Читать книгу Mind-Body Medicine in Inpatient Psychiatry - David Låg Tomasi - Страница 19

Following the classical, clinical, evidence-base models of individual psychotherapy, the University of Vermont Medical Center Psychotherapists/Group Therapists offer group sessions to both Inpatient Psychiatry Units Shepardson 3 and 6. In particular, patient have the opportunity to learn about new coping skills from a theoretical perspective and apply those skills in practice, through patient-provider and peer-to-peer interactions. As group sessions cover cognitive, behavioral, dialectic, emotional, biographical, stressor-, trigger-, or trauma-related issues and specific psycho-diagnostic aspects, patient can rehearse their behavior in a safe, nurturing, and supportive environment before “dealing with the real world out there.” Thus, patient are encouraged to internalize skills and focus on preventive, positive, and effective psychological and physical habits in regard to their health and wellbeing. In this context, mind-body medicine is not only understood in theory, but its benefits are demonstrated in vivo during group sessions. Good examples of this are self-esteem, self-image, nutrition, exercise, gentle movement, meditation, mindfulness, relaxation, dance-music and art therapy sessions. Of course, given the nature and structure of a group therapy session, these areas of clinical intervention are often addressed by allowing the patient to freely relate to her/his personal outlook in life, attitude, philosophy, culture, upbringing, and even spiritual or religious (or lack thereof) interpretation of thoughts, behaviors, and events. Since the context of intervention is a shared environment, some of the challenges the therapist may encounter in providing support and guidance to patients are the differences in this very interpretation. In other words, after elements of cognitive distortions and poor communication or coping skills are addressed, the therapist needs to investigate, understand and “positively (re)direct” differences inn opinions among patients. Thus, the therapist does not have to necessarily embrace-support or reject-confute patients’ philosophies (unless they are, again, connected to cognitive distortions and other areas in need of clinical intervention) but help clarify more effective way of implementing such views in the everyday struggle the patient has in her/his path to recovery. A very commonly used therapeutic model in this sense is offered by the guidelines described by Irvin Yalom in “The Theory and Practice of Group Psychotherapy” (1977). In the concept of Universality, Yalom focuses on the recognition of shared experiences and feelings among patients, in order to promote understanding, tolerance, validation, and mutual support. These elements, together with self-esteem are also connected to the concept of altruism, to develop inter-relational (again, patient-provider and peer-to-peer) support strategies and coping mechanisms. With “instillation of hope”, Yalom refers to the inspiration patients get from the group experience, by learning about the struggles and the success stories of other patients. Imparting information works in a similar way, albeit through fact-based examples of treatment strategies. Issues related to elements of influence, transference vs/counter-transference, interpretation, and identification, especially in the context of close friends vs. family members and support groups, are discussed as part of corrective recapitulation. These areas, together with the focus on childhood and teenage years experiences guide the patient to the next concept of “developing socializing techniques” and imitative behavior, via the understanding and application of modeling processes. “Cohesiveness” is used by Yalom as the cornerstone, the pillar, the “primary therapeutic factor from which all others flow” (Yalom, 1977) to address the very social nature of human beings. As we have seen in the discussion above, and we will further explore in Chapter 5, philosophy plays a fundamental role in the therapeutic process. Yalom defines “Existential factors” following models at the center of existentialism to foster personal responsibility in behavior and decision-making processes. “Catharsis” instead targets emotional distress in opposition to free expression, to work on low self-esteem, shame, guilt, and negative-ruminative factors. Finally, “Interpersonal learning” can be considered the very definition of a group therapy session aimed at improving self-awareness in relation/in the presence of others, which in turns fosters “self-understanding” and personal awareness.

All these elements help patient “find meaning in the process.” However, to fully relate to the need of each individual, also in a group context, therapist might also rely on non-existentialist perspectives close to patients’ worldviews or by combining existentialist perspectives with more spiritual-based strategies. A good example of this is the combination of spiritual care groups directed by the psychotherapist and individual meetings lead by the UVM Medical Center Spiritual Care Department. Since the main goals is working on the whole wellbeing of the mind and body of the patient, some groups will directly target these aspects, by guiding the patient in asking questions pertaining to life meaning and purpose in an effective way (as opposed to circular, ruminative, and negative-distorted way) while working on practical application of the new learned skills.

A very important aspects of therapy utilized regardless of the typology of session offered, is the connection between mind and body. This connection is in turn strengthened through area-specific exercises, via cognitive-behavioral strategies as well as by allowing patients to fully and freely express themselves beyond the classic tasks required in therapy. In other words, the maieutic element of therapy, i.e. the “Socratic method” at the center of the conversation, often serves as an “ice-breaker” for a new awareness (again, awareness of mind and body) of the patient, especially in relation to her/his self and the internal-external environment, her/his history, life experiences, relationships, and traumatic experiences. To best explain these aspects, we want to provide brief descriptions—developed by the members of the Group Therapy Department and included in the original Inpatient Psychiatry Patient Handbook—for some of the most effective15 group therapy sessions offered on the Inpatient psychiatry unit, simply listed in alphabetical order, and presented as directly referred to the patient (thus often utilizing the pronoun “you”):