A dynamic/expressive approach to brief inpatient group psychotherapy

Abstract

Therapeutic action occurs in groups when patients simultaneously become more accepting of their own thoughts and feelings and increase their capacity to share more benign and mature interpersonal relationships with the therapist and other patients. This orientation can guide practitioners of brief inpatient group psychotherapy in choosing when to use interpersonal, problem-solving, or object relations techniques, or more traditional dynamic~expressive techniques. While the brief inpatient modality requires an increase in suppressive techniques compared to the long-term outpatient modality, suppression must be used judiciously, to facilitate rather than interfere with self-understanding and development of therapeutic relationships. Specific technical choices are derived from this principle and iUustrated with a case example.An integrating orientation is needed to guide practitioners of brief inpatient group psychotherapy in the selection of techniques. As brief group therapy has become an increasingly popular modality for inpatients, a literature has emerged advocating at least three approaches: the interpersonal approach, the problem solving/educative approach, and an object relations approach. I shall discuss these approaches, then propose a psychodynamic/expressive orientation that provides guidance in selecting from among these and more traditional dynamic-expressive techniques.The interpersonal approach has been most extensively elaborated (Yalom, 1983). Yalom reasoned that the core problem for all patients involves difficulties in interpersonal relationships, and that these difficulties can be addressed with most immediacy in the here-and-now of the group. Therefore, he recommended that interventions be directed toward facilitating group interaction, focusing attention on interactions as they occur, helping patients identify maladaptive patterns of relating, and developing alternatives. This approach downplays exploration of motives, extragroup experiences, or anything else not observable in the here-and-now.The object relations approach (Kibel, 1978(Kibel, , 1981 also focuses on relationships, but emphasizes internalized and largely unconscious object relations as

The educative model.

“…Genetic insight (i.e., the development of an awareness of the early childhoodfamilial underpinnings of psychopathology) has generally been observed to be of little benefit to inpatient group members (Kibel, 1981). However, some interpersonal researchers ( e g , Rosegrant, 1988) have argued that self-understanding may be of benefit. This factor describes the process wherein the individual gains access to warded-off feelings and impulses that motivate present dysfunctional interpersonal behaviors.…”