GRUPNOANALITIČKI RAD S OBITELJIMA PACIJENATA SA PSIHOTIČNIM POREMEĆAJIMA (ISKUSTVA IZ PROGRAMA RIPEPP U PSIHIJATRIJSKOJ BOLNICI „SVETI IVAN“)

Grupnoanalitička tehnika, koja se prema literaturi nažalost u praksi rijetko primjenjuje u radu s članovima obitelji oboljelih od psihotičnih poremećaja, omogućuje uvid u korijene psihotičnog poremećaja, modele obiteljske komunikacije i ponašanja te poticanje zrelijih načina komunikacije. Funkcija grupnoanalitičke psihoterapije za članove obitelji jest pružiti olakšanje, potporu i elemente edukacije, ali i omogućiti potrebne promjene. Tijekom terapijskog procesa kod članova obitelji raste samopoštovanje, smanjuje se usamljenost i primjena nezrelih mehanizama obrane te jača osjećaj sigurnosti uz općenito bolje obiteljsko funkcioniranje. Potrebna je prilagodba grupnoanalitičke tehnike ovisno o potrebama grupe i stupnju ostvarene kohezije. Takva terapija može se provoditi u bolničkim, i ambulantnim uvjetima te uvjetima dnevne bolnice.Group analysis allows gaining insight into the roots of psychotic disorders, models of family communication and behaviour, as well as encouraging more mature ways of communication. Unfortunately, by looking at the literature, in practice it is rarely used in dealing with family members of patients suffering from psychotic disorders. The goal of group-analytic psychotherapy for family members is to provide relief, support and educational elements, but also to enable needed changes. During the therapeutic process of family members, the self-esteem increases, the process reduces loneliness and the use of immature defence mechanisms, while the feeling of safety empowers family members and provides better overall family functioning. Customization of group-analytic technique is required, depending on the group’s needs and a degree of achieved cohesion. It is possible to implement this kind of therapy in inpatient, day-hospital and outpatient conditions

PSYCHODYNAMIC GROUP PSYCHOTERAPY IN THE EARLY INTERVENTION PROGRAM FOR PATIENTS WITH PSYCHOSIS (RIPEPP)

Psychiatric Hospital "Sveti Ivan" in Zagreb, Croatia, offers an outpatient Early intervention programme for patients with psychotic disorders (RIPEPP), consisting of psychoeducational workshops and group psychodynamic psychotherapy. Psychodynamic group psychotherapy presents a unique conceptual format not offered by other types of psychotherapy, and it is especially useful for population of patients with psychotic disorders. During group work, gradual establishment of communication and interactions, and creating a network of relations through experiences of corrective emotional symbiosis, affect the constellation of internal objects and relationships between members, and their restructuring. The function of group psychotherapy is not only to offer relief, support, and elements of education, but also to enable internal changes. Therapeutic factors contributing to the improvement of people with schizophrenia include supportive aspects such as universality, acceptance, cohesion, hope and altruism. This paper contains vignettes from inpatient and outpatient group dynamics

NEKA OBILJEŽJA DUGOTRAJNE ANALITIČKE GRUPNE PSIHOTERAPIJE U LIJEČENJU PACIJENATA SA PSIHOTIČNIM POREMEĆAJIMA

U radu je prikazana dugotrajna analitička grupna psihoterapija pacijenata u ranoj fazi psihoze. Na početku dinamikom dominiraju šutnja i regresivno funkcioniranje članova te aktivna uloga terapeuta. Razvojem kohezije pojavljuju se interpersonalne interakcije, razmjena iskustava i emocija te ostvarenje ciljeva početne faze liječenja. U sedmoj godini rada dolazi do raslojavanja u grupi zbog različite razine funkcioniranja članova. Izostanci članova i nejednakost razine funkcioniranja postaju česte teme u grupi. Članovi niže razine funkcioniranja odlaze iz grupe, a u grupu se uključuju novi članovi podjednake razine funkcioniranja te grupa nastavlja s radom. U radu su prikazani primjeri iz grupnog procesa.The paper describes long-term analytic group psychotherapy of patients in the early stages of psychosis. Initially, the dynamics were dominated by silence, regressive functioning of members and an active role of the therapist. With the development of cohesion, interpersonal interactions, the exchange of experiences and emotions, and the realization of goals of the initial phase of healing appear. In the seventh year of the work, there is a stratification in the group due to different levels of functioning. Members’ absences and different levels of functioning become common topics in the group. Members with lower levels of functioning leave the group, and new ones, with equal levels of functioning are included in the group, and the group continues to operate. The paper presents examples from the group process

PERSONALITY CHARACTERISTICS OF PSYCHOTIC PATIENTS AS POSSIBLE MOTIVATING FACTORS FOR PARTICIPATING IN GROUP PSYCHOTHERAPY

Background: This study aimed to examine the relationship between some personality characteristics of patients diagnosed with psychotic disorders and the quality of their engagement in psychodynamic group psychotherapy. Given that previous research has shown that self-stigma is significantly negatively associated with the engagement of patients, the measure of self-stigma was used as a correlate of patients’ motivation to participate in group psychotherapy. Subjects and methods: A total of 48 outpatients (52.1% women; mean age 35.30 years) attending group psychodynamic psychotherapy completed The Inventory of Personality Organization, The Pathological Narcissism Inventory, The Measure of Parental Style, The Relationship Questionnaire, and The Internalized Stigma of Mental Illness scale. Results: The findings showed that patients with higher levels of self-stigma have unhealthy attachments styles, perceived their mothers´ parental style as indifferent and achieved greater scores on narcissistic vulnerability scale. They are also are prone to primitive psychological defences, have poorly integrated identity, and achieved lower scores on reality testing dimension. Conclusion: Taking into account the limitations of this study, these findings may contribute to improved understanding of the quality of participation and engagement of psychotic patients in group psychotherapy, and may help to develop more effective therapeutic approaches

TREATMENT OF PATIENTS IN EARLY PHASE OF PSYCHOSIS ON PSYCHOTHERAPEUTIC INPATIENT UNIT – PRESENTATION OF THE THERAPEUTIC PROGRAMME AND EVALUATION OF SOME ASPECTS

Background: Treatment of early phase of psychosis is important not only for overcoming the acute symptoms but also for the later treatment and attitude towards the illness. Psychotherapeutic approach is an integrative part of this treatment. In Psychiatric hospital "Sveti Ivan" in Zagreb, Croatia both psychotherapeutic and sociotherapeutic methods are used on the inpatient unit for young people with psychosis along with medications. The aim of this work is to present the work on the psychotherapeutic inpatient unit and to investigate whether during the hospitalisation of individuals with first psychotic episode changes occur in attitudes towards medications, quality of life, insight and self-esteem. Subjects and methods: 37 individuals with first psychotic episode (20 men, 17 women) completed the following battery of questionnaires upon hospital admission and before discharge: Drug attitude inventory (DAI-10), The World Health Organization Quality of Life (WHOQOL), Insight scale and Rosenberg’s Self-Esteem Scale. Results: Before being discharged from hospital, patients assessed their quality of life as significantly improved over time (p=0.000), especially concerning their physical health (p=0.004), psychological health (p=0.004), and satisfaction with their environment (p=0.001). Also, positive trends were observed in attitudes towards drugs and self-esteem. No changes were shown regarding patients´ insight. Conclusions: The findings are encouraging: during treatment on psychotherapeutic inpatient unit, significant improvement in quality of life was observed, as well as positive trends in self-esteem and attitudes towards medications

CHANGES IN THE LONG-TERM PSYCHODYNAMIC GROUP PSYCHOTHERAPY IN FAMILY MEMBERS OF PERSONS WITH PSYCHOTIC DISORDERS

Background: The experience gained in working with psychotic persons as well as the findings from the literature have pointed to the need for systematic inclusion of the families of affected individuals, facilitating the creation of partnership within treatment, and to the need for a better understanding of family dynamics that reflects on the psychological conditions of the patients. Aim: The aim of this paper is to explore the changes in self-esteem and loneliness of group members during the therapeutic process and whether the use of more mature defence mechanisms is the answer to the treatment of group psychotherapy. Subjects and methods: We followed three groups of 30 members (18 women and 12 men). At the beginning of inclusion in group psychodynamic psychotherapy and after 18 months of psychotherapy, members completed the following questionnaires: Rosenberg Self-esteem Scale, short version of UCLA Loneliness Scale (ULS-7) and Lifestyle Questionnaire (LSI). Results: The research results show a statistically significant increase in self-esteem, a significant reduction in loneliness, and significantly reduced use of defence mechanisms after 18 months of group psychotherapy. Conclusion: Research findings confirmed positive changes in family members who gradually feel better and safer, with less anxiety and fear, all positively reflecting on the family atmosphere, the ability to accept and understand the sick member, as well as his better quality of recovery

Meaning of symptoms in a schizophrenic patient during and after long-term psychodynamic group psychotherapy

Značajan doprinos psihoanalitičkih teorijskih koncepata i znanja u liječenju shizofrenih bolesnika je u razumijevanju značenja simptoma u kontekstu individualnih životnih događaja. Iako se shizofreni bolesnici međusobno značajno razlikuju, njihovi se simptomi najčešće mogu razumjeti kao obrana od nepodnošljivih iskustava. Svjesna i nesvjesna značenja iskustava derivat su unutarnjeg svijeta individuuma, koji isto tako biva formiran od životnih iskustava, najviše onih iz ranog djetinjstva kada se počinje razvijati osjećaj selfa i identiteta. Mogućnost razumijevanja simptoma i ponašanja shizofrenih bolesnika koju daje primjena psihodinamskih teorija i znanja kao i participacija u psihoterapijskom procesu pružaju kliničarima platformu za cjeloviti uvid u psihodinamiku i funkcioniranje ličnosti pacijenta oboljelog od shizofrenije, a time i adekvatno planiranje terapijskih intervencija i procesa liječenja u cjelini. Rad sadrži prikaz dugogodišnjeg grupnog procesa s kroničnim shizofrenim bolesnicima te razvoj razumijevanja psihotičnih simptoma jednog od članova grupe.Understanding the meaning of symptoms in the context of individual life events would be a significant contribution to psychoanalytic theoretical concepts and knowledge in treating schizophrenic patients. Although schizophrenic patients differ significantly, their symptoms can usually be understood as a defence from unbearable experiences. Conscious and unconscious meanings of experience are a derivative of the inner world of the individual, which is also formed of life experiences; most of them come from the early childhood when the feeling of self and identity begins to develop. The ability to understand the symptoms and behaviour of schizophrenic patients by applying psychodynamic theories and knowledge as well as participation in the psychotherapeutic process provides clinicians with a platform for a complete insight into psychodynamics and functioning of a person suffering from schizophrenia and also contributes to adequate planning of therapeutic interventions and treatment process as a whole. This paper presents a long-term group process with chronic schizophrenic patients and the development of understanding of the psychotic symptoms in one member

DREAMS AND FANTASIES IN PSYCHODYNAMIC GROUP PSYCHOTHERAPY OF PSYCHOTIC PATIENTS

Work with dreams in the group analysis represents an important part of the analytical work, with insight into unconscious experiences of the individual dreamer, and his transferrential relations with the therapist, other members of the group, and with the group as a whole. The way dreams are addressed varies from one therapist to another, and in line with that, members of the group have varying frequency of dreams. In groups of psychotic patients dreams are generally rarely discussed and interpreted by the group, with analysis mainly resting on the manifested content. This paper describes a long-term group of psychotic patients which, after sharing the dreams of several members and daydreams of one female patient, their interpretation and reception in the group achieved better cohesion and improved communication and interaction, i.e. created a group matrix. Furthermore, through the content of dreams in the group, traumatic war experiences of several of the group members were opened and discussed, which brought with it recollections of the traumatic life situations of other group members. In expressing a daydream, a female member of the group revealed the background for her behaviour which was earlier interpreted as a negative symptom of the illness

When is it Necessary to Complete Treatment with Psychodynamic Group Psychotherapy for Patients with Psychosis

O završnoj fazi terapijskog procesa u grupama pacijenata sa psihozom te o načinima izlaska individualnog pacijenta iz grupe relativno malo je pisano u literaturi. Zbog prirode psihotičnog procesa koji remeti funkcioniranje ličnosti u svim aspektima (emocionalnom, kognitivnom, voljno-nagonskom) te osobito na planu interpersonalnog i socijalnog funkcioniranja, ciljevi dugotrajne analitičke grupne psihoterapije mogu se podijeliti na ciljeve rane i kasne faze liječenja. U ranoj fazi liječenja cilj je stabilizacija bolesti, nestanak simptoma, kritičnost prema bolesti i potrebi liječenja, prihvaćanje psihofarmakoterapije, prorada traumatskih iskustava hospitalizacije te stigmatizacije u trajanju od godinu do dvije. U kasnijoj fazi liječenja težimo konsolidaciji selfa, postizanju konstantnosti i viših razina objektnog odnosa, rekonstrukciji mehanizama obrane te uvidu u unutarnje konflikte. Završetak grupne psihoterapije sa psihotičnim pacijentima je visokoindividualan proces u kojem sudjeluju sam pacijent, ostali članovi grupe i terapeut/i. Za većinu psihotičnih pacijenata postignuće ciljeva prve faze liječenja znači i kraj terapije, a za pacijente s većim kapacitetima za psihoterapijski rad i interesom za psihološko moguće je postići i više razine objektnih odnosa i funkcioniranja. U ovom radu prikazujemo iskustva iz dugotrajne grupne analitičke terapije pacijenata sa psihotičnim poremećajima iz ambulantnog programa Klinike za psihijatriju Sveti Ivan. Opisuju se različiti načini izlaska pacijenata-članova grupe iz grupne psihoterapije, a zajedničko obilježje je odsutnost procesa prorade separacije bez obzira na dužinu participacije u grupi, postignute pomake te terapijski dogovor.Relatively little has been written in the literature about the final phase of the therapeutic process in groups of patients with psychosis and about the ways in which an individual patient leaves the group. Due to the nature of the psychotic process that disrupts the functioning of personality in all aspects (emotional, cognitive, volitional-instinctual) and especially in terms of interpersonal and social functioning, the goals of long-term analytical group psychotherapy can be divided into the early and late phases of treatment. In the early phase of treatment, the goal is the stabilisation of the disease, disappearance of symptoms, critical attitude towards the disease and the need for treatment, acceptance of psychopharmacotherapy and processing of traumatic experiences of hospitalisation and stigmatisation for one to two years. In the later phase of treatment, we strive to consolidate the self, achieve constancy and higher levels of object relationship, reconstruct defence mechanisms and gain insight into internal conflicts. The completion of group psychotherapy with psychotic patients is a highly individual process in which the patient, other members of the group and the therapist(s) participate. For most psychotic patients, achieving the goals of the first phase of treatment means the end of therapy, and for patients with greater capacity for psychotherapeutic work and interest in psychology it is possible to achieve higher levels of object relations and functioning. In this paper, we present the experiences obtained in a long-term group analytical therapy of patients with psychotic disorders from the outpatient programme of the Psychiatric Hospital Sveti Ivan. Different ways patients (group members) leave group psychotherapy are described where the common feature is the absence of processing separation regardless of the length of participation in the group, the progress made and the therapeutic agreement