From the author: Abstract of the article by Robie Friedman “Individual or group therapy? Indications for Optimal Therapy “Why Group Therapy? Group therapists have a very clear understanding of the benefits of their particular approach. However, they do not always easily convey the unique benefits that people gain from participating in groups, especially in medium-sized groups. With clearer indications for treatment approaches (individual therapy, group therapy, couples and/or family therapy), the unique contribution of small and medium-sized groups can be identified. Example Uri (40 years old), married with three children, felt internally insecure, anxious and especially stressful when I had to start working in a group. These symptoms did not change despite two "satisfactory" individual therapies - and this against the backdrop of his professional success and his success in social life. Group therapy, indications and optimal treatment What makes small and medium group therapy unique to justify its use ? How should therapists ensure that participation in group therapy is absolutely necessary? We need a good enough indication system that connects specific disorders with specific treatment strategies. Acute knee pain can be screened and diagnosed so you always know when you need rest for your knee versus physical therapy or surgery. The doctor's suggestions cannot be ego-syntonic or understandable to every patient. However, patients tend to follow their instructions in therapy. Similarly, in psychotherapy we must ask: what is the disease that needs to be treated? What is the optimal therapeutic space, and when should a specific optimal space be recommended?1. What disorders should be treated? How should disorders be defined? As affecting the individual or as interpersonal disturbances? Classic individual pathologies such as depression or obsessive-compulsive disorder reflect a traditional and general approach, although they are often not specific enough to serve as a specific indication for therapy. Narcissistic disorder may be acceptable in personal relationships but not in the family network, or vice versa. And such a disorder cannot be considered acceptable for participation in the group. Other perspectives for optimal therapy can be found in approaches such as psychological breadth (McCallum and Piper, 1990) or quality of object relations (McCallum et al., 2003).[1] In these approaches, personal abilities in internal and external relationships were identified and their indications for group therapy were explored. I want to propose another possibility, namely, the definition of disorders that are specifically interpersonal and multi-personal. This will serve the therapist to choose between group, couple, family and individual therapeutic spaces - and which are the appropriate treatment modality for specific disorders. Example: Urie was diagnosed as having suffered traumatic ostracism during adolescence, which led to isolation and resentment. Despite subsequent good social development, a sense of basic security remained during group activities; and he needed to periodically retreat into dyadic defense. Defining Relationship Disorders: A Fundamental ViewIn the 1930s, Fairbairn and Balint, one living in Scotland and the other in Hungary, working from very different starting points, took the core symptomatology of neurotic psychopathology and offered clinicians a new perspective on the picture of psychopathology. They suggested that behind the symptomatic picture there was an underlying relationship problem at the pre-oedipal level. According to Fairbairn, neurotic symptoms reflect the needs of unresolved dependence and, according to Balint, disrupt the attachment pattern,which he called the "basic defect". Based on their views, object relations theory was created. Later in the 1950s, Nathan Ackerman, Lyman Wynn and other early family physicians disagreed with the existing view of the individual as a "unit" of psychopathology and introduced another fundamental view, citing attachment - the creation of related bonds - as an issue for research and therapy. I would like to propose categories of relationship disorders for which group therapy is uniquely suited as a treatment choice. To introduce the concept of relationship disorder, we quote Foulkes (1975: 66)... "It is not very useful to talk about individuals in terms of the usual diagnostic labels." And further: we "...must treat the 'neurotic disorder as multi-personal' (Foulkes, 1975: 65, emphasis added). "...transpersonal phenomena go to the very roots of any approach to group psychology and require a fundamental view..." (Foulkes, 1964: 18). I offer a modern view here by adding ''relationship disorders' to our classical definition of individual pathology. Taking a complementary view of the variety of personal dysfunctions will not only improve indications for psychotherapy, but also alleviate optimal contribution of different therapeutic spaces[2], for example, most of the following related disorders may not even appear in the dyadic therapeutic space. The regulation of relationship disorders are multi-personal dysfunctional patterns (Friedman, 2005; 2006 and 2007). behavioral patterns found in community and group therapy. These disorders jointly create interpersonal dysfunctional patterns that result from the failure of all parties involved, for example, the inability to control strong emotions such as separation anxiety and the need for inclusion and aggression. The following are preliminary descriptions of interpersonal dysfunction, a category of disorder based on Agazarian's research in group work (Agazarian, 1994).A. Deficit relationship disorder is the inability of participants to contain the duality between weakness and strength in themselves and others. One member of a group or subgroup will feel chronically deprived, anxious, depressed, and inadequate in his interactions with others. The split between what is called in family therapy the “identified patient” and what colleagues call the “identified Watchman” will often constrain group relationships and create chronic pathologies.B. Rejective [3] relationship disorder as a result of the inability to withstand group aggression. A fantasy of violence is enacted between the rejecting subgroup and the individual. An additional process such as the tendency to be a scapegoat without guilt and shame on the one hand, and the growing aversion of the scapegoat to be included in the group becomes surprisingly strong. These trends are growing as modern communications eliminate facelessness.C. The disorder of the Self relationship sets a pathological relationship in which the social parts lead to insufficient development of the autonomous, mature parts of the Self. Selfless “heroes” (Agazarian, 1994) and their “selfish” counterparts conspire (gender different) to serve as “motives” when harming themselves and others. While women and men selflessly offer their lives for their families, communities and jobs, they become obsessively preoccupied with the sense of heroic use and misuse of them by society.D. In Exclusionary Disorders, the core of society does not wish to eliminate individuals or subgroups, but nevertheless acts to marginalize them. This phenomenon becomes a chronic disease for a group or society when the excluded accept this marginalization, and no movement between the center and the edges is possible. Symptoms thatResembling depression or obsessive-compulsive disorder may develop, resulting in decreased energy, productivity, and satisfaction throughout the group. Various ethnic groups, as well as "other" people such as women (still), homosexuals, ex-convicts, the poor and black, ex-psychotic and many other communities are included in chronic marginalization. This is quite sufficient for psychic adjustment, which should include membership in small groups that move from the edges to the center and back again and can create a significant output of energy. All forms of dysfunctional relationships with the center can be transformed in small, medium or large groups ((de Maré, 2002; Pisani, 2000). Only mutual changes of all involved will lead to movement towards health. Example: Uri underwent group analysis in which he worked mainly over three dysfunctional patterns in succession: His panic of being a scapegoat was worked through in the relationship between him and the group. 1. Mutual tendencies to avoid and reject were worked through. 2. Further, ambivalence about being a “weak” person inside and maintaining a strong façade. outside in the group was worked through in connection with the deficit relationship disorder. The characteristic pathological interactions were clearly reproduced in the group, where they could eventually be properly processed, facilitating their clearer expression. In the end, Uri and the group managed to expand their freedom. in choosing a “hero” and selflessly giving part of your own space to the outside.2. What is the Optimal Therapeutic Space? For many reasons, relationship disorders characterized by dysfunctional patterns need to be treated where they were created. In group analysis, a person is needed to re-enact patterns of interaction and process them through "ego learning in action" (Foulkes, 1968: 181). Differentiating between the presence of a dysfunctional pattern and the therapeutic value of a particular space helps us answer the question: When the middle group is shown, What is the optimal treatment for relationship disorders? From my clinical experience, I would say that at least three relationship disorders (points 2, 3, 4) will definitely be replicated in small to medium sized groups out of necessity. interventions in all directions that mutually contribute to the conflict, the middle group will be most effective in treating 3rd and 4th relationship disorders (about the small group, probably more than 1st and 2nd). The possibility of development will vary depending on). the intensity affected by, for example, hatred, envy. The extent of destructive feelings and motivation or the degree of emotional dysfunction will influence the optimal size of the working group for the treatment of relationship disorders. In Israel, we learned that for the treatment of social trauma, the middle group is clearly the optimal space. Experience after the Second Lebanon War, when Northern Israel was in the process of recovering from the traumatic effects of thousands of rockets, showed that medium groups were particularly effective in working with feelings of exclusion, helplessness, and defensive overidentification.3. When will a specific optimal space be recommended? Most potential patients prefer to start with individual therapy[4]. Those entering therapy are very vulnerable and are afraid that they will appear in a group without support and lack of protection. When we feel very bad, we automatically shout: “Mom”, and not: “Parents” or “Family”! The desire for help, reassurance and protection in dyadic therapy is associated with emotional experiences in the early relationship between mother and child. Thus, rather than giving a specific instruction to place a participant in a medium or small group, we usually appeal to the unconscious promise of individual therapy. We must recognize that most patients will begin therapy within.