Socially phobic clients' self-descriptions, treatment progress and reflexivity in short-term cognitive-constructivist group psychotherapy

Abstract

The aim of the research was to get information about different kinds of clients with social phobia and their therapeutic progress in cognitive-constructivist group psychotherapy. The aim was also to offer relevant information to clinicians working with socially phobic clients on how they could help the progress of the successful therapeutic change process of socially phobic clients, especially in early phases of the therapy when clients are developing a reflexive stance toward their own problematic experiences. Study I supported the view that negative self-image is central to social phobia, but this ranged from total piteousness to relatively few negative feelings of insufficiency. Three subgroups were formed on the basis of commonalities and differences of the self-descriptions which were observed: the other-oriented (n = 7), the isolated (n = 7) and the self-demanding (n = 3). These subgroups describe the different strategies that certain socially phobic persons habitually use when compensating for their social anxiety. In Study II, the treatment progress of clients from these three subgroups was explored, using qualitative assimilation analysis. Some similarities and some differences can be noted, although the clients progressed in their assimilation process to different degrees. The largest variance was in the isolated subgroup, as there were both successful and unsuccessful therapeutic change processes. Study III indicated that reflexivity seems to be a necessary condition for progress in early phases of the therapy process, but it is important to note that reflexivity can appear in diverse forms and at different levels. It appeared to be necessary for the therapist to work inside the client’s therapeutic zone of proximal development (ZPD), since premature exposure to the therapist’s conclusions, meant to increase the client’s reflexivity, can be counterproductive. At this early assimilation stage, the client requires empathy prior to other interventions. The research as a whole emphasizes the challenges a therapist encounters when treating socially phobic clients with differing needs in a group format. Socially phobic clients may differ in many ways, including their compensatory strategies. Thus, a therapist’s responsiveness and ability to work inside the therapeutic ZPD is necessary for successful therapeutic progress.