Petersburggroups2

Unus pro omnibus, omnes pro uno:

Group Work in a

Community Mental Health Clinic

in a Bi-National Town

Jennia Vilinsky, M. S. W.

Clinical social worker

Tsvi E. Gil, B. Sc., M. A.

Clinical and medical psychologist

Juan Bar-El, M. D.

Psychiatrist, Head of clinic

The Middle East

ISRAEL

Acre

ACRE

Acre is a 50,000 inhabitants town located in the

West-Northern part of Israel, nearby the

Mediterranean sea

2/3 Jews, 1/3 Arabs

Surrounded by Arabic and Jewish villages

Characteristics of the Clinic:

About new 600 referrals a year (adults only)

Heterogeneous in diagnoses: psychotics,

personality disorders, mood disorders, anxiety,

traumas, crises, comorbidities

Heterogeneous in demographic variables: Jews

and Arabs – Muslims, Christians, Druzes,

Circassians

Commonly low socioeconomic class

Therapeutic Modalities

Psychiatric (psychopharmacologic)

Individual psychotherapy

Group psychotherapy

Rehabilitation

commonly some modalities are operated

simultaneously, by different staff members

Why Groups?

Groups are the natural environment for people,

not the artificially-invented therapeutic encounter

Universality – "other people troubles"

An opportunity for sharing and mutual learning

The group as "laboratory of life"

Opportunity to re-enact internalized nuclear

family and object-relations

The power of the group for influencing

Source for belongingness and identification

Are groups a way to economize

therapy?Group leaders need training and supervision

Founding a group needs time for interview and

selection of candidates

Management of groups needs time to be in

contact with group members (dropouts,

inattendances, crises)

Many of group participants use additional

treatments simultaneously

How Group therapy works?

Cognitive learning (from leaders)

Social learning (from peers)

Support from mutual sympathy

Raising and resolving conflicts

Containment of acting-out and projections

A safe place for exploring troubling personal

issues

Consistent setting for unsteady people

On the nature of therapeutic

group workPeople in groups are closer to their "Id" (Freud,

Le-Bon) – The groups enable regression to

individual primary themes (e.g., Slavson)

Group may encourage identification: “the deepest

reason why patients... can reinforce each other's

normal reactions and wear down and correct each

other's neurotic reactions, is that collectively they

constitute the very norm from which,

individually, they deviate." (S.H. Foulkes,

1948:29)

On the nature of therapeutic

group work - continiued

Patients may identify their avoided relations and

the consequential relations (H. Ezriel, 1950)

The group matrix enables resonance of social,

group, and inter-personal themes (S. Foulkes)

Conflicts in groups enables development of ways

for individual resolution of conflicts (Whitaker &

Lieberman)

The group as an opportunity for interpersonal

treatment (Yalom)

Groups in our clinic:

Personality disordered patients: (with I. Abu-El-

Higa, M.S.W.)

Life-long maladjustment and misery

Disturbed inter-personal relations (spouses,

offspring, hierarchical, friends)

Difficulty in conforming to norms and staying in

frames

Difficulty in appropriate self-expression

Problems in making a living, accommodation,

health-keeping, management of life vicissitudes

Groups in our clinic:

Psychodynamic group for anxiety disorders:

Anxiety as emanates from difficulty in separation

and fear of loosing significant others

The treatment explores anxiety states in

interpersonal context and in a safe environment

The dynamic approach does not work on exposure

but encourages exploration and increases mental

freedom

Busch F. N., Milrod B. L., Singer M. B. & Aronson A. C. (2012) – Manual

of Panic Focused Psychodynamic Psychotherapy – Extended Range.

Routledge, New-York & London.

Groups in our clinic:

DBT for young borderline female patients (M.

Linehan) (with J. Sherr, M. S. W)

Groups in our clinic:

A continuation group for mentally ills who

dismissed from hospitalization (with O. Ben-Menahem,

M. S. W., and M. Carmon, M. D.)

Groups in our clinic:

Group for family members of the mentally ill (with I. Abu-El-Higa, M. S. W. )

Family members have to deal with the illness

vicissitudes and uncertainties

Family members have to deal with patient’s

acting-out and public stigma

Paradoxically, spouses are empowered by

becoming the head of a formerly patriarchal

family

Unique themes in our groups

Relations between Arabs and Jews

Relations with the environment (political,

economic, urban, etc.)

Influence of traditions and community

Issues of immigration

Somatization of mental problems

Co-treatment with other agencies (psychiatrists,

physicians, welfare, social security, rehabilitation,

legal)

Our Conclusions:

While not all patients are suitable for groups,

many are

Patients may benefit from groups whether with or

without additional treatment, but additional

treatment is often necessary – either for targeting

patient's symptoms, or for support of patient's

participation in the group

While patients often resist group treatment, the

main obstacle for groups usually comes from

the... staff

Our Conclusions (cont.):

Different groups may suit different patients, but

common factors (e. g., setting, sharing,

belongingness, learning, etc.) are usually more

important than specific ingredients of the model

Opportunities for self-expression, group

cohesiveness, interpersonal support, and bonding

with group members are probably the most

important factors unique in group therapy

Thank you for listening and so long from

Israel