To discuss the use of group therapy with the theme of psychosexuality in an open management psychiatric ward. METHODS: By reviewing the birth, development, and exploration of group therapy with this theme in a psychiatric ward, the content, form, purpose, and role of group therapy with this theme, the role and role of the therapist, the context in which it exists, and the problems encountered and handled, are discussed in relation to the theoretical foundations related to psychosexuality. RESULTS: Group therapy on this theme helps patients to learn about psychosexuality, to understand themselves and others, and to contribute to self-acceptance and personality integration. CONCLUSION: Group therapy on this theme was helpful for inpatients in relation to the overall supportive environment of the inpatient-style ward. I. Exploration of inpatient group therapy with a psychosexual theme Psychosexual group therapy did not emerge with the birth of the open management psychology department, but rather with the pace and development of inpatient psychotherapy. As various psychosexual diseases are gradually moving into the wards, many patients are presenting themselves with sexual symptoms, and more and more adolescent patients are confused and curious about sex and are also overwhelmed, the open management of inpatient wards is faced with “sexual” problems. The number of adolescent patients who are confused and curious about sex and who are also overwhelmed is increasing, and the “sex” problems faced by the open management of the inpatient wards are increasing. Since the day it came into being, it has been a source of curiosity, excitement, nervousness, shyness, etc. for all patients with various complex feelings. Although sex is involved in the life of each of us, and the great Freud, who is known to many patients, said that “sexual problems are the root of psychological problems,” [1] it is still quite difficult to talk about such a private and emotionally charged topic in a group therapy atmosphere. It is also an area that is being explored as to how to bring the topic of “sexuality” to a close. The special identity of “sex” affects the way of treatment. In the initial attempts, the content of psycho-education was mainly carried out in the form of lectures, and after the patients gradually had some questions and interactions, the way of discussion was combined. Gradually, a combination of lectures and discussions was adopted, and the proportion of discussions gradually increased in the development of group therapy with psychosexuality as the main theme, and in the later stages, discussions were the main focus. Because the theoretical lecture is a relatively isolated relationship between the therapist and the patient, the discussion is a more likely way to provoke strong empathy and counter-empathy, which is a challenge for the therapist and needs to be acceptable to the patient. Therapy is essentially led by one psychologist, with occasional attempts at inviting a psychologist of the opposite sex to lead the discussion at the same time, and subtle changes in the dynamics of the group can be observed as the therapist changes. The emergence of the therapist’s gender role in this topic is rather specific, even related to the therapy itself. In our attempts to have a female therapist preside, [E] Havelook Ellis <> “Sexual guidance for children should begin very early. A wise and gentle mother can optimally perform this extremely maternal task in time. Indeed, it can be said again that only the mother can do this job properly.” Although the therapist may be both a father and a mother figure in the empathic relationship of psychotherapy, this type of group therapy may be more appropriate for female therapists. The role is still predominantly at the psycho-educational level, and although it is sometimes conducted through discussion, consistent with the theory and techniques of group therapy, there is relatively less interaction between group members and more interaction between group members and the therapist than in motivational group therapy, and the therapist may assume more of a leading role, somewhat bringing this difficult topic The therapist may assume more of a leading role, somewhat moving this difficult topic forward slowly. The content and role of group therapy with the theme of psychosexuality The content of group therapy with the theme of psychosexuality includes the concept and meaning of sexuality; the physiological phenomenon of sexuality; the sexual impulse of adolescence; sexual deviation such as homosexuality; the relationship between the change of adolescence and family; love and marriage; the relationship between sexuality and love; the developmental theory of psychosexuality; male and female psychology; sexuality in interpersonal relationship; the relationship between sexuality and society; sexual education, etc. The discussion may include The main content of the discussion can include (a) content related to yourself, such as your view of your own identity as a male/female, your ideal image of the opposite sex and the relationship with your past life, etc. This part of the patient can be more combined with themselves to talk. (2) Content related to the lecture, such as views and attitudes toward homosexuality, feelings about sexual changes during adolescence, etc. For the more private part of the content, it is not appropriate to combine themselves or talk about their own very difficult topics, advocate to talk about others. (3) Content related to illness, such as the relationship between mental illness and psychosexuality, and the views on this group treatment. (iv) Discussion of events here and now, for example, when discussing the triangle of family relationships with parents, one of the patients jumped to the topic of homosexuality, at this point it is necessary to discuss the feelings of these topics and jumping to the topic, as well as other people’s reactions to this patient’s attempt to understand, etc., or a topic when a patient’s departure may also be appropriate to discuss. The theoretical basis of group therapy on this topic, the psychology of sexuality; object relations theory such as the development of psychosexuality; Freudian literature such as the relationship between sex, Libido and mental illness; social psychology such as: psychological characteristics of men and women, gender roles, etc.; developmental psychology such as changes in adolescence; personality psychology such as differences in gender roles, etc. The purpose of group therapy on this topic: to learn about psychosexuality, to understand oneself and others, to understand the relationship between psychological disorders and psychosexuality, and to better self-acceptance and gradual integration through interaction with the therapist, who symbolizes the parents and authority. When discussing the topic of masturbation, we often hear similar statements from patients: “I’ve read on TV and in books that masturbation is a normal behavior.” However, when discussing this type of problem, the patient does not accept this “normal” phenomenon from the inside, and the group therapy discussion allows the patient to experience his or her inner voice at this moment and understand his or her “abnormal” reaction to the normal. The role of group therapy in this theme is the same as other group therapies. By creating a collective atmosphere and providing a supportive, understanding and accepting atmosphere, the members gradually change from the initial tension, wariness, closedness, sensitivity, self-blame and guilt to a new psychological state of relaxation, acceptance, support, intimacy and openness. Collective members participate in the experience together, more directly allowing individuals to discover similar problems in others, alleviating feelings of isolation and courage to face their own problems. It allows individuals to become aware of and listen to others, to understand themselves and others, and to increase their self-esteem. Different members of the group feel different reflections, observe the behavior of others, have an emulation, practice and learn new patterns of behavior. Safely expressing one’s emotions, perhaps even to the therapist, more contextually separating reality from the inner world, re-experiencing the individual’s deepest emotions and conflicts here and now, providing an additional alternative form of therapy to supplement individual therapy, and sometimes opening a window for individual therapy, for example, often patients will use what is talked about in group therapy to introduce the topic in individual therapy. However, group therapy is easier than individual therapy to eliminate the patient’s dependence on the therapist and to reduce the emotional tension in dealing with the therapist. For example, when talking about gender relationships, one patient spoke directly about her fear of the opposite sex therapist and her feelings of distrust of her individual therapist, when another patient responded directly, “Of course you’re going to react that way when you’re naked!” At this moment, all present laughed, and there was a shared understanding, which gave the patient who asked the question a sense of certainty and reduced anxiety, and helped all patients to understand the therapy itself. The therapist’s role and function is to prescribe a topic and to lead that topic without going off on tangents, sometimes needing to go over the reasons for the tangents themselves. To enhance interpersonal communication in an open and safe atmosphere, the topic is more difficult and challenging to talk about than in other group therapies, so the therapist needs to provide the necessary support to the individual as the patient reveals his or her inner world. For example, when talking about feelings of special closeness to a parent of the opposite sex, one patient revealed that he had incestuous thoughts about his mother, and all the people in the room laughed. “Although the response was still clearly defensive, the group was able to confront this emotion and everyone’s reactions in a relaxed environment, discussing directly how the Oedipus complex presents itself to us and experiencing the complex emotions that result when we have this complex with a parent of the opposite sex, and We are not aware of it when we are in it, but it has an invisible impact in our lives and extends the topic of the Oedipus complex to a broader area, such as the relationship between incest and love; the conflict of growing up, the conflict of self-transcendence, and the fear and complex emotions that come with it. The therapist will discuss the therapist’s need to attend to each member’s impedance and empathy and his or her own counter-empathy. Sexuality is a difficult topic to articulate, especially since inpatient groups are not stable, and there is a great deal of variability among members, with varying degrees of trust and openness, and the therapist needs to give full respect to each member’s defenses and adjust the way he or she works with the group as it is acceptable. For example, when discussing gender relationships, one of the patients objected directly on the grounds that she did not have a relationship with a gender, and the therapist responded, “It is not necessary to talk about gender relationships, there are similar situations in all relationships. ” This also continues or carries the topic deeper. The therapist is still inevitably the target of a range of empathy, especially from patients of the opposite sex, and the therapist must always have a “third eye” on the relationship so as not to become too deeply involved. When the group therapist is both the individual therapist for certain patients, the therapist needs to be more aware of the impact of the empathic relationship outside of group therapy and discuss it in individual therapy, not just in group therapy; the therapist also needs to clarify or moderate appropriately when the patient brings the emotions of individual therapy into group therapy. Although the exploration of group therapy on this topic has been going on for five years, the support of the overall environment of the inpatient ward is still essential for it to be helpful to the patients and to proceed more and more smoothly. For example, when we mentioned the word “psychosexuality” in one of the activities for patients, one of the family members who was watching through the door with their ears became very angry and said angrily outside, “What is this?” The family then brought this behavior, which could lead to the patient going “astray,” to the attention of the leadership. And this is not only true for the family, but also for the patients themselves, who may express their resistance in various ways, such as leaving the treatment, not coming to the next treatment, or dozing off during the treatment. The hospital environment can have an invisible propaganda and influence on this point. For example, in the corridor of the ward, there is a painting that reads, “If you see beauty and do not praise it, or if you eat delicious food and are not willing to eat it, you are not human if you do not have the heart of right and wrong. If you see a beautiful woman and overtake the wall of your home, or eat a delicious food and keep your brother’s arm open, you are not a human being if you do not have a heart of shame and evil. —- Yuan Mei”, this passage can sometimes be used as an introduction to begin group therapy on this topic. The theme of “psychosexuality” and its related contents are often mentioned in this treatment; the theme of this group treatment is also indicated in the schedule of treatment for patients; of course, the arrangement and support of the department and hospital leaders for this work is also a powerful superego for patients and families. In addition, the hospital’s overall set-up includes special health education activities for families to understand the psychosexual characteristics of adolescence and the relationship with the family, and to build a bridge between doctors, patients and families to better serve the overall treatment. For the patients, there are also regular meetings about rules and regulations, which is similar to the role of behavioral therapy and at the same time assists in the group treatment of psychosexuality. Drama therapy in the ward sometimes has plays including Oedipus Rex, and sometimes it can also help with drama therapy by combining drama experiences and discussions with each other. Also very important is individual psychotherapy, for deeper issues and stronger empathic reactions, patients are advised to discuss them in individual therapy. In inpatient psychotherapy, the whole system has an interplay, and group therapy on this topic cannot be done without the support of the system at the same time.