Outpatient Group Therapy with Convicted Pedophiles

Abstract

There is ample theory and research about group therapy, dream work, and bereavement as separate subjects. However, there is little written specifically about utilizing dream work in bereavement therapy groups. Using the Foulksian group analytic model, dreams in one particular bereavement group (for parents of children killed in a terrorist action) were interpreted in such a way as to help members access deep unconscious feelings. This helped facilitate a fuller and more complete mourning process. The analytic, dream interpretive activity also helped overcome resistance in the group-as-a-whole and thereby facilitated movement through group development phases.     

Laying mother to rest: Working with grief-related nightmares through exposure therapy and imagery

Cognitive behavioural therapy of unresolved grief is usually presented as a fairly rapid approach for reducing psychological problems. The present case study shows how behavioural cognitive and symbolic approaches can be integrated to foster griefwork at several levels. The counselling adopted a behavioural exposure technique specifically for eliminating a significant anxiety-provoking obstacle to mourning, namely the experience of recurrent death-related nightmares that surfaced every time the bereavement was recalled in depth. The client was also encouraged to explore the symbolic meaning of the dream images and in drawings modified these images in ways that helped to alleviate her feelings of long-standing guilt. Drawing as well as verbal representation could also be regarded as an effective form of exposure therapy, helping the client to stay with the anxiety-provoking death-related images. The client once relatively free of nightmares could mourn the loss of the mother more deeply in subsequent less directive counselling sessions.     

The critical dream incident in pastoral psychotherapy

Pastoral psychotherapy needs to re-cover one of the most authentic tools of its trade ... the healing dream encounter. A brief outline of operational prejudices and theory prepares discussion of the use of such dream work within a marital system. It is stressed that the dream came aspart of a careful and multi-focused therapy which used the best of psychotherapeutic methodologies. The dream incident reported came as part of the climactic end-stage environment of this counseling experience. A few concluding comments are made about the ongoing schools of thought on dream function and their relationship to pastoral psychotherapy.Dr. Gibson is Counseling/Education Minister at the Christian Counseling Service, 424 South K Street, Tacoma, Washington, 98405. His clinical interest focuses on the dream and similar modes of altered states of consciousness as a direct form of religious experiencing and healing.     

Practitioners' accounts of religious and spiritual dimensions in bereavement therapy

This study explores religious and spiritual dimensions in bereavement therapy through in-depth qualitative interviews with 12 therapists for whom bereavement work constituted a major part of their therapeutic role. Information was gathered on the conceptualization of religious and spiritual issues, the perceived influence of therapists' beliefs on their practice and the therapeutic processes that occur in work with religious and spiritual issues. Interpretative Phenomenological Analysis was used to analyse the data, examining associations between these areas as well as highlighting the diversity of experiences and viewpoints. The multi-dimensional role of the therapeutic relationship was highlighted by participants as well as the perceived limitations of many theoretical models of therapy and bereavement in working with religious or spiritual issues. Some therapeutic processes were described in terms of the exploration of belief systems that have been challenged by bereavement and the re-creation of personal meaning. Implications for therapeutic practice and further research are discussed.     

Dream frequency in psychoanalysis and psychoanalytic psychotherapy

The authors examine data on dream frequency from 50 patients, half of whom were seen in psychoanalysis and half in psychoanalytic psychotherapy. Frequency, defined as the proportion of sessions where at least one dream is related, is analyzed statistically as a function of sex, age, and type of treatment. Also, treatment outcome is examined as a function of sex, type of treatment, diagnosis, and dream frequency. Psychoanalytic patients are found to have higher dream frequency than the patients in the psychotherapy group. Higher average dream frequency is correlated with a better treatment outcome in both patient groups.     

Support groups: A psychological or social device for suicide bereavement?

This paper examines the psychological studies of bereavement support groups as well as exploring the ways in which people talk about their participation in such groups after their family member's suicide. Rather than reflecting any universal human condition, talk about experiences is considered as a local and contextual social construction, which in this case takes place in qualitative interviews in the modernWest (Finland). The paper draws on a study of 16 interviews with bereaved parents and (adult) children, half of whom had attended a bereavement support group after their family member's suicide. The study makes a contribution to the research field of family suicide bereavement from which sociological analysis has been so far largely missing.     

Reply to Commentaries

Each discussant approached my paper on embedded levels of illusion from a different perspective, representing schools as diverse as those derived from Jung and Bion. It is interesting that, although my paper was not primarily about dreams or how to interpret them, but rather about the way in which multiple levels of illusion may open a potential space in treatment, each discussant centered his comments around a dream that I had reported in one of my cases. In this reply, I compare the discussants' approaches to the dream with mine. I also wonder whether the dream itself represents an embedded level of illusion within my paper. If so, it may function as a transitional space in which we may entertain different viewpoints around not only the nature of dream work, but also around questions including the nature of the mind and the therapeutic process.     

The Ego in Love and Sexuality by Edrita Fried

This paper presents a rationale and step-by-step procedure for the interpretation of dreams in a specifically dream-oriented group. Traditionally, dreams have been used across a broad spectrum of approaches to individual psychotherapy. As group methods have evolved, the group context has emerged as a particularly favorable medium for the analysts of dreams. Adherence to the Jungian approach to dream interpretation, together with theoretical insights from dream and imagery research, group research, and behavior modification form the basis of this four-step dream group model. This systematized procedure has utility for the training of professionals in basic psychodynamic dream work, for psychotherapeutic practice, and for research into the efficacy of the model.     

Therapists' views of the relative benefits and pitfalls of group work and one-to-one counselling for bereavement

Aim: To explore therapists' perceptions of the relative benefits and pitfalls of group work and individual counselling for bereaved clients. Method: Semi-structured interviews with nine experienced bereavement therapists from a range of different contexts generated data which was analysed using grounded theory methodology. Findings: Groups were perceived as having a normalising influence, helping members make new social contacts and practice social skills. Individual counselling was seen as facilitating the initial telling of the story and the expression of extreme emotion. Discussion: The findings suggest that individual counselling may be useful as a primary intervention easing ‘emotional loneliness’ caused by the death of a spouse or attachment figure. Group work may be of more benefit later in the bereavement process, facilitating an engagement with the outside world and alleviating ‘social loneliness’. Implications for practice: This suggests that bereavement services might usefully combine group and individual provision. Initial assessment could help clients clarify their needs and facilitate their choice of service. This would be more cost effective and potentially ease clients' bereavement experience.     

Spiritual Evolution of Bereavement Counselors: An Exploratory Qualitative Study

This article draws from a phenomenological study on the experience of being a bereavement counselor. Ten bereavement counselors shared their experiences in bereavement counseling. Spiritual and emotional aspects of bereavement counseling with grieving and dying persons are discussed as well as the spiritual effects on and growth processes of the bereavement counselors. Participants also describe their self‐care strategies pertaining to their bereavement counseling work.     

Zwischen Tod und Urszene

Are there psychoanalytic ideas about what it means to be fully and creatively alive? Thoughts about this are prompted by Winnicott’s account of living by compliance or by creative apperception. A necessary aspect of independent, creative aliveness is a capacity to be interested in what disturbs our usual thought processes. Clinical examples show the truth of this for therapists in the clinical situation and it applies to life in general as well. Being fully alive involves a particular use of memory so as to move actively up and down one’s life experiences between past and present and also the ability to extend this imaginatively into the future, including particularly the experience of one’s own death which is ultimately and inescapably ‘uncanny’. Such freedom of internal movement makes it possible to see the present as a point of encounter between the past and the future. The past is bounded by the primal scene and the future by death, which represent the beginning and end of time. The present is thus also an encounter between time and timelessness. To tell a dream in an analytical session is to bring the timelessness of the unconscious into a time-bound framework. A clinical example shows how a sense of this crossover between time and timelessness helped a patient use his dream experience to develop a greater sense of aliveness. Vermeer’s painting of ‘The Kitchen Maid’ pouring milk is analysed as a visual representation of the intersection of time and timelessness. A case in a clinical seminar is described, which produced a disorienting sense of timelessness in the seminar group. The seminar leader then needed to help the discussion stay poised at a crossing-point between timelessness and time. A discussion of the myth of Orpheus considers Orpheus’ compulsion to look back at Eurydice as a failure of aliveness because he could not dream Eurydice at the intersection between the timelessness of the underworld and the linear temporality of everyday existence.     

DSM‐5 and Bereavement: The Loss of Normal Grief?

The mood disorder work group has proposed to eliminate the bereavement exclusion criterion from the diagnosis of major depression in the 5th edition of the American Psychiatric Association's (2012) Diagnostic and Statistical Manual of Mental Disorders. The proposal would break tradition with the long‐held distinction between depression and normal bereavement. This article reviews the development of the bereavement exclusion, discusses evidence for and against the proposal, and offers some relevant implications for counselors in light of the research on depression and bereavement.     

复杂哀伤丧亲女孩的箱庭疗法个案研究

通过19次个体箱庭和2次家庭箱庭治疗,对一名12岁复杂哀伤的丧亲女孩W进行了个案研究。发现:(1)箱庭治疗能提高丧亲青少年的个体和家庭功能,促进青少年个体和家庭哀伤任务的完成;(2)W的个体箱庭经历了在混乱重复中寻找秩序、重建自我、转化与整合、自我治愈力展现四个阶段;(3)W的哀伤经验经历了在治疗者促进下分享—象征性表达—主动地象征性表达—直接而主动地表达哀伤经验最终获得哀伤任务完成的变化过程。     

Dreaming and bereavement

Bereavement dreams provide an important, though seldom mentioned or recognized, component of the grief process. As the unconscious presses for recognition of the pain and extent of the loss, dream material is presented to help the bereft move to a new and integrative life position. Religious symbols present themselves to give the grieving a new sense of themselves as individuals and an expanding view of the world. Grief therapists have generally ignored this important component of the grief process, and as a result, little significant clinical research has been done. A comprehensive picture of bereavement will not be developed until increased attention is given to this important area.     

Reflections on Preparing the Group Leader for an Analytic Perspective

Preparation of group therapists for an analytic perspective involves awareness of unconscious processes at the group and individual levels. The adequately prepared group leader should have familiarity with dream interpretation and group-as-a-whole transferences. Training in the use of long-term treatment methods is useful whether or not the practitioner uses these methods in actual practice. The ideal training program would include didactic seminars, weekly supervision, the experience of conducting a long-term (at least two years) therapy group, as well as personal analytic group therapy. Previous individual analytic therapy is also encouraged.     

Dreamtelling as a request for containment: three uses of dreams in group therapy

This article is an attempt to develop a coherent, unified, and consistent conceptualization of dreaming and dreamtelling in the clinical setting. Dreams told in a therapeutic setting are challenging events: fantastically rich in content, but often overwhelming in their implications for peoples' relationships. When told in therapy groups, dreams provide additional challenges for all participants. Learning to work with dreams not only enhances understanding of unconscious intrapsychic and group processes, but may also have a strong impact on the therapeutic culture and working relationships in the group. After differentiating dreaming from dreamtelling, I briefly describe three uses of dreams in groups-the classical "informative" and more familiar "formative" uses, and a new perspective that focuses on the "transformative" aspects of a dream told. According to this perspective, a dream told has an interesting past, an important present, and a worthwhile future because of its interpersonal, intersubjective influence on the dreamer-audience relationship.     

以身化梦：意象体现的理论、方法与技术探析

“意象体现”是由罗伯特·伯尼克依据分析心理学的理论创立的一种“梦的工作”方法,主张在介于意识与无意识之间的阈限状态中采用积极想象的方式对梦中意象进行再体验,通过对不同身体感受的觉知使无意识内容意识化来达到相应的治疗效果。意象体现理论主张,梦具有真实性,应当以主客体一致性的隐喻视角来看待梦,并且对梦的工作具有治疗的意义;对梦的工作应当遵循非解析工作与体验科学、阈限状态、共验交流、心理自居与发生转换四个关键原则。其具体技术过程包括工作状态的准备、进入阈限状态、对梦进行持续性体验、心理自居与发生转换、感觉融合与离开梦境五步。其方法沿革于催眠术、自由联想与积极想象。作为分析心理学中有关梦的一套前沿的思想理论以及临床心理治疗中一种创新性的梦的工作方式,意象体现具有广阔的学术研究及实际应用前景。     

Using dream interpretation to resolve group developmental impasses

This paper focuses on the use of dream interpretation in psychoanalytic group psychotherapy. One of the goals of the paper is to demonstrate that the kinds of dreams, manifestly about the group, offered at various points in the life history of the group, are influenced by, and, in turn, influence developmental phases in group. Dream interpretation also helps the therapist to identify emerging developmental themes in the group-as-a-whole as well as illuminate developmental impasses and resistances of the group. The second goal of this paper is to demonstrate how interpretations of these dreams can help lessen resistance and help the group to resolve the impasse. The paper first reviews some basic principles and approaches to dream interpretation in a group setting and then elucidates typical phases in group development. Two extended case examples are presented to illustrate how dream interpretation may be utilized to help the group move beyond the impasse.     

Cognitive Behavior Couple Therapy-REBT Model for Traumatic Bereavement

Following the loss of a child, couple counseling focuses on their grief process as well as the impact of the loss on the marital relationship. Individual differences in reacting to and coping with the loss, different patterns of grieving, and differences in attitudes about relationship issues may cause further distress and increase marital conflicts and adaptation to the loss. When bereavement occurs under traumatic circumstances, the conflicts may be further complicated and involve problems in daily functioning related to distorted cognitions and attributions connected with traumatic bereavement. In this paper, cognitive grief therapy using the ABC model of REBT with a couple who lost a child under traumatic circumstances will be described.