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.     

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.     

Outcome of psychoanalytically oriented group psychotherapy

A study of 100 consecutive persons who terminated, once a week, psychoanalytically oriented group psychotherapy shows that it is an effective treatment for neurotic persons with good ego strength who remain in therapy a year or longer. Analytically oriented group therapy was less effective in treating severely ego-impaired persons, and group members of all levels of ego strength often required augmentation of their group therapy by individual sessions and psychotropic medications. Early dropouts (less than 30 sessions) seemed related to lack of motivation and poor fit with the group. Later dropouts (sessions 30–60) seemed related to low ego strength.     

Combined individual and group psychotherapy: guidelines at the interface

The development of combined individual and group psychotherapy is split between the "separationists" and the "integrationists" with regard to therapists' handling of the interface between the individual and group sessions. To bridge the impasse, a high-benefit--low-risk series of guidelines is offered for therapists that includes techniques for analyzing patients' "cross-references" to the other component modality. The four guidelines provide for a harmonious balance that preserves the confidentiality of the individual sessions vis-à-vis the group, while enhancing the group interaction rather than draining it. The therapist guidelines maximize patient initiative in integrating parts of the self expressed in the individual and group sessions, while employing the least intrusive methods necessary to best integrate the processes into a unified combined modality.     

Concurrent individual and individual-in-a-group psychoanalytic psychotherapy

This paper's thesis is that concurrent individual-in-a-group and individual psychoanalytic psychotherapy can be conducted in conformance with psychoanalytic principles of treatment as well as can individual psychoanalytic psychotherapy alone. American psychoanalysts have shown little interest in group psychotherapy, probably because of earlier criticism that transference is diluted by the greater reality of the therapist in group psychotherapy. This is a misconception extrapolated from the mirror model of dyadic analytic technique. The criticism was formulated during a period when that model was prominent and there was little awareness that the actual personal relationship between patient and analyst played an important facilitating role in the dyadic analytic process, including providing a basis for investiture of transference. Also, the criticism was based on one-session-per-week group psychotherapy, whereas concurrent individual-in-a-group and individual psychoanalytic psychotherapy utilizes two group sessions plus one or two individual sessions per week, enabling a more intensive patient-therapist relationship. Concurrent group and individual psychoanalytic psychotherapy constitutes a contribution to the widening scope of application of psychoanalytic treatment.     

An experiential group model for psychotherapy supervision

This article presents an experiential group model of supervision constructed for both group and individual therapy presentations, emphasizing concepts from object relations theory and group-as-a-whole dynamics. It focuses on intrapsychic, interpersonal, and systems processes, and stresses the group aspect of the supervisory process. Its central thesis is that material presented in a group supervisory setting stimulates conscious and unconscious parallel processes in group members. Through here-and-now responses, associations, and interactions among the supervisory members, countertransference issues that have eluded the presenter can make themselves known and be worked through on emotional as well as cognitive levels. Selected excerpts from supervisory sessions demonstrate various attributes and strengths of the model.     

Cotherapy in psychodynamic group psychotherapy: An approach to training

Cotherapy in a training relationship with a senior therapist/supervisor and a trainee/junior leader is presented. A structured training year with planned sessions for the junior leader to lead the group alone, as well as intensive supervision, is described. The training relationship is seen as evolving into an egalitarian, collegial working relationship. An incidental benefit of this cotherapy approach is that additional opportunities are provided for group members to work through attitudes, feelings, and behaviors associated with attachment, interpersonal relationship (autonomy and affiliation), separation, and loss. Potential drawbacks and applications are also noted.The authors express their appreciation to the many group members and cotherapists whose experiences provided the stimulation and clinical material for the present formulation.     

Dream frequency in psychoanalysis and psychoanalytic psychotherapy

The authors examine data on dream frequency from 50 patients, half of whom were seen in psychoanalysis and half in psychoanalytic psychotherapy. Frequency, defined as the proportion of sessions where at least one dream is related, is analyzed statistically as a function of sex, age, and type of treatment. Also, treatment outcome is examined as a function of sex, type of treatment, diagnosis, and dream frequency. Psychoanalytic patients are found to have higher dream frequency than the patients in the psychotherapy group. Higher average dream frequency is correlated with a better treatment outcome in both patient groups.     

Intensive group psychotherapy of borderline patients

The group modality employed by the authors for the past two years to structurally treat borderline personality patients has proven successful and is presented here for consideration by other clinicians. The authors suggest that the ego deficits that can make the borderline patient a problematic group member are the very deficits that are often best treated in a group setting. The inherent curative factors of groups are discussed in parallel with the structural therapeutic needs of the borderline, and specific strategies and interventions for enhancing borderline structural growth are recommended. Inherent risks of treating this challenging patient population within the group modality are discussed, and suggestions for preempting or minimizing such effects are presented.     

The group's absence norm and commitment to the group as predictors of group member absence in the next session: an actor-partner analysis

The group's absence norm, a construct from the applied psychology literature, was used to examine session absences in personal growth groups. Rather than examining the absence norm statically, we modeled it dynamically as a time-varying covariate (Tasca et al., 2010). We also examined moderation by modeling the interaction of the absence norm and the group member's commitment to the group in predicting the group member's absence in the next group session. Session absences in 1,722 group sessions for 66 group members in 9 interpersonal growth groups were modeled using Kenny, Mannetti, Pierro, Livi, and Kashy's (2002) adaptation of the Actor-Partner Interdependence model. Specifically, a 3-level model (sessions within group members within groups) examined the relationship of the group's absence norm (average previous absences of the other group members), commitment to the group (previous absences of the group member), and the interaction of the group's absence norm and commitment to the group on absence in the next session. As we hypothesized, (a) a greater number of previous individual absences (low commitment) increased the probability of a member being absent the next session, (b) the higher the group's absences norm, the greater the probability that an individual group member would be absent the next session, and (c) individual group members who were more committed to the group were more influenced by the group's absences norm than were group members less committed to the group. Implications for research and practice are discussed.     

Perceptions of Turkish psychiatric inpatients about therapeutic factors of group psychotherapy

Many studies on therapeutic factors in group psychotherapy were done during the 1970s and 1980s, primarily with Western samples, The present study was carried out in a psychiatric inpatient clinic in Turkey. Using Yalom's (1975) therapeutic factor questionnaire administered at discharge, patients rated existential factor, instillation of hope and self-understanding as the most helpful factors and identification as the least helpful. There were significant differences among patients with regard to gender, age, education, comorbid personality disorder, but not with Axis I diagnosis or number of attended sessions. Patients' and psychiatrist's rating showed significant differences. Differences between this Turkish sample and those reported in common Western literature are discussed under the light of relatedness psychology, which is an important concept of cross-cultural psychology.     

Client process in short term dynamic psychotherapy1

In this study, a single case design was used to examine significant client events in a process of short-term dynamic psychotherapy. The Category System of Client Good Moments (Mahrer, 1988) was used as a measure of therapeutic process. Client speaking turns were rated for three sessions (early, middle, and late) of the complete sixteen session treatment conducted according to davanloo's (1978) model of short-term dynamic psychotherapy (STDP), and categories of good moments identified. The results showed that the salient client change-events were related to the client's (a) provision of significant information, (b) exploration of feelings, and (c) insight and understanding across the three sessions. Additionally, the results also showed a statistically significant increase in client-reported behavior change and sense of well-being for the late session. The results suggest that in-session report of behavior change is an important component of therapeutic process. The implications of these results for an atheoretical, data-driven understanding of therapeutic change processes are presented.     

Joining group psychotherapy: developmental considerations.

This article examines the experience of new members joining an ongoing psychotherapy group. The group's stage of development and the new member's personality development are suggested to be important variables in this significant event. The experience of joining is found to share some things in common with the beginning phase of group for the group as a whole, but also noted are some unique elements. The process of joining is viewed as a highly anxious event for the new member, with antecedents in the individual's life experience. The new member is compromised by not knowing the group members, nor their shared history, norms, and dynamics. Concurrently, the group may experience a range of fears, wishes, and anxieties about the new member. Developmental considerations for the new member and the stage of group help to inform intervention strategies.     

Studying Personality Cross-Culturally Edited by Bert Kaplan

This article offers a theory about the evolution of small group systems through a seriesof stages It discusses the relationship of these stages to and their effect on the self-other and therapeutic mteruentive spheres m the long-term group treatment of children. The developmental unfolding is seen as universal to small groups and as operating on an interpersonal and collective level, distinguishable from individual psyches and close dyadic bonds but influenced by them. On an isomorphic level the group stages contain emotive, cognitive, and interactive themes and pr cesses that parallel and evoke those of the bonding and work processes. As such, the group dynamic provides an enabling matrix and a mirror for the other goings on in the member–therapist encounter. Its pacing and its progressions and regressions appear to correspond with those of the development of the transitional space and therapeutic culture of the group. Like the other articles in the symposium, this one offers specific examples in which the three spheres intersect and are integrated.     

Ethical issues in record keeping in group psychotherapy

This article discusses numerous ethical issues regarding the keeping of records in group psychotherapy, those activities that have to do with the creating, retaining, storing, releasing, and disposing of them. A central dilemma for the group therapist is whether to keep records separately for each individual group member or to keep one record for the group as a whole. Confidentiality of records, patient access, and release of information tend to be more complex issues for group psychotherapists than for individual psychotherapists. Although notes written about the entire group may capture important themes, such notes can compromise the privacy and confidentiality of individual group members. An individual record for each patient is recommended.     

Silence in group psychotherapy: a powerful communication

Silence in a psychotherapy group, including leader, member, subgroup, and whole-group silence, is a common phenomenon with many possible forms, uses, and meanings. Five common sources of silence in group psychotherapy are described: situational factors, individual dynamics, member-to-member interactions, group dynamics, and leader-related dynamics. Silence can reflect defenses or indicate conditions favorable to intensified group work. Silence, sometimes mistaken for psychological inactivity, should be viewed as significant communication.     

Results of short-term group psychotherapy of schizophrenic patients

A seven-week group-centered dynamic therapy course was conducted with 12 patients within the framework of a long-term treatment for schizophrenic patients. The purpose and method of treatment and the course of the group sessions are described. Analysis of the Freiburg personality inventory yielded no changes; the degree of agreement between the group mean profile and that of neurotics was striking. Analysis of the Frankfurt complaint questionnaire (Suellwold) revealed a reduction in the number of affirmative answers during and after treatment. The treatment is considered to have had positive results, although it has to be embedded in a more comprehensive treatment plan with supportive individual psychotherapy, psychopharmaceutic treatment and sociotherapy.     

Therapeutic effectiveness of differentially targeted humorous remarks in group psychotherapy

Video records of five different sessions of a single therapy group were scored for the occurrence of laughing, smiling, and talking. Successive five-minute intervals were also scored for therapeutic level through ratings derived from the Hill Interaction Matrix. Humorous remarks were categorized according to humor target: self, other in group, and generalized other. Results indicated that the vast majority of humorous remarks were directed at some specific target, and that over 50% of these remarks were negative in tone. Results also revealed that remarks targeted at others in the group tended to decrease therapeutic effectiveness whereas remarks targeted at individuals or institutions not presently in the group were found to increase therapeutic effectiveness. Selftargeted remarks were found to produce inconsistent effects. These findings are discussed in terms of their significance for a more general analysis of group humor as well as in terms of their more specific implications for therapeutic interventions.