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Presentation – Research and clinical application of group therapy within mental health services

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Since its creation in the forties, group psychotherapy has undergone various changes. Compared to its initial approach in fact, a variety of adaptations inspired by theoretical models and interventions have been implemented. Thus, we agree with Yalom (2005) who prefers to speak of group therapy sub-divided in various  settings: by illness (such as psychosis, eating disorders) to self help groups; from those conducted in prison to those conducted in a prestigious private setting; Cognitive-behavioral, psychoanalytic, psychodrama group therapy.
In this monograph for the Funzione Gamma journal edition, we discuss how the Mental Health Service in Italy and its counterparts abroad utilizes the different group interventions and models inspired by them. The collected papers not only offer the reader the evidence that public services meet the statutory mandate of care but that they also combine the valuable attributes of learning, of shared thought, experimentation and research. We must also add that “far from being just a setting, the institution enters into the life of the group and marks out its characteristics, potential and specific limits” (Patalano, 2014, p. 33).

On this premise, we have identified four different subject matters in the following articles inspired by the characteristics described above regarding groups conducted within the public health sector.

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Reflections on psychoanalytic contributions to understanding (psychiatric) institutions

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Abstract

Personal experience of being a psychoanalyst in a standard and old-fashioned psychiatric service is reviewed to consider how psychoanalytic ideas may be presented as relevant to psychiatry. The difficulties are considered, and several forms of intervention by the psychoanalyst are reviewed – those forms are described under the headings Education and professional Read more

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Inscription into the community. A footnote on a Lacanian approach to the group treatment of psychosis

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Abstract

Situating psychoanalysis as the foundation of the therapeutic community and as a spiritual exercise, the author argues that contemporary approaches articulate a form of akēdia – a desire to be elsewhere – both in its focus on expectation and its misunderstanding of the nature ‘place’. This amounts to an avoidance of being-with the subject of psychosis. This leads to a discussion of the formation necessary for therapeutic community practitioners which is in opposition to the notion of training. Such a formation amounts to an inscription into the discourse of the Read more

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Getting your tutu wet: Creativity, Destructiveness and Survival

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Abstract

We are constantly made aware of destructiveness and hatred at the individual and organizational levels and are exhorted to recognize,  condemn and to expel such behavior or it’s manifestations in ourselves and in our societies. However it is my belief that aspects of destructiveness are inevitable in the development of creative experience and invention.  Further to this, I believe that it is those who fear and oppose the disruptiveness and possible destructiveness, which may accompany change, who are the true destroyers of creative progress, whether in the development of the personal psyche, Read more

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Group Psychotherapy in the Public Sector: The Impact of the Organisation on the Primary Task

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Abstract

In this paper we will discuss psychoanalytic group psychotherapy in the process of treating complex patients as part of their clinical management, both of which are set within the context of a large and changing public sector organisation in the United Kingdom. Included in this we will examine how the many correlative services can be slotted together, acting like a jigsaw of provision, and consider their impact upon group psychotherapy. We will explore how this can lead to the organisation being both a container of high levels of disturbance, but also become a platform for the projection of both an individual pathology and the anxieties within the group itself, there by potentially both enabling and compromising the quality of patient care. Furthermore, we will consider how the organisational dynamics interact with and at times conflate the disturbance within the group itself, the psychotherapists and the patients, thus creating a system where a complex set of dynamics continually moves Read more

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Who do you think you are? Adolescent groups and everyday life

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Abstract

Adolescence is a period of change.  An existential change that is a change in the sense of who one is, a change in one’s identity.  It may be a catastrophic crisis in identity, so that there is an uncertainty about being a person at all.  Adolescence is a process of learning a new identity without knowing clearly where one will get that new identity from. The authors reflect on these issues that nowadays increasingly involve schools, social stakeholders and mental health services when a treatment response is needed for problematic adolescents and their families. Read more

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Clinical psychology internship training and group psychological interventions in Mental Health Centres

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Abstract

To undertake a description of one’s own experience of internship training in clinical psychology means reflecting on the relationship between theory and practice within a process aimed to the acquisition of professional skills. In my case, this process took place within group experiences undertaken in several mental health centres in Rome, where I was admitted as  a Read more

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Supervision and the Working group

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Abstract

This paper, based on the most modern theories regarding evaluation and treatment of acute psychiatric crises, proposes a reflection on the sense of supervision in the acute inpatient ward (SPDC). Moreover, the current issues concerning psychiatry and drug therapy, have prompted the need to examine the approach based on the principles of Recovery, the Dialogic Model of communication with patients and the developments made in the field of Multi-family Group Psychoanalysis. Thus, bearing in mind the acute inpatient ward  mandate, an attempt will be offered to refocus the function of “diagnosis and treatment” of all ward operators as a working group. We have pondered the question of how supervision can free itself from the idea of only one “expert” analyzing the patient and passing on the resulting information. Not only, we have also considered whether the supervisor’s role could catalyze and bring to light the capabilities of the working group in detecting the existential condition of Read more

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Group dimensions in an Adult Mental Health Inpatient Unit

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Abstract

Human beings are immersed in group settings of one kind or another all life long and even when individual mental suffering exacerbates to the point of needing hospitalization, people find themselves sharing space, time and emotions with others. A mental health crisis breaks the individual and family balance and expresses itself with acute and extreme thoughts, emotions and behaviors. Psychiatric hospitalization, although traumatic, gives the patient and his/her relatives an opportunity of living all the alterations in a protected environment also offering them an explanation for these alterations. Clinicians aim to intervene as soon as possible after the onset of a crisis in order to enable the individual to overcome it and to return to normal functioning, Read more

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Set up and evolution of a rehabilitation group in a Therapeutic Community: Grounded Theory

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Abstract

Objective: people with severe mental illness lack in communication skills and social functioning but they do have needs, goals and dreams which can be promoted and empowered. The rehabilitation program employed in this report aims at enhancing the individual’s wellbeing and the social skills of the clients of a Therapeutic Community in Rome. Method: “Entertaining Knowledge Group” is a weekly atelier which was planned to strengthen the clients’ skills to organize cultural and recreational activities in Rome. We used an action research approach project (Hopkins, 1993) in order to monitor, to verify and to improve our practice. Results: main findings indicate clients’ clinical changes and increased social interactions after 10 months. Conclusions: results suggest that working on the reflections and on the proposals of the clients in an existing trustworthy group framework can enhance the healthy and Read more

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CBT-oriented group therapy for acute psychiatric inpatients: effects on aggression and emotional regulation

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Abstract

The treatment of different clinical presentations of the psychosis spectrum in an acute psychiatric ward, require a complex integrated intervention, in which pharmacological treatment is flanked with a psychological therapy. The aim of this study is present the results of a CBT-oriented treatment group specifically structured for acute psychiatric inpatients.
From 321 consecutive patients admitted to an acute patients psychiatric ward, 121 participated at the study. Alexithymia (measured by TAS-20) and emotion regulation strategies (measured by ERQ) were evaluated.
62 patients participated at the single session CBT group therapy, while 59 patients refused to participate. Patients, who participated at the CBT group, make use more frequently of the expressive suppression as emotion regulation strategy. Moreover, they increased number of their psychological interviews and they underwent to physical restraints less frequently.
These findings suggested that a CBT group therapy aimed to management of emotions, is an important tool in the treatment of acute phase of severe mental illness. Read more

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The role of psychoanalysis in the welfare state crisis: from taking care of the patient to taking care of the healthcare institutions

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Abstract

Recent developments in psychoanalytic outreach researches have offered ever more convincing evidences of a circular, mutual relationship between the internal world, the group and the external society. From such point of view, the author explores the current crisis scenarios of the welfare and the parallel crisis of credibility and market of the psychoanalytic therapy. He suggests that in the future psychoanalysis could shift its focus from individual treatment  to the study of group and institution,  to the point of recasting itself as a “clinical approach to organizations” to improve efficiency, awareness and well-being in the workplaces. To make it happen, it is necessary for psychoanalysis to overcome the mistrust for interdisciplinary dialogue with other approaches, methods and disciplines, and the discomfort Read more

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Extended groupality and relationship building How to deinstitutionalize institutions

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Abstract

This article presents the work carried out in a Therapeutic Community in a suburb of Rome. In particular, it describes significant group interventions such as: multi-family group psychoanalysis, the “hearing voices” group as well as interventions aimed at building a relationship with the neighborhood in question. In addition, it shows how a Community of this kind can not only provide therapy but can also be a means to help guide towards recovery. In fact, it acts on the grounds that people who suffer from mental health issues are not “carrying a disease” but rather that they have particular mental health conditions which necessitate support. An external support system as well as specialized and technical help in their daily lives. The combination of all these factors are at the basis of the Therapeutic Community Read more

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The mountain as field of group experience

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Abstract

This article explores a therapeutic intervention in the area of mental illness employing an “outdoor setting”, in the literal meaning of a setting outside any classic model, namely mountain therapy. It is a new practice, where the potential transformative capacity of the mountain scenery is exploited and where even people with severe psychiatryc disabilities can Read more

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Transcript analysis of Multi-Family Psychoanalysis Group and action research in a public Therapeutic Community

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Abstract

This article presents the perspective of a group of authors regarding their action research into the use of group therapy as a means to treat severe psychotic states in a public psychiatric therapeutic community. After recording various Multi-family Psychoanalysis Group sessions and analyzing the transcripts of these recordings, the authors were able to implement their findings as a guideline Read more

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Transit from individual to group: network thinking in the foundation of a limited time group of therapy in a Public Service

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Abstract

The article intends to suggest a reflection about the process of the formation of a limited time group of therapy in a mental health care center located in Rome, Asl Roma 2. The aim is to focus on the delicate process of transition from individual  to group therapy in a Public Institution, which involves several implications.
We will try, in this regard, to point out its advantages and some critical issues related to the care service background. We will explore the functioning of the patients in group therapy and then among the staff.  We will consider the difficulties arising, and the opportunities the transition from individual Read more