Możliwości i ograniczenia muzykoterapii i psychodramy w leczeniu osób ze schizofrenią
Perspectives and limits of music therapy and psychodrama therapy in the treatment of schizophrenia
Basic problems of the treatment of schizophrenic patients by means of music therapy and Moreno’s psychodrama were outlined. The sonority area of psychotic patients, function of music background in the psychiatric ward, as well as therapeutic specific of music in schizophrenia was discussed. In the case of psychodrama the importance of the body area was indicated. In both methods the development and self-identity building process of the psychotic patients was presented. Using of the techniques compatible with the development phases of the patient (see the Moreno’s theory of role development), building of an internal (different kinds of „anchoring and musical inoculating”) and a social (rules, institutional frames, systematic therapeutic work, distinct rules of the game in music therapy and psychodrama) „structure” of the patient was discussed.
The examples of the therapeutic activity, directing the following goals were given: 1. Integration of a patient in the acute phase of psychosis into the therapeutic group. 2. Assistance in solving everyday problems. 3. Presentation of the personality parts, which are difficult to verbalise and contact (possibility of secure self-expression by means of musical instruments or playing the „bad” role, being sometimes part of productive symptoms or gaining of independence, self–reliance and force, by means of playing the role – opposite to the role played in the real life). The following indications and limitations for music therapy were mentioned: 1. Providing and watching the proper stimulation level. 2. Preventing music from being the autistic object for the patient. 3. The choice of the therapeutic program, which would not display patient’s deficits, which he is unable to compensate for, in order to prevent ‘permanent defeats’ of the patient. 4. Expression of aggression by means of a musical instrument preventing him from loosing control.
Referring to psychodrama the following advice is given: 1. More frequent use of group games. 2. Avoiding long biographical psychodramas with a protagonist. 3. Doubling technique in the goal of auxiliary „self” installation or filling-in of empty interior and making contact with oneself rather, then for emotional cathartic doubling. 4. Being careful when using the technique of changing the roles (the patient dropout of the role). The effect of both methods is the growth of energy, activity, openness, spontaneity and creativity of the patients.
„Organiczność” w psychoterapii, psychoterapia w „organiczności”
Organics in psychotherapy, psychotherapy in organics
It is considered that patients with symptoms of organic disorders are not very susceptible to psychotherapeutic methods of treatment. Specific traits of their functioning - memory, thinking and emotional disorders - to a large extent make it difficult for these patients to gain insight into their experience and functioning, as well as consequences of these in social relations. These patients have a tendency to reduce the world to well-understood (by them) stereotypes and schemas, caused by their incomplete psychic possibilities and this stands in contradiction with the aims of the therapy, which are to enrich the number possibilities of behaving. The therapy may be also difficult due to the ambivalence towards the possibility of improvement due to secondary gains from the fact of being ill. Difficulty in adaptation (also to the situation of therapy) arising from the stiff cognitive processes of the patients, make it essential for the therapist to be maximally open and flexible in choosing the methods of acting. Realistic, limited aims of therapy allow to avoid frustration in both participants of the therapeutic relationship, which in turn benefits the atmosphere of the sessions and their effectiveness.
Terapia grupowa jako forma zakończenia długoterminowej terapii indywidualnej pacjentów z zaburzeniami osobowości
Group therapy as a form of an ending of long-term individual therapy in patients with personality disorders
The author describes her experience in leading group psychotherapy of patients with personality disorders. The effects of the psychotherapeutic process are presented.
Ryszard Kamiński, Magdalena Letkiewicz, Agata Lisiecka
Motywacja do poddania się terapii na oddziale dziennym — analiza przypadku
The motivation to a day care treatment — a case study
The authors present the role of motivation in the treatment of patients with schizophrenia in a day care unit. The paper includes a case study, which shows the influence of different sources of motivation for the outcome of the treatment.
Włączanie dzieci do terapii w terapii strategicznej na tle innych podejść
Including children into the family therapy in strategic therapy basing on other family therapy approaches
The article presents benefits deriving from including children into the family therapy. Basing on views held by outstanding representatives dealing with family therapy, an attempt was undertaken to justify the necessity of carrying out therapy with the inclusion of all the family members. Opinions were quoted in the work on the subject under question expressed by representatives of psychoanalytical, behavioural and contextual family therapy, as well as the symbolic family therapy and therapies referring to the systemic approach, that is the communicative, strategic and structural family therapy.
While presenting standpoints of such theoreticians and practitioners in the field of family therapy as V. Satir, S. Minuchin or H. Stierlin, a number of advantages deriving from participation of the whole family in the therapy progress were distinguished. The following aspects, among others were pointed to: possibilities of a more discriminating cognition of the functioning of the family as a whole, more perfected modification and ‘training’ in ways of communication (communicating between each other) in the family, a more efficient restoration of desired roles in the family and group work on concrete problems.
A lot of attention was also paid to activities preceding the inclusion of children into family therapy. The most important ones comprise the following: determining the lower age limit of the children participating in the therapy, establishing the moment of including them into the therapy, the duration of their participation, taking the decision whether or not all the children of a given family should take part in the therapy, or only the ones displaying symptoms.
Difficulties which may occur in the therapist’s work when the latter decides to work with the whole family together, as well as ways of checking and dealing with them. Situations were specified which require that family therapy should be carried out without children (e.g. discussing matters pertaining to sexual life) in order that full intimacy and possibility of open presentation of their viewpoints could be guaranteed to the parents.
Aleksandra Duława, Konrad Dzikowski, Anna Kacperek, Bartosz Puk, Małgorzata Zajączkowska
Ramy czasowe a efektywność psychoterapii
Time limits and the effectiveness of psychotherapy
The study examined effectiveness of psychotherapy in two groups of patients with anxiety disorders. Authors compared results of treatment in two 45-patients groups. The first group treated from 1990 to 1995 was under the unlimited time of treatment and the second one (treated from 1997 to 2000) was under predicted (10 weeks) unchangeable time of treatment. The study shows that effectiveness of psychotherapy in a group where the length of therapy was unlimited is higher.
Sylwetki psychoterapeutów - Rozmowa z Hanną Jaklewicz.