Differential outcomes of skill training,group counseling,and individual cognitive therapy for persons with acquired visual impairment

As part of the Living Skills Training Program, group counseling and individual cognitive therapy were implemented to decrease psychological distress for adults with acquired visual impairment. This quasi‐experimental design study compared the outcomes of a 6‐month skill training program combined with a group counseling program (n = 37), with (n = 9) or without (n = 10) individual cognitive therapy, and with a control group (n = 42). The outcome measures were the Profile of Mood States and the Nottingham Adjustment Scale Japanese Version. The results showed that participants with low psychological distress decreased anxiety and increased acceptance of disability, even when they did not participate in group counseling. However, among the participants with high distress, they did not show any improvement without group counseling or individual therapy. The participants with high distress who engaged in group counseling showed an improving trend in attitudes toward others. Moreover, the participants who chose to engage in individual therapy in addition to group counseling showed decreased tension‐anxiety, depression, and fatigue, and significantly improved acceptance of disability. These results suggest that group counseling, combined with individual cognitive therapy, can be an effective part of rehabilitation treatment for clients who have high psychological distress.     

The Nature of the Co-Therapy Relationship

Termination is a complex phase in the total therapeutic process. Criteria for termination of long-term analytic group therapy encompass both intrapsychic and behavioral changes. One of the useful ways of conceptualizing the termination phase is in terms of the issues of separation-individuation. Three different kinds of termination that can occur and the techniques for working with each are described. Multiple transferences are worked with in the long-term analytic group and both real and transferential losses acknowledged. The ability to leave group therapy with a stronger, better defined sense of self is one of the goals of therapy.     

Treating work inhibition in group psychotherapy

Work Inhibition, defined as an impaired ability to pursue one's career goals, may be treated by combined individual and group therapy. The author presents a method for assessing the degree of work difficulty, a psychodynamic understanding of the problem, and an approach to treatment. He proposes that helping the patient work more actively in group will generalize to the workplace and reduce inhibition. A clinical illustration is provided.     

Psychoanalytically oriented short-term groups for outpatients: Unsettled issues

The psychoanalytic approach to short-term group therapy for outpatients has been less prevalent than other approaches. Unsettled issues associated with this approach concern the feasibility of carrying out psychoanalytic work on an ongoing basis, patient selection, group composition, patient preparation, therapist technique, and cotherapy. Recent literature relevant to a conceptual consideration of these issues is reviewed. A vignette from a recent therapy group is presented as part of a clinical consideration of the issues. In addition, practical suggestions for conducting such groups are provided.This article was derived from a paper presented at the Seventh Annual Meeting of the Canadian Group Psychotherapy Association, October 16, 1986, Mont Tremblant, Canada.     

Co-leader termination in an outpatient alcohol treatment group

The termination of a co-leader from a long-term therapy group for alcoholic outpatients is described over a seven-week period from the initial termination announcement to the first week following the co-leader's departure. The authors highlight salient themes and defensive maneuvers that appear as the group struggles with the difficult task of termination. Attempting initially to flee from the impending loss, the group defends with pseudomature responses and veiled hostility. These are followed by themes of abandonment and loss. The group leaders' initial collusion with the group's denial of loss is described, along with leader tactics to facilitate the group's termination work. Finally, the meaning of a group farewell gift is discussed in terms of both its implicit communications and as a form of resistance.     

Premature termination: A risk in eating disorder groups

This study examines the influence of combined vs. conjoint psychotherapy on the phenomenon of premature termination in eating disorder groups. Thirty-eight women with a diagnosis of anorexia nervosa or bulimia enrolled in group psychotherapy were designated as group completers or premature terminators using individually defined treatment objectives. Those eating disorder patients in combined group and individual psychotherapy showed a lower frequency of premature termination than patients in conjoint group and individual psychotherapy.     

The Present Status of Group Therapy in United States Correctional Institutions

A time-limited group treatment program focusing on mothers of toddlers with a borderline personality disorder is reported. The project involved two intersecting groups—the toddler group and the mother group. The focus of the work with the children was to promote their social interests and skills to an expanded world beyond the maternal dyad. The focus of the work with the mothers was on their difficulties with emotional separation-individuation and on strengthening their ego functioning, particularly in the area of mothering so that they could participate positively in their child's separation-individuation phase.

Representative group process is presented as it organized around three distinct phases. The initial phase was marked by intense resistance, and ambivalence. During the middle phase, group cohesion developed around shared feelings and issues. The termination phase focused insistently on issues of separation. Conclusions drawn from the project include the utility of a group approach in influencing maternal behavior.     

Focused group therapy: An integrative approach

Focused Group Therapy (FGT) was developed within a research project on treatment for burned out patients on long-term sick leave. The core of FGT is to find and formulate an individual focus expressed in behavioural terms. This focus is then worked with in the here-and-now of the group therapy. It is argued that the use of common factors in group therapy, rather than a special technique, improves the clinical work. Thesupport factor in group therapy is understood in terms of cohesion, therapeutic alliance and goal-corrected empathic attunement. Thelearning factors that are stressed are the experience of being a part of a developing group, building on similarities instead of differences, affective communication and the implicit knowledge developed in new ways of dealing with interpersonal relations. Theaction factor is considered to consist of challenging interpersonal situations corresponding to the individual focus, which are mastered in the here-and-now of the group.     

Intuition in family therapy: A short manual on post-modern witchcraft

Intuition is an important part of a mature clinician's work. Yet, it is a component of clinical work which is looked upon with suspicion, due in part to the Middle-Age's association between intuition and the work of witches. This paper describes a tenuous link between intuition, witches, and Carl Whitaker. Patterns for including intuition in family therapy are discussed.     

The Lonely Crowd: A Study of Changing American Character by David Riesman; in collaboration with Reule Denny and Nathan Glazer

This paper describes a form of combined psychotherapy in which the individual sessions are used as an adjunct to group therapy. Each group member is seen regularly in individual sessions to focus primarily on the member's ongoing group work. The individual sessions are scheduled on a rotating basis. Typically, each group member is seen in an individual session once every four weeks. Additional individual sessions are available only when immediate attention is appropriate and necessary. The group is viewed as the primary therapeutic component. A cost-effective therapeutic approach that uses both individual and group methods, this modality lends itself well to a clinic and to a private practice setting.     

Transference and Countertransference: New Horizons

In this exploratory study one set of patients (n – 50) was randomly assigned to either short-term group therapy or short-term individual therapy. Another set of patients was randomly assigned to either long-term group therapy or long-term individual therapy. All patients were rated prior to therapy on fifteen variables which were believed to be important for psychoanalytically oriented therapy. A comprehensive battery of outcome measures was administered both before and after therapy. Univariate and multivariate analyses were conducted in an effort to discover differential predictors of improvement for group therapy and individual therapy. None of the variables was found to be a significant predictor of improvement in one type of therapy and of nonimprovement in the other type. However, a number of variables were found to be significant predictors of improvement for one type of therapy but not for the other. It is suggested that for a given patient, a pattern of scoring on a number of such variables might tend to favor one type of therapy over another. The authors hope that the present study will serve to encourage further research work on the issue of assisting clinicians in their decisions concerning general and differential prediction of therapy outcome.     

Five Issues in Training Edited by Irving R. Weschler and Edgar H. Schein

This case study illustrates how combined therapy (individual, group, and marital) by the same therapist was used to resolve a woman's narcissistic transference. The author's position is that combined therapy creates a psychologically stimulating environment, which uniquely elicits a depth and range of transference feelings, thereby generating multiple therapeutic opportunities to experience and work through transference resistance in the here-and-now. Highlights of the treatment demonstrate how the synergy of three modalities is used to elicit, modulate, and resolve positive and negative aspects of the narcissistic transference. Four guidelines are suggested for treatment of patients in combined therapy.     

Transference in Gerontologic Group Psychotherapy: Studies in Gerontologic Human Relations IV

For a number of reasons, we decided to bring three long-term, open-ended psychodynamic therapy groups to termination. We examine the process that began with the announcement of the change to a time-limited format, and concluded with the termination of the group. The transition had a powerful impact on the members and the group-as-a-whole. The therapists used supervision to deal with the intensity of the group process and the countertransference demands posed by the transition. Groups facing a similar change due to economic pressures may benefit from these observations.     

Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy

Premature termination from group psychotherapy continues to be a serious problem in the treatment of patients with borderline personality disorder (BPD). Qualitative research is regarded as an important means to shed light upon the complex dynamics leading to dropout. We conducted an interview study with patients having a diagnosis of BPD (n = 8) who dropped out from long-term group psychotherapy as a continuation therapy following intensive day treatment. The group therapists for these patients were interviewed as well (n = 12). The findings suggest the operation of many processes that contribute to dropout. Most significant appeared to be experiences of separation and loss of the day hospital that were not worked through and a failure of the group to regulate and contain the patients' affects. To integrate patients at risk of premature termination it seems necessary to pay attention to the strong negative emotions that they experience in the group. A higher treatment intensity than weekly group sessions may help to promote more beneficial group processes.     

James Hillman: the unmaking of a psychologist Part one: his legacy

This two‐part essay offers a critical assessment of Hillman's archetypal psychology and enquires into its viability as a psychological model. The first part explores his legacy and reviews the metapsychological frame in which his work operates. It considers the relation between his thought and Jung's, and argues that Hillman's work is not so much post‐Jungian as pre‐Jungian. The second part is primarily intrapsychic; it explores Hillman's character, as discerned through his writings and interviews, and considers his work as an expression of the puer aeternus. It is argued that the puer prefers to live in an eternal dream‐state resistant to growing up: yet denial of the maturational impulse will only lead to it happening anyway but in a negative form. The paper considers how Hillman's model was ‘unmade’ by the missing developmental element of his thought. Development is an archetypal and bio‐psychological necessity, and if rejected it can ruin any system that refuses to take it seriously. In Hillman's case this manifested in the form of a repressed masculine shadow, destroying the credibility of his earlier work. The two‐part paper attempts to weave an objective appraisal with a running commentary based on the author's personal engagement with the man and his work.     

Intensive Group Psychotherapy by George R. Bach

Emotional insight, is essential in order for therapeutic change to take place. Profound resistances to experiencing expressing, and understanding emotions are present in group members, the group as a whole, and the group therapist. Reasons for the three types of resistances are described. Specific therapist attitudes and therapeutic techniques are suggested to understand and effectively work through resistances at individual, interpersonal, and whole-group levels. Examples are given from an ongoing therapy group to illustrate the processes of understanding and working through resistances. Resistances on the part of the group therapist are identified and their possible effects on the group's resistance are explored.     

The psychological growth of women in a short-term inpatient group

This paper identifies ways in which a short-term inpatient group can support psychological growth of women. A four-stage developmental model of women's work in an inpatient group is described. In each stage, women achieve greater comfort in new modes of relating. Women also gain greater appreciation of their interpersonal strengths. In the first stage, women face issues related to autonomy and connection. In the second stage, women focus upon conflictual feelings in relation to authority. In the third stage, women address obstacles to the achievement of satisfying, intimate, peer-based relationships. In the fourth stage, women focus upon the issues of separation and loss that are precipitated by the termination of the group. At each stage, the developmental tasks women perform are contrasted with related but nonidentical tasks performed by men.The author wishes to thank Drs. Joan Cooper and Francine Deutsch for their comments on an earlier draft of this paper.     

The Archaic Personality Structure of Alcoholics and Its Implications for Group Therapy

The purpose of this investigation was to obtain a better understanding of the nature of expectations about group psychotherapy, given a consistent body of research pointing to the relationship between specific treatment expectancies and premature termination. The Group Therapy Survey was developed and utilized to assess the predominant beliefs, attitudes, and expectations of 206 clinical and nonclinical subjects toward group therapy. The results of the investigation reflected three major categories of expectations: (1) Group therapy is unpredictable, (2) group therapy is not as effective as individual therapy, and (3) group therapy can be detrimental to participants. Possible explanations for the origin and development of such expectations are entertained, including the publicizing of the more radical aspects of the encounter group movement and other negative portrayals of group therapy in the media and the film industry. Recommendations are offered concerning the use of the survey prior to intake or a pregroup orientation interview in order to tailor a discussion to the prospective client's personality, expectations, and problems.