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How to study treatment of small outpatient groups of Concentrative Movement Therapy (CMT)?

Deutscher Arbeitskreis für Konzentrative Bewegungstherapie e.V.[German Association for Concentrative Movement Therapy]

Konzentrative Bewegungstherapie

Karin Schreiber-Willnow, Rhein-Klinik, Hospital for Psychosomatic Medicine and Psychotherapy, Bad HonnefRoland Brückl, Sinova Klinik, Hospital for Psychosomatic Medicine and Psychotherapy, Ravensburg, Germany

Klaus-Peter Seidler, Clinic for Psychotherapy, Social Psychiatry and Psychotherapy, Hannover Medical School, Germany

Objectives: Outpatient group psychotherapy by CMT after psychosomatic hospitaltreatment was performed in eight monthly one-day meetings for about a year. CMTis an approach of body oriented psychodynamic therapy. It can be described especiallyas a perception and movement oriented approach with the intention to increase thepatients’ ability to symbolize and verbalize implicit body memories and to enhancecompetency in relationships (1). The group was conducted by two experienced CMTgroup leaders, a man and a woman. Focus of the closed group was “finding one’spath into life again” after psychosomatic inpatient treatment. Method: A quantitative naturalistic study in pre-post-design including process data ofCMT group experiences was performed. Because of the small sample size no statisticaltests were performed, but clinical significant changes are described. A descriptive com-parison to a multicentre inpatient CMT study with the same instruments (2) is added.

Instruments: The patients answered three questionnaires on the first, the fourth andthe last meeting of the group: Severity of psychopathological symptoms: The Brief Symptom Index BSI-18 (3)provides an overview of a patient's psychic symptoms and the severity at a specificpoint in time with Global Severity Index (GSI) as a single score for symptom severity. Interpersonal problems: The Inventory of Interpersonal Problems IIP-32 (4) identifiesa person's most salient interpersonal difficulties and the change during treatment. Body Experience: The Body-Image-Questionnaire FKB-20 (5) describes body expe-rience and body image disturbance with two scales: “rejecting body evaluation“ (AK)and “vital body dynamics“ (VK). The patients received the CMT session questionnaire after the first, third and fourthmeeting: CMT Session Experience: Specific experiences with CMT during the sessions weremeasured by CMT Session Questionnaire SB-KBT (2) with two scales: “benefit fromthe session” (NK) and “body related self experience” (KB).

Results: Pre-Post-Changes: The mean psychological distress in the post hospital group (Fig.1)was still relatively high with GSI=1.19 (s=0.56) in the beginning, compared to 218 in-patients with a mean GSI=1.29 (s=0.70) in the beginning. It reduced significantly du-ring the year of treatment to GSI=0.66 (s=0.45), which is in normal range. The interpersonal problems (Fig. 2) in the beginning were even higher with IIP=1.80(s=0.22) than those of the inpatients with IIP=1.75 (s=0.53). They significantly reducedduring the year of treatment to IIP=1.38 (s=0.45), reaching a normal level. Rejecting body evaluation (Fig.3) was high in the beginning. The outpatients hadAK=1.73 (s=0.90) compared to the inpatients’ AK=1.75 (s=0.53). They reduced onlyin half of the group to a mean of 1.48 (s=0.82), which is in the normal range. Vital body dynamics (Fig. 4) of the outpatients was in normal range throughout theyear with VK=1.65 (s=0.37) at the beginning and VK=1.73 (s=0.60) in the end, whileinpatients had pathological scores at the beginning: VK=1.30 (s=0.68).

Group process: Evaluating the benefit of the single session by SB-KBT (Fig. 5), pa-tients could use the first (NK=3.2) more that the third (NK=3.0) and the fourth(NK=2.5). NK≥2.0 means a good benefit. The inpatients showed a 2.6 at their thirdsession. So basically a benefit from the session war rated by all patients. Mean body related self experience (Fig. 6) remained stable, while standard deviationincreased: KS=2.6 (s=0.6) in the first session, KS=2.9 (s=0.5) in the third and KS=2.7(s=1.0) in the fourth session. Inpatients showed a 2.5 at third session.From the subjective group leaders’ point of view all patients finally profited from thegroup, as it is seen in BSI and IIP.

Discussion: The one-year outpatient CMT group reached the aim of diminishing theseverity of psychosomatic symptoms and interpersonal problems from pathologic tonormal range. A specific aim of CMT as body psychotherapy, to increase the negativejudgement of the body, was only reached by half of the group. Patients choosing aCMT-group seem to have a better body vitality than average psychosomatic inpatients.But they also have a lot of difficulties in accepting their body. The group could usethe sessions und had a good bodily self experience (in the mean). The increase of stan-dard deviation of bodily self experience may be a sign for conflicts in the group in themiddle of treatment. Due to group process theory crisis and conflicts are happeningin the middle of treatment, when the deepest regression level is reached. Unfortunatelydata of SB-KBT of the last session are missing, so it is not known by SB-KBT, how thesession experience went on.

Conclusion: This first pilot process-result-study of an outpatient CMT group shows, that even in small body psychotherapy groups it can be studied by question-naires, how symptoms, interpersonal problems and body experience change during treatment. The session questionnaire SB-KBT seems to be helpful indicatingcritical incidents in CMT group process. The next step in evaluation should be a replication study with greater numbers.

Corresponding author: Dr. rer. medic. Karin Schreiber-Willnow, Rhein-Klinik, Luisenstr. 3, 53604 Bad Honnef. E-Mail: karin.schreiber-willnow@johanneswerk.de

Fig. 1 and 2: Global changes during the year of CMT-treatment (N=6) Comparison group of inpatients at admission (N=218)

Severity of symptoms (GSI) Interpersonal problems (IIP) (normal: GSI ≤ 0.7) (normal: IIP ≥ 0,77 and IIP ≤ 1.8)

Fig. 3 and 4: Body experience during the year (FKB-20)Comparison group of inpatients at admission

Rejecting body evaluation (AK) Vital body dynamics (VK) (normal: AK ≤ 1.6) (normal: VK ≥ 1.6)

Fig. 5 and 6: Session experience during first half of the year (SB-KBT) Comparison group of inpatients at third session

Benefit of the session (NK) Body related self experience (KB) (good: NK ≥ 2.0) (good: KB≥2.0)

1 Schreiber-Willnow K (2015). Concentrative Movement Therapy. In: Edward S. Neukrug (ed.): The Sage Encyclopedia of Theory in Counseling & Psychotherapy. Thousand oaks CA: Sage. 214-216 2 Seidler K-P, Epner A, Grützmacher S, Schreiber-Willnow K (2013): Der Stundenbogen zur Konzentrativen Bewegungstherapie (SB-KBT). Reliabilität und Validität eines Fragenbogens für die Prozessdiagnostik in der körperorientierten Psychotherapie.

[CMT Session Questionnaire (SB-KBT). Reliability and validity of a questionnaire for body orientated therapy process diagnostics]. Poster presented at the 64th meeting of the DKPM [German Council for Psychosomatic Medicine] Heidelberg 6.-9.3.20133 Franke GH, Ankerhold A, Haase M, Jäger S, Tögel C, Ulrich C, Frommer J (2011). Der Einsatz des Brief Symptom Inventory 18 (BSI-18). [The usefulness of the Brief Symptom Inventory 18 (BSI-18) in psychotherapy patients]. Psychother Psych Med, 61:82-86.4 Horowitz LM, Alden LE, Wiggins JS, Pincus AL (2000). Inventory of Interpersonal Problems (IIP-32/IIP-64). London: Psychological Corporation 5 Clement U, Löwe B (1996): Fragebogen zum Körperbild (FKB-20). [Body Image Questionnaire]. Göttingen: Hogrefe

Deutscher Arbeitskreis für Konzentrative Bewegungstherapie e.V.[German Association for Concentrative Movement Therapy]

8th WORLD CONGRESS FOR PSYCHOTHERAPY 24-28 JULY 2017 PARIS