The group as an object in the cultural field

This paper illuminates the interplay between group and individual processes by exploring members' notions of the group itself. What members hold in common about the "group" is understood as an object in the cultural field, which is a particular kind of transitional phenomenon (Winnicott). The paper connects this notion to Bion's concept of "basic assumptions," and describes members' motivations for creating the "group" as well as its role in the psychotherapy group. The object in the cultural field is then further elaborated in its more general role in the relation between the individual and the group, which leads to a consideration of psychotherapy groups in terms of their value in facilitating living in the social world.     

Group psychotherapy and neuro-plasticity: an attachment theory perspective

This article selectively highlights relevant areas of neuroscience research which have direct application for attachment theory and group psychotherapy. Emerging evidence from the neurosciences is revealing that the developing brain of the infant, sculpted by the earliest attachment relationships, continues to be malleable in adulthood and can be profoundly influenced by ongoing relationships throughout one's lifespan. Advances in the neurosciences are also supporting the idea that strong attachment bonds and external interpersonal interactions that arise within the context of these attachments are registered as a person's neurophysiology and neurobiology. Attachment theory in particular provides a common language and conceptual framework from which the contributions from the neurosciences can be made applicable to group psychotherapy.     

Comparison of Dreams in Individual and Group Psychotherapy

This article gives specific reasons and evidence why group psychotherapy is the treatment of choice for addictions. Utilizing object relations theory and the self-psychology of Kohut, the authors present a model of group psychotherapy that combines these perspectives with those of Yalom's interactional group psychotherapy. Agreeing with Kohut and other object relation theorists, the authors view addiction as a condition that is the result of a person's misguided attempts at self-repair because of deficits in psychic structure. Vulnerability of self is the consequence of developmental failures and deprivation. Substance abuse only exacerbates this condition leading to exaggerated difficulty in regulation of affect, self-care, and characterological pathology. Abstinence is usually required as the first step in arresting this process and establishing a treatment regimen that will allow the vulnerabilities of the self to be altered and restored. This article suggests that this recovery and treatment process is best accomplished in a group therapy setting that is conducted within the guidelines of the principles of object relations theory and a modified version of Yalom's interactional group therapy format.     

Contributions of object relations theory and self psychology to relational psychology and group psychotherapy

Object relations theory and self psychology are psychoanalytic perspectives that are especially concerned with interpersonal relations and their mental representations. Object relations theory began as an intrapsychic "singleton" psychology with the work of Freud and Melanie Klein. It subsequently evolved into a multi-person psychology with the work of Bion on groups, as well as the clinical and theoretical contributions of Winnicott and Fairbairn. Kohutian self psychology, which emerged later, has been interested in the relations between the self and significant others as mirroring and idealizing "self-objects." Stolorow's "inter-subjective perspective" emerged from self psychology as a full-fledged multi-person point of view. This article considers the significance of contemporary object relations theory and self psychology as relational, multi-person perspectives in terms of their application to group psychotherapy, focusing upon the group-as-a-whole, projective identification, transitional space and object, and self/self-object relations as particularly useful constructs. A clinical vignette is provided.     

Introduction to object relations group psychotherapy.

The author shows how object relations group therapy focuses on primitive defense mechanisms that shape the group-entity image or "basic assumptions group." Such primitive defense mechanisms as splitting, projective identification, omnipotent denial, projection, and introjection are the mental resources to protect the endangered self and the threatened objects from the fantasized imminent destruction. Object relations group psychotherapy addresses those defenses and the underlying psychotic anxieties, offering members opportunities to search for other ways to respond to their primitive fears. The author introduces two extensive clinical vignettes to illustrate how object relations group methods are different from other group-centered psychoanalytic techniques. He concludes by commenting on future theoretical refinements and on the problems in the professional practice of this modality.     

Good God?!? Lamentations as a Model for Mourning the Loss of the Good God

This article will address the devastating psychological and social effects due to the loss of one's primary love-object, namely God in the case of faith communities and religious individuals. By using Melanie Klein's Object Relations Theory (Klein in Envy and gratitude and other works 1946/1963. The Free Press, New York, 1975a) as a way to enter the text of Lamentations, I will articulate an alternative reading that can serve as a model for Pastors and Educators to use when walking with individuals and communities through unspeakable losses. I will argue that Lamentations may be used as a tool for naming confounding depression and anxiety that stems from a damaged introjected object (one's personal God). This tool may provide individuals and communities a framework for placing anger and contempt upon God in order to re-assimilate this loved yet hated object, eventually leading toward healing and restoration of the self.     

Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment

This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues, selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring.     

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.     

Coalition or derogation? How perceived discrimination influences intraminority intergroup relations

Five studies explored how perceived societal discrimination against one's own racial group influences racial minority group members' attitudes toward other racial minorities. Examining Black-Latino relations, Studies 1a and 1b showed that perceived discrimination toward oneself and one's own racial group may be positively associated with expressed closeness and common fate with another racial minority group, especially if individuals attribute past experiences of discrimination to their racial identity rather than to other social identities (Study 1b). In Studies 2-5, Asian American (Studies 2, 3, and 4) and Latino (Study 5) participants were primed with discrimination against their respective racial groups (or not) and completed measures of attitudes toward Black Americans. Participants primed with racial discrimination expressed greater positivity toward and perceived similarity with Blacks than did participants who were not primed. These results suggest, consistent with the common ingroup identity model (Gaertner & Dovidio, 2000), that salient discrimination against one's own racial group may trigger a common "disadvantaged racial minority" (ingroup) identity that engenders more positive attitudes toward and feelings of closeness toward other racial minorities.     

The problem of reinterpretive distortions in group psychotherapy with borderline patients

Group psychotherapy with borderline patients is challenging work. A group in which the core of patients falls within this nosological category is described. The phrase reinterpretive distortion is used to characterize an aspect of these patients' communication style which makes their effective treatment quite difficult. Examples of the phenomenon are offered, as is an explanation of the dynamics which give rise to it and the functions it seems to serve. Effective ways to deal with reinterpretive distortions in the group psychotherapy context are suggested.     

Critical Incident Stress Debriefing and crisis groups: A review of the literature

The concern about the psychological consequences to groups of individuals exposed to traumatic events as part of their work role has led to the introduction of a group mode of intervention for work systems called Critical Incident Stress Debriefing. However, the term debriefing is foreign to the language of group psychotherapy. Most journal articles and leader training workshops do not address CISD within the familiar context of group psychotherapy. This paper seeks an integration through discussion of the literature on crisis theory, group modes of crisis intervention, and the history, development, and process of CISD. It will be shown that CISD can be understood as a form of crisis group with some similarities to as well as differences from the crisis groups noted in the literature.     

Combining group psychotherapy and pharmacotherapy: a survey

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their "typical" outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication. Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.     

The Patient-Staff Community Meeting: A Tea Party with the Mad Hatter

The author shows how object relations group therapy focuses on primitive defense mechanisms that shape the group-entity image or “basic assumptions group.” Such primitive defense mechanisms as splitting, projective identification, omnipotent denial, projection, and introjection are the mental resources to protect the endangered self and the threatened objects from the fantasized imminent destruction. Object relations group psychotherapy addresses those defenses and the underlying psychotic anxieties, offering members opportunities to search for other ways to respond to their primitive fears. The author introduces two extensive clinical vignettes to illustrate how object relations group methods are different from other group-centered psychoanalytic techniques. He concludes by commenting on future theoretical refinements and on the problems in the professional practice of this modality.     

Interpersonal Psychotherapy for Co-occurring Depression and Chronic Pain

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one-fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans and Latinos all report higher rates of pain and depression compared to other groups. This article describes a version of Interpersonal Psychotherapy tailored for patients with comorbid depression and chronic pain, Interpersonal Psychotherapy for Depression and Pain (IPT-P). While IPT-P potentially could be delivered to many different patient populations in a range of clinical settings, this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non-treatment seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option has the potential to improve clinical outcomes for individuals with depression and chronic pain.     

On the object relational texture of affects

Marty Mayman will be remembered as a uniquely gifted clinician, diagnostician, supervisor, and teacher. In this article, I link his distinctive capacity for empathic understanding to his reliance on self-representational and object representational concepts as a vehicle for accessing the inner life of his participant. Mayman's special brand of empathy was remarkable for its sensitivity to nuance as well as its ability to strike a chord with vivid resonance. His understanding of ego development included the notion that self-representation and object representation make up part of the internalized structure of all ego functions. Self- and object representations can be thought of as embedded in the individual's subjective experience of the very performing of those ego functions. Self- and object representations can also be thought of as embedded in the individual's attitudes toward the exercising of particular ego functions, for example, where the individual struggles with whether or not he or she feels a sense of permission to "own" or exercise specific ego capacities. In this article, I apply the use of self- and object representation as a way of "texturizing" the ego to the way object relations are embedded within affects. I use some Early Memory Test (Mayman, 1968) material to elucidate the role of object relational themes in the specific way in which affects are experienced.     

Medication as object

People experience and treat medication as though it were a person: in other words, as an object. Among the many symbolic meanings attributed to medication, this sort of personification, or object representation, is a meaning that medication is uniquely positioned to contain and convey: imbued with intentionality and influence, medication moves beyond the sphere of static, iconic representation and enters the changeable, dynamic object world of action, aim, and agency. Unlike more generic or stereotypic meanings, object representations attributed to medication may reflect the patient's specific dynamics and object relations. These representations are many and mutable, and take on shifting and overlapping forms that evolve with the analytic process. Medication may represent a third person within the framework of an analytic treatment, expanding the analytic dyad into a triad and offering new transference paradigms to explore. The defensive displacement of transferential qualities and attitudes, or split-off parts thereof, from the analyst onto medication can serve as a powerful resistance to the awareness of the transference to the analyst. Clinical examples illustrate the utility and importance of the analysis of medication as object, for both patient and analyst, with particular attention to the transference.     

Interpersonal predictors of group therapy outcome for complicated grief

This study investigated three aspects of patients' interpersonal functioning as predictors of outcome for two forms of group psychotherapy for complicated grief. Patients presented with a variety of death losses and met criteria for complicated grief. The three aspects of interpersonal functioning were the patient's (1) attachment to the lost person, (2) quality of object relations (QOR), and (3) level of recent social role functioning. A more secure attachment to the lost person and better social role functioning were associated with more favorable outcome in both forms of therapy. In addition, patients with higher QOR had more favorable outcome in interpretive therapy while lower QOR patients had more favorable outcome in supportive therapy. The results suggest that each aspect of interpersonal functioning is important to consider when treating patients for complicated grief.     

Group psychotherapy of the characterologically difficult patient

A broad range of characterologically difficult patients present for treatment in psychotherapy groups. Despite different clinical presentations, including features of the schizoid, borderline, and narcissistic personality disorders, these patients share a common developmental failing. Specifically, these individuals have failed to attain object constancy and the associated stable internalization of tolerably ambivalent representations of the self, and of the other, in relationship with one another. Splitting mechanisms predominate over integrative ones, as primitive defenses are utilized to deal with the individual's powerful needs and fears related to engagement and intimacy. These maladaptive interpersonal styles are clearly illuminated in group therapy, but often to the exclusion of the latent, intrapsychic derivatives of this behavior, with detrimental effects. This paper examines the group therapy of such patients from the perspective of object relations and self psychology theories, models that provide the essential link between the interpersonal and the intrapsychic worlds.     

Daily Goals, Life Goals, and Worst Fears: Means, Ends, and Subjective Well-Being

This study addressed the relations among personal strivings (daily goals) and future life goals and worst fears. Eighty undergraduate participants (62 women, 18 men) listed their daily goals, their ultimate life goals, and their worst fears, and completed questionnaire measures of subjective well-being. Daily goals were content-analyzed for relevance to attaining life goals or avoiding worst fears. Daily goals that were instrumental to life goals or that avoided worst fears were rated as more important but also more difficult by participants. Working on daily goals avoiding one's worst fears was negatively related to measures of subjective well-being, controlling for daily goal progress, difficulty, ambivalence, and importance. Working on daily goals that were instrumental to one's life goals only weakly predicted well-being. The avoidance of worst fears interacted with daily goal appraisals such that individuals who experienced little progress at daily goals that served to avoid their "worst case scenario" experienced the lowest levels of subjective well-being. In addition, progress at daily goals that were relevant to accomplishing one's life goals was significantly more strongly related to subjective well-being than progress at daily goals that were unrelated to one's life goals. Results indicate that daily goals are used to enact life goals and avoid worst fears and that these means–end relations have implications for well-being.     

Suicide survivors: psychotherapeutic implications of egocide.

Interviews with seven of ten known survivors of jumps from the Golden Gate Bridge and San Francisco-Oakland Bay Bridge revealed that all of them experienced transcendence and spiritual rebirth phenomena. The psychotherapeutic implications of these findings lie in helping depressed and suicidal individuals confront death in a symbolic and meaningful way. The issue is one of "egocide" (symbolic suicide) and aiding individuals in the rebirth process. In this way actual suicides can be prevented. When individuals experience partial "deaths" (like loss, failure, rejection, depression, suicidal states, or negative parts of their egos), there is opportunity for "rebirth" (positive transformation, creative change, growth, and significant spiritual reawakening). The therapeutic task is to help individuals differentiate between "ego death" and total death and to discover through the creative process of psychotherapy that overt suicide need not be a solution.