lecture on groups held in conference of dynamic psychiatry, St. Petersburg, 2014

1. Unus pro omnibus, omnes pro uno:
Group Work in a
Community Mental Health Clinic
in a Bi-National Town

2. 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

4. The Middle East

5. ISRAEL

6. Acre

7. 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

8. 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

9. Therapeutic Modalities
Psychiatric (psychopharmacologic)
Individual psychotherapy
Group psychotherapy
Rehabilitation
commonly some modalities are operated
simultaneously, by different staff members

10. 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

11. 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

12. 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

13. On the nature of therapeutic
group work
People 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)

14. 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)

15. 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

16. 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.

17. Groups in our clinic:
DBT for young borderline female patients (M.
Linehan) (with J. Sherr, M. S. W)

18. 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.)

19. 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

20. 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)

21. 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

22. 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

23. Thank you for listening and so long from
Israel