Modified group therapy for psychotic and depressed patients

This paper describes a group treatment program for chronically ill patients which has been found to be more economical than traditional modalities of treatment of such patients and to minimize transference and countertransference problems. Technical guidelines and the theoretical rationale are discussed, as are the therapeutic factors in such a group. Case vignettes are given to illustrate both the group process and the individual patient's use of the group.The authors are deeply grateful to the residents of the department who, as cotherapists, shared in the planning and work of the coffee lounge groups. Invaluable to us also were the interest and ideas of Dr. Donald Miller who served as a consultant to this project.This is a revised version of a paper presented at Grand Rounds, Montefiore Hospital and Medical Center, Bronx, N.Y. in September, 1975.Miss Emery is, and Mrs. Levitan was, a social worker at Montefiore Hospital and Medical Center, Bronx, N.Y. Mrs. Levitan was formerly Principal Associate in Psychiatry (Social Work), Albert Einstein College of Medicine. Dr. Gadlin is Director of the Group Therapy Training Program at Montefiore Hospital and Medical Center, and Assistant Professor, Albert Einstein College of Medicine.     

Sequential cotherapy of groups for training and clinical care

Cotherapy has often been used as the leadership model in group therapy. The literature is full of contradictory data and impressions as to the efficacy of this model. In this article a new form of cotherapy is presented which may offer some of the assets attributed to the cotherapy leadership model while at the same time reducing some of the liabilities. Sequential cotherapy refers to cotherapy when each of the therapists leads sequentially rather than at the same time. The pros and cons of such an approach are discussed from both the perspectives of training new group therapists and of service to patients in groups.Dr. Rutan and Mrs. Alonso are members of the faculty of Harvard University Medical School and share responsibility for training psychiatric residents in group therapy at Massachusetts General Hospital, Boston, Massachusetts.     

Techniques for handling resistances in group psychotherapy with severely disturbed patients

There has been an increased interest in recent years in the treatment of those with severe psychopathology through application of object relations theory and modern ego psychology. Yet, for the past 20 years, such patients have been treated in day hospitals where rehabilitation and socialization concepts have been employed. This paper integrates some of the advances in psychoanalytic theory with more established methods of milieu therapy. In the patients studied, the therapists noted the presence of severe envy, dependency, passivity and with-holding, an intolerance for aggression along with an intransigent, paranoid-schizoid position. The techniques described here worked through the effects of these resistances so that the patients could use the psychotherapy group, and the entire milieu, more constructively than they did before.Ruthe Feilbert-Willis, C.S.W. was formerly Senior Social Worker in the Adolescent and Adult Day Hospital at The New York Hospital-Cornell Medical Center, in White Plains, New York.He was a psychiatric resident at The New York Hospital-Cornell Medical Center, in White Plains, New York, during the time the clinical work of this paper was undertaken.     

What We Owe the Dead

abstract   My aim in this paper is to argue that we have at least some obligations to the dead. After briefly considering some previous (unsuccessful) attempts to establish such obligations, I offer a reductio argument which establishes at least some obligations to the dead. Following this, the surprising extent of these obligations (given a few roughly Kantian assumptions) is considered. I then argue that there are and must be some significant limitations on the duties of the living in relation to the dead. My aim in this paper is not to sort out how we should deal with all of the particular cases in which the question of obligations to the dead emerge — in archaeological digs, research involving the newly dead, the execution of wills, or the fulfilment of last requests — but I will attempt to lay some groundwork for the future assessment of these questions.     

From Knowledge-based Programs to Graded Belief-based Programs,Part I: On-line Reasoning<Superscript>*</Superscript>

Knowledge-based programs (KBPs) are a powerful notion for expressing action policies in which branching conditions refer to implicit knowledge and call for a deliberation task at execution time. However, branching conditions in KBPs cannot refer to possibly erroneous beliefs or to graded belief, such as “if my belief that φ holds is high then do some action α else perform some sensing action β”. The purpose of this paper is to build a framework where such programs can be expressed. In this paper we focus on the execution of such a program (a companion paper investigates issues relevant to the off-line evaluation and construction of such programs). We define a simple graded version of doxastic logic KD45 as the basis for the definition of belief-based programs. Then we study the way the agent’s belief state is maintained when executing such programs, which calls for revising belief states by observations (possibly unreliable or imprecise) and progressing belief states by physical actions (which may have normal as well as exceptional effects). ^* A premliminary and shorter version of this paper in the Proceedings of the 16th European Conference on Artificial Intelligence (ECAI-04), pp. 368–372 (Laverny and Lang 2004).     

Modified group psychotherapy with chronic renal dialysis patients

Renal dialysis is a life saving, chronic medical procedure for those patients whose kidneys no longer function. However, the psychological reactions to this procedure, which necessitates a state of passivity for several hours, often overshadow the medical implications, and, in some instances, are decisive in terms of the patient's adjustment to treatment. Frequently, patients are unable to utilize individual psychotherapy to its maximum because of their need to perceive their illness as only medical. Group therapy however provides a less threatening psychological milieu and tends to give rise to peer support and mutual interaction.Barbara Halin Willinger, M.S.W., A.C.S.W., was the social work supervisor of the Renal Dialysis Unit at Metropolitan Hospital at the writing of this paper. She is a private psychotherapist and is affiliated with a mental health clinic where she also practices individual and group psychotherapy.The author wishes to thank Martin Saltzman, M.D. and Haley Glazer, M.S.W. for their suggestions.     

The reparation of the self: Clinical and theoretical dimensions in the treatment of Vietnam combat veterans

This paper discusses a broad range of theoretical and clinical issues pertaining to a proposed approach to individual psychotherapy with Vietnam combat veterans. Called theself-reparative process, this approach features four phases, ranging in the first from anactive behavioral-cognitive approach to the fourth phase that utilizes a less active, psychoanalytic approach. This range of approaches is essential in order to adapt to the ongoing progressivespectrum-of-needs of the veterans, with the objective of increasing psychological control to resolving narcissistic rage and building a cohesive self.The views contained in this paper represent those of the author, who is solely responsible for its contents. As such, the views herein are not necessarily those of the Veterans Administration. Paper presented at a Queens Hospital Center (affiliation of Long Island Jewish-Hillside Medical Center) Department of Psychiatry, Grand Rounds in Jamaica, New York on April 10, 1981. The author acknowledges the gracious assistance of Doctors Scott Mykel and Robert Mednick of Queens Hospital Center during the first draft of this paper.     

Significant events in a psychodynamic psychotherapy group for eating disorders

This qualitative pilot study was designed to identify and explain significant events for patients participating in a psychodynamic psychotherapy group for eating disorders. Specifically, seven members of a mixed (i.e., anorectic, bulimic, obese) eating disorders group recorded what they perceived as the three most significant events in group meetings for 14 weeks. In addition, group members were instructed to record why each event was significant. Manifest and latent content analyses of the data revealed that members found feedback and observing others the two most common types of significant events, and emotional experience, insight, and relationship the reasons these events had such impact. The implications of these results for working with the eating-disordered patient in group, as well as their implication for general group theory and practice, are discussed.An earlier vesion of this paper was presented at the 1991 meeting of the American Group Psychotherapy Association, New York. This paper was funded, in part, by a California State Faculty Support Grant and a Santa Barbara Cottage Hospital Research Grant awarded to the first author. The authors would like to thank Sean T. Casey, Sally Barton, Dr. Allison Wollitzer, Tom Knowlton, Craig Park, and Beth Buxton for their assistance in the preparation and execution of this study.     

Signals use by leaders in Macaca tonkeana and Macaca mulatta: group-mate recruitment and behaviour monitoring

Animals living in groups have to make consensus decisions and communicate with each other about the time, or the direction, in which to move. In some species, the process relies on the proposition of a single individual, i.e. a first individual suggests a movement and the other group members decide whether or not to join this individual. In Tonkean (Macaca tonkeana) and rhesus macaques (Macaca mulatta), it has been observed that this first individual displays specific signals at departure. In this paper, we aimed to explore the function of such behaviours, i.e. if these behaviours were recruitment signals or only cues about the motivation of the first departed individual. We carried out temporal analyses and studied the latencies of the first departed individual’s behaviours and of the joining of other group members. We also assessed whether the social style of a species in terms of dominance and kinship relationships influenced the patterns of signal emissions. We then analyzed how the first departed individual decided to make a pause or to stop it according to the identities of group members that joined the collective movement. Results showed that Tonkean macaques and rhesus macaques seemed to use back-glances to monitor the joining of other group members and pauses to recruit such individuals. This was especially the case for highly socially affiliated individuals in Tonkean macaques and kin-related individuals in rhesus macaques. Moreover, back-glances and pauses disappeared when such individuals joined the first departed individual. From these results, we suggested that such behaviour could be considered intentional. Such findings could not be highlighted without temporal analyses and accurate observations on primate groups in semi-free ranging conditions.     

Participant self-disclosure in group therapy

Thirty-nine adult hospitalized psychiatric patients, 18 men and 21 women, participated in a study aimed at investigating the relationship between participant self-disclosure in a therapy group and personality and therapy outcome. The results showed that in this type of sample the more disturbed patients disclosed more, which is contrary to results usually obtained among normals and neurotics. Similarly, for some patients, higher degrees of disclosure were related to worse therapy outcomes. These results indicate that the indiscriminate insistence of some therapists on selfdisclosure is inappropriate with hospitalized patients. Improving self-esteem by encouraging positively toned self-disclosures appears more promising.Barbara Polikoff, formerly a Research Assistant at Friends Hospital. The authors want to express their appreciation to Dr. Paul Curnow and Michael Bopp who conducted the groups under study and to Joseph Sillitti for his assistance in the data analysis.     

Combined therapy with borderline and narcissistic inpatients at the cassel hospital

An account is given here of a rather unorthodox approach to psychodynamic therapy with Borderline patients in part of the therapeutic community at the Cassel Hospital. ‘Combined therapy’ here refers to the setting in which one therapist sees patients in groups and individual sessions concurrently. The paper demonstrates the manner in which this approach brings to the fore the massive destructiveness and rage which so often lies at the core of these patients' difficulties. This is done by describing the development of the group over its first nine months. The therapist comes to be split in the patient's perception, the group sessions representing separation in all its most hated aspects rather than as a prerequisite for differentiation and growth. The resultant rage and destructiveness threaten to render the group unworkable and dangerous. The individual sessions, by contrast, represent a fantasy of being regressed and at one with the ideal mother. It is my belief that these difficulties can be contained only within a therapeutic community. The strength of this approach lies in the vivid reconstruction of a central conflict for these patients and corresponding potential for working through difficulties in the area of separation and individuation. It is also particularly effective in bringing the therapeutic community alive within the therapy. The discussion attempts to address some of the complex theoretical issues raised by the transformation of the transference in both settings which occurs when they are used together and with the same therapist.     

The Role of Argument in Negotiation

The purpose of this paper is to show the pervasive, though often implicit, role of arguments in negotiation dialogue. This holds even for negotiations that start from a difference of interest such as mere bargaining through offers and counteroffers. But it certainly holds for negotiations that try to settle a difference of opinion on policy issues. It will be demonstrated how a series of offers and counteroffers in a negotiation dialogue contains a reconstructible series of implicit persuasion dialogues. The paper is a sequel to van Laar and Krabbe (2017), in which we showed that for some differences of opinion it may be reasonable to shift from persuasion dialogue, aimed at a resolution of the difference on the merits, to negotiation dialogue, aimed at compromise, whereas in the present paper we show that such a shift need not amount to the abandonment of argumentation. Our main aim in this paper as well as in the previous one is to contribute to the theory of argumentation within the context of negotiation and compromise formation.     

Cognitive architectures: Research issues and challenges

In this paper, we examine the motivations for research on cognitive architectures and review some candidates that have been explored in the literature. After this, we consider the capabilities that a cognitive architecture should support, some properties that it should exhibit related to representation, organization, performance, and learning, and some criteria for evaluating such architectures at the systems level. In closing, we discuss some open issues that should drive future research in this important area.     

Identity,past and present,in an historical child-care setting

This article puts into context the service offered today to adults (former pupils) who grew up in the care of the Foundling Hospital. Key issues referred to are attachment, loss, identity and the urge to reconnect with one's personal history. Reflections on these issues are based on the experience of Coram Family social workers, who have for the past thirty years provided a birth-record service to the former pupils of the Foundling Hospital and their descendants. It is a moving experience to hear from this group of individuals something of what it has meant to have grown up in such particular circumstances. Although there are many echoes with adoption and fostering today, other significant issues are raised which do not apply in the work of family placement as it is now practised. Some historical background is given below in order to set the scene for this unique piece of child-care history, also to allow examination of the challenges faced by some 20,000 children over 200 years, in recognition of which the service to those former pupils and their families is still offered.     

Women who lead

Summary This essay reviews aspects of historical and cultural changes that now permit women increasing opportunities to lead both women and men. Women assuming leadership responsibilities undergo psychic reorganization, reworking their personal histories and their modes of interaction. The author challenges women who inhibit their leadership potential to scrutinize their attitudes and to consider the implications for the next generation of women. Presented at the American Academy of Psychoanalysis Seminar Series: Clinical Advances in Dynamic Psychotherapy, October 30, 1994, New York University Medical Center Chestnut Lodge Hospital in Rockville, MD. She teaches at the Washington Psychoanalytic Institute, Walter Reed Army Hospital, the Uniformed Services University of the Health Sciences and the Washington School of Psychiatry. She coordinates a Washington School of Psychiatry study group with Maurine Kelly, Ph.D., and Tybe Diamond, LCSW, “Women’s Contributions to Psychoanalysis,” where many of the ideas in this paper were discussed.     

计算机支持下协同工作的心理学研究

计算机支持下协同工作（ｃｏｍｐｕｔｅｒｓｕｐｐｏｒｔｅｄｃｏｏｐｅｒａｔｉｖｅｗｏｒｋ,简称ＣＳＣＷ）是计算机科学和认知科学的新兴交叉研究领域,主要研究在高技术支持下的群体协作。ＣＳＣＷ中蕴含着大量的心理学研究问题。心理学家需要更好地理解群体协作的性质以评估新技术是否与群体协作相适应,其研究成果会有助于理解如何构建技术和哪些技术可能成功。本文首先从分析ＣＳＣＷ的领域维度入手,然后讨论与之相关的一些重要的心理学研究问题,最后简要介绍国外在该领域进行的研究工作     

Group intervention for medical patients—A treatment for damaged self-esteem

There is a need to integrate our knowledge of psychoanalytic theory, group therapy and medical care delivery systems. Understanding the importance of selfesteem, based upon the study of psychoanalytic theory, can help to determine appropriate technique in medical groups as well as to add to our understanding of the profound importance of such groups in the delivery of medical care. Groups in hospitals help patients to get in touch with their strengths, feel less isolated, and be more active—all of which enhance selfesteem. As patients participate in groups, narcissistic defenses can be enhanced and the quality of life improved. When interdisciplinary teams participate in patient groups, delivery of medical care can be more comprehensive: The totality of the patient emerges more clearly and staff becomes more aware and sensitive to his/her emotional and physical needs.This paper was presented at Thirty-Sixth Annual Conference, American Group Psychotherapy Association, 1978. The author would like to acknowledge Hazel M. Halloran and Susanne A. Kohut, Director and Associate Director, Department of Social Work, who conceived of and supported the expansion of the group work program in the General Hospital Division of St. Vincent's Hospital and Medical Center of New York. The following professionals contributed clinical material used in this paper: Sara Bookbinder, M.S.W., Carol Coven, M.S.W., Linda Haselman, R.N., Barbara Horn, M.S.W., Kathleen McQuade, R.N., Ellen McGuire, M.S.W., Sister Marita Rose O'Brien, R.N., and Emile Powe, M.D.     

Student essay competition prize winner basket weaving: Sharing stories in a group setting

Abstract

Participating in a self-awareness group (in this case for counsellors in training) is an exercise in give and take - an interweaving of stories - through which we share ourselves with our peers. This paper explores some personal discoveries about the processes at work in (a) listening to others, (b) relating my own story - and assessing thereby the extent of my belonging, role and investment in the group. A dream alerted me to our shifting to another dimension of story-sharing by the end of forty sessions. The imagery I use is of basket weaving and creating a mandala.     

Working with psychotic processes in art therapy

In this paper the author describes in some detail her work in the art-therapy department of Hill End Hospital. She used not only her understanding of the work of psychoanalytical writers on schizophrenia, particularly Bion and Searles, but, more importantly, her own experience of the patients at the Hospital, to gain an insight into how these very regressed patients think of themselves and their relationship to reality. She illustrates how she used objects and images created by patients from the art materials supplied, during (usually) five two-hour sessions a week, together with conversations (and notes made in the patients' presence of these conversations) about these images at structured weekly individual-therapy sessions, to help patients to develop from a state of meaninglessness to a position in which they can choose to engage in continuing therapy.