Experiential Group Psychotherapy Supervision

Following a review of various traditional models of supervising group therapy, an experiential model of supervising group in a group setting is presented. The model stresses the group aspect of the supervisory process, encourages group interaction, here-and-now responses and associations, and employs concepts from both object relations and group-as-a-whole theory to understand what is taking place. The model's premise is that case material presented in a supervision group stimulates parallel material in supervisees, which is then used to elucidate what has taken place in the therapy group being presented. Excerpts from one supervisory group are used to illustrate major features of the model.     

Group Therapy with Individuals and Families Coping with Illness or Disability in Israel

This paper illustrates a group intervention with individuals and family caregivers coping with illness/disability, and focuses on the relationship between the process of group development and the process of coping with the illness/disability. People experiencing illness/disability cope with a great deal of pressure and stress that stem from the illness's biopsychosocial demands. A group can provide encouragement and support and reduce helplessness, isolation, and despair through cooperation and use of mutual resources. The design of the intervention was based on our clinical experience with numerous groups for ill/disabled individuals or their family. The process is described and analyzed using examples from three documented groups, and is presented in terms of four variables: group process, group atmosphere, group content, and group intervention.     

The Interplay Between Therapy and Supervision

This paper examines the relationship and interplay between therapy and supervision; and how the therapist who has particular similarities to the patient brings her own armentarium of defenses as well as life problems into the therapeutic and supervisory space. The paper explores how unconscious factors from childhood become reenacted in the therapeutic space and produce emotions that affect both patient and therapist. The paper describes in detail an upward as well as downward parallel process acted out by the therapist and patient in the transference–countertransference encounter along with the supervisor's conscious and unconscious role in this process. The paper concludes by offering recommendations to beginning analytic therapists.     

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.     

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.     

A Comparison of Computer-Assisted Psychotherapy and Cognitive-Behavioral Therapy in Groups

This study is the first independent, randomized controlled study in a clinical setting of a computer-assisted therapy program (Therapeutic Learning Program; TLP) developed to permit individualized therapy in a group setting. This software differs from other computer-assisted approaches in that targets for change are chosen by the patient rather than determined by the software. TLP was compared to a standard cognitive-behavioral treatment in 109 patients with 6-month follow-up. Although both treatments were associated with a significant reduction in symptoms of anxiety and depression at posttreatment and follow-up, no differences were found between treatments with respect to patient-rated satisfaction and effectiveness, clinician ratings of improvement, and scores on measures of anxiety and depression. At treatment midpoint patients tended to give more neutral ratings of satisfaction and treatment effectiveness of the TLP treatment, perhaps suspending judgment about this more novel treatment until its completion. It is concluded that at least one form of computer-assisted psychotherapy is as effective and acceptable to patients in a clinical setting as standard short-term cognitive-behavioral therapy conducted by experienced clinicians.     

Psychoanalytic Psychotherapy for Severely Disturbed Borderline Patients: Observations on the Supervision Group of Psychotherapists

The authors describe the role of a supervision group of psychotherapists within a wider therapeutic field for severely disturbed borderline patients. The group concentrates on the transference and countertransference, seen according to Racker’s distinction between concordant and complementary identifications. The implications of the prevalence of the complementary identifications over the concordant identifications of the therapists to their patients and the resulting regression to primitive defense mechanisms can be counterbalanced by the group’s integrative functioning as receiver (1) of a variety of information about the patient, (2) of the therapist’s attempt to understand and synthesize, and (3) of the therapist’s countertransference reactions to his patient. The major discrepancies between the various conceptions of the borderline patients’ psychic world and the appropriate therapeutic technique to be applied are also discussed, as well as the way the group filters the information and integrates the therapeutic thought. It might be said, therefore, that, in the “inpatient” phase of the individual psychotherapy, the group of psychotherapists functions, for the patient and the treatment, in a synthesizing context, as it provides the therapist with a space of integration for his split-off part of self and object representations, which the therapist makes use of for his patient.*Members of the Athens University Project for Borderline Patients’ research team consisting of psychoanalysts and psychotherapists, Eginition Hospital, 74 Vas Sophias Avenue, Athens 11528, Greece.Maria Chatziandreou, M.D., is a member of the Hellenic Psychoanalytical Society.Haris Tsani, M.D., is a candidate of the Hellenic Psychoanalytical Society.Nikos Lamnidis, M.D., is a candidate of the Hellenic Psychoanalytical Society.Claire Synodinou, Ph.D., is a member of the Paris Psychoanalytical Society and an associate professor at Panteion University, Athens.Grigoris Vaslamatzis, M.D., is a training analyst of the Hellenic Society of Psychoanalytic Psychotherapy and an associate professor of psychiatry at Athens University.Address correspondence to: Maria Chatziandreou, M.D., 1-3, Skippi Street, 11525 Athens, Greece.     

Psychological Consequences of Pregnancy Loss and Infant Death in a Sample of Bereaved Parents

This study aimed to explore a broad range of psychological reactions to trauma in a sample of bereaved parents in order to assess whether the traumatic framework is adequate for describing the entire range of emotional reactions to infant death. A sample of bereaved parents (N = 455) who lost their child through perinatal or postnatal loss were compared to a control group of parents (N = 110) who gave birth to a healthy child. Multivariate regression analysis clearly demonstrated that bereaved parents scored significantly higher on the Depression, Anxiety, Dissociation, Sleep Disturbances, Somatization, Interpersonal Sensitivity, and Aggression subscales of the Trauma Symptom Checklist. Consistent with previous studies, the results showed that for up to 5 years postloss bereaved parents expressed elevated levels of trauma-specific and psychological outcomes, in particular interpersonal sensitivity and aggression.     

团体心理治疗中凝聚力的概念及测量研究述评

团体心理治疗中的凝聚力最初多被定义为人际信任、吸引和卷入,随着研究的深入,凝聚力的概念逐渐向多维的方向发展。对凝聚力的测量主要有MacKenzie的团体氛围量表、Lese等的治疗因素-凝聚力分量表及Piper的凝聚力量表等。目前团体心理治疗领域的研究对凝聚力的认识缺乏一致性。从凝聚力的概念建构着手,探索团体心理治疗过程,开发评估工具,构建系统的理论和模型,是值得国内研究者关注的方向。     

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.     

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.     

Intermodal Expressive Arts in Group Supervision

Group supervision is an integral part of developing counseling skills and case conceptualization. Group supervision can also be used as a supervision intervention to facilitate the development of supervisory skills when group members are supervising counselors and the focus of the group is on supervision of supervision. As with any group, group supervision members can often become stagnated when group trust and cohesiveness have not been well developed, thus hindering the group supervision process. The authors describe how an intermodal expressive arts technique was employed to develop trust and cohesiveness in a supervision group that was experiencing ineffective group dynamics.     

Caring for the Care-Giver: The Benefit of a Peer Supervision Group

I presented the following case to my leader-led peer supervisiongroup twice as the case evolved over the course of one year. During my firstmeetings with Mr. and Mrs. M we discussed a prenatal diagnosis of a skeletaldysplasia at thirty-three weeks of pregnancy and the option of a third trimesterpregnancy termination. One year later I presented follow-up on the outcome ofthe affected pregnancy, a new pregnancy, and Mrs. M's suicide. Although bothsegments of the case were completed by the time I presented, my peersupervision group was invaluable. With the encouragement and support of groupmembers, I could openly express and process my sadness and grief for the M'ssituation and the loss of Mrs. M's life.     

Process and Content in a Therapy Group for Bipolar Outpatients

Although the literature suggests that homogeneous therapy groups are useful for bipolar outpatients, little is known about the process in such groups. Using the GCQ-S and a content analysis of discussion topics, we evaluated group process during the first 31 sessions of an outpatient bipolar group. Compared with normative samples, our group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions and in the anxiety/tension scale. Furthermore, 81% of the discussion topics were related to the three group goals, and an additional 18% dealt with general group issues such as orienting new members and attendance. The results from this pilot study suggest that bipolar patients can discuss relevant issues in a homogeneous group environment that is cohesive, open, and safe.     

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.     

A Developmental Approach to the Supervision of Therapists in Training

Supervision is considered essential to therapeutic effectiveness yet trainees frequently report negative supervisory experiences. Although such experiences may be due to inadequate or poor supervision, more often they result from differing needs or expectations among trainees. Thus, supervisors must struggle to determine how to best conduct supervision. We propose that many negative experiences result from a supervisors inattention to the trainees development as a mature individual. By examining the cognitive and emotional development of trainees supervisors are offered a framework from which to select interventions and strategies that encourage rather than discourage trainees.     

The Social Psychology of Groups and Group Psychotherapy: One View of the Next Century

Will fields that study groups in general, such as social psychology, and fields that use groups to achieve therapeutic goals, such as group psychotherapy, move toward unification in the future or will they drift apart? One possible future assumes that these two approaches to groups will become better integrated as (a) societal changes increase individuals' reliance on groups; (b) research and theory on group processes become more sophisticated; and (c) basic and applied researchers work together more closely in examining groups. Such unification requires, however, changes in the training, outlook, and procedures used by both practitioners and researchers.     

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.     

The Efficacy of Adult Christian Support Groups in Coping with the Death of a Significant Loved One

Psychologists sometimes minimize important resources such as religion and spiritual beliefs for coping with bereavement. Alienation of therapeutic psychology from religious values contrasts to professional and public interest in religious experience and commitment. A supportive viewpoint has come about partially as a result of recognizing important values which clinicians have found absent in many of their clients. Until spiritual belief systems become integrated into the work of clinicians, clients may not be fully integrative in coping with loss. The key finding of this study was that individuals who participated in Christian and secular support groups showed no statistically significant difference in their mean endorsement of negative criteria on the BHS, and no statistically significant difference for their mean score endorsement of positive criteria on the RCOPE. However, a Christian-oriented approach was no less effective than a psychological-oriented one. In both groups, a spiritual connection to a specific or generalized higher power was frequently identified which clients ascribed to facilitating the management of their coping.