Integrating group and individual psychotherapy for complex PTSD: A pragmatic case study

IF 1.9 Q3 PSYCHIATRY
Emilie Ubico , Christelle Ziebel , Baptiste Alleaume , Caroline Vieilleribière , Christelle Anglade , Nathalie Duriez
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引用次数: 0

Abstract

Introduction

Young’s Schema therapy has shown effectiveness in treating individuals diagnosed with Complex Post-Traumatic Stress Disorder (C-PTSD) (Ubico et al., 2025). Dissociative symptoms are frequently observed in this clinical presentation. However, how do they evolve over the course of treatment? To address this, we have developed a psychotherapeutic program that integrates group and individual therapy, grounded in Contextual Schema Therapy (Roediger et al., 2018). This program also draws on key principles from psychotraumatology, particularly the theory of structural dissociation of the personality (Van der Hart et al., 2006). While these theoretical frameworks share certain conceptual foundations, they differ in how they understand dissociation and in the therapeutic strategies they propose. Still, given the well-documented influence of therapeutic alliance and group cohesion on treatment outcomes, the common factors model of psychotherapy may offer a valuable, integrative lens. This raises a central question: What mechanisms of change can be observed in an individual with Complex PTSD undergoing a combined group and individual psychotherapy program? 

Methodology

This study employs a mixed-methods design grounded in Fishman’s (2017) pragmatic case study methodology. Standardized instruments were administered at four time points: pre-treatment (T0), mid-group therapy (T1; after 10 sessions), post-group therapy (T2; after 20 sessions), and at a three-month follow-up (T3). Variables assessed encompassed complex post-traumatic stress symptoms, psychoform and somatoform dissociative symptoms, quality of life, and the therapeutic alliance. Group cohesion was evaluated at the conclusion of each of the twenty group sessions. The clinician-researcher also conducted monthly assessments utilizing the Dimensions of Therapeutic Movement Instrument (DTMI) for complex trauma. At the conclusion of therapy (T2), an independent clinical psychologist conducted a research interview to explore various dimensions of change. A thematic analysis (Braun & Clarke, 2006) was conducted to identify emerging themes from the interview.

Results

The trajectory of the combined psychotherapy is delineated in detail. By the conclusion of treatment, a substantial reduction in complex post-traumatic symptoms, along with psychoform and somatoform dissociative symptoms, was observed, with these improvements sustained at follow-up. Quality of life also demonstrated notable enhancement. Regarding common therapeutic factors, the therapeutic alliance progressively strengthened throughout the course of treatment. ​In contrast, group cohesion declined sharply at the tenth session but subsequently improved and stabilized following the resolution of a rupture within the group. The research interview highlighted several therapeutic gains, including symptom reduction, the contribution of group therapy, the value of the combined approach, enhanced insight into psychological functioning, improved interpersonal relationships, increased self-confidence, emotional regulation, appropriation of therapeutic tools, and the central importance of the therapeutic relationship.

Discussion

These findings are examined in the context of existing literature on post-traumatic and dissociative symptoms, as well as associated comorbidities. The participant’s integrative process is analyzed through the lens of structural dissociation theory and Liotti’s conceptualization of disorganized attachment in traumatized and dissociative individuals. The study further substantiates the efficacy of schema therapy techniques, including chair work and imagery rescripting. Moreover, the findings align with existing research on common therapeutic factors, highlighting the significance of emotionally salient experiences in facilitating psychological change. This single-case study exemplifies the reciprocal and cyclical interplay between two therapeutic modalities conducive to transformation: individual therapy, which focuses on intrapsychic processes and trauma processing, and group therapy, which centers on interpersonal dynamics.

Limitations and Future Directions

Although the single-case design limits the generalizability of the findings, this study offers promising avenues for future research and clinical innovation.
综合团体和个人心理治疗复杂创伤后应激障碍:一个实用的案例研究
杨氏图式疗法在治疗诊断为复杂创伤后应激障碍(C-PTSD)的个体方面显示出有效性(Ubico et al., 2025)。这种临床表现经常出现分离性症状。然而,它们在治疗过程中是如何演变的呢?为了解决这个问题,我们开发了一种基于情境图式疗法(Roediger et al., 2018)的心理治疗方案,将团体和个人治疗结合起来。该项目还借鉴了心理创伤学的关键原则,特别是人格结构分离理论(Van der Hart et al., 2006)。虽然这些理论框架共享某些概念基础,但它们在如何理解解离和提出的治疗策略方面有所不同。尽管如此,考虑到治疗联盟和团体凝聚力对治疗结果的良好影响,心理治疗的共同因素模型可能提供一个有价值的综合视角。这就提出了一个核心问题:在接受团体和个人联合心理治疗项目的复杂PTSD患者身上,可以观察到什么样的变化机制?本研究采用基于Fishman(2017)实用案例研究方法的混合方法设计。在四个时间点使用标准化工具:治疗前(T0)、组中治疗(T1; 10次治疗后)、组后治疗(T2; 20次治疗后)和三个月随访(T3)。评估的变量包括复杂的创伤后应激症状、精神和躯体形式的分离症状、生活质量和治疗联盟。小组凝聚力在20次小组会议结束时进行评估。临床研究人员还利用治疗运动仪器(DTMI)对复杂创伤进行了每月评估。在治疗结束时(T2),独立的临床心理学家进行了一次研究访谈,以探索变化的各个维度。进行主题分析(Braun & Clarke, 2006)以确定访谈中出现的主题。结果详细描述了综合心理治疗的发展轨迹。治疗结束时,观察到复杂的创伤后症状以及精神和躯体形式的分离症状显著减轻,这些改善在随访中持续存在。生活质量也有显著提高。在共同治疗因素方面,治疗联盟在整个治疗过程中逐渐增强。相比之下,集团凝聚力在第十届会议上急剧下降,但随后在解决集团内部的分裂后有所改善和稳定。研究访谈强调了几项治疗成果,包括症状减轻、团体治疗的贡献、综合方法的价值、对心理功能的深入了解、人际关系的改善、自信心的增强、情绪调节的增强、治疗工具的使用以及治疗关系的核心重要性。这些发现是在现有的关于创伤后和分离症状以及相关合并症的文献的背景下进行检验的。通过结构分离理论和Liotti对创伤性和分离性个体无组织依恋的概念分析了参与者的整合过程。该研究进一步证实了图式治疗技术的有效性,包括椅子工作和意象重写。此外,这些发现与现有的关于常见治疗因素的研究相一致,强调了情绪突出体验在促进心理变化方面的重要性。这一个案研究举例说明了两种有助于转变的治疗方式之间的相互作用和周期性相互作用:个体治疗,侧重于心理过程和创伤处理,团体治疗,侧重于人际动态。局限性和未来方向虽然单例设计限制了研究结果的普遍性,但本研究为未来的研究和临床创新提供了有希望的途径。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.40
自引率
4.80%
发文量
60
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