Existential issues in group psychotherapy

Existential issues in group psychotherapy derive from existential thought both as a philosophy and as a value system. Its origins derive from the weakening of traditional values and the growing alienation of man from himself. The unique features of existentialism can be applied to all forms of therapy. These features are universal to humankind. They are finiteness, aloneness, guilt, responsibility, and freedom. In including existential concerns as part of group psychotherapy, therapist and patients move more closely to bilateral relationships and subjective interactions.     

Ethical and legal issues in group counseling

Legal and ethical issues involved in group work are reviewed and discussed. Variations in different professional ethics codes are discussed. Recommendations for consideration by group leaders are made.     

Ethical considerations in psychotherapy effectiveness research: choosing the comparison group

The primary purpose behind effectiveness research is to determine whether a treatment with demonstrated efficacy has utility when administered to the general population. The main questions these studies are meant to answer are these: Can the typical patient respond to treatment? Is the treatment acceptable to the typical patient? Can the treatment be administered safely and in its entirety in the typical treatment setting? Is the treatment under study significantly better than the community standard of care both from and a cost and outcome perspective? Answering these questions is meant to provide sufficient information to providers and policymakers so that effective interventions can be adopted and become the new community standard. For this research to make a meaningful impact on a provider and policymaker's decision to change the status quo, study interventions should be compared to the existing community standard of treatment, often referred to as treatment as usual (TAU). From an ethical perspective, this decision may not always be the safest choice. In some populations, TAU may mean no treatment at all, and in others TAU may be worse than withholding treatment. The effectiveness researcher is then caught between the pull to do no harm and the need for research to have an impact on change. The purpose of this article is to highlight certain conditions when TAU is ethically acceptable and to discuss alternatives when TAU may be an unethical treatment condition. For purposes of precision, we focus exclusively on psychotherapy effectiveness research rather than system-intervention research or medication-intervention research.     

Religious issues in psychotherapy

Religious belief is important to a large proportion of our population. It has been found to be a potent neutralizer of death anxiety. Religion and psychotherapy shave values relating to self-actualization. It is the responsibility of psychotherapists to be aware of their own ambivalences and biases; to assess the significance of religious belief in the lives of their clients; to clarify conflicting views and values of client and therapist; to treat the client's psychodynamic problems; and respectfully to refer spiritual problems outside the domain of psychotherapy to the client's minister. An illustrative example from the author's practice is included.Based in part on a paper presented at the annual meeting of the California State Psychological Association, San Francisco, California, February 4, 1983. Dr. Sacks is Associate Dean Emeritus California School of Professional Psychology, Fresno. He has been in the private practice of psychotherapy for more than 30 years.     

Developmental issues in psychotherapy research

Research on psychosocial interventions with children requires attention to developmental principles such as age-specific competence, maturational shifts, increasing cone of relevant contacts, and socioeconomic context of biological stages. Research strategies that include such variables should lead to ecologically sound investigations and the correct selection of outcome variables. A consideration of the specificity of treatment and controlled design alone are not sufficient to guide the study of the psychological treatment of developing organisms and persons.     

Ethical issues in genetics

The first section of the Notes on Moral Theology reviews ethical issues in genetics through the lenses of privacy-confidentiality; risk-benefit analysis in relation to prenatal diagnosis and gene therapy; and freedom-determinism/human dignity in the context of cloning. The author provides an overview of developments in genetics and highlights thematic issues common to these developments.     

Ethical issues in diagnosis

The ways in which ethical issues arise in making clinical judgments are briefly discussed. By showing the topography of the role of value judgments in medical diagnostics it is suggested why clinical medicine remains inextricably a value-infected science.     

Countertransference in group psychotherapy

This paper attempts to up-date our understanding of countertransference in the therapy group setting. After a brief review of some of the psychoanalytic and the group psychotherapy literature dealing with countertransference, the paper points out the vulnerability of the group therapist and presents examples of possible countertransferential situations, such as stereotyped roles, reactions to external aspects of patients, and therapists' insecurities. It concludes by suggesting ways in which group therapists can become more sensitive to their countertransferences.     

Hostility in group psychotherapy

To run a psychodynamic group therapeutically, the leader must understand the meanings and functions of hostility. Fundamental to this task is the leader's awareness of his or her bias toward hostility as a constructive or destructive feeling and willingness to serve as a lightening rod for it. This paper discusses the sources of hostility during different stages of group development. The therapeutic handling of hostility is discussed under the following topics: theoretical considerations, defensive functions, and communicative functions. Case examples illustrate the proper handling of contractual violations, scapegoating, and narcissistic injury. Countertransference reactions to anger and rage in the group are discussed.     

Resistance in group psychotherapy

The authors view resistance generally as healthy and a sign of a more or less intact ego. A brief review of the psychoanalytic literature and the group therapy literature presents resistance as a mechanism that closes off aspects of the internal and external world seen as potentially dangerous. Patient resistances are identified as coming from cultural values, fear of strangers, fear of regression, and resentment toward the therapist. Clinical vignettes of group patients and group interaction are presented. Finally, resistance of therapists and indications of such resistance are also explored.