Treatment of Male Homosexuals in Groups

Abstract

The healing power of psychodynamically oriented therapy and training groups rests, to a large degree, upon the quality of the here and now interactions. For the work to be effective, the basic principles of analytic group work need to be followed, including the observance of no extra–group contact. Simply said, nothing leaves the room. This principle has both ethical and clinical implications. It is my premise that while some forms of outside contact between members are relatively benign, other types are not. Outside contact that is built into the fabric and context of the group may pose a risk, as may be the case where dual relationships exist between members. The impact of dual relationships between group members in the particular instance of analytic training institutes is the focus of this article. What happens to the transference in this context when members reveal too much of their personal lives to each other through dual relationships is explored. It is suggested that extra–group contact can disrupt the balance between reality and transference distortion in group interactions in at least three ways: (a) “The Emperor’s New Clothes” effect, (b) looping, and (c) gaslighting. Vignettes are presented to illustrate these phenomena and suggestions for reform are offered.     

Analysis of transference in Gestalt group psychotherapy

In Gestalt therapy, transference is viewed as a contact boundary disturbance which impairs the patient's ability to accurately perceive the present therapy situation. The boundary disturbances in Gestalt therapy most closely related to the analytic notion of transference are projection, introjection, and confluence. In Gestalt group psychotherapy, group members interfere with the process of need identification and satisfaction by distorting their contact with each other through projecting, introjecting, and being confluent. The Gestalt group therapist uses interventions directed to individuals and to the group to increase participants' awareness of these boundary disturbances and of the present contact opportunities available to them when these disturbances are resolved. In formulating interventions, the leader is mindful of the function of boundary disturbances to the group-as-a-whole as well as to individuals.     

Group process and group phenomena on the Internet.

This article identifies group processes and group phenomena in discussion lists on the Internet and examines the differences and similarities with the processes in small and large groups. Group dynamics and phenomena, such as boundaries, cohesion, transference, scapegoating, and the leader's role are addressed. Large group features, such as alienation, vulnerability, and the vast amount of issues discussed in parallel are described. There are similarities between the discussion list and small groups on issues of cohesion and group norms, and in the psychological mechanisms of transference and scapegoating. There are differences regarding the contract, boundaries, leaving the group, and extra-group socialization. Although many of the phenomena described resemble a large group, a discussion list on the Internet maintains the illusion of being a small group and frequently acts like one. While a virtual therapy group would be somewhat different from a real group, it could nonetheless be useful.     

All the Lonely People...Where Do They All Belong?

The author uses humor and fosters empathy in order to establish a fragile group cohesion for five isolated patients at a group analytic training institute. Self-psychological concepts, in particular the alter ego or twinship transference, help explain the profound and painful yearnings of these unlikely group members, whose great need for relatedness was generally trumped by the terror of it. The group's poignant wish for affiliation (somewhat paralleled in the therapist's joining a training program) was similarly impeded by a fear of an aversive affiliation, a fear which for these group members remained understandably powerful after a lifetime of false and failed affiliative starts. The author concludes that it is these lonely people who should be (and can be) served by analytic group work.     

Destructive and reparative transference in multiple levels of group psychotherapy

Group members are challenged to form psychologically meaningful relationships with therapists, other members, and the group as a whole. The way in which individuals perceive this challenge is based on their past experiences. Early relationships establish a perceptual frame in which fears of being hurt and concern about hurting others coexist. Balance between these two ways of generating meaning enables individuals to form relatively healthy relationships. Imbalance in this perceptual frame results in distorted perceptions and maladaptive patterns emerging as transference manifestations. Working through involves repeatedly addressing distortions as members relate to therapists, others 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 group-as-a-whole approach in Foulksian group analytic psychotherapy

The group analytic group-as-a-whole approach of Foulkes privileges the concept of the group matrix. The term matrix is a metaphor for the network of all individual mental processes, the psychological medium in which they meet, communicate, and interact. The developing group matrix acts both as a container and as a holding environment for the psychic processes of the individual members in the group context. The concept of coherency is evoked to describe the process of the developing capacity of a group to be therapeutic. The concept of coherency is applied both to conscious and to unconscious mental process.     

A current look at transference in combined analytic therapy

This article examines transference from the vantage point of combined analytic therapy, a model that starts the patient in individual analytic treatment, then introduces him/her to group with the same therapist. Definitions of transference in the psychoanalytic literature are noted, as is the designation of transference interpretation as the distinguishing characteristic of psychoanalytic treatment. Working with transference is examined clinically, with attention to archaic transferences as well as more developed responses. In comparison with individual treatment, combined therapy offers an enlarged arena for the transference to emerge, because of the reexperiencing of the family gestalt in the group, and the more immediate stimulation in the group of envy and competition. Communications in the individual session enlighten the therapist further about what has gone on in the group.     

Transference reactions in conjoint therapy: A view from an observation group

Summary This paper reports on conjoint therapy conducted with the individual therapists of two of the group's members observing the group sessions. The development of the transference reactions of all group members are highlighted and suggestions are made regarding the most useful methods of handling these transference reactions to help create a mutative experience for the members of the group.The author wishes to thank Dr. Judith Isaac for her comments and editorial assistance throughout the preparation of this paper.     

Coming to our senses: the application of somatic psychology to group psychotherapy

Somatic psychology, the interplay of the body, the mind, the emotions, and the social context, significantly contributes to the theory and practice of group therapy. The processing of sensory experiences in the here-and-now of the therapy group helps group members to develop self-awareness, the ability to understand their relationships with others, and the capacity for empathy. When group members know what they experience, they can understand how others feel and resonate emotionally with those feelings. Neurobiology, sensory processing, and attachment theories help us to understand how the sense of self develops somatically. Principles of somatic therapies are applied to group therapy practice in working with attachment disorders, transference impasse, and trauma. The importance and implications of the group therapist's embodied attunement are explored.     

From identified patient to identifiable group: the alchemy of the group as a whole

Group-as-a-whole theory is a relational paradigm of some complexity. Despite the growing popularity of this perspective, there is abiding confusion about the essence of group-as-a-whole practice and whether the approach attends sufficiently to members and part processes. The threefold aims of this article are to (a) show how group-centered thinking differs essentially from traditional psychodynamic theory that relies heavily on familial dynamics, interpretation, and transference analysis; (b) present the mind-set and working principles for a generic treatment that specifically utilizes collective forces generated in the context of the group matrix; and (c) compare and contrast the thrust of recent dyadic relational therapies with group therapy generally and the group-as-a-whole approach more particularly. The relationship between the whole (group) and its parts (members and what they bring) is detailed and demonstrated as it appears in the context of fused, affiliated, fragmented, and differentiated groups.     

Group rational-emotive and cognitive-behavioral therapy.

The theory of rational-emotive therapy (RET) and of cognitive-behavioral therapy (CBT) is briefly explained and is applied to group therapy. It is shown how RET and CBT therapy groups deal with transference, countertransference, levels of group intervention, process versus content orientation, identifying underlying group process themes, here-and-now activation, working with difficult group members, activity levels of therapist and group members, and other group problems. Although they particularly concentrate on people's tendencies to construct and create their own "emotional" difficulties, RET and CBT group procedures fully acknowledge the interactions of human thoughts, feelings, and actions and active-directively employ a variety of cognitive, emotive, and behavioral group therapy techniques.     

Reality in analytic group psychotherapy: Beyond transference and countertransference

This study reports the results of a questionnaire, applied to therapists and their patients in 14 analytic therapy groups. It was found that the patients studied had an accurate perception of the group reality in the following dimensions: therapists' preferences for the members in their groups; power position held by each member in the group; and therapeutic benefit achieved by members in the group. Support was given to the existence of a relation among popularity, power position and therapeutic benefit; members who rated high in one of these variables generally were assigned a high position in the other two, and vice versa. These results suggest that patients in analytic group psychotherapy can be objective in their perceptions of the group reality, and that these perceptions are not always distorted by transference. The idea that, no matter how low-disclosing therapists remain, the patients in their groups will perceive their attitudes and feelings was supported by patients' accuracy in perceiving their therapists' preferences for members in their groups. These findings indicate the important role played by reality and the real relationship in psychoanalytic group psychotherapy.     

Developments in cognitive neuroscience: II. Implications for theories of transference

An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades-the role of the analyst in eliciting transference, and the nature of "real" and "transferential" components of the therapeutic relationship-are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between "real" and "transferential" perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.     

Working with dreams in a bereavement therapy group

There is ample theory and research about group therapy, dream work, and bereavement as separate subjects. However, there is little written specifically about utilizing dream work in bereavement therapy groups. Using the Foulksian group analytic model, dreams in one particular bereavement group (for parents of children killed in a terrorist action) were interpreted in such a way as to help members access deep unconscious feelings. This helped facilitate a fuller and more complete mourning process. The analytic, dream interpretive activity also helped overcome resistance in the group-as-a-whole and thereby facilitated movement through group development phases.     

Parent‐infant‐psychotherapy and psychoanalytic treatment: contradiction or mutual inspiration?

Psychoanalysis and parent‐infant‐psychotherapy are compared. Although parent‐infant‐psychotherapy developed from psychoanalysis, it appears at first glance not to be “analytic” with its aim of dealing quickly with the symptoms presented and also with its different setting. The author shows that an analytic approach in understanding the multi‐facetted net of relationships between family members and the infant in its “phantasmic interaction” and a consideration of the implication for analysis of the empirical research carried out in conjunction with parent‐infant‐therapy can lead to a fruitful exchange of ideas. One example of this is research into the correlation between attachment patterns and the processing of conflicts. Furthermore a dialogue between these two disciplines can remind psychoanalysts that a critical discussion of the external circumstances of their methods does not immediately call into question their fundamental approach to therapy: the work in transference on relationship fantasies.     

Infant-led innovations in a mother-baby therapy group

A mother-baby therapy group for mothers and infants in their first year who are experiencing difficulties is described. In a literature review no comparable group where the infants are seen as members in their own right has been found. Themes in the mothers' material are outlined, followed by the infants' evolving interactive and internal processes. Some therapeutic factors, in particular interactions between the infants and interventions on the part of the therapists, are then illustrated with clinical material. Some infant-led innovations are described, such as the way the infants' activity is used as a basis for making ‘group as a whole’ interpretations, and in particular how the therapists' actions towards the infants have come to be viewed as a non-verbal form of interpretation. The role of attuned play in direct work with infants is discussed further.     

Cognitive and affective patterns of alcoholics: Implications for group therapy

Alcoholics bring unique problems with them into treatment. This paper reviews the research on their cognitive and affective patterns of behavior. These include a low expectation of success in interpersonal relationships, the use of denial, insensitivity to mood states, and faulty attribution patterns. These difficulties hamper the expressive dimensions of their relationships with others and manifest themselves in the group therapy setting. Recommendations for facilitating group cohesion and developing an agenda are presented. Also discussed are the interactional means by which the work of the group is done. The supportive interchange is noted as a method by which group members gain access to the deeper layers of each other. The remedial interchange is the interactional means by which group members challenge each other and resolve conflicts.     

The helping process in group therapy: A review and discussion

The essential activity of group therapy consists of members taking an interest in each other by asking questions, showing concern, and conveying understanding. When members have not done this it has often been taken as a sign of resistance. A review of the research on helping suggests that there are four social factors that affect assistance giving in groups: 1) ambiguity-often people fail to give help because they are uncertain about who should give it, what should be done, and how it should be done; 2) often help is not given because of the way in which problems are presented; 3) the social comparisons that individuals make affect help-giving; and 4) there are costs associated with providing assistance. This discussion suggests that leaders can facilitate interaction among group members as teachers who clarify and as indirect helpers who redirect concerns back to group members.     

The analytic therapist in the group 1980: Continuities and discontinuities with Sigmund Freud

Freud's clinical concepts, formulated in the course of psychoanalytic treatment of individual patients, remain viable today in the practice of analytic group therapy. The context has changed. The transition into the group modality adds dimensions and intensifies the existing ones. Crucial, too, is the increased awareness we have of the therapeutic relationship with its power and complexity, as the context for these clinical concepts. The knowledge that each individual is unique and human applies to the therapist as well as to the patient. Comprehension of this permits better understanding of transference and resistance.Paper given in introduction to a Postgraduate Center three-day workshop, The Therapist in the Group, April 1980.