Parting gifts: termination rituals in group therapy

A patient's termination from group therapy is a powerful experience for the departing patient, the therapist, and all group members. Unless the feelings evoked are channeled into constructive expression, they may undermine this potentially valuable phase of both the departing patient's group treatment and the life of the group as a whole. A termination ritual, styled by a particular patient according to his or her own need, therapy goals, and personality may help the patient achieve a more clearly defined sense of self. The authors suggest that the group therapist's careful attunement to and thorough exploration of the significance of any termination ritual or gift will help to extract maximum therapeutic benefit for the departing member and the group as a whole.     

Oppression, freedom, and recognition in an analytic therapy group: group and therapist interactions from relational and group analytic perspectives

Group analytic and relational writings point to the development of mutual recognition between individuals as a main treatment goal. To achieve this, it is necessary to face up to issues of control and oppression in the therapeutic relationship, particularly as enacted by the therapist. The relationship between the therapist and group members is a co-construction, shaped by their respective subjectivities. The therapist's willingness to enter into an open examination of his or her enactments can stimulate change in relationships with patients, resulting in freer and more spontaneous communication in the group. To illustrate, several sessions of an analytic therapy group are presented in which there were struggles between (1) the desire for equality and mutuality and (2) firm exercise of authority.     

The therapist's self in dialogical family therapy: some ideas about not-knowing and the therapist's inner conversation

In this article, the focus is on the therapist's self, which will be in line with Bakhtin's thinking, viewed as a dialogical self. First, the dialogical view of the self is situated in the context of psychology's traditional focus on the individual self. Then, leaning on Bakhtin and Volosinov, the self is described as a dialogue of multiple inner voices. Some of the implications of this concept for family therapy practice are examined, focusing especially on the therapist's participation in the therapeutic process and on the therapist's inner conversation. The author argues that not-knowing does not only refer to the therapist's receptivity and respect but also implies that the therapist is aware of his or her experience and reflects on how his or her inner conversation might inform and enrich the therapeutic conversation. Finally, these ideas are illustrated with a brief clinical vignette.     

Therapist Self Disclosure in Group Psychotherapy from an Intersubjective and Self Psychological Standpoint

The history of therapist self disclosure is traced from the early struggles of Ferenczi and Burrow to its valued, yet still ambivalent, contemporary status. The symmetry of self disclosure by therapist and group members is differentiated from the parity of their different roles and responsibilities. Using a case example, the process is discussed through which a therapist's self disclosure fosters task-appropriate satisfaction of selfobject needs as it also helps group members articulate and loosen archaic selfobject binds. The therapy group is described as a transitional space within which a therapist's disclosure offers members an intersubjective bridge to the therapist as well as a model for members' own active participation in the group's work.     

Self psychology,intersubjectivity, and group psychotherapy

The basic concepts of self psychology are presented. The three self-object transferences of mirroring, idealizing, and twinship are described and applied to group therapy. The therapist's role is: 1) to accept the patient's need to idealize the leader, the group, or the specific members; 2) to receive recognition and admiration; and 3) to understand the patients search for twinship. The group therapist also has the responsibility of teaching group members to have empathy for one another.     

Sexual misconduct in psychotherapy: reactions to a consumer-oriented brochure

Reactions of subjects to a brochure addressing the topic of sexual intimacy in psychotherapy was assessed. Fifty-four psychotherapy clients and 52 licensed psychologists responded favorably to the brochure, with the majority indicating that the brochure should be made available before therapy begins or during the first session. Potential clients (120 college students) read either the brochure on sexual misconduct or a control brochure containing general information about psychology. Subjects who read the sexual misconduct brochure showed increased ability to understand what is appropriate and inappropriate therapist behavior, see unwanted touch as nontherapeutic, regard a therapist talking a lot about his or her own sex life as inappropriate, view sex in the therapeutic relationship as inappropriate, and intend to behave assertively within the session if their therapist's behavior should make them feel uncomfortable. Subjects who read the control brochure showed no such changes.     

An alternative view of the spouse of the therapist

A therapist's relationship with a spouse, i.e., partner in living, has an important influence on the quality of his or her professional functioning as this relationship offers a vital source of personal support and renewal. This relationship may aid in counterbalancing the weight of the therapist's professional demeanor by focusing on aspects of the therapist's interpersonal relatedness not commonly experienced with other professionals or with clients. The concept of a support-power base from which a therapist extends him or herself toward clients provides a context within which to view the therapist-spouse relationship. If this relationship is approached by the therapist without reliance upon a well-practiced professional role, it can make available opportunities for self-exploration which lead to enhanced personal growth and more effective functioning both personally and professionally.     

When the therapist says goodbye

Therapist-initiated termination poses several unique problems for both the group and the therapist. This paper describes the termination process from the point of view of this therapist's experience in planning the termination of her group therapy practice. The reactions of other analysts to her decision to retire and the group processes and individual patient's reactions in this long-term psychoanalytic therapy group are described in detail. The author follows the group process and her own inner processes in the final six months of the group. The importance of the working through of the termination phase of therapy is supported by the experiences that were shared by the group and the therapist.     

The therapist's inner conversation in family therapy practice: some ideas about the self of the therapist, therapeutic impasse, and the process of reflection.

In this article, a distinction is made between the outer therapeutic conversation and the therapist's inner conversation. The therapeutic conversation is a circle of meaning in which both the therapist and the clients play a part. The therapist's inner conversation is described as a negotiation between the self of the therapist and his role. In this process of negotiation the therapist has to take seriously, not only his observations, but also what is evoked in him by these observations, that is, images, moods, emotions, associations, memories, and so on. Furthermore, therapeutic impasse is conceptualized as a paralysis of the circle of meaning and of the therapist's inner conversation. A process of reflection is proposed as a way out of the impasse. In that process, the inner conversation of the therapist is externalized with the help of an outsider. In the final part of this article, a case study illustrates the importance of these ideas for the family therapy practice.     

Difficult Terminations in Group Therapy: A Self Psychologically Informed Perspective

In group therapy, terminations that are neither planned nor anticipated are sometimes referred to as difficult. This complex issue of difficult terminations is used as a vehicle to challenge the prevailing, though often unspoken, assumption that the goal of the group therapist is to keep the members in the group. The author presents the notion that the leader needs to maintain a balance between the group as a treatment context, and the goal of that context. The goal of group-as-treatment context is to provide for the therapeutic needs of each individual patient in the group. Self psychology provides a basis for redefining the therapy group as a treatment context. A specific rationale, goal, and process of that redefinition is presented along with illustrative case material. With this understanding, unanticipated terminations can be as readily accepted and understood as ones that are planned. All terminations are viewed as further opportunities to understand how a patient defines his or her sense of self, sense of other, and sense of self with other.     

Separation and loss in psychoanalytic therapy with borderline patients: Further remarks

This paper is a continuation of an earlier one concerning borderline patients, and I can recapitulate only a few of the many areas touched upon here. The borderline individual is faced continually with the threat of loss, either of his tenuously established individual identity, through fusion with the other person, or of his fragile interpersonal relatedness, through uncontrollable flight into autism of psychotic degree. A basic theme in one's work with these persons is that of unconscious, fantasied omnipotence, variously an aspect of the patient's unconscious self-image or projected into the therapist. The acting-out which the patient does consists in his inflicting loss, deprivation, and other forms of injury upon his introjects of part-aspects of the therapist. The grief involved in the relinquishment of so-called bad introjects is discussed. The patient early in therapy is aware of his inability to grieve, and endeavors to conceal this deficiency by spurious emotionality. I give examples of patients' manifesting regressive dedifferentiation to fusion with elements of the nonhuman environment, as an unconscious defense against feelings of separation and loss. Effective therapy with these patients involves the therapist's deeper working through of his own losses. The significant losses occurred so early in these patients' lives that the therapeutic exploration of these areas may enable the therapist to gain access to comparably early losses on his own part, losses from a developmental era which many a training analysis may not have explored at all adequately.     

Aspects of the Client's Conscious Control of the Psychotherapeutic Process

An analysis is made of the opening moments of dialogue between and a client and her therapist in the light of the client's commentary given during an Interpersonal Process Recall interview about the moments. These moments are drawn from a study of 14 clients' reports on their experiences of therapy, thus particularizing the general understanding derived in the larger project. This passage of dialogue was chosen because the client's commentary revealed that, in the brief space of time involved, she had exerted control in terms of the three main relationships as experienced by all clients in the larger study: the relationship with the self, the therapist, and the therapist's techniques. Such control is understood to be an expression of clients' reflexivity, defined as self-awareness and agency within that self-awareness. The understanding that there is an agential involvement in reflexivity is based on both the participants' reports and the author's examination of his own consciousness. The study is discussed in terms of clients' covert experience of therapy and ways of gaining greater access to the unspoken in order to facilitate the working alliance.     

Amelioration of transference resistance: substitute therapists in milieu group psychotherapy

Building upon Wolf's (1949) notion of the use of an alternate session in group psychotherapy, this paper suggests that an alternate therapist substituting for an absent regular therapist in milieu group psychotherapy can facilitate similar therapeutic benefits. The mechanism of this process of overcoming transference resistance is seen as twofold: (1) sessions with a substitute therapist allow patients to confront the infantilization often present in a milieu setting and experiment with more autonomous ego functioning. (2) Sessions with a substitute therapist create conditions which are apart from the ongoing process of the therapy group, thereby allowing for a therapeutic splitting process to develop wherein transference feelings about the regular therapist can be expressed to his or her "alter ego." Several case vignettes are presented in order to illustrate the clinical utility of a substitute therapist.     

Developing the Working Alliance in Marital Therapy; A Psychodynamic Perspective

A good working alliance in marital therapy is one in which the partners are actively collaborating with their therapist to work through conflicts. The therapist begins to develop the alliance by setting the frame of therapy and helping the couple understand the guidelines of treatment. The partners gradually identify with and emulate the therapist's working style and use of self as a reflective instrument. The working alliance can be weakened by empathic failures and strengthened by increased feelings of trust in the therapist and the process of treatment This paper looks at the development of the working alliance in marital therapy from a psychodynamic perspective. A clinical illustration is included.     

On Phallicism; Developmental Aspects,Neutralization, Sublimation and Defensive Phallicism

Many children in need of psychotherapy are latency-age boys who have little or no contact with their fathers. Their problems typically include low self-esteem, identity problems, depression, difficulties in peer relationships, and aggression. Clinical material illustrates that the consequences for the child of fatherlessness depend on many factors, among them the mother's attitude to the father and other mature males. If the mother devalues all men, her son has little space to grow into a healthy adult. The male therapist may be experienced as a threat to the mother-son union, which may render his efforts to help the boy fruitless. If, in contrast, the mother's experiences of her own father and other men are more positive, her pride in her son's masculinity may strengthen his need to find support for his male development. These observations are discussed as affecting the capacity for triadic object representations in mothers and sons.     

Situational countertransference

Situational Countertransference refers to those responses on the part of the therapist that are generated primarily by severe, though temporary, distresses in the therapist's personal life. It has been this writer's experience that many patients are quite attuned to the inner turmoil of their therapist, and that they will react to it in a variety of ways, which will be described. Moreover, a comparison of the level of functioning of two similar therapy groups over the course of nine months found that the group which had inadvertently learned the source of their therapist's distress functioned significantly better than the group which ostensibly knew nothing about it.     

Achieving relationship harmony in groups and its consequence for group performance

Relationships are formed to meet individual goals, and one consequence of this joint effort towards mutual goal fulfillment will be a level of relationship harmony achieved between the interaction partners. The present study investigated the personality correlates associated with the achievement of relationship harmony in a group setting and its consequences for group performance. Students from a social psychology course formed groups for completing task assignments. After a 3-month collaboration, each student evaluated his or her level of relationship harmony attained with each of his or her other group members. It was found that a member's agreeableness positively predicted his or her achievement of relationship harmony in the group, but that conscientiousness and openness to experience had detrimental effects on the relationship harmony achieved with other group members. A group whose members attained higher relationship harmony performed better on its group assignments, suggesting that relationship harmony among members of a group might have beneficial effects on group processes like performance focus and shared exchange at least in a collectivist, Chinese culture.     

The role of optimism in the process of schema-focused cognitive therapy of personality problems

The aim of this study was to examine the determinants and effects of optimism in the process of schema-focused cognitive therapy of personality problems. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits who participated in an 11-week residential program with one symptom-focused and one personality-focused phase. This study examines the role played by optimism during the individual sessions of the second phase, using a time series approach. Decreased patient's belief in his/her primary Early Maladaptive Schema and increased patient-experienced empathy from the therapist in a session predicted increased patient-rated optimism before the subsequent session. Increased patient-rated optimism in turn predicted decreased schema belief and distress and increased insight, empathy, and therapist-rated optimism. The slope of optimism across sessions was related to change in most of the overall outcome measures. There appears to be a positive feedback in the process of schema-focused cognitive therapy between decreased schema belief and increased optimism. In addition, optimism appears to mediate the effects of schema belief and therapist empathy on overall improvement, and to serve as an antecedent to decreased distress and to increased empathy, insight, and therapist's optimism.