Psychological Interventions Lecture 8

Psychoanalytic psychotherapy

• Focuses on the patient’s inner thoughts and feelings

• Looks at how the patient sees themselves and other people

• Believes that some thoughts and emotions are unconscious (outside awareness)

• Early attachment experiences create internal working models
  → mental patterns about relationships and trust

• These patterns are stored deeply in memory (procedural memory) and influence current relationships

Goal of Psychoanalytic psychotherapy

• Make these unconscious patterns visible

• Understand them

• Change unhealthy relationship patterns into healthier ones

Group therapy

• Different type of groups

• Type of patients (indication)

• Setting

• Patient tasks

• Therapist tasks

• Mechanisms of change in a group

• Inter-personal learning

  • How others see you and what you elicit in them

  • Hoe your behavior influences your own self-image, acting as a self-fulfilling prophecy

• Social testing ground

• Roles

• Norms

  • Therapeutic (helpful) and anti-therapeutic (harmful)

• The group therapist

• → Psychoanalyitc group therapy: Focuses on unconscious relationship patterns and emotions that appear in the group interactions

Which factors help people to improve in Group Therapy?

1. Hope: Seeing others improve → Gives motivation and belief that change is possible

2. Universality: Realizing “I’m not alone” → Reduces shame and isolation

3. Information / Guidance: Learning about problems + receiving advice → Psychoeducation helps understanding and coping

4. Altruism: Helping others → Increases self-worth and meaning

5. Corrective emotional experience: Group can feel like a new, healthier “family” experience → Old relationship patterns can be changed

6. Social skills learning: Practice communication and relationships in a safe space

7. Imitation: Learning by observing others (and therapist)

8. Interpersonal learning: Getting feedback → understanding how you affect others

9. Group cohesion: Feeling accepted and connected (similar to a strong therapeutic alliance)

10. Catharsis: Expressing emotions → emotional relief

11. Existential factors: Accepting life realities (e.g., responsibility, mortality)

• It’s hard to measure exactly which factor causes change

• Different people benefit from different factors

• The combination of factors is what makes group therapy effective

Group therapy research

Extensive meta-analyses show that group treatment is equivalent to individual therapy for most conditions, including depression, anxiety disorders and personality disorders

Long-term psychoanalytic group therapy research

• A long-term format, relative to a time-limited short-term format, is more effective for patients with PD

• The sleeper effect: It is at the 7-year follow-up measurements that it becomes clear that patients in the long-term group continued to improve, whereas the progress in the short-term group stagnated or even showed a slight decline

Definition of Interpersonal Learning

• One of the main therapeutic factors in group therapy

• People learn about themselves through interactions with others

• Focuses on:

  • How others perceive you

  • How your behavior affects relationships

  • Changing maladaptive interpersonal patterns

Why is interpersonal learning important?

• Many psychological problems originate in disturbed relationships

• Group therapy provides:

  • Feedback from others

  • Opportunities for new relational experiences

  • Practice of healthier interpersonal behavior

• Helps reduce isolation and improve self-understanding

• Patients experience interactions that differ from past harmful relationships

• Old expectations (e.g., rejection, criticism) are disproven

• Leads to healthier relationship models

The Group as a Social Microcosm

• The therapy group becomes a “mini-version” of the patient’s social world

• Members behave in the group similarly to how they behave outside

• Interpersonal patterns become visible in real time

• Examples:

  • Withdrawal

  • Need for approval

  • Hostility

  • Avoidance of intimacy

Main processes of interpersonal learning

• Maladaptive interpersonal behavior appears in the group

• Group members provide feedback

• Patient gains insight into their behavior

• Patient experiments with new behavior

• Others respond differently

• New interpersonal learning develops

Feedback in Group therapy

• Honest feedback helps patients understand:

  • How others experience them

  • The impact of their behavior

• Feedback should be:

  • Clear

  • Specific

  • Supportive rather than attacking

Insight in Interpersonal Learning

• Insight = understanding:

  • Your interpersonal patterns

  • Their origins

  • Their effects on others

• Insight alone is not enough:

  • Emotional experience and behavioral change are also necessary

Reality Testing

• Group members compare perceptions and reactions

• Helps patients distinguish:

  • Reality

  • Personal assumptions/distortions

• Goal: → More accurate understanding of social situations

Therapist’s Role in Interpersonal Learning

• Encourages feedback

• Helps members recognize patterns

• Maintains safety and cohesion

• Directs attention to here-and-now interactions

• Encourages experimentation with new behaviors

Transfer of learning

Changes in the group generalize to everyday life:

• Better communication

• Healthier relationships

• Increased self-esteem

• More adaptive coping

Definition of Group Cohesion

• The sense of belonging, acceptance, and solidarity within the group

• Often compared to the therapeutic alliance in individual therapy

• Members feel:

  • Accepted

  • Supported

  • Valued

  • Connected to others

• Considered one of the strongest therapeutic factors in group therapy

• Strong cohesion is associated with:

  • Better therapy outcomes

  • Lower dropout rates

  • Greater self-disclosure

  • Higher attendance

  • Increased participation

Group Cohesion as the “Therapy Analogue” to Therapeutic Alliance

• In individual therapy:
  → healing occurs through therapist–client relationship

• In group therapy:
  → healing occurs through relationship with:

  • Therapist

  • Group as a whole

  • Other members

Acceptance by the group

• Reduces shame

• Increases self-esteem

• Encourages openness

• Allows members to reveal vulnerable parts of themselves

Cohesion and Self-Disclosure

• High cohesion promotes:

  • Honest self-disclosure

  • Emotional risk-taking

  • Exploration of difficult experiences

  • Greater authenticity

• Important idea: → People disclose more when they feel accepted and safe

Cohesion and Interpersonal Learning

• Cohesion creates conditions for:

  • Feedback

  • Reflection

  • Emotional correction

  • Interpersonal experimentation

• Without cohesion:

  • Members become defensive

  • Feedback feels threatening

  • Growth becomes difficult

Constructive Conflict in Cohesive Groups

• Cohesive groups:

  • Encourage honest communication

  • Allow emotional expression

  • Support repair after conflict

• Members learn:

  • Relationships can survive disagreement

  • Conflict does not automatically lead to rejection

Therapist’s role in building cohesion

• Creates psychological safety

• Encourages inclusion

• Models acceptance and empathy

• Protects members from humiliation

• Encourages respectful communication

• Helps manage conflict constructively

Factors that increase group cohesion

• Consistent attendance

• Mutual support

• Shared goals

• Trust

• Open communication

• Emotional honesty

• Positive feedback

• Successful conflict resolution