Countertransference in group psychotherapy

This paper attempts to up-date our understanding of countertransference in the therapy group setting. After a brief review of some of the psychoanalytic and the group psychotherapy literature dealing with countertransference, the paper points out the vulnerability of the group therapist and presents examples of possible countertransferential situations, such as stereotyped roles, reactions to external aspects of patients, and therapists' insecurities. It concludes by suggesting ways in which group therapists can become more sensitive to their countertransferences.     

The Impact of Specific Psychotherapist Beliefs Regarding Managed Care on Prospective Psychotherapy Clients

The purpose of this study was to investigate the separate impact of each of thirteen therapist beliefs that, presented collectively, were previously found to have a significantly negative impact on prospective clients' attitudes toward managed care psychotherapy (Pomerantz, 2000). Participants in this study initially completed a brief questionnaire measuring their willingness to enter psychotherapy and their expectations regarding psychotherapy under managed care. Participants subsequently completed the same brief questionnaire again after being instructed to imagine seeing a hypothetical psychologist and being presented with the psychologist's supposed beliefs regarding managed care (which were actually derived from survey data by Murphy et al., 1998). Results suggest that almost every discrete therapist belief had a significantly negative impact on participants' attitudes toward managed care psychotherapy. Several specific therapist beliefs produced particularly salient negative effects. Implications regarding ethics and informed consent are discussed.     

Reflections on group psychotherapy with eating-disordered patients

This paper addresses some of the dynamics, resistances, and transference and countertransference considerations in group psychotherapy with eating disordered patients. Several resistances are delineated, including guilt over being helped, the recreation of early problems around control and forced feeding, and withdrawal as a defensive operation. A brief vignette is presented which highlights the demand on the part of the therapist as well as the patient to contain and manage feelings rather than acting on them. Lastly, the author argues that group participation helps the patient to identify, articulate, and accept feelings and to promote assertiveness.This paper is based on a presentation given at the Training Institute for Mental Health on May 11, 1991.     

A dynamic/expressive approach to brief inpatient group psychotherapy

Therapeutic action occurs in groups when patients simultaneously become more accepting of their own thoughts and feelings and increase their capacity to share more benign and mature interpersonal relationships with the therapist and other patients. This orientation can guide practitioners of brief inpatient group psychotherapy in choosing when to use interpersonal, problemsolving, or object relations techniques, or more traditional dynamic/expressive techniques. While the brief inpatient modality requires an increase in suppressive techniques compared to the longterm outpatient modality, suppression must be used judiciously, to facilitate rather than interfere with selfunderstanding and development of therapeutic relationships. Specific technical choices are derived from this principle and illustrated with a case example.     

Playing for time: A psychotherapist's experience of counselling young people

This article describes the experience of a psychotherapist working for several years with adolescents and young adults at a centre offering weekly psychoanalytic psychotherapy. It describes some of the pressures placed on the therapist by young people engaging in considerable degrees of acting out and the difficulties in holding on to a sense of valuable work in the face of different attacks.     

The Integration of Behavior,Vol. III by Thomas M. French

This article presents a model for understanding development within children's psychotherapy groups. It is proposed that two complementary cultures exist within children's groups, one, indigenous peer culture, strictly of the children's making and the other, therapeutic group culture, created by the therapist in collaboration with group members. The therapist is wise to approach indigenous peer culture as an ethnographer might a native culture, with an emphasis on observation and seeking understanding rather than on intervention. The therapist can use the indigenous peer culture to speak to the children in their own language and eventually to engage them in collaboratively building a meaning system that is uniquely designed to address their psychotherapeutic needs. The article defines these concepts, develops them theoretically, and illustrates them clinically.     

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 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.     

Not starting psychotherapy is more often initiated by the therapist than the patient

The phenomenon of not starting psychotherapy is seldom investigated. The present study of psychotherapy in the Swedish mental health services differentiates between patients applying for and being offered psychotherapy but choosing not to start (n = 69), patients recommended to receive no treatment, another type of treatment or treatment at another clinic (n = 133), and therapy starters (n = 1294). After the initial assessment, nearly twice as many patients did not start based on the therapist’s decision than on the patient’s. Cases of not starting psychotherapy decided by the therapist were more frequent among patients whose occupational status was less stable, presented a danger to others, had lower levels of initial therapeutic alliance, and by therapists with lower levels of psychotherapy training and those at less structured and more unstable clinics. Patients choosing not to start therapy had lower levels of mental ill-health than both starters and therapist-initiated nonstarters. The most frequently presented reason for a patient-initiated decision to not start therapy was “patient wished another treatment or therapist,” whereas the most common therapist-initiated reason was “recommended or referred to another treatment or clinic”.     

The issue of sexuality in group psychotherapy

Sexuality is an underlying, but often unspoken and ignored issue in group psychotherapy. Within the context of how a group reacts to and uses sexuality, the authors focus on three relationship areas: client/client, client/therapist, and therapist/therapist. Some of the hazards of failing to deal with sexually laden conflicts and intimacy issues in these relationships are explored. Some of the advantages of an open and honest approach to uncovering sexrole related stereotypes and behaviors are proposed. The authors attempt to demonstrate that recognition of therapists' and group members' sexuality must be appreciated as an important element in the therapeutic process.     

The impact of transference and countertransference in activity group therapy

The effective use of countertransference reactions in children's group psychotherapy is discussed. Countertransferences activated by the group dynamics or by the dynamics of individual group members must be analyzed and understood by the therapist if they are to be utilized. The analysis of resistances in children's therapy groups is enhanced by the therapists' awareness of their own countertransference reactions. Clinical examples are presented.     

Treatment of the chronically mentally ill: an opportunity for the group therapist

This article focuses on the therapist's task of engagement in the group treatment of the chronic mentally ill. The dynamics of individual and group processes are reviewed with an emphasis on the contributions of social, interpersonal, and intrapsychic factors. Drawing upon the observations of Friedman (1988), the presentation explores therapists' efforts to restore their inner balance by (1) acting like a therapist, that is, according to their theory; (2) satisfying their curiosity; and (3) eliciting "something desirable," which is formulated as the therapist's search for interactive responses. Examples illustrate these elements as they emerge in group psychotherapy.     

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.     

The effects of therapist turnover in a training clinic: The core group phenomenon

Group psychotherapy conducted in training settings presents the membership with a unique opportunity to experience and work through loss. This paper describes the potentially problematic influence of predictable therapist turnover in these clinical settings. The core group phenomenon which emerges as a function of this anticipatory grief is described, as are the dynamics of core group members who are particularly vulnerable to the comings and goings of therapists in training. Finally, the importance of therapist attention to the impact of the turnover process in group psychotherapy training programs is underscored.     

Freud: Dictionary of Psychoanalysis Edited by N. Fodor and F. Gaynor

Acting out should be expected in the treatment of incest victims. These persons attempt to communicate through actions a plethora of confusing feelings resulting from the incest; such actions occur outside the therapy sessions and their meanings are out of the patient's awareness. Working through the underlying feelings is the necessary therapeutic task. It is unlikely that acting-out behavior will be completely eliminated, but the development of self-acceptance and a willingness to explore the meaning of the behaviors are reasonable and attainable therapeutic goals with the help of the other group members.

Three areas of acting out are elucidated: sex, power and sadism, and self-destructiveness. Clinical vignettes drawn from the authors' experience conducting group psychotherapy are used to illustrate both acting out and working through.     

Small and unfilled psychotherapy groups: Understanding and using them effectively

Many open-ended psychotherapy groups have fewer than five members, and fewer than the number the therapist considers necessary for the group to be filled. This paper discusses the rationale for starting such groups and the special dynamics of running them. It then suggests strategies for the therapist to use in maximizing their therapeutic effectiveness. Suggestions are made for further research into the demographic and dynamic aspects of such groups.     

Parallel Group Treatment of Pre-School Children and Their Mothers

Object relations concepts are applicable in children's group psychoanalytic psychotherapy. The author attempts to explore and delineate areas in which developmental conflicts in object relations, emotional deprivations, traumas, and family pathologies are recapitulated in the group, and how the manifestations of pathologies can be rectified by the process and formation of the group and the role of the therapist as a “new object” in the management of individual and group transferences. Clinical examples are presented.     

Psychoneurotic Art: Its Function in Psychotherapy by Margaret Naumburg

This article describes group psychotherapy with nursing home residents, ages 64-96, which utilizes the nonverbal and symbolic activities of drama therapy to facilitate an orientation to insight and transference phenomena, in contrast to the purely supportive techniques often used with the elderly. A case study of a long-term therapy group is described with examples of how the patients confronted their physical limitations, the death of their parents and of themselves, and transferences to the therapist. The media of creative drama, by concretizing and symbolizing difficult feeling states, and thus encouraging verbalization, may be a useful aid in extending the benefits of expressive psychotherapy to the impaired elderly.     

精神科住院患者团体心理治疗准备性会谈与治疗后访谈初探

精神科住院患者团体心理治疗较门诊患者团体心理治疗存在临床情境的特殊性,本研究探索将准备性会谈与治疗后访谈纳入治疗计划,治疗前向患者普及住院治疗、心理治疗的知识,澄清团体心理治疗的形式、目标、内容,了解患者对团体心理治疗的疑问、期望,允许患者做出是否参加治疗的决定,并在治疗后的访谈中强化疗效因子。     

Screening for Psychotherapy by an Open-Ended Group

A developmental model of conducting a time-limited, short-term inpatient psychotherapy group is described. The therapist's primary goal in this model is to promote members' awareness of their dysfunctional interpersonal behaviors and the conflicts underlying these behaviors. The therapist pursues this goal by facilitating the group in resolving the conflicts of the four phases through which the group passes. In Phase I, the group addresses conflicts related to the establishment of trust. In Phase II, issues related to dependency wishes focused upon authority figures occupy the group's attention. In Phase III, conflicts within peer relation-ships become focal. In Phase IV as the group approaches termination, group members explore feelings related to the acceptance of loss. For each phase, optimal therapist interventions are described.