Introduction to Group-Analytic Psychotherapy by S. H. Foulkes

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she “understands” because of having also grown up in an alcoholic family); (b) the “will to restore,” which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a “rush to recovery” on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) “countertransference goodness and availability” as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

“Not with me you don't”: A story of narrative practice and dissociative disorder

This paper discusses issues relating to therapeutic practice based upon the narrative metaphor. A case of someone suffering the effects of Dissociative Identity disorder is used to illustrate the difficulties that clients can experience with the “expert” knowledge conception of therapy. The value of the “respectful” and “non-expert” emphasis of Narrative Practice emerges even when the therapist believes that he or she lacks expertise in the client's apparent “condition.” Three themes emanating from the case form the basis for the discussion: the client's experience of being recruited into accepting the diagnostic label of Dissociative Identity Disorder; the effects of being forced to accept a contract to eliminate self-abusive behaviour; and the therapist's dealing with a gun in the therapy room.     

A married couple in separate therapy groups

Abstract

A behavioral contract was used to change several behaviors in a married couple's relationship. A multi-assessment “package” was used to determine the effect of the behavior change on the couple's relationship. A multiple baseline, single-subject design demonstrated that the treatment “package” was responsible for producing behavior change and changes in levels of satisfaction. Further research should concentrate on which components of the “package” may be the most critical. Multi-assessments provide the therapist or researcher with concrete data on a couple's progress in behavioral marital therapy.     

Reiteration: The ‘Imperative of the Word’ and Echoing the ‘Significative Terms’

Abstract

The act of reiteration is viewed as a therapeutic reply that is especially responsive in the face of what Lacan (1977) and Heidegger (1927/1962) respectively refer to as “empty speech” and “idle talk.” By hearing and selecting those key signifiers and phrasings that bear the client's story of distress, the act of reiteration allows us to focus and address the “subject who speaks” rather than the commonsense storyline itself. As an active and continuing punctuation of the client's direct discourse at the level of the word, the act of reiteration is only the first moment of a more complete narrative reply. But in keeping the therapist ever grounded in the client's direct expressions, it is this first moment of reiteration that leaves the therapist positioned to be responsive to the client's discourse of “rhetorical displacements,” of intimation and allusion, as these “echo” from “elsewhere.”     

The Edge of Chaos: Enactment,Disruption, and Emergence in Group Psychotherapy

The author outlines his approach to the theory and practice of group psychotherapy. The emphasis is on therapy by the group rather than therapy in the group. The therapist's task is to help the group itself become the agent of change. The group is conceived as being composed of many multiple selves. The process of group psychotherapy unfolds through enactments that involve the whole group and the group therapist entering into the grip of repetitive and unmentalized self-states. These enactments are resolved when the group members, with the therapist's help and containment, can access alternative self-states that allow for new and unformulated experience to emerge. This dialectical movement between the rigid “familiar chaos” of enactment and the reflective and related working through is compared to the dynamic systems theory articulation of the tension between rigidity and chaos captured by Kauffman's notion that “life exists at the edge of chaos.” A group session is described that involves a painful enactment. It illustrates how the therapist allows the enactment to unfold by holding and containing intense affect and how the group members are helped to find their own meaning and new experience in interaction with each other.     

Sequential analysis as a method of feedback for family therapy process

Abstract

The purpose of this study was to examine the relationship between therapist verbal behavior and family cooperation and resistance during the second session of family therapy with juvenile delinquents. Sequential analysis was used to investigate the impact of one therapist's behavior on family resistance and cooperation in a sample of 12 families. The results of the sequential analysis revealed that therapist “support” and “teach” behaviors were associated with significant increases in the likelihood of family cooperation. The study provides an example of how sequential analysis can be used to inform family therapists about the impact of their behavior on families.     

A preliminary examination of the role of psychotherapist fidelity on outcomes of cognitive processing therapy during an RCT for military sexual trauma-related PTSD

While cognitive processing therapy (CPT) is an effective evidence-based treatment for many veterans with military-related post-traumatic stress disorder (PTSD), not all veterans experience therapeutic benefit. To account for the discrepancy in outcomes, researchers have investigated patient- and research design-related factors; however, therapist factors (e.g. fidelity) have received less attention. The present study is a preliminary examination of the effect of psychotherapists’ fidelity during CPT on clinical outcomes during a randomized clinical trial (RCT) for military sexual trauma-related PTSD. PTSD symptoms, trauma-related negative cognitions (NCs), and depression symptoms were assessed for 72 participants at baseline, and 1-week, 2-month, 4-month, and 6-month posttreatment. Of the four CPT therapists, two were found to have significantly poorer (i.e. “below average”) treatment fidelity scores compared to the other two therapists who had “good” treatment fidelity scores. To examine possible therapist effects on outcomes, hierarchical linear modeling was utilized with therapist fidelity entered as a Level 2 predictor. Participants treated by a therapist with “good” treatment fidelity experienced significantly greater reductions in PTSD symptoms, NCs, and depression symptoms than patients treated by a therapist with “below average” treatment fidelity. Our preliminary findings highlight the importance of monitoring, maintaining, and reporting fidelity in psychotherapy treatment RCTs.     

Bruno Bettelheim and the Chazon Ish: Toward a New Jewish Psychotherapy

Jeremiah is quoted and cited to show the basic optimism of Judaism. Why did Freud create an “Oedipus Complex,” rather than a “Joseph Phenomenon”?—especially since Freud had such a great knowledge of the Bible, including the Joseph story; and the Biblical Joseph made frequent appearances in Freud's dreams. Many of the advances in psychology and psychiatry were made in part as a rebellion against the ideology of psychoanalysis—this includes family therapy, behavioral therapy, and psychopharmacology. Bettelheim saw the shortcomings of psychoanalysis, both as a theory to explain human behavior and as a cure for psychological problems. The experiences of Bettelheim and of The Chazon Ish can give us new hope. The Chazon Ish and Bettelheim both sought to help in the context of a type of community. Reading of the Bible throws light on people's problems; and people can be helped by identification with Biblical characters. There is often specific advice in the Bible. Bible therapy can strengthen the bond between the therapist and the patient, which is important for patient improvement. There is a need for this type of psychotherapy.     

David and Judith

SUMMARY

This paper begins with a discussion of Dialogicai Psychotherapy-that “healing through meeting” which comes when the relation between therapist and patient is central-and explores inclusion, making present, confirmation, and the “normative limitation of mutuality.” Secondly, it discusses a Dialogicai Psychotherapy particularly important for couples therapy-Ivan Bos-zormenyi-Nagy's Contextual (intergenerational family) Therapy with its emphases on multidirected partiality, trustbuilding, rejunction, and the intergeneration merit ledger. The third part of the paper applies Dialogicai and Contextual therapy to the case of David and Judith, a couple who show clearly the importance of families of origin.     

La psychothérapie assistée par la MDMA dans la prise en charge du syndrome de stress post-traumatique

Posttraumatic stress disorder (PTSD) is estimated to remain chronic and severe for 25–50% of patients despite psychotherapeutic treatment. Part of the reasons is that patients with PTSD can have difficulties in establishing a good therapeutical alliance with the therapist. Moreover, they often fail to re-think the content of the trauma without being overwhelmed by negative emotions and tend to rely on avoidance strategies and/or to abandon the therapy. MDMA (“ecstasy”) is a drug classified as an entactogen (en “within”, tactus “touch”, and gen “produce”), an amphetamine with psychedelic properties that possesses psychopharmacological properties to overcome these issues. Indeed, MDMA triggers the release of oxytocin, which favors the establishment of interpersonal relationship based on kindness and trust. Moreover, MDMA diminishes the activity of the amygdale, allowing patients to work on challenging memories with less fear and anxiety. Finally, MDMA may also provide access to meaningful spiritual experiences, release of tensions and a sense of healing on a non-verbal level that are not completely understood. But are viewed as important by patients. Today, there is no evidence that the use of MDMA in a clinical setting has bad neurologic, psychological or cognitive consequences. Results of phase II trials in the United States and Europe confirm that MDMA favors psychotherapy's outcome without severe adverse effects. Phase III trials are underway. The Multidisciplinary Association for Psychedelic Studies (MAPS) has published online a method proposal and trains therapists in MDMA-assisted psychotherapy.ConclusionFood and Drug Administration (FDA) and European Medicines Agency (EMA) could approve this therapeutic tool in the coming years.     

McCandless's Response to “Soul Healing: A Model of Feminist Therapy”

The term soul healing captures the reader's imagination by intimating that therapy may do more than just focus on the healing of emotional pain. The author of “Soul Healing: A Model of Feminist Therapy,” Patricia M. Berliner, a psychologist, therapist, and sister of St. Joseph (Brentwood, New York) is to be applauded for recognizing the need for a model of therapy that consciously intends to address the concerns of women “who value the spiritual dimension in their lives” (p. 2).     

The therapeutic relationship as a paradoxical experience

The therapeutic relationship exists within multiple levels of reality—including that of ordinary life and that of the therapeutic frame. This interplay between these two levels of reality gives rise to paradoxical experiences for both participants. Certain “principles”; or “rules”; of technique can be understood as a means of enabling the therapist to cope with what is usually referred to as “boundary”; issues. It is essential that the analyst or therapist demonstrate capacity to shift playfully from one level of reality to another. The “rule”; of abstinence and the asymmetry of desire that exists between the two participants are discussed. Gratification within the therapeutic frame is paradoxical in that gratification at one level of reality leads to privation at another level of reality. These paradoxical experiences for both patient and analyst are examined in relation to projective identification and to the analyst's countertransference.     

A Family Therapist for Life: Observations and Options

“Life” is used here in the chronological sense of years spent as a family therapist and in the existential sense of experiencing “life” in terms of satisfaction, meaning, and vitality in one’s living. In the 1950s, there were few guidelines for professionals recognizing the need for working therapeutically with families. Becoming and being a family therapist are discussed, along with lifetime learning about family and tolerance for ambiguity in understanding family and marital relationships and dynamics; flexibility in implementing therapeutic interventions; functioning in ways that fit with one’s personality, beliefs, and principles; working where one functions best; and what works at what stage for the family therapist and relating these to establishing and maintaining “life” in one’s living.     

Incognito or not? the patient's subjective experience of the analyst's private life

This paper examines the meaning for the patient of the analyst's personal life and personality which are ostensibly banished from the consulting room. The therapist has a not‐always‐so‐secret “secret life”; that the patient is supposed to “not know”; about. Yet, more or less unconscious perceptions, impressions, and fantasies about extratherapeutic aspects of the analyst are omnipresent and significantly color the psychoanalytic enterprise.

Moreover the analyst as a person generally plays a critical and underacknowledged role in the patient's experience of the endeavor. Constructing multiple overlapping images of the analyst and of the analytic relationship, the patient discovers himself or herself in the matrix of these relationships with various images of the analytic other. The analysand is motivated to make sense of the analyst as wholly as possible, the better to place into context the analyst's interventions. The patient's resulting view of the analyst's subjective experience acts as a lens that filters and subtly alters the meaning of the analyst's communications.

I illustrate these points by relating my work with a patient whose dreams uncannily picked up on a (consciously) unknown aspect of my private life—my having a handicapped son. The treatment thereafter centered on the patient's identification with my child (as someone “disabled") and on the meaning of her having dreamt something so personal about her therapist.     

Aikido: A Model for Brief Strategic Therapy

Building on Watzlawick's observations of certain similarities between judo and brief strategic therapy, this paper develops theoretic and pragmatic parallels between brief strategic therapy and a sophisticated martial art system, Aikido. After presenting the contextual similarities of the two conceptual systems as parallel “challenges” to the therapist and Aikidoist to effect change, the similarities in basic principles of practice are presented. The similarities in the philosophical and attitudinal positions of these conceptual systems are then delineated, followed by a case example that integrates the various concepts in the paper.     

Crippled feet

Critics of Lars von Trier's film Antichrist have regarded the depicted woman's destructive fury as difficult to understand. In this paper, separation anxiety is discussed as a central unconscious motivation behind the aggressive interaction between husband and wife, and the child is discussed as an obstacle to the mother's exclusive relationship with her husband. The film powerfully conveys how sadistic aggression is unconsciously acted out between mother and son, as symbolized by the mother's crippling of her son's feet. The woman's violence is also a reaction to a her husband “therapist” who, wishing to correct her, fails to understand and contain her inner world, wherefore the therapeutic dialogue itself, disguised as help, is experienced as violently aggressive. This in turn engenders a wish for revenge. Against this background, the film is seen as a critique of cognitively oriented therapy.     

Hearing Metaphor: An Approach to Working with Family-Generated Metaphor

This article presents a step-by-step approach to working with family-generated metaphor in family therapy. Although the use of therapist-generated “therapeutic metaphors” has been widely advocated and practiced for many years now, less attention has been paid to the metaphors used by family members. We argue that the family's metaphors are a neglected linguistic resource in family therapy. Highlighting and validating these metaphors produces a therapeutic conversation in which the voices of family members are heard more clearly by the therapist, and the families' own imaginative energies are engaged in defining and pursuing the goals of therapy. Several case examples illustrate the use of this approach with children of various ages.     

The Group Psychotherapy Literature 1958

This study applies Kohut's self-psychology toward an understanding of the self-functions that membership in a religious cult group (Divine Light Mission) provides for the narcissistic personality. It is proposed that there exists a psychosocial fit between the appeal of the cult group's structure and process and the needs of the narcissistic personality. The cult group offers reparative and substitutive functions to the follower who seeks an idealized selfobject to stabilize a defective sense of self. The special relationship of the follower to the Guru bears a close resemblance to the “idealizing transference” which arises between certain narcissistic patients and their group therapist. The therapeutic use and misuse of the “idealizing transference” in group therapy is explored and suggestions are made for its appropriate clinical management.