The narcissistic personality in group psychotherapy

The author presents an interesting version of the Narcissus myth which she combines with the legend of Peter Pan for a better understanding of the narcissistic personality in group therapy. A lively case is presented of a young man named Jeffrey, whose narcissistic defenses were dismantled during a three-year group participation. A particular encounter between Jeffrey and another client and a powerful intervention by the therapist is described. The therapeutic importance of the group therapist as a firm but protective parent for these clients is emphasized. Definitions of narcissistic are given and some generalizations about these personalities in group therapy are explored.She has completed a book entitledChange in the Context of Group Therapy to be published by Brunner/Mazel in 1984.     

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.     

Some thoughts on the existential lens in group psychotherapy

Existential psychotherapy provides a useful perspective, or lens through which to view the practice of group psychotherapy. The field encompasses a variety of theoretical and practical points of view, many not usually thought of as existential. Some relate to the therapist, some to the enterprise of psychotherapy, and some to conceptions of psychic or external reality. This paper identifies several of these vertices, emphasizing especially (1) the importance of relationship in psychotherapy, (2) the problem of meaning (3) addressing existential concerns, especially the centrality of death as a problem in living, and (4) the task of the therapist. Attention is paid to the historical development of these ideas. The work of Martin Buber, Otto Rank, Wilfred Bion, and Viktor Frankl is especially emphasized, although proto-existential concepts from other waters are also noted. The heart of the paper deals with the application of these vertices to group psychotherapy. Extensive attention will be given to the differing viewpoints of Hugh Mullan and Irvin Yalom. Practical applications in group psychotherapy, including clinical vignettes, are offered.This paper was originally delivered, in somewhat different form, at the National Group Psychotherapy Institute of the Washington School of Psychiatry on April 23, 1995. It was dedicated to Hugh Mullan, who had been one of my teachers at the school two decades earlier.     

Taoism and psychotherapy

An attempt is made in this paper to apply the principals of Taoism to the practice of psychotherapy. The Eastern approach to the nature of experience is described in order for the therapist to become more present for himself as well as for the patient. The relationship of insight to the process of change is explored, contrasting Eastern notions of transcendent liberation to the traditional psychoanalytic model of personal transformation, which has been viewed as curing the patient. Taoist precepts are described, comparing the Eastern view of the enlightened teacher to an ideal therapist. Finally, fifteen Zen tenets are described, as outlined by Holmes and Horioka, with an effort made to relate each tenet to the experience of being a therapist.     

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.     

Individual psychotherapy as an adjunct to group psychotherapy

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.     

Therapeutic relationship and progress in the first six sessions of individual psychotherapy: A panel analysis

The temporal nature of the associations between client-rated therapist empathy and acceptance, and both client-and therapist-assessed therapeutic progress at sessions 2 and 6 were examined pairwise with cross-lagged panel correlatation (CLPC) and linear structural relationships (LISREL) analyses in 37 clients treated in weekly individual sessions of long-term psycoanalytic and person-centred therapy by 37 experienced therapists. Although none of the cross-lagged differences in the three CLPC analyses which met the necessary conditions for interpretation were significant, two of them approached it, suggesting that session 2 client-rated progress was a stronger determinant of session 6 therapist empathy and acceptance than vice versa. However, the LISREL analyses indicated that while session 2 client-rated progress was unrelated to session 6 therapist acceptance, session 2 therapist empathy was negatively correlated with session 6 client-rated progress. furthermore, both session 2 therapist empathy and acceptance were positively associated with session 6 therapist-rated progress, thereby providing some support for the therapeutic role of these two therapist variables as postulated by person-centred theory.     

The different patterns of group climate critical incidents in high and low cohesion sessions of group psychotherapy

The total data set for this study consisted of 958 critical incidents from high and low cohesion sessions in person-centered group psychotherapy. These incidents were typically noted on a group climate questionnaire at the end of each session. Altogether 211 clients and students participated in twenty-six groups. The high cohesion sessions were dominated by the following cohesion dimensions in rank order: self-disclosure and feedback (24.0%); attraction and bonding (20.2%); listening and empathy (20.0%); process performance and goal attainment (15.0%); and support and caring (10.6%). The corresponding rank order for the low cohesion sessions was strikingly different: avoidance and defensiveness (43.5%); conflict and rebellion (22.2%); and self-disclosure and feedback (8.9%). Apparently then, there are very different patterns of critical incidents in high and low cohesion sessions of group psychotherapy.     

The autistic moment in psychotherapy

This is a report on the author's experience in treating four autistic children and their families. The importance of making available the therapist's own autism is stressed. The difficulty in doing this and reverting defensively to an administrative approach is described. A previous paper discussed the corrective autistic experience with a focus on the autistic person. This follow-up describes the autistic moment which is a relational experience between the therapist and both the autistic person and the autistic family. The family needs to have an experience of its own autism as a continuum of normal before it can relate to an autistic child. To the extent that the therapist can bring his own autism into the therapy can the family experience its own. The patients are the person, the relationships, the family, and the therapist.The author would like to thank Richard B. Anderson, MD, Lindy T. Barnett, MSW, David V. Keith, MD, JoEllen Barnett Smith, MA, and Orion Smith for their participation as cotherapists. The comments made on an earlier draft of this paper by the members of the Atlantic Psychiatric Clinic are warmly acknowledged. Valuable editorial assistance has been extended by Robert Garfield, MD, and Stuart Sugarman, MD. Lastly, the author would like to extend his appreciation to Robert R. Haubrich, PhD, for stimulating his interest in the field of comparative ethology.Presented at the Conference Honoring the Retirement of Carl A. Whitaker, MD, in Madison, Wisconsin, June 25, 1982.     

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.     

The manifestation of transference during early psychotherapy sessions: Exploring an alternate data source for therapist narratives in transference research

Introduction: Previous transference studies have compared in‐session client narratives about significant others to in‐session client narratives about the therapist, limiting data to the information that clients are willing to share with the therapist. Method: The first three sessions of 30 therapies with high‐functioning individuals were examined using the Core Conflictual Relationship Theme (CCRT) method. Client narratives about others were drawn from the psychotherapy sessions and client narratives about the therapist were drawn from a Participant Critical Event (PCE) interview conducted after the third session of therapy. Results: Factor analyses of the CCRT components indicated several relational patterns: a complementary pattern of relating characterised by a devaluation of the therapist and idealisation of others; a concordant relational transfer where clients feel bad with both the therapist and others; and as clients experience control issues with significant others, they wish to adopt a submissive stance toward the therapist. The results suggest that the source of therapist narratives may influence the results of transference research.     

In Experiential Sessions, There Is No Therapist or Client: There Is a “Teacher” and a “Practitioner”

In virtually every kind of psychotherapy, therapist and client attend mainly to one another throughout almost the entire session. If each experiential session is to be successful in enabling the person to become the whole new person that the person can become, and to become free of the painful feeling in the painful situation, the radical alternative is for the experiential teacher–therapist and the person to attend mainly to the third thing that is the important center of attention for the person. An even more radical glimpse into the future includes the person having one's own sessions by oneself, complemented by skill-development sessions with the experiential teacher.     

Reflections on thomism and client-centered psychotherapy

Conclusion To summarize, Rogers and Aquinas both stress the importance of existential experience and sense data. Although Rogers is more concerned with human freedom and being than are many modern adjustment psychotherapists, he is still circumscribed by his initial positivistic assumptions about the nature of man in his therapy. but these assumptions may be in the process of change.But like Aquinas, Rogers has a deep respect for the person, a respect for his emotions, a respect for his whole existential being.³⁸ Rogers once stated that the client-centered point of view is devoid of thequid pro quo aspect of most experiences we call love. It is the simple outgoing human feeling of one individual for another, a feeling it seems ... which is even more basic than sexual or parental feelings. It is a caring enough about the person that you do not wish to interfere with his development, nor to use him for any self-aggrandizing goals of your own. Your satisfaction comes in having set him free to grow in his own fashion.³⁹ Isn't this the spiritual detachment of real Christian love?He has taught at the University of California at Los Angeles and at Loyola University (Los Angeles), and has been a staff psychologist at the Metropolitan State Hospital, Los Angeles. He is a member of the American Psychological Association and the American Academy of Psychotherapists.Portions of this paper were presented at the 16th Annual Scientific Session, Guild of Catholic Psychiatrists, Los Angeles, 1964.     

Mapping sex group stereotypes of elementary and high school students

This study investigated the sex group stereotypes of youths of elementary and high school age. A total of 60 males and 60 females evaluated boys and girls on a semantic differential type scale. The results indicated that younger members of both sexes were more positive about their own sex and more negative about the opposite sex than were their older counterparts. In addition, adolescent males, but not adolescent females, adopted more favorable evaluations of the opposite sex over their own sex group. Possible explanations are offered to account for these findings.     

Metaphorical analysis and hermeneutical interpretation in analytical group psychotherapy

The principle of hermeneutical interpretation (i.e., the art and discipline of analyzing the symbols of sacred texts) is explained and applied to the analytical group situation. It is maintained that the approach employed by this methodology provides a viable manner for understanding patients' unconscious communications. In particular, the relationship between metaphorical communication and the hereand now therapeutic experience is discussed. It is argued that the unconscious manifests itself as a set of metaphorical expressions. The paper presents two clinical vignettes illustrating how this hermeneutical methodology can aid the therapist to read the unconscious meanings of such metaphors.     

The impact of group psychotherapy on the self-image and self-feelings

Group psychotherapy is presented as an effective way of changing the self-image and self-feelings; the image of the self and feelings about the self being brought into awareness by the group process. After a brief review of relevant literature, group-specific experiences that affect the self-image and self-feelings are described. These include: the mirror phenomenon and triadic relationships; resonance; direct confrontations and challenges from other members; comparing oneself with, and differentiating oneself from, other members; and experimentation with new, different ways of relating to other group members. Some of the experiences of group members and, finally, the significant role of the therapist in this process are described.     

The Angry Patient: Case and Session Presentation

Responding to patients who become angry at the therapist is difficult for many clinicians. In the case and session presented, the patient is not only angry, but devalues the therapist by not paying while asking for more frequent sessions. The therapist loses it, states she is angry, and remains insistent on the patient keeping his bills paid or reducing the frequency of sessions. The therapist is conflicted over confronting the patient with what she believes has to change in order for his symptoms to diminish—the irrational beliefs, life style, and sense of entitlement related to the personality disorder of this patient, but likely to drive him away from treatment. The therapist engages in a risky confrontation and remains unclear about the eventual benefit of this response.     

Treatment of oral character neurosis in group psychotherapy

Summary In summary, orally regressed neurotic characters are generally regarded as extremely resistive and discouraging patients because of their excessive narcissism, weak, unadaptable ego, clinging passive dependency, intense infantile rage, strong psychic masochism, and intense need to provoke aggression. This author has found, however, that patients in this category are more likely to respond to treatment when it is provided in a group setting.This hard core of oral character neurotics who frequently resemble borderline psychotics because of their tenacious masochistic defenses often find it easier to recognize the rigid and inappropriate defenses they habitually employ after they have seen similar defenses enacted by their group peers. Watching others play out their various senseless and stubborn delaying tactics stimulates such patients to question their own inflexible behavior when it is challenged or interpreted. Moreover, in the group setting, they are made aware of the fact that the acknowledgment of anxiety by their peers does not demean them; nor do they become passive and vulnerable objects for annihilation as a result. They find instead that the uncovering of conflicts evokes sympathy, and produces tangible help by all the members of the group, including the unconsciously feared therapist who is perceived as the bad mother.Reprinted with permission from Sager, C. J. and Kaplan, H. S. (Eds.)Progress in Group and Family Therapy. New York: Brunner/Mazel, 1972.     

The group as selfobject: brief psychotherapy with women

This article applies the theory of self psychology, which was developed by Heinz Kohut, to brief group psychotherapy. The article discusses the significance of the group as an expanded selfobject for individuals who do not have appropriate, available selfobjects in their environment. The article addresses the rationale for developing a 12-week women's group from a self-psychological perspective and illustrates key theoretical concepts in the beginning, middle, and end phases with group process. The role of the therapist in each phase of group development is emphasized.