Group Processes in Family Therapy: a Psychoanalytic Approach

This paper describes a model of family therapy that draws on experiences and theories of psychoanalysis as applied to individuals and groups. It suggests concepts that help to understand and work with the family as a system. A brief example is given to illustrate the effort to engage with the patients' immediate feelings in the session in relation to each other and the therapist.     

The Value of Integration: Psychoanalytic Psychotherapy Meets Ego Psychology in a Psychotherapy Group for Children

ABSTRACT

Psychotherapy integration requires us to look beyond the confines of a particular theoretical or technical approach towards other perspectives. Integrative work with children, in particular, meets the socio-emotional needs of the child while simultaneously modeling behaviors and skills. This paper presents an explicitly integrative approach to child group psychotherapy: Relationships. Individuals. Skills. Engagement (RISE) Group. We begin with an in-depth discussion of the RISE group structure illustrated by clinical examples (the “what”) followed by a review of the theory and treatment modalities that inform the approach (the “why” and “how”). The RISE group is grounded in two theoretical perspectives (psychoanalytic principles and ego psychology) and draws upon clinical techniques from multiple treatment modalities (including cognitive behavior therapy, psychodynamic play therapy and dialectical behavior therapy). Combined, the merger of these perspectives results in a multilevel intervention that forges pathways to mastery and competence within the child. Finally, we discuss the value and limitations of integration as applied to group psychotherapy for children.     

Group Therapy for Loss: Attachment,Intersubjectivity, and Healing

Loss is a fundamental human experience that can impact a person’s mental health in diverse ways. While this experience is potentially formative, harmful manifestations can fracture one’s sense of self and undermine relational health. In this article, we present a rationale for process-oriented group therapy focused on healing relational injuries associated with loss. We draw on attachment, self-psychology, intersubjectivity, and Yalom & Leszcz’s (2005) model of group psychotherapy to explore how group processes allow clients to work through losses and relational frustrations in the here-and-now. A case vignette and discussion offer practical insight on the ways in which loss manifests in the room and demonstrate the uniqueness of the group setting for reparative processing.     

Clinical Dynamics During Adolescence: Psychoanalytic and Attachment Perspectives

In this essay, we discuss the contribution of psychoanalytic theory and attachment to the understanding of dynamics in adolescence. While psychoanalysis describes adolescence as a period of upheaval that challenges the balance achieved in childhood between Ego and Id and begins the shedding of family dependencies and the loosening of infantile object ties, attachment, on the contrary, considers this period as one characterized by the persistence of strong bonds to parents, which become more complex and articulated. In order to illustrate psychoanalytic and attachment perspective, a clinical vignette of a 17-year-old boy is presented and discussed to consider his difficulties in the area of identity and loss.     

Psychoanalytic Couple Therapy: Classical Style

In this essay, the core concepts of psychoanalysis are set forth as the context for the application of classical psychoanalytic theory to the practice of couple therapy. Infantile sexuality and aggression are shown to have a powerful role in the interpersonal lives of family members. The repetition compulsion structures marital interaction and intergenerational dynamics. The intrapsychic emphasis of classical ego-psychology is viewed in the interpersonal arena, and the author suggests adding to the Oedipus and Narcissus myths a myth that resonates with this shift in emphasis. In introducing the “Pygmalion–Galatea process,” the author captures the universal attempt to change the psychic dynamics of the other or others. This ultimately mutual process begins with the infant's mirroring of its caretakers—which includes language acquisition. Much of human interaction is fueled by subsequent attempts to create others in our own images of them and by their reactive compliance or resistance to that dynamic. Three case illustrations are presented to show how these phenomena manifest themselves in marital interaction and in dreams.     

An Attachment Perspective on Reunions in Couple Psychoanalytic Psychotherapy

Psychoanalysis has been slow to acknowledge attachment theory as one of its own. Yet traditions of observational and representational research associated with it have much to offer in shedding light on intrapsychic as well as interpersonal phenomena. This paper explores these traditions and their potential clinical utility for couple psychoanalytic psychotherapy. In particular, attention is drawn to behaviour and representations associated with the experience of reunion in therapy sessions.     

Intimacy-Anger and Insecure Attachment as Precursors of Abuse in Intimate Relationships1

One hundred and twenty men referred for treatment for wife assault and forty demographic controls completed self-report questionnaires assessing attachment patterns, anger, jealousy, Borderline Personality Organization, and trauma symptoms. This constellation, with the exception of attachment, has been found to represent a profile related significantly to the frequency of both verbal and physical abuse. In the present study, attachment was found to correlate significantly with these other measures. A measure of secure attachment correlated significantly, but negatively, with the constellation measures. A measure of fearful attachment correlated significantly and positively. A preoccupied attachment pattern correlated with the other measures less strongly than did the fearful measure. A dismissing measure was not correlated with any constellation measures. The role of attachment anger is discussed; it is suggested that fearful attachment could also be described as angry attachment. The concept of intimacy anger is introduced from early studies in attachment and applied to the explanation of assaultiveness in adult relationships.     

Problem Behaviors in Adolescence: The Opposite Role Played by Insecure Attachment and Commitment Strength

In this study we examined the relations between insecure attachment styles, commitment and behavioral problems, focusing on the unique and common contribution that avoidant and anxious styles and commitment made to internalizing and externalizing problems. 535 adolescents, 267 boys and 268 girls, aged from 16 to 18 years, completed self-report measures of attachment, identity and problem behaviors. The data showed that both internalizing and externalizing problems were positively related to insecure attachment styles and negatively to commitment. Results supported a unique contribution of both insecure styles to the prediction of internalizing and externalizing problems, whereas commitment negatively predicted only internalizing behaviors. The data supported a joint effect of avoidant attachment and commitment such that commitment contributed to moderate the display of internalizing and externalizing problems among avoidant adolescents.     

Adult Attachment Interview and Psychoanalytic Perspective: A Single Case Study

In this single case study we present a female patient diagnosed with a narcissistic personality disorder and a borderline organization. The interplay between attachment and psychoanalytic perspective will be focused. The analyst describes his impressions of the initial interview with the patient and essential steps during treatment. The patient was interviewed with the Adult Attachment Interview and classified as “insecure preoccupied” with an “unresolved state of mind” concerning loss and abuse. The analyst was asked to comment the AAI's essential characteristics of this patient. We discuss converging and diverging aspects of clinical and attachment interpretation in this single case.     

A Clinician's View of Attachment Theory and Research: A Discussion of the Papers in Three Issues of Psychoanalytic Inquiry

In this essay, I take up concepts raised in papers in the three issues of Psychoanalytic Inquiry edited by Diana Diamond and Sidney Blatt. To give coherence to my discussion, I consider the many subjects covered (often several in one paper) under the headings of Mothering, Representation, Trauma and Pathology, and Therapeutic Change and Its Measurement. I focus throughout on the relevance of findings to the outlook of a clinician, at times providing examples based on my experience as an analyst to further elucidate my conceptualizations.     

Insecure Attachment,Gender Roles,and Interpersonal Dependency in the Basque Country

Gender, gender role, and attachment style were used to predict emotional and instrumental dependency in a Basque student sample (N = 602). Psychometrically sound Spanish adaptations of English–language measures of dependency and attachment were created. As predicted, women were more emotionally and instrumentally dependent than men, but the sex differences were mediated by psychological masculinity and femininity. The anxious attachment dimension was correlated with emotional and instrumental dependency, the preoccupied rating with emotional dependency, and the avoidant attachment dimension and fearful rating with instrumental dependency. When the two attachment dimensions and the two gender–role variables were combined to predict dependency, emotional dependency was a function of anxious attachment and femininity; instrumental dependency was a function of anxious and avoidant attachment and low masculinity. Limitations and future directions are discussed.     

On the Future of Group Therapy Theory

The author presents a hypothetical view of group therapy theories as they may evolve over the first decades of the New Milennium. Looking at the problem of prediction from the standpoint of postmodernism and social constructivism, the importance of these perspectives as frameworks of the social sciences is emphasized. The influence of general systems theory, Foulkesian group analysis, object relations theory, self psychology, cognitive-behavioral psychology, and neuropsychiatry are briefly examined with respect to the expected evolution of increasingly sophisticated, detailed, and nuanced theories of group psychology and group psychotherapy.