[Symptom-centered group therapy for phobias--the problem-oriented workshop in psychotherapy].

Abstract

Short term psychotherapy is increasingly recognized as a socioeconomic necessity. Problem-oriented treatments, particularly if applied in problem-homogenous groups, are one means of economizing and sometimes even improving psychotherapy. They also require a re-evaluation of the nature of the patient-therapist dyad. The "task-oriented small group" as a basic field of human interaction has been studied intensively in experimental social psychology. Nevertheless, group psychotherapy and behavior therapy have largely neglected group-specific aspects of such variables as cohesion, task-orientation, modelling, mutual self-help, risk-taking, motivation and insight. This paper outlines some recent changes in this respect, and discusses in particular the "symptomoriented peer workshop" as a treatment milieu. The general therapeutic potential of the peer workshop is briefly assessed with regard to the application of the above mentioned group variables in peer self-help groups, rehabilitation programs for the chronically hospitalized, symptom or depth-treatment in short-term psychotherapy, and in re-education programs for problem-children. The main concern is with its specific application to the treatment of phobias. Phobias are comparatively easy to define, yet are often connected with other personality problems. This has made them a model-problem in the arguments about symptom-substitution between "psycho"- and "behavior" -therapists, and it has stimulated discussion as to how behavior-focused treatments affect cognition and emotion, and to what extend depth and insight-oriented therapies change behavior. The interaction between treated and non-treated problems, and the behavioral, cognitive and emotional effects of differential treatment ingredients are discussed with special reference to the first controlled study in behavior therapy, that applied behavior-focussed confrontation with reality (flooding in vivo) under the sociodynamics of the small gsoup. Problem-focussed retraining under real-life conditions (reality testing) as group-therapeutic fieldwork can be a means of treatment in its own right may open up the patient for subsequent attempts to tackle more complex problems, or may just be an adjuvant in a multi-level approach. This certainly applies for phobias and can probably be generalized to other problems.