Group Psychotherapy: Group Dynamics / 신경정신의학

This article on 'group dynamics' is the last part following the 'history and prospect' and the 'theory and practice', series composed of three parts to understand the group psychotherapy. To explain the core theme concerning the group dynamics, we compared the therapeutic group in clinical scope with the work group in social scope for convenience. And this article principally was for the therapeutic group. We can discover many similarities between groups and organizations when we observe the details although they appear quite different with different goals. Therefore, if the leader of a group in the clinical and social setup has a full knowledge in group dynamics, he would be effective in functional roles with increased sensitivity and understanding of group process. This article was written in order of the history of group dynamics, the theory of group dynamics, group development, and leadership. The group psychotherapy derives from individual psychotherapy. To lead group psychotherapy successfully, Therapists have to be knowledgeable not only of the concept of psychotherapy but also the concept of group dynamics.

Effects in Combining Pharmacotherapy and Group Psychotherapy for Outpatients with Schizophrenia / 신경정신의학

OBJECTIVES: The objective of this study is to prove that combining pharmacotherapy and group psychotherapy is more effective way to prevent recurrence and rehospitalization, to promote their interpersonal relations and to improve their satisfaction on treatment by making a comparison with pharmacotherapy and individual psychotherapy (supportive therapy). METHODS: This study was performed from September 2000 to October 2001. The subjects were all schizophrenic outpatients who were treated by authors in the specialized mental hospital, the psychiatric department of a general hospital, and psychiatric clinics. The experimental groups and the control groups were composed in matching, sex, diagnosis, duration of illness, number of admission and function level. During this period, the experimental groups had been treated by pharmacotherapy and group psychotherapy, and the control groups by pharmacotherapy and individual supportive therapy. Numbers of admission (ratio of readmission) and changes of drug doses were traced, at the same time' group psychotherapy effectiveness scales' were applied. Just after each session, Yalom's 13 therapeutic factors scale was administered. RESULTS: During study periods, 3 cases (17%) among total 18 cases of the experimental groups were re-admitted and 6 cases (33%) among total 18 cases of the control group were re-admitted. During study periods, the doses of chlorpromazine in the experimental groups were decreased from 267 mg at start to 185 mg at closure and the doses of chlorpromazine in the control groups were increased from 264 mg at start to 265 mg at closure. The mean scores of insight, satisfaction on treatment, and satisfaction toward therapist were statistically high in the experimental groups in comparison with the control groups (<0.05). CONCLUSION: 'Combining pharmacotherapy and group psychotherapy' to outpatients with schizophrenia is very effective and expedient for therapists. We expect that this combined treatment model would be practiced more broadly as an economic treatment method which could minimize problems caused by practicing pharmacotherapy only and to give patients full service, though there are accompanied problems including the difficulties of structuring, the eack of motivation of patients, and the financial burden.

Effects of Interpersonal Group Therapy for Adolescents with Behavioral Problems / 신경정신의학

OBJECTIVES: Fast change and confusion of the value system in society affect the identity formation of adolescents. So Adolescents' behavioral problems seem to be increasing yearly. It is known that the interpersonal group therapy is the most effective treatment modality among many group programs for adolescents with behavioral problems. Objectives of this study are as follows; first, evaluate therapeutic effects of the interpersonal group therapy for adolescents with behavioral problems second, examine the therapeutic factors; third, analyze the group process; fourth, orgamize the group therapy for adolescents with behavioral problems as an applicable treatment modality. The types of group therapy performed in this study are small, closed, homogeneous, outpatient, time limited, and adolescent group. METHODS: This study was carried out at one of the adolescents mental health services in Uiwang Mental Health Center, from April to June and from September to November in 2000. The subjects were 2nd grade students in K middle school with behavioral proplems. The experimental groups were composed of 4 groups including 2 male groups and 2 female groups (male 11, female 17), and the control groups matched the same conditions as the experimental groups (male 10, female 19). The group therapy was performed weekly in CA (club activity) time, and it took 60-70 minutes at one time. They met total 10 sessions including preparatory meeting and termination meeting. Before and after this program, self-rating scales (behavioral problems, aggression, and impulsivity) were applied for subjects, and the teacher rating scales (behavioral problems, aggression and impulsivity) were performed by teachers in charge. After each session, Yalom's 13 therapeutic factors scale was performed. At the last meeting, total assessment questionnaire was completed. RESULTS: The mean scores of all self-rating scales (behavioral problem, aggression, and impulsivity) were lower in the experimental groups (both male and female group) than the control groups, but not significant statistically except the behavioral problem scale of female students. The mean scores of all teacher rating scales (behavioral problem, aggression, and impulsivity) were lower in the experimental groups (both male and female group) in comparison with the control groups, all significant statistically. As faras the therapeutic factors are concerned; first, the mean scores of all therapeutic factors in female students were higher than in male students and the mean scores of all therapeutic factors in the later half sessions were higher than the former half sessions; second, catharsis and existential factor were high in all students and sessions; third, identification with therapist factor was high in all students and sessions; fourth, during the later half sessions, interpersonal input was relatively high in male students and socializing technique was relatively high in female students. Its for the total assessment questionnaires; 100% of male students and 88.2% of female students reported that they were helped by this group therapy; 100% of male students and 82.4% of female students reported that they would participate willingly if future opportunity of the same group therapy is given for them. CONCLUSION: Adolescents with behavioral problems who participated in this study showed the decrease of behavioral problems and the change of aggressive and impulsive attitudes in comparison with the control groups although they had some differences between male and female students. The group therapy with adolescents would be practiced more broadly and extensively though there are several accompanied problems including the difficulty of structuring, the deficit of motivation, and financial problem.

Group Psychotherapy: Theory and Practice / 신경정신의학

The aim of this article is to understand group psychotherapy. In group psychotherapy, psychoanalytic theory and cognitive-behavioral theory have been accepted as perennial effective therapeutic modalities. But nowadays, all theories give the group psychotherapy vitality and liveness as a therapeutic modality in practical setting. The orders of the group psychotherapy that current therapists prefer according to their theoretical background are as follows: psychodynamic/psychoanalytic, group as a whole/systems, transactional analysis/gestalt/redecision, interpersonal/interactional, cognitive/behavioral, object relations, group analysis, psychodrama, existential/humanistic, and self psychology. The practice of group psychotherapy includes four therapy group, encounter group, training group, and education group or self-help group. Therapy group has the goal of symptom relief and personality reconstruction for patients. Encounter group has the goal of self growth and self realization for non-patients. Training group has the goal of training in human relationship and self maturation for mental health personnels. Self help group has the goal of education and support for patient families and patients. Group psychotherapy has been accepted as a therapeutic modality that are equally effective as individual psychotherapy although group psychotherapy has been derived from individual psychotherapy. Recently, individual psychotherapy has been less practiced yearly because of the pressure of economic difficulties of medical insurance in developed countries. Therefore, the importance of group psychotherapy with its therapeutic effectiveness and cost-efficiency is uprising.

Time-Limited Group Psychotherapy with Outpatients / 신경정신의학

OBJECTIVES: Recently, the outpatient group psychotherapy has been changed from traditional long-term therapy to short-term or time-limited therapy. The termination time and session numbers are given from start line in the time-limited therapy while 10 to 40 sessions are needed in the short-term therapy. And therapist and patients come to an agreement of the accomplishable therapeutic goal and work together actively. The time-limited group psychotherapy is being accepted newly as an efficient therapeutic modality because effective therapeutic outcomes within given time have been reported. The objectives of this study are as follows; firstly, we examine the therapeutic outcomes and the therapeutic factors after performing the time-limited group psychotherapy for outpatients in the psychiatric clinic; secondly, we analyze the characteristics showed in the process of study; lastly, we verify the feasibility and the validity of this group psychotherapy and then establish the basis of the effective outpatient therapy that would be settled down as an applicable treatment modality economically and efficiently in the current medical environment of Korea. METHODS: This study was performed weekly in total 12 sessions from July 1999, April 2000 to and each session took 70-80 minutes. The experimental group were composed of the highly-functioning psychotic patients among outpatients in the psychiatric clinic. The control group were composed of the similar patients through one-to-one matching of age, sex, diagnosis, and duration of illness. The participants were 8 patients each. BDI(Beck Depression Inventory), STAI(Spielbergs State-Trait Anxiety Inventory), MMPI(Minnesota Multiphasic Personality Inventory), and EDMT(Ewha Defence Mechanism Test) as the evaluation scales were performed before and after treatment. And 13-therapeutic factors scale was performed just after each session and the self-report total assessment questionnaire was performed only in experimental group at the end of this study. RESULTS: The mean score of BDI was decreased significantly in experimental group in comparison with control group. The mean score of STAI-S was not changed significantly in both group, and the mean score of STAI-T was decreased in experimental group in comparison with control group. The mean score of MMPI was decreased significantly in experimental group in comparison with control group, but the comparison of difference scores(post-treatment score - pre-treatment score) between the experimental and control group was not decreased significantly. This result may come from psychopharmacotherapy and individual supportive psychotherapy given equally to both group. The mean scores of immature defence and neurotic defence in EDMT were decreased significantly in experimental group compared with control group. Comparing the therapeutic factors to divide into the first, middle, and the last stage, existential factor was ranked first, and catharsis, identification with therapist, universality, and group cohesiveness were ranked high in all stages. Interpersonal learning was ranked first in the last stage although being ranked low in the first and middle stage. The total assessment questionnaires about group psychotherapy were reported that 100% of participants were helped, 75% of participants were changed in their lives, and 75% of participants had minds to join this kind of program again if given for them. CONCLUSIONS: This result shows that not only symptom relief but also personality change was achieved when the time-limited group psychotherapy was practiced in addition to simple psychophamarcotherapy and individual supportive psychotherapy for outpatients. The degree of satisfaction for group psychotherapy of participants were evaluated highly. Group psychotherapy has been accepted in public as a therapeutic modality that must be as equally effective as psychotherapy although group psychotherapy derives from individual psychotherapy. In our current medical environment that has been changed suddenly by the separation of medical practice and pharmaceutical dispensing and the decrease of medical fee, group psychotherapy or time-limited therapy would be settled down as low-expense and high-efficiency therapeutic modalities that were as equally effective as individual psychotherapy or long-term therapy.

Group Psychotherapy with Adolescents / 신경정신의학

OBJECTIVES: Group psychotherapy is more economic than individual psychotherapy and effective to adolescents especially. Group psychotherapy with adolescents will be used widely when adolescents problems are becoming more important so that government focuses on them. This article aims for the readers to understand group psychotherapy easily. METHODS: This article is based on reviewing lots of articles related to adolescent group psychotherapy published at home and abroad and our researches and practical experiences in regard with inpatient and outpatient group with adolescents for a long time. This article is described in order of history, theory, model, development stage, and therapeutic factor. RESULTS: Theories of group psychotherapy have been affected by about 200 psychotherapy theories. Among a lot of theories, psychoanalytic theory and cognitive-behavioral theory have been accepted as a perennial effective therapeutic modality. In Korea, structuralized cognitive-behavioral group therapy is currently pervaded in Youth Counselling Center or General Social Welfare Center. But because that is generally consist of skill training and problem solving centered approach, it is difficult to achieve therapeutic goal of ultimate behavioral change in basis of genetic insight. On the contrary, it is known that psychoanalytic group therapy has more benefit to raise adolescent universal value, group norms, group rules, confidentiality, and community consciousness for adolescents. and that group therapy provides adolescents with more secure and caring conditions. Here and now, adolescent group therapists apply wide theories and various techniques with flexible attitudes to go together with unapproachable adolescents. Models of group psychotherapy have various mode related to age, disorders, functional level, developmental level, clinical environment, structural modalities, and intervention goal. Developmental stages of the group psychotherapy consist of formal stage, conflictual stage, normal stage, and performing stage. And then those are divided with the first stage, middle stage, and the last stage in an adolescent group. Therapeutic factors of an adolescent group are as follows. Interpersonal learning, catharsis, existential factor, and group cohesiveness are highly evaluated in an encounter group and a long-term group for personality change. And catharsis, universality, identification, and group cohesiveness are highly evaluated in a short-term group. To handle the adolescent group, therapist capability is very critical. Special knowledge, technique, and endurance are needed for the group therapist to lead an adolescent group. Even though some therapist lead the adult group for a long time, they have to get special training and supervision to lead the adolescent group. CONCLUSIONS: Group psychotherapy has been formally accepted as one of therapeutic modalities that must be as equally effective as individual psychotherapy even if it derives from individual psychotherapy. Adolescent group psychotherapy is currently accepted as one of the most important therapeutic modalities although it is not highlighted as same as adult group psychotherapy. Group therapy is the most desirable therapeutic method for adolescents because they go through a transitional critical time for change and they are especially affected by peer group.

Training Group with Mental Health Professionals / 신경정신의학

OBJECTIVES: Training group with mental health professionals includes didactic process, experience as a member(patient) and a leader(therapist). It is divided into four parts as like 1) lecture, case conference, book reading and seminar about theory and practice, 2) observation, 3) training group(including workshop), and 4) supervision. Among them, the training group and the supervision have been accepted as the most effective methods. Authors have developed and practiced the training group model for mental health professionals including psychiatric residents which aim for the activation of group psychotherapy in mental health area, psychiatrists' initiative in group psychotherapy area, and the training and nurturing of qualified mental health professionals. The objectives of this study are as follows;firstly, we examine the change of defense mechanism and ego function after performing group psychotherapy for mental health professionals;secondly, we analyze the therapeutic factors reported that participants were helped;thirdly, we analyze main features which include group content and process manifested in training group:lastly, we have objectives that the training group is settled down as an effective educational method to foster the personal growth and qualification as a specialist, and also that this study provides a basic research data to set up the training program and the requirements for group psychotherapy. METHODS: This study was performed 5 times from 1997 to 2000. The participants were composed of 37 mental health professionals including psychiatric residents. Among them, 29 participants(male 2, female 27) were chosen as the final subjects except 9 participants dropped out in the process of this study. At first, we take an application of pre-treatment/post-treatment experimental design to evaluate the personality change after performing the training group. EDMT(Ewha Defence Mechanism Test) and EC(Egogram Checklist), the objective questionnaires, were used as the evaluation scale. And 13-therapeutic factor scale and simple subjective questionnaires were performed just after each session and the self-report total assessment questionnaires were performed at the end of this study. RESULTS: To compare mean scores between pre-treatment and post-treatment in EDMT, the mature defense was increased significantly, the immature defense was decreased significantly, and the narcissistic defense and neurotic defense were not changed significantly. To compare mean scores between pre-treatment and post-treatment in EC, Nurturing Parent(NP), Adult(A) and Free Child(FC) were increased significantly. Therapeutic factors ranked highly were interpersonal learning, existential factor, Identification with therapist, catharsis, and socializing technique in order. The total assessment questionnaires reported that the 100% of participants were helped, the 48.3% of participants were changed in their lives, the 89.7% of participants would propose training group to others positively, and the 58.6% of participants had minds to join this kind of program if given again for them. CONCLUSIONS: This result showed that the defense mechanism and ego function of participants were changed. The training group experience makes participants reflect themselves, examine their conflicts and understand others. That also gives them chances of improving insight about group phenomena and understanding about therapeutic factors essential to the mental health professionals, having confidence on the group therapy by learning leadership and techniques, and improving understanding about the psychotherapy on the whole. Therefore, it is needed in the future that the training group would be widely adapted as an educational tool of psychotherapy and group psychotherapy for the mental health professionals as well as psychiatric residents in mental health area.

History and Prospect of Group Psychotherapy / 신경정신의학

Recently, the Korean psychiatrists has faced to the difficult situation because of the separation of medical practice and pharmaceutical dispensing and the revision of mental health law. In this situation, this article was written for the desirable development and application of group psychotherapy in Korea in the basis of the history of foreign group psychotherapy. Introduction is composed of definition of group psychotherapy, reasons why the group psychotherapy is not applied so actively in psychiatric area, the present of group psychotherapy, therapeutic effect, and therapeutic outcome. Main subjects are the history of foreign group psychotherapy, the prospect of group psychotherapy, and Korean group psychotherapy. Group psychotherapy has been formally accepted as one of therapeutic modalities that must be as equally effective as individual psychotherapy even if group psychotherapy derives from individual psychotherapy. Those days, in psychiatric clinic in Korea psychophamacotherapy and brief symptom oriented therapy have been applied mainly due to the economic principle of medical environment and insurance policy. And psychiatrists apply psychotherapeutic modalities in there less and less. The importance of group psychotherapy should be emphasized one of holistic and humanistic therapy which provides the field of encounter for therapists and patients. As Community Mental Health Service in Korea are expanding and the separation of medical practice and pharmaceutical dispensing is being performed. The group psychotherapy and psychodrama should be perceived as a much more effective and efficient therapeutic modality in the settings of inpatient and outpatient clinics.

A Survey of Adolescent Substance Uses in a Small City / 신경정신의학

OBJECTIVES: The purpose of this research is to help solve adolescent issues involving substance uses, which may become begin to undergo many changes(i. e. practising various roles, thereby leading to independent life styles). More often than not, adolescent drug problems develop into social problems, chiefly behavioral imitations and heavy dependence on medicine. The authors conducted a survey of adolescent substance uses to develop preventive measures against the drug habit prevalent among young people, thereby formulating a policy to deal with problematic community. Funded by a Youth Counselling Center in the city of H. the research was conducted on the following assumptions that there will be:Firstly, a comparison of drug uses by sex and age:Secondly, variance of substance users by family background and peer group:Thirdly, a combination of heavy drinking, smoking and delinquency resulting in the drug habit. METHODS: The survey included a total of 1613 students during 3 days, 12 through 14, July, 1999. The subjects were 833 pupils(51.6%) from 4 middle schools and 780 students(48.4%) from 3 high schools in the city of H with a ratio of 49.5 %(males) and 50.5%(females). RESULTS: 1) Experience of substance use is most referable to drinking(59.4%) and smoking(34.4%) while given to analgesics(33.1%) among medicines, glue(0.7%) among inhalants and philophone(0.4%) among narcotics. 2) High school students found more than double the amount of smoking and drinking as well as uses of hypnotics, stimulants and sedatives by junior high school students. 3) Our resalt showed was significantly noted that non-users had a better relationship with their parents than most users. 4) Smoking and drinking problean could be more easily developing into adolescent substance uses. 5) Alcohol, cigarette, and drug users showed more misconducts than other adolescents. 6) Most adolescents believe that drinking is necessary for making friends(55.0%), while smoking is just for killing time(50.9%). 7) Drinking, smoking, and other substance users were found to develop into more problematic habits. CONCLUSION: The present survey and several others show that adolescent substance uses in Korea are on the rise. Therefore, extensive counter-measures will be necessary followed by nationwide epidemiological survey of the pending issue, with the psychiatrists participating in the campaign.

Therapeutic Factors in Large Group Psychodrama with Delinquent Adolescents / 신경정신의학

OBJECTIVES: This study is designed to develop a large group phychodrama for light delin-quent adolescents (hereinafter called as "Psychodrama") thereby determining therapeutic factors for dealing with them. METHODS: The study was conducted in the program of Seoul Metropolitan Youth Centre called "the class of love" during the period of July through December, 1998. The subjects consisted of a total of 827 young delinquents (759 boys and 68 girls, with the average age of 15.9 years old). To develop "this psychodrama", after we composed of therapeutic team centered by psychiatrists, we prepared from January to June, 1998 by practicing psychodrama with delinquent adolescents and by analyzing the results. "This psychodrama" has three basic steps: (1) warming-up (small group me-eting), (2) action (situation drama and main drama), (3) sharing. A survey of treatments, from a pool of participating adolescents, based on evaluation sheets and 13 therapeutic factors scale followed every session of this psychodrama. RESULTS: "This psychodrama" was helpful for 47.4%, interesting for 49.2%, not helpful for 12.1% and not interesting for 16%. In the whole group of subjects, the important therapeutic factors were existential factor, universality, identification with the therapist and the instillation of hope in the order of rank. When categorized in four different groups (audience, participants in situation drama, auxiliary egos, participants in sharing) the 4 groups displayed different results to one another. First, the therapeutic factors of audience were similar to that of the whole group. Second, participants in situation drama showed a higher catharsis than others. Third, auxiliary egos were leading in the guidance of members and therapists. Fourth, participants in sharing displayed higher group cohesiveness. CONCLUSION: As it is getting harder to find program's suitable for the treatment of increasing number of delinquents due to limited budget and experts, this psychodrama could be more cost-effective than any other measures.

Therapeutic Factors in the Long-Term Outpatient Group Psychotherapy with the Chronically Mentally Ill / 신경정신의학

OBJECTIVES: The long-term outpatient group psychotherapy with the chronically ill is an effective, expedient therapeutic modality that makes patients maintain medication and improve their symptoms, helps patients resolve emotional conflict, and corrects their maladaptive interpersonal relationship. Therefore, we performed weekly the semi-opened, heterogeneous, long-term(open-ended), outpatient group psychotherapy to be applicable effectively for the chronically ill. The objectives of this study are as follows; first, we introduce therapeutic principles and management methods of the group psychotherapy to be applicable in the clinical environment with the chronically ill; second, we examine the therapeutic factors in each group development stage which are helped by participants, and analyze the characteristics showed in the process of study; third, we verify the appropriateness and the validity of this group psychotherapy and then establish the base of the effective long-term outpatient therapy for the chronically ill that will be settled down as a applicable treatment modality economically and efficiently in the present medical environment of Korea. METHODS: This study was performed in the subject of the chronically ill who attended at the day care program of Community Mental Health Center in Hanam city from January 1998 to June 1999. The participants were 27 patients, but we dropped 7 patients who attended under 6 months because of long-term group. So the last subjects were 20 patients (12 males and 8 females) who attended for 18 months. The 13 therapeutic factors scale was filled out by participants just after each session and the self-report total assessment questionnaire was performed at the time of study-termination and patient-termiation. RESULTS: The ranks of 13 therapeutic factors scale are as follows: in the forming stage, the upper ranks of therapeutic factors were existential factor, guidance of therapists, instillation of hope, altruism, and catharsis in order. And in the storming stage, the upper ranks of therapeutic factors were existential factor, instillation of hope, guidance of therapists, catharsis, and group cohesiveness in order. Lastly in the norming stage, the upper ranks of therapeutic factors were existential factor, altruism, corrective recapitulation, interpersonal learning, and catharsis in order. According to the total assessment questionnaire about group psychotherapy reported by the participants 90% of them were helped, 80% of them had an idea to recommend this program to other patients actively, and 75% of them had an opinion to attend again this program if given for them. And they evaluated positively about the structure of this program and the therapist. CONCLUSIONS: The long-term outpatient group psychotherapy would be applicable effectively to the chronically ill as a economic, efficient therapeutic modality for rehabilitation. It is much more effective for therapist to perceive in detail the therapeutic factors in each group develop-ment stage when he perfoms the group psychotherapy.

A Model of Inpatient Large Group Psychodrama / 신경정신의학

As an alternative to group psychotherapy, worked out by Dr. Moreno, the psychodrama is being carried on mainly for a large group of inpatients at 40-50% of the country's psychiatric and training hospitals. The authors have developed a Korean psychodrama model for a group mental health having following characteristics:(1) a one-time treatment, (2) open-group therapy, and (3) structured, large group approach. Korean psychodrama model was proved to be a low cost, highly effective approach in that patients could be dealt with en masse to quite a satisfactory degree: at the same time Korean psychodrama model is easily accessible for any psychiatric doctor or trainee in dealing with a patient. In addition, Korean psychodrama model is highly conducive to experiencing and training related people in psychotherapeutic practice as this model has shown up 79.4% approval rate among patients after treatment. Due to the recent crunch in medical insurance financing, psychotherapy is changing from individual long-term type to a more time-limited type. Despite the mental health law passed in 1995, from the human psychotherapy standpoint, the worsening economic situation has made it difficult for a psychiatrist to deal with patient on a one-to-one basis. As a result, the burden of most psychiatrists, is snowballing day by day. In this context psychodrama seems to be a promising, reliable alternative to group psychotherapy, both medically and economically. It will be a treatment modality for years to come.

Therapeutic Factors in the Outpatient Group Psychotherapy for the Adolescents with Conduct Disorder / 신경정신의학

OBJECTIVES: Group psychotherapy is known to be an effective treatment program for adolescents who attach importance to peer relationship, but it is not activated in Korea. Therefore, researchers performed weekly the closed, homogeneous, time-limited (10 sessions), outpatient group psychotherapy for adolescents with conduct disorder. Objectives of this study were as follows: first, we practiced the group psychotherapy for adolescents with conduct disorder and evaluated its effectiveness: second, we examined the therapeutic factors which were used by participants: third, we intended to settlee down the group psychotherapy for adolescents with CD as an effective and efficient treatment modality. METHODS: This study was performed two times from October to December in 1998 and from April to June in 1999. It was sponsored by Youth Counselling Center in H city. The case group were composed of 15 female students who were second grade in H high school, and 4 students were dropped out. The control group were composed of 18 female students who were same grade in H high school and 3 students were dropped out. Before and after this program, self-report delinquency scale, aggression scale and impulsivity scale were asked to them. And just after each session, Yalom 13 therapeutic factors scale and satisfaction questionnaire for group psychotherapy were asked to them. And at last meeting, total assessment questionnaire was asked to them. RESULTS: We compared the change of therapeutic factors between the former half sessions(1-5) and the later half sessions (6-10), and the results were as follows: in the former half, the upper ranks of therapeutic factors were existential factor, universality, catharsis, identification with leader, and identification with members in order. And in the later half, the upper ranks of therapeutic factors were catharsis, existential factor, identification with leader, identification with members, and guidance of members in order. The rank of catharsis and guidance of members went upward and the rank of universality went downward when we compared the ranks in the former half to those in the later half. Altruism and family enactment were the lowest ranked in both half. The satisfaction questionnaire for group psychotherapy showed to be helped by participants at the rate of 45.7% in former half, 83.3% in later half. The total assessment questionnaire showed the willingness of re-participation at the rate of 85.7% if future opportunity of group psychotherapy is given for them. CONCLUSIONS: The time-limited group psychotherapy for adolescents diagnosed by conduct disorder was very effectively practiced and the participants reported high level of the satisfaction. The outpatient group psychotherapy for adolescents would be expanded and practiced though there are several accompanied problems including the difficulty of structuring, the deficit of motivation, and financial problem.

Past, and Here-and-Now of Group Therapy in Korea / 신경정신의학

OBJECTIVES: A group therapy includes various types: group psychotherapy, psychodrama, activity therapy including occupational therapy as well as recreation therapy, art therapy of drawing, music, dancing and drama. It has long been in use for in-patients, and became more trendy at day hospitals and community mental health centers after the enactment of a mental health law. It was surprising that a few researches have been made in the field, including a basic fact finding and that a few Korean psychiatrists have been inclined toward it. Meanwhile, we finished a research work on: how a group therapy has been conducted so far, its current status across the country, possibly the best way to heal, and deal with, psychiatric patients. METHODS: The 1997 annual report by Korean Neuropsychiatric Association, has been available for random sampling in the following categories: training hospital, general hospital, psychiatric hospital, clinic with admissions, clinic without admissions, day hospital, community mental health center. Telephone polls were conducted on contents of frequency and status of a group therapy available with psychodrama, main therapists, co-therapists, duration & times of therapy, size of group therapy recipients etc. RESULTS: The group therapy is broken down into the order of percentage; Art therapy(30.9%), Activity therapy(28.4%), Group psychotherapy(27.2%), Others(24.1%), Large group therapy(23.2%), with the psychodrama(10.9) least of all. Against in-patients(61.6%), the group psychotherapy shows its greatest diagnosis for a combined gorup(51.4%), and finds its biggest type in a general group(83.2%), Against in-patients(65.3%), the psychodrama diagnosis is mostly conducted for a combined group (69.4%). For a main therapist, the group psychotherapy is taken care of by boardmen(31.1%), and social workers(29.5%), while psychodrama by psychiatric boardmen(36.1%), and social workers(36.1%). On the other hand, for a co-therapist, the group psychotherapy is done by nurse(40.8%), while psychodrama by social workers(25.9%), and volunteers(23.5%). At a time most group psychotherapies takes some 60 minutes, psychodrama 120 minutes. Group therapies take place each once a week. Its participation amounts to 26.0(+/-17.8) for a psychodrama, and to 11.0(+/-5.8) for a group psychotherapy. Clinics with admission rooms(83.6%), exceedingly enjoy more group therapy than ones without (2.2%). CONCLUSION: The group therapy is run at most hospitals as the main part of a psychiatric treatment. However, the job has been undertaken on a small scale by outpatient clinics as well as psychiatric boardmen. Therefore, more attention is urged toward a group therapy, its professional training, plus its more brisk business at outpatient clinics.

A Day Care Model for Chronic Psychotic Patients in Community Mental Health Center / 신경정신의학

OBJECTIVES: The purposes of this study were as follows: introducing general structure and management of a day care model practiced in Community Mental Helth Center where a psychiatrist participates weekly as a consultant analyzing; the results after performing this model and then verifying appropriateness and validity; brooding the possibility of generalization as an effective day care model in Community Mental Health Service of a small city and promoting maintenance, rehabilitation and returning to community of chronic psychotic patients. METHODS: We performed this model from May 1997 to December 1998 for about 20 months. The subjects were composed of 33 psychotic patients. PANSS (Positve and Negative Sydrom Scale), QLS (Quality of Life Scale), LSSS (Life Satisfaction Self-Rating Scale) were administered twice before starting and after 6 months of participation in this program. RESULTS: 1) This model helped the maintenance and rehabilitation of chronic psychotic patients, reducing symptoms and increasing quality of life; 2) This model was useful in integrating multi-disciplinary personnel and therapeutic methods as a whole with a psychiatrist intervening the least; 3) This model enabled a psychiatrist as a consultant to manage and control all Community Mental Health Service with him participating weekly; 4) It is possible for this model to be easily applied to Community Mental Health Service in a small city. CONCLUSION: model will be likely to be applied effectively and efficiently to the Community Mental Health Service in a small city for maintenance, rehabilitation and returning to community of chronic psychotic patients.

Therapeutic Factors of Large Group Psychodrama for Psychiatric Inpatients / 신경정신의학

OBJECTIVES: This study was performed to make a model of large group psychodrama suitable for Korean inpatients and easy for psychiatrists trained in the individual psychotherapy and the group psychotherapy to use, to investigate the therapeutic factors after applying this model to inpatients, and then to contribute to the treatment of inpatients. METHODS: The study subjects were all the inpatients and the therapists(the auxiliary ego's) who participated in psychodrama from March 1998 to September 1998. The subjects were composed of 346 inpatients(152 males, 194 females) and 60 therapists. To the inpatients 13-Therapeutic Factors Scale, Scale of General Attitude to Psychodrama, and the Questionnaire describing helpful things in psychodrama were administered. To the therapists 13-Therapeutic Factors Scale and the Questionnaire describing helpful things in psychodrama were administered. The inpatient group were divided into 4 groups(the audience, the auxiliary ego's, the participants in sharing, the protagonists). The therapeutic factors among 4 groups were compared. RESULTS: First, the therapeutic factors described by the inpatient group were as follows: 1) Most inpatients made great account of 'existential factor' and 'the corrective recapitulation of the primary family group' regardless of their roles in psychodrama. 2) The inpatients who participated in psychodrama directly as the protagonists, the auxiliary ego's, or the participants in sharing made much account of 'development of socializing techniques'. The inpatients who participated in psychodrama more directly as the protagonists or the auxiliary ego's made much account of 'catharsis'. 3) All the inpatients except the protagonists made much account of 'instillation of hope'. 4) The audience made much account of 'identification' and 'universality'. Especially, 'identification with members' was much accounted of by the participants in sharing. 'Universality' also was much accounted of by the auxiliary ego's. Next, when we compared the therapeutic factors in the inpatient group with those in the therapist group, the therapist group made much account of 'group cohesiveness' which the inpatient group made little account of. And the therapist group made no account of 'development of socializing techniques' which the inpatient group made much account of. CONCLUSION: By dividing the inpatient group according to their roles, we found the characteristics of the inpatient large group psychodrama and of the therapeutic factors according to the roles of the inpatients. This model could be applied to the treatment for the inpatients easily and was helpful to many inpatients on the whole.

A Comparative Study on the Therapeutic Factors of Group Psychotherapy and Psychodrama Applied to Psychotic Patients / 신경정신의학

OBJECTIVES: This study was performed to investigate the therapeutic factors of group psychotherapy and psychodrama which were applied to psychotic patients, and to compare the therapeutic characteristics of two therapies. METHODS: The subjects of this study were patients of a day hospital from September 1996 to May 1997. The subjects were composed of 35 psychotic patents(22 males, 13 females). Both of group psychotherapy and psychodrama were done to the patients of the day hospital. After these therapeutic factors were checked by the members of group psychotherapy, the protagonists of psychodrama, and the audience of psychodrama using 13 therapeutic factors scale. All three groups divided into higher functioning group and lower functioning group by mutual consent of the therapists in the treatment team meeting according to the patient's life of the day hospital, the attitude in programs, and the state during the interview with the therapist. And then therapeutic factors of higher and lower functioning group were compared. By the mean score of each therapeutic factor the rank of therapeutic factors was decided. By these ranks we compared the important therapeutic factors on the members of group psychotherapy, the protagonists, and the audience. RESULTS: The results were as follows : 1) The protagonists of psychodrama set a very high value on 'catharsis' and 'the corrective recapitulation of the primary family group', regardless of their functional level. 2) The protagonists with a higher function set a higher value on 'guidance of therapists', while those who had a lower function set a higher value on 'guidance of members'. 3) The audience of psychodrama set a very high value on 'identification with therapists', 'identification with members', and set a high value on 'universality'. 4) The higher functioning group of the group psychotherapy, the audience, and the protagonists set a high value on 'interpersonal learning', especially the patients of group psychotherapyset a very high value on 'interpersonal learning' 5) The lower functioning group of the protagonists and the group psychotherapy set a high value on 'development of socializing techniques'. CONCLUSION: From the results of this study, we can draw some suggestions. First, if therapists take the above-mentioned therapeutic factors into consideration during the sessions of group psychotherapy or psychodrama, they can obtain more effective therapeutic outcome. Second, it is desirable that both group psychotherapy and psychodrama should be used more extensively as important methods of treatment in clinical settings. Third, the combination of group psychotherapy and psychodrama would be more effective than the separate application of each therapy.

A Day Care Model for Rehabilitation of Chronic Psychotic Patients / 신경정신의학

OBJECTIVES: The purpost of this study was to present general system,operation,and program of a day care model managed by a psychiatrist,to evaluate the results of performing this model,and thus to developa day care model applied to Korean situation appropriately for promoting maintenance and rehabilitation of chronic psychotic patients. METHODS: We performed this day care model(hereinafter called as this model) from March 1997 to February 1998. The subjects were composed of 23 psychotic patients. PANSS, Quality of Life Scale,Life Satisfaction Self-Rating Scale were used before beginning this model-and after three months of performing this model. Program Helpfulness Scale,13 Therapeutic Factors Scale were used at one month of day care and after three months of day care. RESULTS: 1) This model helped maintenance and rehabilitation of chronic psychotic patients through reducing their symptoms and increasing quality of life. 2) This model used the various group therapy, especially creative art therapy and activeity therapy, played an important fole,for recovering Physical,psychological,and social functions. 3) Important therapeutic factors at early and late period of this model were identification with therapists,guidance of therapists,and the corrective recatitulation of the primary family group. Important therapeutic factors at early period were group cohesiveness and altruism, and at late period instillation of hope. 4) This model was useful for integration the multidisciplinary therapeutic team and the various therapeutic methods. CONCLUSION: This model would be applied to day care in this country effectively and efficiently for maintenance and rehabilitation of chronic psychotic patients.

The Effectiveness of a Day Hospital Model for Integrated Therapy of Psychotic Patients / 신경정신의학

OBJECTIVES: A day hospital has been remodeled after a vision to help psychotic patients quickly recover their psychological and social functions and lessen their induced regressions caused by long-term hospitalization, thereby enhancing their social abilities. The authors concerned once developed a day hospital model of an integrated therapy for psychotic patients suitable for Korean situation in their previous paper. Based on it, the present study was to determine how effective a day hospital would be, in comparison of the following two paired groups: day hospital group with experience of hospitalization(hereinafter abbreviated as DH group) & day hospital parents group with experience of hospitalization(hereinafter abbreviated as DH parents group) and OPD group with experience of hospitalization(hereinafter abbreviated as OPD group) & OPD parents group with experience of hospitalization(hereinafter abbreviated as OPD parents group). METHODS: During the 18-month long research period(from May to 1996 October 1997), 17 day hospital patients with experience of hospitalization & their parents and the same number of OPD patients with experience of hospitalization & their parents were corespondingly paired with at random, who identified themselves closest in the following categories: diagnosis, age, sex and function. All of them were asked to check questionnaires on their respective quality of life, insight, and their attitude about drug. Day hospital patients with experience of hospitalization and their parents were checked from the first day they were treated while OPD patients with experience of hospitalization and their parents were examined after discharge from hospital, commonly at the interval of 2 weeks, 3 months, 6 months, 12 months, and 18 months. RESULTS: 1) The quality of life scored higher in DH group than in OPD group. It turned increased significantly at the 3rd month and continued the same until the 12th month. At the 18th month, it showed a significant downturn. Meanwhile, DH group showed a significant upturn at the 3rd month and it turned down at 12 month. 2) The insight of DH group and DH parents group scored higher compared with OPD group and OPD parents group between the 3rd and 18th month, with the 3rd and 6th month showing a particular strength as well. Meanwhile, it continued unchanging for day DH group and DH parents group from the date on, of their discharge from hospital. 3) Attitude towards drugs scored higher in DH group than in OPD group at the 3rd and 6th month. It continued unchanging between the 6th and 18th month. It didn't score significantly higher in DH parents group than in their counterparts. 4) Satisfaction on the therapy started upward in DH group at the 3rd and 6th month, and scored higher in them than in their counterparts during the period form the 6th and 18th month. It started upward as well in DH parents group at the 3rd and 6th month, and scored higher in them than in their counterparts during the period form the 6th to the 18 month. 5) Number, and duration of DH group totalled lower than those by OPD group during the research period. CONCLUSION: The day hospital model, developed by the authors concerned, has proved a highly effective treatment for psychotic patients, as the data scored higher in the day hospital patients and their parents than in the OPD patients with experience of hospital and their parents in terms of "quality of life" by patients, insight, attitude toward drugs and satisfaction on its therapy.

Review of Group Psychotherapy: For Its Activation of Practical Applications / 신경정신의학

In Korea Mental Heath Law came into operation in 1997, and the management of the mentally ills has become an important issue and it is inevitable to train mental health workers for the management of the mentally ills. The purpose of the management seems not only to care the patients' symptoms but also to improve the quality of life. Nowadays, in the best approach of treatment and management it is difficult that one to one management is used because of the cost limitation and management efficacy. So it is highly recommended that the group approach should be used. Hence 'the activation of group psychotherapy' is very important for the effective treatment and efficient management of the mentally ills. And therapists should know group psychotherapy well and to use it properly. In these viewpoints, we first introduced various types of group psychotherapy generally, including Yalom's group psychotherapy which focus on the interpersonal relationship and is the representative type of group psychotherapy. And then we classified group psychotherapy simply, describe the concepts of practical application of group psychotherapeutic approach. And last on the basis of understanding group psychotherapy in this paper, we explored the necessity of its activation on the practical setting and the surrounding circumstances.