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.

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.