Hand I
Fortschr Neurol Psychiatr Grenzgeb. 1975 Jun;43(6):285-304.
Short term psychotherapy is increasingly recognized as a socioeconomic necessity. Problem-oriented treatments, particularly if applied in problem-homogenous groups, are one means of economizing and sometimes even improving psychotherapy. They also require a re-evaluation of the nature of the patient-therapist dyad. The "task-oriented small group" as a basic field of human interaction has been studied intensively in experimental social psychology. Nevertheless, group psychotherapy and behavior therapy have largely neglected group-specific aspects of such variables as cohesion, task-orientation, modelling, mutual self-help, risk-taking, motivation and insight. This paper outlines some recent changes in this respect, and discusses in particular the "symptomoriented peer workshop" as a treatment milieu. The general therapeutic potential of the peer workshop is briefly assessed with regard to the application of the above mentioned group variables in peer self-help groups, rehabilitation programs for the chronically hospitalized, symptom or depth-treatment in short-term psychotherapy, and in re-education programs for problem-children. The main concern is with its specific application to the treatment of phobias. Phobias are comparatively easy to define, yet are often connected with other personality problems. This has made them a model-problem in the arguments about symptom-substitution between "psycho"- and "behavior" -therapists, and it has stimulated discussion as to how behavior-focused treatments affect cognition and emotion, and to what extend depth and insight-oriented therapies change behavior. The interaction between treated and non-treated problems, and the behavioral, cognitive and emotional effects of differential treatment ingredients are discussed with special reference to the first controlled study in behavior therapy, that applied behavior-focussed confrontation with reality (flooding in vivo) under the sociodynamics of the small gsoup. Problem-focussed retraining under real-life conditions (reality testing) as group-therapeutic fieldwork can be a means of treatment in its own right may open up the patient for subsequent attempts to tackle more complex problems, or may just be an adjuvant in a multi-level approach. This certainly applies for phobias and can probably be generalized to other problems.
短期心理治疗日益被视为一种社会经济需求。以问题为导向的治疗方法，特别是应用于问题同质群体时，是一种节省心理治疗成本且有时甚至能改善治疗效果的手段。它们还需要对患者与治疗师二元组的性质进行重新评估。“任务导向型小群体”作为人际互动的一个基本领域，已在实验社会心理学中得到深入研究。然而，团体心理治疗和行为治疗在很大程度上忽略了诸如凝聚力、任务导向、模仿、互助、冒险、动机和洞察力等变量的群体特定方面。本文概述了这方面最近的一些变化，并特别讨论了“以症状为导向的同伴工作坊”作为一种治疗环境。关于上述群体变量在同伴自助小组、长期住院患者的康复项目、短期心理治疗中的症状或深度治疗以及问题儿童的再教育项目中的应用，对同伴工作坊的一般治疗潜力进行了简要评估。主要关注的是其在恐惧症治疗中的具体应用。恐惧症相对容易定义，但往往与其他人格问题相关。这使其成为“心理”治疗师与“行为”治疗师之间关于症状替代争论中的一个典型问题，并且激发了关于以行为为重点的治疗如何影响认知和情感，以及以深度和洞察力为导向的治疗在多大程度上改变行为的讨论。结合行为治疗中的第一项对照研究，特别讨论了已治疗问题与未治疗问题之间的相互作用，以及不同治疗成分的行为、认知和情感影响，该研究在小群体的社会动力学下应用了以行为为重点的现实对抗（现场冲击疗法）。在现实生活条件下以问题为导向的再训练（现实检验）作为团体治疗的实地工作本身可以成为一种治疗手段，可能会使患者为后续解决更复杂问题的尝试做好准备，或者可能只是多层次方法中的一种辅助手段。这肯定适用于恐惧症，并且可能可以推广到其他问题。
