Group psychology in the totalitarian system: A psychoanalytic view

The author discusses the ideas of three important psychoanalytic thinkers about group processes in large social groups: Sigmund Freud, Wilfred Bion, and Erich Fromm. Their ideas are developed and applied to analysis of group processes in totalitarian systems, as they were known to the author in Czechoslovakia and the Soviet Union. In conclusion, treatment considerations as they apply to patients who grew up in these regimes are developed and illustrated by clinical cases.This paper is dedicated to Dr. Alexander Wolf, who made his groups growth-promoting, free and holding environments.The author wants to thank Valerie Angel, M.S.W., Eva Papiasvili, Ph.D., Susan Kavaler, Ph.D., Maria Luisa Bastos, Ph.D., and Nancy Smith for their support, critical commentary, and helpful suggestions.     

Modified group psychotherapy with chronic renal dialysis patients

Renal dialysis is a life saving, chronic medical procedure for those patients whose kidneys no longer function. However, the psychological reactions to this procedure, which necessitates a state of passivity for several hours, often overshadow the medical implications, and, in some instances, are decisive in terms of the patient's adjustment to treatment. Frequently, patients are unable to utilize individual psychotherapy to its maximum because of their need to perceive their illness as only medical. Group therapy however provides a less threatening psychological milieu and tends to give rise to peer support and mutual interaction.Barbara Halin Willinger, M.S.W., A.C.S.W., was the social work supervisor of the Renal Dialysis Unit at Metropolitan Hospital at the writing of this paper. She is a private psychotherapist and is affiliated with a mental health clinic where she also practices individual and group psychotherapy.The author wishes to thank Martin Saltzman, M.D. and Haley Glazer, M.S.W. for their suggestions.     

Self psychology and group therapy

This paper illustrates how the theories of Heinz Kohut elucidate the curative aspects of group treatment. Group therapy is an ideal milieu in which mirroring, idealizing and alterego transferences can be experienced and worked through. Transmuting internalizations, or psychic structure building, occur when optimal frustration of these needs can be provided by available selfobjects. In group therapy a patient can use the group-as-a-whole, the individual members as well as the leader as potential selfobjects. With the help of individual sessions to reflect on group encounters, a patient can gain a more fully integrated therapeutic experience.The author wishes to acknowledge Susan Sands, Ph.D., Jane Jordan, M.S.W., and Ruth White, Ph.D., for their help.     

Parental responses to competence and trauma in infants with reproductive casualty

This study of 31 infants in neonatal intensive care and their parents examined the relationship involving infant characteristics (medical and behavioral), parent characteristics (personality and situational variables), and the development of parental attachment. As expected, infants who were more visually competent had mothers who were more attentive. Contrary to expectation, greater prematurity was related to greater parental involvement. There were important differences in maternal and paternal responses, with mothers using more denial to cope with the medical crisis. Parents who relied heavily on denial were found to have impaired attachment.This study is based on a M. A. thesis submitted to Michigan State University by the first author under the direction of the second author. The authors are grateful for the support and assistance of Thomas Helmrath, M. D., Elizabeth Seagull, Ph.D., Dess Johnson, M.S. W., and the staff of the Regional Neonatal Intensive Care Unit at E. W. Sparrow Hospital.     

From the private I to the public ear: Effective learning groups for college-age students

This paper addresses the problem of organizing and conducting groups at a college counseling center. It focuses on the importance of a therapist learning from his/her errors, of appropriately matching a client with a particular group and of preparing clients and group leaders for work with a group. The concept of boundary management is used as a way to understand group events and to make sense of group leader errors. Throughout the paper, attention is given to how best to develop groups within the unique framework of a college community.This paper was presented at Brandeis University's Conference on Psychological Work with College Students, November 6, 1982. It was written in the memory of Eugenia Hanfmann, Ph.D., who as Director of the Brandeis University Counseling Center encouraged the author to appreciate the value of learning from his errors! In writing this paper the author is grateful for the support and for the suggestions offered by his colleagues, Bruce Weiss, Ph.D., and E. Martin Schotz, M.D.     

Forgiveness,Cognitive Restructuring and Object Transformation

Forgiveness is described as a process that includes (1) re-constructing cognitions about the offender and self and (2) re-imaging the offender and re-experiencing self and violator. Object relations theory can help to show that the violated individual’s conflict is within as the person struggles inwardly with hostile images (object-representations) during the process of forgiveness. Cognitive restructuring points to the crucial importance of choice to help initiate the forgiveness process. Within the context of forgiveness as a therapeutic process, cognitive restructuring and object transformation can promote the client’s psychological health and well-being. It is proposed that forgiveness is a spiritual as well as a psychological process, which includes grace-filled choices and behavior. Patrick F. Cioni's academic background includes a Master’s of Arts in Psychology with a major in Personality from New School University, New York, N.Y. Previously, he obtained a Master of Science in Counseling from the University of Scranton, Scranton, PA. He began private practice of counseling and psychotherapy in September 1983 following work in the psychology department of a maximum security mental hospital as psychotherapist and treatment team coordinator. Present practice includes individual and marital therapy. He developed a treatment program for use with married couples in conjunction with the Prepare/Enrich inventory. The author wishes to thank Cheryl L. Sancafon, M.D., who encouraged his interest in object relations, Jared P. Pingleton, Psy.D., John C. Norcross, Ph.D., other reviewers and, most essentially, the Spirit of God. Correspondence to Patrick F. Cioni, Private Practice of Counseling and Psychotherapy, 138 South Cameron Avenue, Scranton, PA, 18504, USA; e-mail: patrickcioni@netzero.net     

The ecological validity of laboratory and analogue assessment methods of ADHD symptoms

An important question in the attempt to generalize laboratory findings on attention deficit-hyperactivity disorder (ADHD) children to clinical issues concerning their assessment, diagnosis, outcome, and treatment response is the ecological validity of the commonly used tasks and analogue behavioral observation procedures. This paper examines the concept of ecological validity and issues inherent in its evaluation. The evidence from a variety of sources is then reviewed on the relationship between laboratory methods of assessing inattention, impulsivity, and overactivity and measures of these same constructs in natural settings. Additional findings pertaining to this issue from a recent study of 140 ADHD and normal children and 159 ADHD and normal adolescents using a multimethod battery of tests are also reported. In general, the ecological validity of most methods is of a low to moderate degree, with some traditional laboratory tasks proving unsatisfactory. A few tasks demonstrated acceptable degrees of ecological validity but even these require improvement. It is concluded that future advances in ecological validity are likely to come from: (a) a greater reliance on assessments of the target behaviors in natural settings and (b) combining several of the more promising tasks and analogue methods into a battery that is taken over longer time intervals than has been customary and averaged across repeated administrations.An earlier version of this paper was presented at the International Symposium on Attention Deficit Hyperactivity Disorder, Amsterdam, The Netherlands, April 6 and 7, 1989. The author wishes to thank Charles E. Cunningham, Ph.D., Susan Campbell, Ph.D., Mark Rapport, Ph.D., Eric Mash, Ph.D., and Herbert Quay, Ph.D., for their comments on an earlier version of this paper, and to Marcel Kinsbourne, M.D., for his comments on the presentation itself. The author was supported by funds from NIMH grants 41464, 41583, and 42181 during the preparation of this review.     

Short term family therapy following parental loss: A case report

Summary The main therapeutic task was to help the family gradually finish the natural mourning process that was initially impeded by their denial. Negative memories of father, as well as the favorable ones, were brought to light, the expected punishment for the verbalization of these feelings was not fulfilled, and the family had a second chance to work through the mourning process in an atmosphere of acceptance, understanding, and support.The author wishes to express appreciation to Daniel Offer, M.D., and Andrea H. Lazarus, M.S., for their assistance.     

Issues in the supervision of group psychotherapy: Countertransference and the group supervisor's agenda

Countertransference issues are of particular importance to the beginning group therapist. This paper describes the role of supervision in helping the beginning group therapist deal with counter-transference issues as they effect the formation of a group and the role that the group leader plays in facilitating therapeutic activity within the group. Particular problem areas and the countertransference they evoke and the role of supervision in working through are described.The author wishes to acknowledge the suggestions and support of Aaron Stein, M.D., and other members of the Division of Group Psychotherapy of the Department of Psychiatry of the Mt. Sinai School of Medicine.     

Group intervention for medical patients—A treatment for damaged self-esteem

There is a need to integrate our knowledge of psychoanalytic theory, group therapy and medical care delivery systems. Understanding the importance of selfesteem, based upon the study of psychoanalytic theory, can help to determine appropriate technique in medical groups as well as to add to our understanding of the profound importance of such groups in the delivery of medical care. Groups in hospitals help patients to get in touch with their strengths, feel less isolated, and be more active—all of which enhance selfesteem. As patients participate in groups, narcissistic defenses can be enhanced and the quality of life improved. When interdisciplinary teams participate in patient groups, delivery of medical care can be more comprehensive: The totality of the patient emerges more clearly and staff becomes more aware and sensitive to his/her emotional and physical needs.This paper was presented at Thirty-Sixth Annual Conference, American Group Psychotherapy Association, 1978. The author would like to acknowledge Hazel M. Halloran and Susanne A. Kohut, Director and Associate Director, Department of Social Work, who conceived of and supported the expansion of the group work program in the General Hospital Division of St. Vincent's Hospital and Medical Center of New York. The following professionals contributed clinical material used in this paper: Sara Bookbinder, M.S.W., Carol Coven, M.S.W., Linda Haselman, R.N., Barbara Horn, M.S.W., Kathleen McQuade, R.N., Ellen McGuire, M.S.W., Sister Marita Rose O'Brien, R.N., and Emile Powe, M.D.     

Treatment of alcoholic couples in outpatient group therapy

This paper summarizes special issues that group leaders are likely to encounter when adapting their skills to outpatient group therapy with alcoholic couples. More specifically, the paper: (a) discusses the advantages of treating alcoholic couples in a group as opposed to individual couple's therapy; (b) outlines the parameters of a couples group with alcoholic members that differentiate it from working with other kinds of couples in group; and (c) provides guidelines and techniques for tackling some of the specific kinds of problems and situations that arise.This paper was presented at the Annual Meeting of the American Group Psychotherapy Association, New York City, February, 1985.The author wishes to acknowledge the contribution of Geraldine Alpert, Ph.D., whose thoughtful comments and discussion helped to crystallize the concepts presented.     

Sex role orientation and marital satisfaction in dual- and one-provider couples

Scores on the Baucom scales of Masculinity (MSC) and Femininity (FMN), and on three scales from the Snyder Marital Satisfaction Inventory, were obtained from samples of dual- and one-provider couples. Data on rewards and difficulties of the dual- and one-provider lifestyles were collected by means of open-ended questions. The two groups of couples did not differ in sex role orientation or marital satisfaction. The men's levels of MSC were positively related to their marital satisfaction in both groups, and the women's levels of FMN were especially important to couples' satisfaction in the dual-provider group. In both groups, cross-sex scores (women's MSC and men's FMN) were positively related to couples' satisfaction with marital companionship.Bernadette Gray-Little, Ph.D., W. Grant Dahlstrom, Ph.D., and Elizabeth Rossman, Ph.D. are gratefully acknowledged for the guidance and support they provided to the author during this research.     

Relationship: The bridge to the delinquent child

Summary We have attempted to isolate a crucial component in work with juvenile delinquents and their families. This component, defined as relationship, is felt to be the link between the disorganized, infantile, self-destructive world of the delinquent child, and the organized, productive world of society.We feel that those engaged in either individual or mass efforts to help delinquent children and their families are not operating in opposition to each other. We feel instead that these efforts can complement each other when they are organized, systematized, and utilized along a continuum that has meaning for each individual child and his family. We have expressed the idea that this crucial relationship or bridge can be established, nourished, and built skillfully under controlled conditions by many kinds of trained people.The concept of relationship which is developed in this article is very heavily based on the extensive work done in this area by the following persons: Irving Kaufman, M.D., Harry Durkin Jr., M.D., Thomas Frank, M.D., Lora W. Heims, Ph.D., Dorothea Jones, M.S.S., Joan Zilbach, M.D., and Joy Rabinowitz, M.S.S.The author gratefully acknowledges his long association with this group and the opportunities to crystallize and utilize the concept of relationship building in his work with the Massachusetts Society for the Prevention of Cruelty to Children, the Judge Baker Guidance Center, the Roxbury Chronic Problem Family Project, the Massachusetts Division of Legal Medicine, and the Massachusetts Youth Service Board.     

Sex differences in ADHD: Conference summary

Clinical samples of attention deficit hyperactivity disorder (ADHD) have been dominated by males. Consequently, female manifestations and sex differences have been relatively neglected in the extensive ADHD research. Because ADHD is so common (3% to 5% of school children) and chronic (lifelong in many cases), even a small proportion of females multiplied by such a large base means hundreds of thousands of girls and women with ADHD, a significant public health problem. An NIMH conference concluded that research is needed not only on sex differences related to ADHD, but also on manifestations of ADHD in females as such. Areas of focus should include differences in life course (sex-differential age effects); effects of hormones; effects of ADHD parenting (in utero and postnatal) on the next generation; response to and implications for design of psychosocial treatment; effects of differential comorbidity; normative background sex differences that influence the manifestation of ADHD; differences in development of verbal fluency and social behavior; possible interactions of sex and ethnicity; a prospective study of both sex offspring of ADHD adults; and such methodological issues as appropriate instruments and diagnostic thresholds, power to prevent false negatives, valid impairment measures, validity and reliability of child self-reports, and more inclusive samples (all three subtypes: inattentive, hyperactive-impulsive, and combined).The following participants in the November 16–17, 1994, NIMH Conference on Sex Differences in ADHD may be considered ghost co-authors of the contents in this summary. Special thanks are due to Euthymia Hibbs, Ph.D., co-organizer of the conference; Peter Jensen, M.D., who suggested the successful format; Delores Parron, Ph.D., who gave much helpful advice on the conference arrangements; Emily Areia, Ph.D., who thoroughly critiqued the summary; Joan Cole, who helped abstract the recorded proceedings; and Jose Bauermeister, Ph. D., F. Xavier Castellanos, M.D., Stephen Hinshaw, Ph.D., and Mark Stein, Ph.D., who helped with referencing. Other participants, in alphabetical order, included Russell Barkley, Ph.D.; Joseph Biederman, M.D.; Caryn Carlson, Ph.D.; C. Keith Conners, Ph.D.; Monique Ernst, M.D.; Miranda Gaub; Jay N. Giedd, M.D.; Michael Gordon, Ph.D.; Jeffrey Halperin, Ph. D.; Betsy Hoza, Ph.D.; Hans Huessy, M.D.; Jean King, Ph.D.; Kathleen Kiely; Rachel Klein, Ph.D.; Benjamin Lahey, Ph.D.; Jan Loney, Ph.D.; Elizabeth Lorch, Ph.D.; Spero Manson, Ph.D.; Keith McBurnett, Ph.D.; Richard Milich, Ph.D.; Douglas Novins, M.D.; Daisy Pascualvaca, Ph.D.; Linda Pfiffner, Ph.D.; Jane Steinberg, Ph.D.; James Swanson, Ph.D.; Marcus Thomeer, Ph.D.; Lillie Williams, M.D.; Alan Zametkin, M.D.The opinions expressed herein are the views of the author and conference participants and do not necessarily reflect the official position of the National Institute of Mental Health or any other part of the U.S. Department of Health and Human Services.     

The making of a group psychotherapist: Needs and goals for graduate and postgraduate training

Group therapy is a widely practiced, effective, but underrated specialty. Unfortunately, group therapy seems to be taught more haphazardly, with less attention to quality, than is individual therapy. Group therapy has a technique, history, and literature of its own and should be taught independently from individual psychotherapy. The training of psychiatric residents is particularly crucial for group therapy to prosper and be seen as more prestigious. A common core of experience is vital for training in group therapy, whether the trainee's background is psychiatry, psychology, social work, pastoral counseling, or nursing. This core consists of: 1) clinical experience doing group therapy; 2) supervision; 3) a professional training group experience; 4) observation of experienced group therapists; 5) exposure to current thinking in the field; 6) personal group therapy; and 7) a didactic course in theory and technique. Clinical experiences involving cotherapy and combined individual and group treatments are especially useful, both as training and as treatment modalities.He is on sabbatical leave from John Jay College of Criminal Justice where he is Professor of Psychology and was founding Chairman of the Psychology Department.The authors wish to thank Arnold Rachman, Ph.D., Michael Lapidus, M.D., Fayek Nakhla, M.D., Nyapati R. Rao, M.D., and Dorothy Gartner, Ph.D., for their helpful comments on earlier versions of this paper, and Ms. Deloris J. Johnson for her typing and editorial assistance.     

Clinical approaches to the near-death experiencer

The literature on near-death experiences (NDEs) and their aftereffects has focused on the positive personality transformations and spiritual development that often follow an NDE, while it has neglected the emotional and interpersonal problems sometimes precipitated by the experience. We report general guidelines and specific interventions, developed at an interdisciplinary conference, to assist NDErs in coping with psychological difficulties following their experiences.This report was based on a conference on Clinical Approaches to the Near-Death Experience, sponsored by the International Association for Near-Death Studies, February 5–9, 1984, in Pembroke Pines, FL, and funded in part by a grant from the Institute of Noetic Sciences. The authors gratefully acknowledge the contributions of the other participants in that conference: Patricia Bahr, Boyce Batey, Sharon Batey, Nancy Bush, Kimberly Clark, M.S.W., Diane Corcoran, R.N., Ph.D., Elaine Durham, Linda Fleishman, Charles Flynn, Ph.D., Margaret Huddleston, Joan Kaye, Esther Knecht, Carolyn Lewis-Stone, M.S.W., Jean Marr, Ph.D., John McDonagh, Ph.D., Anne-Marie Meagher, M.D., John Migliaccio, M.Ed., Judith Miller, Ph.D., Raymond Moody, Jr., M.D., Ph.D., Leslee Morabito, Annalee Oaks, R.N., M.A., Ruth Orner, Ph.D., Carol Parrish-Harra, Madelaine Podurgiel, R.N., Ph.D., Laurie Schwartz, Joyce Strom-Paikin, R.N., M.S., Robert Sullivan, Nina Thornburg, M.S.N., Israel Topel, M.D., and Kate Wyatt, Ph.D.     

The shattered mirror: Treatment of a group of narcissistic patients

Increasingly, group psychotherapy takes its place as a valid treatment model for patients with severe character pathology. This paper explores the impact of group treatment on a homogeneous group of patients with narcissistic character problems. The clinical example serves to illustrate the particular dynamics of this patient population; addresses the challenges inherent in treating these patients in a homogeneous, long-term therapy group; and, finally, underscores the countertransference pitfalls in such a clinical situation. Nonetheless, the successful working through of some of these patients' terrifying pathology supports the important of continuing experience and research into this arena.The author wishes to acknowledge with gratitude the invaluable assistance of J. Scott Rutan, Ph.D., in the planning and preparation of this clinical report.     

Self-efficacy and depressive affect in college students

In an attempt to extend Bandura's theory of self-efficacy, we investigated the hypothesis that increases in self-efficacy, based on mastery experiences, would lead to improvements in mood and problem solving among dysphoric subjects.College students (N=79), classified as dysphoric or nondysphoric by the Beck Depression Inventory, were randomly assigned to anagram training groups that received bogus bar graphs suggesting either task ease or difficulty. Before and after training, subjects rated themselves on depressive affect (DACL) and self-efficacy. A difficult anagram task and a final DACL rating completed the procedure.Anagram training conditions did not lead to differential self-efficacy. However, multiple regression analyses showed that self-efficacy was related to depressive symptoms. Greater DACL decreases after training were seen in dysphoric subjects who reported higher posttraining self-efficacy. This improved mood is consistent with Bandura's theory. An unexpected finding among dysphoric subjects was that the higher their self-efficacy was, the lower was their final anagram performance. It appears that dysphoric/high self-efficacy subjects may have become more demoralized than dysphoric/low self-efficacy subjects when they encountered a need for much greater effort expenditure on the difficult anagram task.The findings suggest that skills training interventions which raise self-efficacy may be most effective in reducing depressive symptoms. The relevance of effort expenditure to the development of competine in depressed undiriduals appears to merit further investigation.where he served previously as Director of Clinical Psychology and as Chairperson of the Department of Psychology.Jeffrey Schwartz, Ph.D., a clinical psychologist, has been a staff member at the Cliffwood Mental Health Center in Englewood, New Jersey for the past five years. He is also engaged in private practice in New York City.Jefferson M. Fish, Ph.D., is Professor of Psychology at St. John's University in New York City, where he served previously as Director of Clinical Psychology and as Chairperson of the Department of Psychology.This paper is based on the first author's Ph.D. dissertation in Clinical Psychology at St. John's University under the direction of the second author. Both authors wish to thank Jeffrey Nevid and John Hogan for their support and contributions as committee members, and Marc Garcia for his invaluable assistance with data analysis. Requests for reprints should be addressed to the second author, Department of Psychology, St. John's University, Jamaica, New York 11439. All other correspondence should be directed to the first author at the same address.