집단정신치료

이후경,오병훈 최신의학사 1987 最新醫學 Vol.30 No.1

문제행동 청소년을 위한 대인관계 집단치료의 효과

이후경,김선재,윤성철,안현주,봉수연 대한신경정신의학회 2003 신경정신의학 Vol.42 No.5

Effects of Interpersonal Group Therapy for Adolescents with Behavioral Problems*

품행장애 청소년을 위한 외래집단정신치료 치료요인

이후경,김선재,차정화,봉수연,안현주 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 집단정신치료는 또래집단을 중요시하는 품행장애 청소년의 치료로서 매우 효과적인 것으로 알려져 있으나 한국에서는 아직 활성화되지 못하고 있다. 이에 따라 저자들은 품행장애 청소년에게 효과적으로 적용될 수 있는 폐쇄형, 동질적인, 시간제한(10회), 외래집단정신치료를 주 1회 실시하였다. 본 연구의 목적은 ①품행장애 청소년을 대상으로 집단정신치료를 시행하여 효과성을 평가하고, ②치료요인을 조사하여, ③ 집단정신치료를 품행장애 청소년에게 효과적이면서 효율적으로 적용될 수 있는 치료방법으로 정착시키는 데 있다. 대상 및방법: 본 연구는 1998년 10월붜 12월까지, 1999년 4월부터 6월까지 두차례에 걸쳐 실시하였다. 대상군은 품행장애 범주에 해당하는 H고교 2학년 여학생 총 18명(4명 도중 탈락), 대조군은 같은 범주에 해당하는 H고교 2학년 여학생 중 치료에 참여하지 않은 총 18명(4명 도중 탈락)이었다. 평가도구로는 프로그램 실시 전후에 자기보고식 비행척도, 공격성척도, 충동성척도을 시행하였고, 매 회기가 끝난 직후 Yalom의 13가지 치료요인척도, 집단치료 만족도 설문지를 시행하였으며, 종결모임시 총평가 설문지를 시행하였다. 결과: 치료요인의 변화를 집단발단단계에 따라 전후반기로 나누어 비교하였을 때, 전반기(1∼5회)에 상위를 차지한 치료요인은 순서대로 실존적인자, 보편성, 카타르시스, 리더와의 동일시, 구성원과의 동일시이었으며, 후반기(6∼10회)에 상위를 차지한 치료요인은 카타르시스, 실존적인자, 리더와의 동일시, 구성원과의 동일시, 구성원의 조언이었다. 전반기에 비해 후반기에 상대적으로 카타르시스, 구성원의 조언이 상승하였고 보편성은 하락하였다. 이타주의와 일차가족집단의 교정적 반복발달은 전후반기 모두 최하위를 기록하였다. 집단치료 만족도 설문에서 전반기는 45.7%, 후반기에는 83.3%가 도움받는 것으로 나타났고, 총평가 설문에서 85.7%가 기회가 있다면 다음에도 참여하고 싶다고 보고하였다. 결론: 시간제한 외래집단정신치료가 품행장애 청소년 에게 적용할 때 매우 효과적이면서도 만족도가 높은 것으로 나타났다. 청소년을 대상으로 외래집단정신치료를 시행하는 것은 구성상의 어려움, 동기부족, 기금부족 등, 여러 제반 문제가 있으나 확대 시행되어야 할 것으로 생각된다. Objectives: Group psychotherapy is known to be an dffective treatment program for adolescents who attach importance to peer relationship, but it is not activated in Korea. Therefore, researchers performed weekly the closed, homogeneous, time-limited(10 sessions), outpatient group psychotherapy for adolescents with conduct disorder. Objectives of this study were as follows ; first, we practiced the group psychotherapy for adolescents with conduct disorder and evaluated its effectiveness ; second, we examined the therapeutic factors which were used by participants ; third, we intended to settlee down the group psychotherapy for adolescents with CD as an effective and efficient treatment modality. Methods: This study was performed two times from October to December in 1998 and from April to June in 1999. It was sponsored by Youth Counselling Center in H city. The case group were composed of 15 female students who were second grade in H high school, and 4 students were dropped out. The control group were composed of 18 female students who were same grade in H high school and 3 students were dropped out. Before and after this program, self-report delinquency scale, aggression scale and impulsivity scale were asked to them. And just after each session, Yalom 13 therapeutic factors scale and satisfaction questionnaire for group psychotherapy were asked to them. And at last meeting, total assessment questionnaire was asked to them. Results: We compared the change of therapeutic factors between the former half sessions (1-5) and the later half session(6-10), and the results were as follows ; in the former half, the upper ranks of therapeutic factors were existential factor, universality, catharsis, identi- fication with leader, and identification with members in order. And in the later half, the upper ranks of therapeutic factors were catharsis, existential factor, identification with leader, identi - fication with members, and guidance of members in order. The rank of catharsis and guidance of members went upward and the rank of universality went downward when we compared the ranks in the former half to those in the later half. Altruism and family enactment were the lowest ranked in both half. The satisfaction questionnair for group psychotherapy showed to be helped by participants at the rate of 45.7% in former half, 83.3% in later half. The total assessment questionnaire showed the willingness of re-participation at the rate of 85.7% if future opportunity of group psychotherapy is given for them. Conclusions: The time-limited group psychotherapy for adolescents diagnosed by conduct disorder was very effectively practiced and the participants reported high level of the satisfaction. The outpatient group psychotherapy for adolescents would be expanded and practiced though there are several accompanied problems including the difficulty of structuring, the deficit of motivation, and financial problem.

영남문집해제 : 외재집

이후경 영남대학교 민족문화연구소 1988 민족문화연구소 자료총서 Vol.4 No.-

집단정신치료:이론과 실제

이후경 대한신경정신의학회 2002 신경정신의학 Vol.41 No.2

본 논문은 집단정신치료의 전반적인 이해의 제고를 목적으로 하여 집단정신치료의 이론과 실제에 초 점을 맞추어 기술하였다. 집단정신치료의 이론은 정신분석 이론과 인지행동 이론이 비교적 영속적인 것으로 인정받고 있지만 오늘날 모든 다양한 이론들이 실질적으로 집단정신치료를 더욱 생동적이고 살아있는 치료 양식으로 만 들어 준다. 최근 집단치료자들이 선호하는 이론적인 배경에 따른 집단정신치료를 중요한 순서대로 나 열하면 다음과 같다. 정신역동/정신분석, 전체로서의 집단/체계 이론, 교류분석/게스탈트/재결단, 대인 관계/상호작용, 인지/행동, 대상관계, 집단분석, 사이코드라마, 실존주의/인본주의, 자기 심리학이다. 집단정신치료의 실제는 환자의 증상 호전 및 성격 재건을 위한 치료 집단, 일반인의 자기 성장 및 자기 실현을 위한 만남 집단, 일반인이나 전문가의 인간관계 훈련 및 자기 성숙을 위한 훈련 집단, 환 자들과 가족들의 교육 및 지지를 위한 자조 집단으로 나눌 수 있다. 집단정신치료는 정신치료에서 뿌리를 두면서 정신치료와 버금가게 치료효과가 있는 것으로 공인된 치료 양식이다. 최근 선진국에서는 의료보험 재정의 압박으로 개인정신치료의 비중이 날로 줄어들고 있다. 이에 따라 치료적인 효과성과 비용효율성이 입증된 집단정신치료의 중요성이 점증하고 있다. The aim of this article is to understand group psychotherapy. In group psychotherapy, psychoanalytic theory and cognitive-behavioral theory have been accepted as perennial effective therapeutic modalities. But nowadays, all theories give the group psychotherapy vitality and liveness as a therapeutic modality in practical setting. The orders of the group psychotherapy that current therapists prefer according to their theoretical background are as follows:psychodynamic/ psychoanalytic, group as a whole/systems, transactional analysis/gestalt/redecision, interpersonal/ interactional, cognitive/behavioral, object relations, group analysis, psychodrama, existential/humanistic, and self psychology. The practice of group psychotherapy includes four therapy group, encounter group, training group, and education group or self-help group. Therapy group has the goal of symptom relief and personality reconstruction for patients. Encounter group has the goal of self growth and self realization for nonpatients. Training group has the goal of training in human relationship and self maturation for mental health personnels. Self help group has the goal of education and support for patient families and patients. Group psychotherapy has been accepted as a therapeutic modality that are equally effective as individual psychotherapy although group psychotherapy has been derived from individual psychotherapy. Recently, individual psychotherapy has been less practiced yearly because of the pressure of economic difficulties of medical insurance in developed countries. Therefore, the importance of group psychotherapy with its therapeutic effectiveness and cost-efficiency is uprising

청소년 집단정신치료

이후경,김선재 대한신경정신의학회 2001 신경정신의학 Vol.40 No.5

연구목적: 집단정신치료(이하 집단치료라 함)는 개인정신치료에 비해 경제적이면서 청소년에게 특별히 효과적이다. 향후 청소년 문제에 대한 중요성이 부각되고 국가 정책적인 관심이 증대되면 청소년 집단치료가 더욱 활성 화될 것이다. 이에 따라 저자는 청소년 집단치료의 전반적인 이해의 제고를 목적으로 종설을 작성하였다. 방 법: 본 논문은 과거 국내외 청소년 집단치료에 관련된 논문들을 검색 정리하고, 청소년 입원집단과 외래집단에 대한 저자의 오랜 임상경험 및 연구결과를 기초로 하여 구성되었다. 본 논문은 집단치료의 역사, 이론, 모델, 발달단계, 치료요인의 순서로 기술되었다. 결 과: 집단치료 이론은 200여 개의 정신치료 이론에 영향을 받았는데, 이 중 정신분석적 이론과 인지행동 이론 이 비교적 영속적인 것으로 인정받고 있다. 최근 국내에서 청소년상담실과 종합사회복지관을 중심으로 구조 화된 인지행동 집단치료가 널리 보급되어 있다. 그런데 이는 기술훈련과 문제해결 중심으로 시행되어 원인적 인 통찰을 기초로 한 궁극적인 행동변화가 어렵다. 이에 반하여 정신분석적 집단치료는 청소년의 보편적인 가치관, 집단규범 및 규칙, 신뢰감, 공동체의식을 심어주는데 보다 장점이 있으며. 청소년에게 자연스러운 환 경에서 보다 안전하고 양육적인 분위기를 제공하는 것으로 알려져 있다. 오늘날 청소년 집단치료자들은 접근 하기 힘든 청소년에게 다가가기 위해서 유연한 자세로 광범위한 이론과 다양한 기법을 적용하고 있다. 집단 치료 모델은 구성원의 나이, 질병군, 기능수준과 발달수준, 그리고 임상환경, 구성양식, 개입목적 등에 따라서 여러 형태를 취한다. 집단치료 발달단계는 형성기, 갈등기, 안정기, 수행기로 나누는데, 보통 단기 및 시간제 한집단이 적용되는 청소년집단에서는 초기, 중기, 말기로 나눈다. 청소년집단에서의 치료요인은 만남집단과 성격변화를 주로 하는 장기집단에서는 대인관계학습, 정화, 실존적 인자, 집단응집력이 중시되고, 단기집단에 서는 정화, 보편성, 동일시, 집단응집력이 중시된다. 청소년집단에서는 치료자의 역량이 매우 중요하다. 청소 년집단을 이끄는데 특별한 지식, 기술 및 지구력을 필요로 한다. 성인집단을 이끌어오던 치료자라도 청소년 집단을 이끌기 위해서는 특별한 훈련 및 지도감독이 요구된다. 결 론: 집단정신치료는 정신과 영역에서 정신치료에 뿌리를 두면서 개인정신치료와 비슷하게 치료효과가 있는 것 으로 공인된 치료양식이다. 청소년 집단치료는 성인 집단치료에 비교할 때 큰 주목을 받지 못했지만, 오늘날 청소년 정신의학의 가장 중요한 치료양식의 하나로 인정받고 있다. 청소년기는 부모의 의존에서 독립으로 향 하는 변화의 결정적인 과도기로서 특별히 또래집단의 영향력에 민감한 시기이기 때문에 청소년을 대상으로 집단치료를 시행하는 것은 최적의 방법이라고 할 수 있다 Objectives:Group psychotherapy is more economic than individual psychotherapy and effective to adolescents especially. Group psychotherapy with adolescents will be used widely when adolescents problems are becoming more important so that government focuses on them. This article aims for the readers to understand group psychotherapy easily. Methods:This article is based on reviewing lots of articles related to adolescent group psychotherapy published at home and abroad and our researches and practical experiences in regard with inpatient and outpatient group with adolescents for a long time. This article is described in order of history, theory, model, development stage, and therapeutic factor. Results:Theories of group psychotherapy have been affected by about 200 psychotherapy theories. Among a lot of theories, psychoanalytic theory and cognitive-behavioral theory have been accepted as a perennial effective therapeutic modality. In Korea, structuralized cognitive-behavioral group therapy is currently pervaded in Youth Counselling Center or General Social Welfare Center. But because that is generally consist of skill training and problem solving centered approach, it is difficult to achieve therapeutic goal of ultimate behavioral change in basis of genetic insight. On the contrary, it is known that psychoanalytic group therapy has more benefit to raise adolescent universal value, group norms, group rules, confidentiality, and community consciousness for adolescents. and that group therapy provides adolescents with more secure and caring conditions. Here and now, adolescent group therapists apply wide theories and various techniques with flexible attitudes to go together with unapproachable adolescents. Models of group psychotherapy have various mode related to age, disorders, functional level, developmental level, clinical environment, structural modalities, and intervention goal. Developmental stages of the group psychotherapy consist of formal stage, conflictual stage, normal stage, and performing stage. And then those are divided with the first stage, middle stage, and the last stage in an adolescent group. Therapeutic factors of an adolescent group are as follows. Interpersonal learning, catharsis, existential factor, and group cohesiveness are highly evaluated in an encounter group and a long-term group for personality change. And catharsis, universality, identification, and group cohesiveness are highly evaluated in a short-term group. To handle the adolescent group, therapist capability is very critical. Special knowledge, technique, and endurance are needed for the group therapist to lead an adolescent group. Even though some therapist lead the adult group for a long time, they have to get special training and supervision to lead the adolescent group. Conclusions:Group psychotherapy has been formally accepted as one of therapeutic modalities that must be as equally effective as individual psychotherapy even if it derives from individual psychotherapy. Adolescent group psychotherapy is currently accepted as one of the most important therapeutic modalities although it is not highlighted as same as adult group psychotherapy. Group therapy is the most desirable therapeutic method for adolescents because they go through a transitional critical time for change and they are especially affected by peer group.

문제행동 청소년을 위한 대인관계 집단치료 효과

이후경,안현주,김선재,윤성철,봉수연 大韓神經精神醫學會 2003 신경정신의학 Vol.42 No.5

Objectives : Fast change and confusion of the value system in society affect the identity formation of adolescents. So Adlescents' behavioral problems seem to be increasing yearly. It is known that the interpersonal group therapy is the most effective treatment modality among many group programs for adolescents with behavioral problems. Objectives of this study are as follows ; first, evaluate therapeutic effects of the interpersonal group therapy for adolescents with behavioral problems second, examine the therapeutic factors ; third, analyze the group process : fourth, orgamize the group therapy for adolescents with behavioral problems as an applicable treatment modality. The types of group therapy performed in this study are small, closed, homogeneous, outpatient, timelimited, and adolescent group. Methods : This study was carried out at one of the adolescents mental health services in Uiwang Mental Health Center, from April to June and from September to November in 2000. The subjects were 2nd grade students in K middle school with behavioral proplems. The experimental groups were composed of 4 groups including 2 male groups and 2 female groups (male 11, female 17), and the control groups matched the same conditions as the experimental groups (male 10, female 19). The group therapy was performed weekly in CA (club activity) time, and it took 60-70 minutes at one time. They met total 10 sessions including preparatory meeting and termination meeting. Before and after this program, self-rating scales (behavioral problems, aggression, and impulsivity) were applied for subjects, and the teacher rating scales (behavioral problems, aggression and impulsivity) were performed by teachers in charge. After each session, Yalom's 13 therapeutic factors scale was perfbrmed. At the last meeting, total assessment questionnaire was compleled. Results : The mean scores of all self-rating scales (behavioral problem, aggression, and impulsivity) were lower in the experimental groups (both male and female group) than the control groups, but not significant statistically except the behavioral problem scale of female students. The mean scores of all teacher rating scales (behavioral problem, aggression, and impulsivity) were lower in the experimental groups (both male and female group) in comparison with the control groups, all significant statistically. As faras the therapeutic factors are concerned ; first, the mean scores of all therapeutic factors in female students were higher than in male students and the mean scores of all therapeutic factors in the later half sessions were higher than the former half sessions ; second, catharsis and existential factor were high in all students and sessions ; third, identification with therapist factor was high in all students and sessions : fourth, during the later half sessions, interpersonal input was relatively high in male students and socializing technique was relatively high in female students. Its forthe total assessment questionnaires ; 100% of male students and 88.2% of female students reported that they were helped by this group therapy ; 100% of male students and 82.4% of female students reported that they would participate willingly if future opportunity of the same group therapy is given for them. Conclusion : Adolescents with behavioral problems who participated in this study showed the decrease of behavioral problems and the change of aggressive and impulsive attitudes in comparison with the control groups although they had some differences between male and female students. The group therapy with adolescents would be practiced more broadly and extensively though there are several accompanied problems including the difficulty of structuring, the deficit of motivation, and financial problem.

집단정신치료:집단역학

이후경 대한신경정신의학회 2003 신경정신의학 Vol.42 No.2

This article on ‘group dynamics’ is the last part following the ‘history and prospect’ and the ‘theory and practice’, series composed of three parts to understand the group psychotherapy. To explain the core theme concerning the group dynamics, we compared the therapeutic group in clinical scope with the work group in social scope for convenience. And this article principally was for the therapeutic group. We can discover many similarities between groups and organizations when we observe the details although they appear quite different with different goals. Therefore, if the leader of a group in the clinical and social setup has a full knowledge in group dynamics, he would be effective in functional roles with increased sensitivity and understanding of group process. This article was written in order of the history of group dynamics, the theory of group dynamics, group development, and leadership. The group psychotherapy derives from individual psychotherapy. To lead group psychotherapy successfully, Therapists have to be knowledgeable not only of the concept of psychotherapy but also the concept of group dynamics.

Lifter design for enhanced heat transfer in a rotary kiln reactor

이후경,최상민 대한기계학회 2013 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.27 No.10

Rotary kiln reactors are frequently equipped with an axial burner with which solid burden material is directly heated. The burner flame provides the heat required for the vaporization of the water and the reaction of the solid phase. Lifters are commonly used along the length of the system to lift particulate solids and increase the heat transfer between the solid bed and the combustion gas. The material cascading from the lifters undergoes drying and reacting through direct contact with the gas stream. In this study, volume distribution of materials held within lifters was modeled according to the different lifter configuration and appropriate configuration was used for the design purpose. This was applied to the simplified one-dimensional heat balance model of a counter-current flow reactor, which contributes to the increase of the effective contact surface, and thereby enhances the heat transfer.

집단정신치료의 역사와 전망

이후경 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.2

본 논문은 의야분업과 정신보건법 개정으로 날로 어려워지는 한국 정신의학계의 현 실정에서, 외국 집단 정신치료의 발전사를 거울삼아 한국 집단정신치료의 바람직한 발전과 적용을 목표로 하여 작성하였다. 본 논문의 서론에서 집단정신치료의 정의, 정신과 영역에서의 집단정신치료에 관심이 적은 이유, 집단 정신치료의 현실, 치료효과 및 치료결과에 대하여 간단히 살펴보았다. 이어 본론에서 외국 집단정신치료의 역사, 집단정신치료의 전망, 한국의 집단정신치료의 순서로 서술하였다. 집단정신치료는 정신치료에서 뿌리를 두면서 정신치료와 버금하게 치료효과가 있는 것으로 공인된 치료양식이다. 최근 선진국에서는 의료환경과 보험정책이 경제성의 원칙에 의거하여 약물치료와 단기증상 지향치료가 중심이 되면서 정신치료는 점점 위축되고 있는 실정이다. 이에 따라 집단정신치료가 치료자와 환자간의 만남의 장을 제공하는, 보다 전체적이고 인간적인 치료방법으로서 그 중요성이 날로 부상되고 있다. 새천년을 전후하여 한국에서도 지역사회정신보건사업의 확대와 의약분업의 실시로 집단정신치료가 사이코드라마와 더불어 입원환자 및 외래환자(낮병원 포함) 치료에서 매우 중요한 치료양식으로 인식되고 있다. Recently, the Korean psychiatrists has faced to the difficult situation because of the separation of medical practice and pharmaceutical dispensing and the revision of mental health law. In this situation, this article was written for the desirable development and application of group psychotherapy in Korea in the basis of the history of foreign group psychotherapy. Introduction is composed of definition of group psychotherapy, reasons why the group psychotherapy is not applied so actively in psychiatric area, the present of group psychotherapy, therapeutic effect, and therapeutic outcome. Main subjects are the history of foreign group psychotherapy, the prospect of group psychotherapy, and Korean group psychotherapy. Group psychotherapy has heen formally accepted as one of therapeutic modalities that must be as equally effective as individual psychotherapy even if group psychotherapy derives from individual psychotherapy. Those days, in psychiatric clinic in Korea psychophamacotherapy and brief symptom oriented therapy have been applied mainly due to the economic principle of medical environment and insurance policy. And psychiatrists apply psychotherapeutic modalities in there less and less. The importance of group psychotherapy should be emphasized one of holistic and humanistic therapy which provides the field of encounter for therapists and patients.As Community Mental Health Service in Korea are expanding and the separation of medical practice and pharmaceutical dispensing is being performed. The group psychotherapy and psychodrama should be perceived as a much more effective and efficient therapeutic modality in the settings of inpatient and outpatient clinics.