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The document summarizes group therapy work at a community mental health clinic in Acre, Israel that serves both Jewish and Arab clients. The clinic uses various group therapy modalities to treat patients with diagnoses like psychosis, personality disorders, mood disorders, anxiety, trauma and comorbidities. Groups are used because they provide universality, opportunities for sharing and learning from peers, and a safe place to explore personal issues. Unique challenges include addressing relations between Arab and Jewish clients and influences of traditions and community. The conclusion is that while not all patients are suitable for groups, many benefit from the social support, learning, and self-expression opportunities groups provide.

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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 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)
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