.A new equilibrium is achieved, until the flow of tensions in thegroup, inevitably, draws attention to subgrouping elsewhere.In all this, the conductor isa ringmaster rather than a co-ordinator of ceremonies, staging a series of set pieces in away that can nevertheless feel surprisingly natural. 80 | CHRIS MACEThe fluidity of systemic work of this type can make it seem elusive.Its principles havebeen set out by Agazarian (1998).They might be best illustrated from familiar ground.An impasse was reached in Dick s group at point [A] (cf.page 00).To see how this mightbe addressed by a systemic group therapist, assume that the members of the group havesome working familiarity with systemic ideas, and the group is now led by a systemictherapist, Diane.Diane turns to Kevin, and suggests he feels intensely uncomfortable about being inthe group.She asks if he has a strong urge to do anything.He says he does.He wantsto leave the room.She turns to the other members, asking if anybody else is feelingthis urge and inviting them to join Kevin s subsystem.Both Otto and Mary, sitting oneither side of Kevin, say they are.Diane invites them each to describe their urge toleave.Otto says he s afraid of hitting someone.Mary says she feels everybody is aboutto turn on her and that she d better leave to prevent this.Diane asks if anybody elsewould like to join this leaving subsystem.When no one volunteers, she identifieseverybody else as members of the staying subsystem, and asks what they are feeling.When Larry says he doesn t see why members of Kevin s subsystem should feel theyhave to go, Diane remarks that what he has said is not a feeling.Larry obliges by say-ing he wants everyone to calm down.When he is challenged again, he admits he isfeeling frightened and actually he did want them to go but was afraid of saying so.Norman admits he felt the same and is ashamed now.From the leavers subsystem,Mary says that she is now feeling less like leaving.Diane suggests Mary checks outwith Kevin how he is feeling now [ Pobierz całość w formacie PDF ]