Academic journal article The Spanish Journal of Psychology

Group Psychotherapy of Psychosomatic Outpatients - Analysis of the Ten First Sessions

Academic journal article The Spanish Journal of Psychology

Group Psychotherapy of Psychosomatic Outpatients - Analysis of the Ten First Sessions

Article excerpt

This work presents a description of a psychotherapeutic group of psychosomatic patients conducted in an out-patient setting. We show the gains of insight in the group's organization and inter-personal communication, as well as the relief of symptoms in seven patients attended by this psychoanalytically oriented group therapy. We discuss the extent and the limits of the group technique for such patients and we conclude with some proposals about the efficacy of this therapeutic approach.

Keywords: psychoanalysis, psychosomatics, groups, psychotherapy

Este trabajo presenta la descripción de un grupo psicoterapéutico de pacientes psicosomáticos llevado a cabo en un entorno ambulatorio. Mostramos las ganancias de "insight" en la organización y la comunicación interpersonal del grupo, además del alivio de síntomas en siete pacientes atendidos por esta terapia de grupo de orientación psicoanalítica. Comentamos la extensión y los límites de la técnica grupal para estos pacientes y concluimos con unas propuestas acerca de la eficacia de este enfoque terapéutico.

Palabras clave: psicoanálisis, psicosomáticos, grupos, psicoterapia

In this paper we aim to describe in some detail the first 10 sessions of a psychotherapeutic group, conducted based on the psychoanalytical approach for group psychotherapy (Anzieu, 1987; Bach, 1972; Bion, 1970; Foulkes & Anthony, 1972; Käes, 1976, 1997; Pichon-Rivière, 1998). The group was composed of a psychotherapist, two observers and patients with psychosomatic symptoms, with therapy being conducted in the out-patients department of a public general hospital in Sao Paulo, Brazil.

The group setting is conceived as a space for the individual expression of members' singular histories. It is also an ambient where group phenomena occur; identifications, transferences and link processes can be acknowledged and translated. We understand the group as a privileged therapeutic space, inasmuch as it is within the group that the historical components of each member's subjectivity are updated by the very act of expression. It is in the links that psychical organization is accomplished; by interaction, the crossed identifications that sustain the elaboration of the individuals' identities will transit making them meaningful.

The basic proposal of this therapeutic group of psychosomatic patients seen in the out-patients department is to provide a setting where, from the beginning, there is recognition of the common nature of their symptoms. The group works as a special type of mirror, where participants are able to see themselves reflected in others organized around a common production axis. The model for the psychoanalytical understanding of symptoms in general, and also for psychosomatic symptoms, conceives them as a language, where what is expressed is the totality of the conflicts that are present in the interior of each psychic apparatus. If the symptom is a translation, then the group becomes the ambient for reciprocal translation. The therapist has the role of collecting the expressions of each patient emerging from the interactions among group participants, searching for unconscious determinants that struggle to be expressed and find their symptomatic path in the suffering body.

The therapeutic group is guided towards the verbal dimension, inhibiting the manifestation of actions and behavior discharges, as these, in general, are considered substitutes for the elaboration process (acting out). The group is, therefore, stimulated to speak, discuss and to interact. It is from the whole set of links and interactions of the group discourse, that the therapist searches for the elements that can explain the individual and group aspects that constitute the psychical life of the participants and, especially, the symptomatization process specific to each subject.

On many occasions, psychosomatic symptoms may function as body symbols, as was proposed by Georg Groddeck (1984, 1992) and Joyce McDougall (1991). …

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