입원 및 외래 집단정신치료에서의 치유인자들에 대한 비교 연구

A Comparative Study on Therapeutic Factors in In-Patient and Out-Patient Group Psychotherapies

A questionnaire was administered to 38 in-patients and 18 out-patients in an attempt to assess which specific factors are helpful to each of the psychotherapy groups and also comparative value of therapeutic factors operate in these two settings. These two settings differ greatly, both in terms of the patient population they serve and the over-all systems within which they operate. We supposed that the theoretical considerations, practical techniques and important therapeutic factors of out-patients group psychotherapy may not always be applicable to in-patients. This paper aims to explore the therapeutic factors operating in both in-patient and out-patient psychotherapy groups, so as to provide useful guidelines for clinicians running groups in these contrasting areas of psychiatric practice. In-patient groups valued instillation of hope and interpersonal learningC out-put), but outpatient groups especially valued self-understanding. Both groups placed a high value on cohesiveness. Also in-patient groups gave relative importance to the guideline and altruism but out-patient groups perceived universality and family re-enactment as more helpful. These results show that in-patient and out-patient groups differ considerably in terms of therapeutic factors perceived to be helpful. It is suggested that these differences are a consequence of the interplay between the in-patient’ s unique experience of himself and his participation in only the early and developmental stages of the group. The discrepancy between the factors valued by in-patient and out-patient groups would suggest that the theoretical assumptions and practical techniques utilized by out-patient group therapists may need modification if they are to be used more effectively with psychiatric in-patients. In-patient group therapists should encourage factors related to the here and now interpersonal behavior, cohesiveness, instillation of hope and guidance. By contrast, it is more appropriate for out-patient group psychotherapists to focus on the self-disclosure, insight and self-understanding. However, it is difficult to assess the extent to which clinical practice will be influenced by this work on therapeutic factors.