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Irvin Yalom, an outstanding theoretician of the group process has addressed this book to the group therapists on inpatient psychiatric wards. On the premise that the clinical setting of the contemporary psychiatric ward differs radically from conventional group psychotherapy, Yalom suggests the need for significant modification of traditional group therapy techniques and proposes a body of strategies and techniques appropriate to the exigencies of acute inpatient care.
The author visited 25 inpatient units in preparation for this work, interviewing staff and personally observing group sessions. This careful reconnaissance is reflected in his understanding of the multiple variables inherently operative in the inpatient setting. The “stark clinical facts of life” that the inpatient group therapist faces are:
Considerable patient turnover, with an average length of stay of from 1-3 weeks, with a new patient generally present at almost every group session.
Insufficient time for working through or termination.
Great heterogeneity of psychopathology.
All patients are in crisis and in acute discomfort or despair, and they strive for relief from these feelings rather than toward personal growth or self-understanding. Many patients are unmotivated and see no need for therapy.
Therapists frequently do not have time to prepare or screen patients.
Therapists frequently have no control over group composition.
Patients see the group therapist in other roles throughout the day on the ward.