Group Therapy in Israel

This paper is an analysis of the group therapy and the group work phenomena in Israel as a microcosm of the Israeli society and culture. We discuss the structure of Israeli society and its features, identify the key norms and myths that express the social unconscious, and pinpoint events that mark critical points of change. Drawing on these, the paper then describes some examples of the influence of Israeli identity on participants' and group therapists' behavior, and on current training programs.     

Spirituality in Disability and Illness

Spirituality appears with increasing frequency in the research literature, and a paradigm involving mind-body-spirit interaction is emerging. The relationship of spirituality to disability and illness is at the center of a growing body of knowledge. A comprehensive literature review supported spirituality as coping method among individuals experiencing a variety of illnesses including hypertension, pulmonary disease, diabetes, chronic renal failure, surgery, rheumatoid arthritis, multiple sclerosis, HIV/AIDS, polio and addictive illnesses. Additionally, spirituality is a resource when dealing with critical illness as well as terminal illness and end of life issues, and it is utilized by both patients, and family members. Discussion of research findings, implications for health care practice and future research is also presented.     

Facilitating Individuation Processes in Supervision Groups Comprised of Co-Therapists Conducting Group Therapy with Bereaved Parents

Helping Israeli bereaved parents work through losses and anger poses great emotional challenges for group therapists. Separation-individuation becomes an issue for both mourners and conductors alike. Supervision groups composed of such co-therapists often go through unique stages in the course of their development. The conflict between a defensive belonging to a dyadic subgroup with their co-therapist on the one hand, and involvement with the supervision group and its leader on the other, are the main reasons for this uniqueness. In these stages, special difficulties in the co-therapist's separation/individuation may be observed and furthered. An important emotional function we call reverse parallel process can be activated in supervision groups, and can eventually influence the therapy. It is achieved in the supervision through the containment and working through of difficult emotions disowned by the therapy group. What seemed to be an obstacle to the group's development, if processed by the co-therapists, can enable patients to work through their difficulties and improve their functioning. If, on the other hand, the co-therapists' separation/individuation development is faulty, containment dysfunction may burden the receptiveness and working through of dreadful projections, and result in massive acting-out. The rich Israeli experience in this field could contribute to cope with similar group situations.     

On Disability and Illness. A Reply to Edwards

This paper is a reply to an article by Steven Edwards in a previous issue of Theoretical Medicine and Bioethics. In this paper Edwards discusses two types of problems which he finds to be inherent in my theory of disability, mainly as presented in my On the Nature of Health, Kluwer 1995. First, Edwards discerns a tension in my basic definition of health, a tension between my “subjectivistic” and my “objectivistic” aspirations in the definition. Second, he finds that my theory of disability does not allow for a distinction between disability due to illness or injury and disability which has no such (at least not immediate) background. In my answer to Edwards's arguments I claim that his first criticism must be due to a misunderstanding of my intentions. I find his second criticism to be more to the point. It raises important issues in the theory of health which partly concern our interpretation of the notion of illness. Edwards introduces the notion of capacity in order to separate between disability due to illness or injury and disability without such a background. In the last part of my paper I argue that this distinction, however, will not fulfil its purpose. This revised version was published online in August 2006 with corrections to the Cover Date.     

Illness Perceptions,Coping, Benefit Finding,and Adjustment in Individuals with Hepatitis C

Objective

To investigate the ability of illness perceptions, adaptive, and maladaptive coping strategies, and benefit finding to predict physical and psychosocial adjustment among individuals diagnosed with the hepatitis C virus (HCV), within an expanded self‐regulatory model of illness (SRM).

Method

A total of 126 participants with HCV completed an online questionnaire assessing illness perceptions, coping, benefit finding, and four adjustment outcomes, depression, physical functioning, life satisfaction and positive affect.

Results

Illness perceptions made significant contributions to the variance in adjustment outcomes across the four psychosocial and physical adjustment areas. At an individual level, personal control, identification with HCV symptoms, perceptions related to illness duration, illness coherence, and emotional responses to HCV made significant contributions to the prediction of adjustment. Similarly, the combined contributions of adaptive and maladaptive coping strategies explained significant variance across the four adjustment areas. Greater adoption of maladaptive coping strategies predicted poorer physical health, higher reported depression, greater life satisfaction, and positive affect outcomes, while increased engagement with adoptive coping strategies predicted higher positive affect. Increased benefit finding predicted greater positive affect, life satisfaction, and higher depression.

Conclusion

Results demonstrate the ability of the SRM features of illness perceptions and coping, and benefit finding to predict physical and psychosocial adjustment outcomes within the context of HCV.     

Raising Fees in Group Therapy: Some Ethical and Clinical Implications

Of all money matters in group psychotherapy, one of the most neglected in the literature is the issue of raising the fees. The premise of this paper is that there are ethical and clinical considerations to group fee increases. One consequence of the lack of attention to the subject of raising of fees is that many neophyte group leaders do not learn about its complexity. It will be argued that the raising of fees is not merely a straightforward matter of informing groups about an impending change in the amount of money that they will pay but rather, it is a knotty, emotionally charged issue with both realistic and subjective components for members and leaders alike. Further, it will be argued that the issue of raising fees in group therapy is dissimilar, in significant ways, from raising fees in individual treatment. When leaders use subjective criterion to decide an increase, then the group process may be disrupted. Suggestions for reform will be offered.     

Trauma, Regression, and the Intensive Group Experience

Ferenczi contributed a theory of trauma and regression that has application in the contemporary practice of group therapy. This article seeks to present an extension of these seminal ideas in the form of interventions based on therapist induced regression. The Intensive Group Experience (I.G.E.), a time extended group format found to be necessary for extensive emotional reliving and working through of trauma is described. A clinical case example is then discussed in detail and concludes this report.     

Psychological Illness in Presidents: A Medical Advisory Commission and Disability Determinations

Although the 25th Amendment is intended to provide for instances of presidential disability, critics claim that it is impractical since it requires vice presidents and cabinet members to move overtly against the president—which they are unlikely to do. Also, they warn that medical information about the president is likely to be concealed. To overcome these problems, they recommend that a Medical Advisory Commission be established at the outset of every presidential administration to examine the president annually and then provide formal medical input so that the vice president and cabinet would be "compelled" to act in the presence of medically determined "inability," whether physiological or psychological. This paper argues, however, that such a proposal is badly flawed and quite unworkable, particularly in the case of psychological illness where accurate diagnosis typically depends on long-term, continuous doctor-patient interaction rather than through sporadic and superficial interchange. It concludes that less draconian measures in implementing the Amendment are far more sensible, such as those proposed by the Working Group on Presidential Disability which are discussed here.     

住院期白血病患儿的疾痛经验与应对策略

通过对武汉市Z医院12名住院期白血病患儿疾痛叙事的记录与分析,发现疾痛造成了他们日常生活中身体、时间、关系三个维度的破坏。然而,疾痛并非一成不变,其对日常生活造成的破坏可以通过个人的主体行动得以修补。住院期白血病患儿为重新达至自我的平衡与对生命的掌控,能动地采取了承认自身脆弱性、时间的意义重构、情感的内外支持等疾痛应对策略。上述疾痛应对策略不仅是住院期白血病患儿在特定医疗情境下进行的主体行动,也受到社会结构和文化环境的型塑作用。研究最后探讨了以意义为中心的医学解释模式在我国的必要性与可能性,提出了相应的思考与建议。

     

Ethical Challenges and Legal Issues for Mental Health Professionals Working With Family Caregivers of Individuals With Serious Mental Illness

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify and communicate ethical obligations to family caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy.     

Exploring Recovery Perspectives in Individuals Diagnosed with Mental Illness

Using a phenomenological research design with a photovoice method, we aimed to understand the lived experience of eight individuals diagnosed with mental illness and identify factors affecting their recovery. We conducted focus group interviews whereby participants discussed their recovery, shared photographs taken of items symbolizing their recovery, and created personalized photobooks or scrapbooks. Data analysis yielded the following themes: (1) caring relationships, (2) leisure and outings, and (3) relaxation, stress reduction, and coping. Findings revealed factors influencing recovery from mental illness and can be used to develop person-centered and occupation-based interventions to promote recovery in clients with mental health issues.     

Hatred in Group Therapy: A Rewarding Challenge

Hatred is a powerful affective experience that can be disruptive to the work of a therapy group, yet it may also enhance a member's capacity to deal with strong affects. This paper explores a particular aspect of hatred, the hate directed at one member of a cotherapy team. An effort is made to explore the experience from an intersubjective and motivational systems perspective, focusing primarily on the therapist and one patient. The impact of the cotherapy relationship is also considered, as well as the whole group's capacity to contain and work with this powerful affective response. The way that the group managed this explosive situation speaks to the power of group therapy in healing and transforming its members.     

Dealing with Masochistic Behavior in Group Therapy from the Perspective of the Self

The self psychological understanding of masochism differs from traditional views in that it perceives masochistic behaviors as maladaptive attempts to experience vitalization, greater self-esteem and self-cohesiveness. Motivational systems theory may be especially useful in understanding the purposes served by masochistic behavior. Masochistic behavior in interpersonal relations is of particular importance to group therapy. Such behavior serves to maintain a relationship with the object as well as to gain selfobject experiences. Exhibitionism appears to be a prominent aspect of the behavior of individuals acting masochistically in group therapy. The group leader has the responsibility of establishing and maintaining an empathic atmosphere among the group members so that the individual engaging in self destructive behavior, as well as other members, can hear and understand their own and each other's subjective experiences.     

Rapid Adoption and Implementation of Telehealth Group Psychotherapy During COVID 19: Practical Strategies and Recommendations

Behavioral health services have been tasked with rapidly adopting and implementing teletherapy during the SARS-CoV-2/COVID-19 pandemic to assure patient and staff safety. Existing teletherapy guidelines were developed prior to the pandemic and do not capture the nuances of rapidly transitioning in-person individual and group-based treatments to a teletherapy format. In this paper, we describe our approach to quickly adapting to a teletherapy technology platform for an intensive outpatient program (IOP) guided by cognitive and behavioral modular principles for adults with serious mental illness. A review of existing guidelines was conducted and the staged approach for teletherapy implementation (Muir et al., 2020) was selected as the most appropriate model for our organizational context. We describe the most pertinent implementation strategies and report our preliminary findings detailing the feasibility of IOPs delivered via telehealth. This model of rapid teletherapy implementation offers practical clinical guidelines for administrators and clinicians seeking to transition traditional in-person behavioral health services to a teletherapy format.     

Difficult Terminations in Group Therapy: A Self Psychologically Informed Perspective

In group therapy, terminations that are neither planned nor anticipated are sometimes referred to as difficult. This complex issue of difficult terminations is used as a vehicle to challenge the prevailing, though often unspoken, assumption that the goal of the group therapist is to keep the members in the group. The author presents the notion that the leader needs to maintain a balance between the group as a treatment context, and the goal of that context. The goal of group-as-treatment context is to provide for the therapeutic needs of each individual patient in the group. Self psychology provides a basis for redefining the therapy group as a treatment context. A specific rationale, goal, and process of that redefinition is presented along with illustrative case material. With this understanding, unanticipated terminations can be as readily accepted and understood as ones that are planned. All terminations are viewed as further opportunities to understand how a patient defines his or her sense of self, sense of other, and sense of self with other.     

Group Therapy with Terror-Injured Persons in Israel: Societal Impediments to Successful Working Through

This paper describes a group intervention with terror-injured people in Israel to show the parallels between developments in the group and Israeli society's difficulties in working through and mourning its experiences of terror. Despite the development of group cohesion and a sense of empowerment, the group members remained unable to deal with the powerful emotions stemming from the experience of terror and continued to cling to their shared identity as terror victims, irrevocably helpless and isolated from others. Without excluding other explanations, we suggest that these difficulties reflect the defense mechanisms employed by Israeli society in dealing with the threat to its survival that is implicit in the terror to which it is exposed.     

Spontaneous Reports of Religious Coping by Patients with Chronic Physical Illness

Individuals undergoing the stress of physical illness often report the use of religious coping activities. This study compared the frequency of spontaneous reports of religious coping in three groups of patients including those with cancer preparing for a bone marrow transplant (n = 22), chronic pain (n = 36), and cardiovascular disease (n = 53). Participants were asked to respond to a written, open-ended question asking how they were coping with the challenges involved in their medical condition. The question asked them to list the resources, strategies, strengths, or behaviors that they found most helpful. No mention of religion or religious coping was included with the question. Of the 111 participants surveyed, 26.1% included religious coping in their responses. The relative percentage of religious coping was calculated by dividing the total number of coping responses by number of religious responses. Mean percentage of religious coping was highest in participants preparing for a bone marrow transplant (22.9%), followed by the cardiac group (5.7%), and the chronic pain group (3.8%).     

Integrating New Members into an Ongoing Therapy Group: The Life-Line Technique

Integrating a new member into an existing group poses many problems, both for the new member and the group as a whole. To address these, the authors propose use of a life-line technique to introduce a new member to the group. Following review of the basic narrative assumptions, a specific procedure that utilizes the life-line is described. Comments of new and old members after one typical life-line presentation are given. These comments are representative of those made on other occasions. They indicate that this life story review is therapeutically helpful and assists the process of integration of a new member into an ongoing group. Some limitations of this method are addressed in the discussion.     

Multiculturalism and Group Therapy in the United States: A Social Constructionist Perspective

Multiculturalism encourages the inclusion of the broad range of cultural differences that exist in society into our therapeutic dialogues. This paper examines multicultural group therapy through the perspective of social constructionism. Emphasis is given to the unacknowledged and unspoken imbalance of power that exists in psychotherapeutic contexts. The concepts of multiple individual identity and cultural representation are discussed and illustrated with case examples. Clinical considerations for the multicultural group therapist are provided.     

Participating From the Comfort of Your Living Room: Feasibility of a Group Videoconferencing Intervention to Reduce Distress in Parents of Children With a Serious Illness or Injury

ABSTRACT

This study explored the feasibility and potential effectiveness of a videoconferencing group intervention for parents of children with a life-threatening illness. Parent functioning was assessed at pre, post, and 6-month follow-up (N?=?13). Semistructured interviews explored parent experiences of the program and clinicians’ experiences were systematically recorded. Attendance was high (92%) and parents reported comfort with the online delivery. Quantitative data revealed significant reductions on three of the nine measures examined (parent guilt/worry; unresolved sorrow/anger; lack of psychological flexibility). Clinician data are described and highlights the skills and program modifications required to adapt to the videoconferencing modality. A randomized controlled trial is now underway.