How to Begin A Therapy Group: Six Approaches

Japanese “groupism,” or the tendency to emphasize groups rather than individuals, often favors the use of group psychotherapy with Japanese patients. However, the author recommends that the clinician should be sensitive to other cultural phenomena, which are thought to be related to groupism that will influence the nature of group treatments. For example, the traditional Japanese relationship to authority may make it difficult for many patients to express negative attitudes and to share intimate material. Differences regarding confidentiality and gender, distinction between “miuchi” (families) and “tanin” (strangers), and attitudes toward silence may also influence the nature of group therapy. The author discusses these and related cultural differences and highlights implications for the therapist's style of intervention. Finally, the amount of influence that groupism has on group psychotherapy must be considered. The author suggests that it is greater for patients with mild neurosis than severe psychosis.     

The structure of psychosomatic symptoms

1. According to our findings, a psychosomatic structure is not an alternative to neurosis. The syndrome of alexithymia appears to be, in our cases, a transitional phase, the dynamics of which can be understood and treated by psychotherapy. In the course of psychotherapeutic treatment, alexithymia always disappears. 2. However, a special psychotherapeutic technique is advisable, one different from that applied in classical neurosis. 3. For this reason the term psychosomatic structure can be used as a way of expressing a variation of neurosis. 4. Modern concepts of psychosomatic disease describe pathological personalities that are different from the classic pseudoneurotic type because of their narcissistic and pregenital structures. These structures can be concealed underneath a facade of genital and psychoneurotic defense. 5. The old relationship between psychosomatosis and psychosis can be better understood on the basis of our findings, which reveal a borderline structure and splitting mechanisms in many psychosomatic patients. 6. Psychosomatic pathology can be better understood today by relating it to the structure of the psychosomatic family. 7. It appears that if, on the one hand, psychosomatic diseases of a more hysterical picture are frequent among preindustrial cultures and in low-income classes, on the other hand psychosomatic syndromes of a narcissistic and borderline type are characteristic for our civilization.     

Commentary

Conclusion Self psychology has added several dimensions to working with difficult oral patients in group psychotherapy. Elucidation of selfobject transferences provides a new understanding of members' linkages to the therapist, to one another, and to the group-as-a-whole. The emphasis on the process of narcissistic injury and repair has shed light on subtle processes that precipitate provocative, self-defeating behaviors that are compatible with dynamic constellations subsumed under the rubric of oral character neurosis.Glatzer paved the way for further advances when she accurately began to explore many facets of these individuals' characteristic behavioral patterns and their underlying dynamics. She provided a sound treatment base, using available theory, for patients who had been previously thought to be unacceptable or untreatable in group psychotherapy.One of the challenges that lies ahead is development of satisfactory evaluation of our treatments. Unless we can begin to demonstrate that long-term treatment is necessary and that group treatment is cost effective, extended insurance support for these deserving individuals will disappear. If our dynamic formulations are accurate, these personality malformations are not amenable to brief interventions, although acute symptoms might be alleviated. In light of our current knowledge, significant change will only take place with extended treatment.     

Group Psychotherapy and the Nature of Drug Addiction

There is little evidence that the development and resolution of a regressive transference neurosis is an important or useful experience for patients in once-a-week outpatient group psychotherapy. Rather, research evidence and clinical experience suggest that a broad range of therapeutic factors are important. Before group treatment, patients expect to gain from insight, catharsis, interpersonal output, and interpersonal input. Patients who have had short therapeutic experiences indicate that catharsis, learning to trust others, and learning how one relates to others are most important. In longer-term therapies, a broad range of factors comes into play, including universalization, altruism, guidance, and existential factors, in addition to catharsis, insight, and interpersonal learning.     

Change in self-concept differentiation after psychotherapy and its relation to psychological maladjustment

The research was carried out with a group of 105 psychotherapy participants, diagnosed with neurosis or personality disorders, and 36 controls. Analysis supported the hypotheses that self-concept differentiation (SCD) decreases after psychotherapeutic interventions and that the reduction in SCD is positively correlated with an improvement in neurotic symptoms and neurotic personality traits.     

Patients’ Perceptions of Risky Developments During Psychotherapy

Research on risks and unwanted effects is largely missing in psychotherapy. Using exploratory factor analysis six dimensions of personal therapy situation were identified in a preliminary study, three of them were associated with risky developments during the psychotherapeutic process: (1) (poor) quality of therapeutic relationship, (2) burden caused by psychotherapy, and (3) dependency/isolation. Based on the finding of this study an online survey was performed to examine these three dimensions. Aside from these three factors another variable was associated with risky therapy developments: the online questionnaire also asked for premature terminations of psychotherapy as a consequence of risky conditions for the therapeutic development. Risky conditions were found to be associated with the following variables: (1) the combination of female patient–male therapist, (2) the therapeutic orientation (particularly with the psychodynamic approaches) and (3) the duration of therapy. Fewer humanistic and systemic psychotherapies were found among the high risk-prone group of patients who were at risk in at least three of the four variables which were associated with risky developments. Differences in the findings of the study regarding the four therapeutic orientations stress the importance of an extensive differential indication and a cooperative partnership between patient and therapist, in order to facilitate a positive patient participation towards the choice of therapy method and subsequent successful participation throughout the course of treatment. Further studies should also focus on female patient and male therapist psychotherapies.     

Unerwünschte und schädliche Wirkungen von Psychotherapie

Unwanted effects or even damage due to psychotherapy are largely neglected issues within psychotherapy research as compared to other fields. On the other hand, it is reasonable to assume that unwanted effects of a treatment which intends to influence patients into a positive direction are very likely. The rate of negative effects of psychotherapy (the deterioration effect according to Bergin) is consistently estimated to be 10% of all cases and shows this same rate in a variety of studies. This review highlights side effects of psychotherapy both on the part of the patients and of the therapists. It reports unwanted effects related to different psychotherapeutic methods, i.e. psychoanalysis, cognitive behaviour therapy, client-centered psychotherapy and – beyond these basic orientations – group psychotherapy. The paper also reports on negative effects of psychotherapy on an untreated partner. Finally, some proposals are given on how negative effects of psychotherapy could be diminished. The authors especially highlight the possibilities of changing the therapist, the treatment technique, or the theoretical treatment approach as a way to reduce negative effects.     

The advantages of formulation over categorical diagnosis in explorative psychotherapy and psychodynamic management

In neurosis and personality disorder, formulation is a clearer guide to aetiology, prognosis and treatment than is categorical diagnosis. Diagnosis and formulation have different and complementary functions. The formulation is an essential component in explorative psychotherapy but also has wide application in psychodynamic management. The content and the making of a formulation are described. the value of a psychodynamic approach in decision making, and in choosing between explorative psychotherapy and psychodynamic management, is illustrated by case examples.     

Supervising Humanistic-Existential Psychotherapy: Needs, Possibilities

The competency movement within professional psychology, evidence-based practice concepts, and the trend toward incorporating psychological services as a component of an integrated care approach within health care settings are major developments in the changing landscape of psychotherapy practice that have important implications for psychotherapy supervision. This article examines each of these developments as they relate to conducting psychotherapy supervision from a humanistic-existential perspective. The current status of supervision guided by a humanistic-existential framework is described, followed by exploration of needs and possibilities for the future evolution of the supervision approach in light of developments in the field.     

Reflections on the idea of personal fate and its psychopathology: Helene Deutsch's "Hysterical Fate Neurosis" revisited

The idea of a psychopathology of fate or what had come to be called a fate neurosis has failed to retain any established place in the structure of psychoanalytic thought. The clinical observations and theoretical formulations, to which the idea of a fate neurosis answered, have been subsumed in the course of things by more fundamental and systematic conceptualizations. A review of Helene Deutsch's (1930) paper, "Hysterical Fate Neurosis," is therefore bound to be largely an excursion into an area of intellectual history. However, such history never fails to shed light on certain ongoing clinical and theoretical problems that may have lost too much to current developments in psychoanalytic thought. It is with this historical purpose that the present study of Deutsch's classic paper on a fate neurosis is undertaken.     

Ökonomisierung und Psychotherapie

Former fundamental social structures are disappearing and, especially by the economization and industrialization of medicine, the self-understanding of patients, doctors and hospitals has changed. From these developments psychotherapy gets into a strange area of tension, not only in the society as a whole, but also within medicine: on the one hand psychotherapy is needed more than ever, but on the other hand it finds itself in an outsider position. Thereby, the reality constructions of patients and psychotherapists are affected as well, mostly gradually, so that the consequences for the relationship between psychotherapists and patients escape attention. Dealing with these problems in a considered and transparent manner can avoid damaging the therapeutic work.     

Rorschach Correlates of Traumatic Neurosis of War

Only two cases out of a total population of 1500 military men evacuated from a war zone with psychiatric diagnoses were found to be suffering from traumatic neurosis. The Rorschach protocols of these two cases are presented and discussed within Kardiner's theoretical framework. Despite diverse social, educational, and occupational backgrounds these two Ss produced markedly similar protocols illustrating how in traumatic neurosis projective stimuli may serve as releasors for the abreactive repetition of the trauma as seen in highly charged responses which are affect-laden, violent, phobic and sometimes psychotic-like in nature.     

Group Psychotherapy in Rehabilitation of Female Opium Addicts in Uzbekistan

Increase in substance abuse and addictive disorders is one of the most significant and urgent problems in contemporary society, especially among young women of childbearing age, thus affecting the health of future generations. This study assessed the effectiveness of group psychotherapy in rehabilitation of female opium addicts. Our findings suggest that women respond best to short-term group psychotherapy consisting of women only as compared to participation in co-ed groups. At follow-up, there was significant change in desire for opiates and abstinence in the study group.     

Proof of complex theories regarding conflicts, neuroses and their therapy, exemplified by Mjasiscew's theory of relations

Most psycho-dynamic theories emphasize the role of intra-personal conflicts in the aetiology and therapy of neurotic disorders, but very few can be empirically tested. The social psychological and psychodynamic "pathogenetic" theory of the "Leningrad School" of psychotherapy according to Mjasiscew (Lauterbach, 1984) maintains that conflicts between a person's relations with his social, material and cultural environment may be the cause of his neurosis. This theory is used to demonstrate that psychodynamic hypotheses about the role of intra-personal conflicts can be empirically tested with the help of "tests of conflict" (Lauterbach, 1987).     

Combined group and individual treatment for the borderline patient

This article discusses the attenuating mechanisms of group psychotherapy that support and enhance analytic work with borderline patients in combined group and individual psychotherapy. A group case study is presented which addresses the manifestations and management of transference and countertransference in a combined treatment approach. Combined treatment was observed to respond effectively to both the intrapsychic and interpersonal difficulties of borderline patients. A multidimensional model for treating these patients in a community mental health setting is proposed.     

Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy

Premature termination from group psychotherapy continues to be a serious problem in the treatment of patients with borderline personality disorder (BPD). Qualitative research is regarded as an important means to shed light upon the complex dynamics leading to dropout. We conducted an interview study with patients having a diagnosis of BPD (n = 8) who dropped out from long-term group psychotherapy as a continuation therapy following intensive day treatment. The group therapists for these patients were interviewed as well (n = 12). The findings suggest the operation of many processes that contribute to dropout. Most significant appeared to be experiences of separation and loss of the day hospital that were not worked through and a failure of the group to regulate and contain the patients' affects. To integrate patients at risk of premature termination it seems necessary to pay attention to the strong negative emotions that they experience in the group. A higher treatment intensity than weekly group sessions may help to promote more beneficial group processes.     

Concurrent group and individual psychotherapy in a psychiatric day hospital for depressed elderly

Concurrent psychotherapy is used in various settings for patients of different diagnoses and ages. The concurrent group and individual psychotherapy of older adults with depressive disorders in a psychiatric day hospital is described, emphasizing phases of treatment and transference and countertransference themes uniquely relevant to working with depressed elderly patients in a day hospital. Case examples are offered to illustrate these issues. The special technical considerations that need to be utilized when multiple therapists and settings are present are described. The model employs the use of an integrative, interactive group therapy, along with various other group treatments and antidepressant medication, with individual therapy serving a subordinate but organizing role.     

BEHAVIOR THERAPY AND THE CONDITIONING MODEL OF NEUROSIS

The methods of applied science are usually based on the findings of pure science, and the discovery of successful methods of therapy for the neuroses is dependent on the formulation of appropriate theories for these disorders. It is argued that the only viable theory about neurosis at the moment is an adaptation of the Watsonian conditioning model, suitably altered to fit in with more recent discoveries in the fields of the formation and extinction of conditioned responses. Such a model has important relevance to behaviour therapy and the various methods for treating neuroses falling under that heading, and indeed for an explanation of the apparent effectiveness of psychotherapy, psychoanalysis, and whatever events mediate spontaneous remission.     

Developing the matrix representation grid (MRG): A method for observing group processes. Findings from time-limited group psychotherapy for alcohol-dependent patients

The MRG was published 1988 in order to support developments in group psychotherapy methods as one of the all too few process observation research methods for studying group-as-a-whole. After 9 years of what pilot studies have labeled successful clinical trials, this study aims at validating the MRG against the established SAVI: Structural Analysis of Verbal Interaction (Agazarian & Simon 1989). Videotaped group sessions from short-term groups for alcohol dependent patients conducted along two therapy methods, one behaviorally oriented and the other group analytic, are used as material. The MRG is validated in the study, confirmed to be clinically valuable, and some interesting comparisons between the two treatment modalities are also made.     

History of psychotherapy in Russia and the Soviet Union]

Previously, articles on and contributions to the history of psychotherapy proceeded on the assumption that the most essential sources were to be found in Anglo-Saxon and German literature. Developments in other civilizations were usually treated as undeserving of consideration. It is important to note that a large amount of specialized literature on psychotherapy has been published in the Soviet Union, and this shows that a great importance is attached in that country to the treatment of nervous and mental disorders by psychological methods. A review of the writings of S. S. Korsakov and V. M. Bekhterev shows that the essential principles of group psychotherapy had been recognized by those authors already in the late nineteenth and early twentieth centuries, respectively. Results achieved by Makarenko appear valuable in the light of what we know today. The method of "collective psychotherapy", which was first described by Libch, is discussed in detail. This method is being widely used in the Soviet Union. The concern of this paper is to describe developments which have not so far been covered in our literature, thus attempting to make an addition to psychotherapeutic activity in this country.