The psychiatric nurse as group psychotherapist

An overview of current dimensions of group psychotherapy practice by psychiatric-mental health nurses is presented. The relationship between graduate education and the characteristics of the nurses' current practice is demonstrated. The psychiatric-mental health nurse's involvement in the general health care arena with nonpsychiatric populations is highlighted. Future trends for the practice of group by nurses is explicated and projected. In addition, implications for the education and practice of other group practitioners is drawn.Marianne DiMinno, R.N., M.S.N., assisted in the development of the survey questionnaire.     

The absent psychotherapist

This paper explores the effects in psychotherapy of the therapist's sudden and unexplained twelve-week absence, caused by a pregnancy that was threatened and ultimately miscarried. The anxieties of the patients stirred up by the absence and the therapist's own countertransference difficulties are considered.     

The ethical group psychotherapist

Group psychotherapists in their everyday practice confront a series of ethical problems, some of which rise to the level of ethical dilemmas. This two-part special series will address how the group psychotherapist can address these problems and dilemmas in a way that leads to an ethical course of conduct. This article introduces the series by examining ethical principles and decision-making processes that are relevant to the wide range of issues that confront the group psychotherapist. The article also considers the person of the group psychotherapist him or herself and notes that certain personal qualities might create a foundation for ethical thinking and behavior.     

The group psychotherapist as contemporary mystic: a bionic object relations perspective

Mysticism is a heightened awareness facilitating intuitive knowledge of group realities. In contrast to logical positivism, in which scientific knowledge consists of logic applied to a set of observations, the author holds that mystical awareness is pertinent to the conduct of therapy groups. The work of Bion, and also so-called "structuralist" theories, postulate pre-given templates that inform experience. The application of mystical thought to group consultation, leadership, and transformation of the self is discussed. The group context which allows for mystical experience is called the "sacred space." To emphasize the sacredness of the group, a kabbalist parallel to early development and projective identification is used to show how sacred metaphor and myth can enrich interpretation in groups.     

The client as expert: Researching hindering experiences in counselling

This paper identifies the importance of valuing clients’ experiences when seeking to understand hindering experiences in counselling. Since the research literature reports that client perceptions of counselling are better predictors of outcome than counsellor ratings, client viewpoints are critical to furthering understanding of hindering experiences. Clients are generally reluctant to share negative experiences and a discussion regarding the difficulty in soliciting these experiences is presented. Examples of the process of conducting a client-oriented investigation into hindering experiences convey some of these difficulties. Several implications for counselling practice are addressed: (1) the need for counsellors to notice and repair hindering experiences, (2) the value of attending to the quality of the relationship, (3) the need for counsellors to cultivate flexibility and responsiveness, and (4) the use of methods to encourage clients to share their unspoken experiences.     

Searching for the enriching sense of otherness: The psychoanalytic psychotherapist as a meaning-bearing other

Abstract

This paper is a theoretical and clinical examination of the patient's search for the otherness of the therapist as a prerequisite for change and development in relational psychoanalytic psychotherapy. A basic assumption is that being in a relationship as well as being a personal self, is to be understood, as being with a “meaning-bearing other”; that is, someone who allows for the possibility of meaningful thoughts and feelings, either through an actual communicative presence or as a consciously, prereflective, or unconsciously imagined communication partner. The term “meaning-bearing other” is used to differentiate distinct, although often synchronic, modes of relatedness. The need for intersubjective “depth”—that is, to discover the otherness of the other, and for oneself to be recognized as an experiencing subject—is regarded as a main motivational force. Winnicott's, as well as Sullivan's developmental approaches, Mitchell and Aron's views on psychoanalytic interaction, and Heidegger and Gadamer's phenomenology and hermeneutics are used as theoretical points of reference for the present discourse. The theoretical points of view are examined and discussed through excerpts from twice-a-week psychotherapy with a six-year old girl.     

The ethical group psychotherapist: a coda

This concluding article of a two-part special section on the ethical group psychotherapist are highlighted: (1) the importance of the cultivation of the skill and knowledge base of the group psychotherapist in terms of pertinent legal statutes and ethical guidelines; (2) the criticalness of certain personality features related to the concept of virtue; (3) a therapist's self-awareness contributes to the capacities to think and respond ethically; (4) ethical decision making is most likely to occur when the group psychotherapist attends comprehensively to all dimensions that define the setting in which a dilemma emerges; and (5) that in the service of positive ethics, attention to the ethical dimensions of group psychotherapy practice should be continuously present. In agreement with other contributions to this section, I conclude that the commitment to the ethical practice of group psychotherapy must be made not only by the individual practitioner but also by educational and training programs and professional organizations.     

The one-interview client

A census of National Marriage Guidance Council cases showed that a third of them lasted for one interview only. This finding was met with some surprise by the counsellors. An investigation into one-interview cases was therefore undertaken, with the result that several distinct categories were identified. In some cases one interview seems to be all that is needed by the client.     

The client as consumer and evaluator of community mental health services

Discussion of ethical issues which concern community psychologists and other mental health professionals has generated new emphasis on the psychiatric client as consumer. In light of the studies questioning the efficacy and ethics of various clinical procedures, it would seem that the client-consumer is being asked to accept treatment which is often less than desirable. In light of recent trends to safeguard the rights of the client-consumer, it is now appropriate to focus on the client as evaluator of services contracted. Having clients evaluate clinical services finds its logical fruition in the creation of client advisory boards. Avoiding many of the problems of citizen mental health advisory boards, client boards ensure continued and systematic client evaluation of community mental health services. The accomplishments of one client board are offered as evidence that there should be increased emphasis on the consumer as evaluator.     

Values and the psychotherapist

One cannot live without encountering the problem of values. Certainly, one cannot go through psychotherapy without becoming involved implicitly and explicitly in the problem. Nor can one engage in psychotherapy as a therapist without bringing certain convictions about values into one's work. These convictions may or may not be specifically communicated to the patient, but they underlie the therapist's activity; they help determine the goal he sets for himself and his patient; and they are consciously or unconsciously reflected in his questions, statements or other reactions.“^1,p.1