Introduction

It is a well-established principle in medical practice that patients' autonomy and self-regard are enhanced if the clinician does nothing for them that they can do for themselves. This principle underlies the philosophy of community care and is found again in group therapy where the 'community' is called into the consulting room and, with the therapist, becomes the therapeutic agent. The therapist's first challenge is to assemble a group of people who can contribute to a commonly held resource from which they can each derive benefits. The second challenge is to do nothing for them, in the context of the group, that they can do for themselves and one another. Today group therapy is one of the most widely practised treatment methods in psychiatry with an extensive literature.

In this chapter we first provide a simple classification of the different methods and applications, and a historical overview of their evolution this century. We discuss the main theoretical models, explore the dynamic life of therapy groups, and consider some of the key clinical issues facing practitioners, their applications to a range of patient populations and settings, and their evaluation and justification. In conclusion, we consider the planning of group services and the training of their practitioners.

It has been clearly demonstrated that group psychotherapy is effective. Some 700 studies spanning the past two decades have shown that the group format consistently produced positive effects with diverse disorders and treatment models. (I) These show that both individual and group psychotherapy will produce much the same results. Importantly, for group therapy to be effective it has to utilize those therapeutic factors originally laid out by Foulkes and later by Yalom—the group has to be the primary focus of therapy, patients need to be well selected, and therapists need to be adequately trained. The chapter will address these questions of focus, selection, and training.

Brown and Pedder's Introduction to Psychotherapy(2) sets group therapy in context. Stock Whittaker's introduction, Using Groups To Help People}3) and Aveline and Dryden's Group Therapy in Britain Today(4) give a good general overview of past United Kingdom practice. A recent introduction by Barnes et al.and the Workbook of Group-analytic Interventions(6) introduce the group-analytical approach. The range of other books in the nternational Library of Group Analysis and the journals Group Analysis and International Journal of Group Psychotherapy give access to the many specialist applications discussed here. Although the two authors of this chapter are both group analysts, we have set out to provide a full account of the range of applications, methods, and models in current group work practice.

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