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.

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.

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.

Therapeutic Factors Recognized by The Patient and The Therapist in Community Meeting / 신경정신의학

This research was conducted to investigate the responses of the patients and the therapists who attend the community meeting, to evaluate the therapeutic effects of community meeting as a group psychotherapy by applying short form scale of Yalom's Q-sort, to diagnose and complement the problems of the community meeting and to aim at activating the therapeutic function as the group psychotherapy The community meeting was held by 10 times during the stage of oscillation of the community and 26.7 patients group(+/-2.95) and 8.5 therapists group(+/-1.43) attended the every meeting. Consequently, both patients group and therapists group evaluate the community meeting as positive, and on the item which is helpful to them, while patient group responds it is 'mutual understanding and love' and 'self-understanding', therapist group does it is 'frank self-expression' and 'conversation'. On all items of group psychotherapy factors in the community meeting, the patients group evaluates it is more therapeutic in comparison with the therapists group, especially there is a significant difference in nine items such as 'altruism', 'group cohesiveness', 'interpersonal input', 'interpersonal output', 'identification', 'instillation of hope', 'family reenactment', 'self-understanding' and 'existential awareness'. In addition, on the therapeutic factor which is activated group psychotherapy factor in the community meeting, both patients and therapists respond that it is 'existential awareness' and 'universality', and they evaluate 'interpersonal output' as an non-activated therapeutic factor.