Models of group psychotherapy: sifting through confusion

Contribuições da poética social à pesquisa em psicoterapia de grupo

Esse artigo tem por objetivo apresentar algumas contribuições do construcionismo social e da poética social ao entendimento da psicoterapia de grupo e de sua investigação científica. O construcionismo social se define como uma forma alternativa de inteligibilidade em ciência, que privilegia a compreensão do modo como as pessoas constroem sentidos sobre o mundo e sobre si mesmas em suas práticas discursivas. Coerente com essa perspectiva, a poética social caracteriza uma prática de pesquisa útil à investigação dos processos conversacionais, enfatizando a centralidade do pesquisador na construção de sentidos sobre seu objeto de estudo. Nesse artigo, buscamos demonstrar como estas perspectivas podem sustentar uma prática sistemática de pesquisa sobre a psicoterapia de grupo. Para tanto, apresenta os passos metodológicos desenvolvidos em um estudo acerca de um grupo em saúde mental, demonstrando como esses permitiram compreender o processo conversacional por meio do qual o próprio grupo se constituiu como um recurso terapêutico.

Psicoterapia de grupo: como surgiu e evoluiu

Este estudo tem por objetivo oferecer um panorama histórico do surgimento e evolução da psicoterapia de grupo, delineando suas raízes, principais modelos e pressupostos teóricos. Sua origem remonta ao início do século passado (1905), estendendo-se por cerca de cinco décadas: período de configuração e desenvolvimento técnico. Posteriormente, a psicoterapia de grupo passou pela fase de expansão teórica nos anos 50 e 60, seguida da fase de consolidação na década de 70, e de amadurecimento nos anos 80 e 90. Finalmente, examina-se sua evolução recente, dando ênfase especial à construção de novos modelos. Nos últimos anos, diversas técnicas desta modalidade de tratamento têm sido desenvolvidas para atendimento de populações específicas de pacientes, com as mais diversas condições médicas e psicossociais, o que sugere uma tendência crescente rumo a uma maior especificidade de sua aplicação.

From classical to eclectic psychodrama: conceptual similarities between psychodrama and psychodynamic and interpersonal group treatments

A study was conducted to explore the hypothesis that contemporary U.S. psychodramatists evince a shift from strict adherence to the conceptual frame of reference espoused by classical psychodrama toward a degree of sharing concepts with those valued by psychodynamic and interpersonal group therapists. Sixty-two senior psychodramatists ranked a form comprised of 44 concepts. Their rankings were compared to the results of a study by Dies (1992). In general, the results supported the hypothesis.

Joining with resistance: addressing reluctance to engage in group therapy training

Although research has documented the effectiveness of group psychotherapy, trainees are often reluctant to embrace this modality. This reluctance may reflect an informed choice based on knowledge, interest, and skill. Alternatively, reluctance may reflect misinformation or resistance due to conflicted feelings that arise from group dynamics. The latter are a major obstacle to the success of group therapy training and treatment programs. Understanding the origins of this reluctance and the developmental challenges of group therapy for trainees better equips supervisors to address this difficulty. This article uses case examples to illustrate how trainee reluctance emerges. It also provides strategies for working with hesitant trainees. The success of group therapy programs rests on the supervisor's ability to manage trainees' inhibitions to group therapy.

The future of the group

Group oppositional and destructive processes have been insufficiently understood and integrated into the fabric of group psychotherapy. To strengthen our field for the future, this area requires further elucidation. The author's concept of the Anti-Group is used as a basis for exploring antagonistic group processes in the clinical setting in parallel to group disruption and threat in the social domain. Further, it is suggested that the legacy of our training organizations is tied to problematic and institutional group processes that tend to be repeated rather than acknowledged and resolved. These gaps in our understanding limit the power of the group because creativity and growth come from the recognition and transformation of destructive impulses.

The group psychotherapy movement at the millennium: some historical perspectives

Although almost a century old, group psychotherapy has experienced an unprecedented expansion over the last 50 years. By the 1970s, human helping groups had found application in virtually all the human services, including the media. The growth of professional organizations for group work specialists was accompanied by a burgeoning literature and by accelerated research endeavors. The recent advent of the managed health care "revolution" has shaken the very foundations of this prospering group psychotherapy movement. Undue pressure from third-party payers for greater accountability and for cost-containment has come to threaten the traditional autonomy and dedication to quality of care by group therapy practitioners. Professional organizations have begun to meet these challenges by educational endeavors addressed at insurers, legislators, and the public. Current training programs and literature for clinicians have focused on the need for a new "business orientation" and on less costly group treatment measures (i.e., short-term and combined). Given group therapy's proven effectiveness, coupled with its practitioners' flexibility, the movement is bound to regain its secure footing at the dawn of the new millennium.

Group dynamics and group psychotherapy revisited: four decades later

On the occasion of the 40th Anniversary of a symposium held on this controversial subject, the history of the relationship between group dynamics and group psychotherapy is reviewed. Within the contemporary framework of pluralism and integration, some guideposts are advanced that might help in the conceptual clarification of the affinity between these disparate, yet related, fields. This might lead, in turn, to a more refined elicitation of the specific therapeutic factors inherent in the group treatment modality.

Group psychotherapy and managed behavioral health care: current trends and future challenges

The rising cost of health care within the private and public sectors has created an increased demand for the management of benefit dollars. This trend has significant implications for group psychotherapists, as group modalities offer cost-effective ways of delivering services to traditional outpatient and inpatient populations. Continued cost-containment pressures and increasing attention to outcome studies will fuel trends toward briefer, manualized group treatments and intensive group outpatient programs as alternatives to hospitalization. Quality-based demands will challenge payors to (a) address biases against group psychotherapy among providers and patients and (b) integrate recent process-and-outcome research in determining the appropriateness of group versus individual modalities for particular patients and presenting problems.

Brief group treatment and managed mental health care

There is increasing interest in the application of brief group psychotherapy to treat a wide variety of patient conditions. This paper reviews a selected set of controlled and comparison studies of brief, outpatient group treatment with adults, and considers findings that support the effectiveness of this approach. Authors discuss barriers to the use of brief group interventions and make recommendations regarding increased utilization of this approach in managed mental health settings.