A group analytic contribution to family therapy

This paper represents an attempt to add to the conceptual and technical repertoire of family therapy by drawing on experiences derived from group analytic practice. Despite many theoretical points of intersection, there are significant differences in technique dictated by an evolving experience with two fundamentally different types of group. This paper sets out the core concepts of group analysis, compares them with related concepts in family therapy and aims to achieve a synthesis of group analytic family therapy, which, though sharing matters of language and theory with many schools of family therapy, provides in its total conception a unique perspective on family therapy.     

An account of a time-limited therapeutic group in an NHS setting for women with a history of incest

Group therapy may be a useful treatment modality for women who have been sexually abused as children. The group described here involved patients referred to the British NHS psychiatric service. This closed time-limited group was run by male and female cotherapists. Reasons are advanced for advocating a mixed-sex cotherapy team. The progress of the group is described. Issues of selection, preparatory individual therapy, further individual therapy following the group, and stress on the therapists are discussed. It is suggested that the mode of referral influences the severity of presenting problems and the level of additional support likely to be required by group members. The participants' views concerning the most helpful components of therapy are recorded and self-report measures are considered alongside the assessments of the therapists.     

When the therapist says goodbye

Therapist-initiated termination poses several unique problems for both the group and the therapist. This paper describes the termination process from the point of view of this therapist's experience in planning the termination of her group therapy practice. The reactions of other analysts to her decision to retire and the group processes and individual patient's reactions in this long-term psychoanalytic therapy group are described in detail. The author follows the group process and her own inner processes in the final six months of the group. The importance of the working through of the termination phase of therapy is supported by the experiences that were shared by the group and the therapist.     

Joining with resistance: addressing reluctance to engage in group therapy training

Although research has documented the effectiveness of group psychotherapy, trainees are often reluctant to embrace this modality. This reluctance may reflect an informed choice based on knowledge, interest, and skill. Alternatively, reluctance may reflect misinformation or resistance due to conflicted feelings that arise from group dynamics. The latter are a major obstacle to the success of group therapy training and treatment programs. Understanding the origins of this reluctance and the developmental challenges of group therapy for trainees better equips supervisors to address this difficulty. This article uses case examples to illustrate how trainee reluctance emerges. It also provides strategies for working with hesitant trainees. The success of group therapy programs rests on the supervisor's ability to manage trainees' inhibitions to group therapy.     

Network therapy for addiction: bringing family and peer support into office practice

Network therapy was developed as a specialized type of combined individual and group therapy to ensure greater success in the office-based treatment of addicted patients by using both psychodynamic and cognitive-behavioral approaches to individual therapy while engaging the patient in a group support network composed of family members and peers. This article outlines the role of group cohesiveness as a vehicle for engaging patients in this treatment; the patient's family and peers are used as a therapeutic network, joining the patient and therapist at intervals in therapy sessions. This network is managed by the therapist to provide cohesiveness and support, to undermine denial, and to promote compliance with treatment. The author presents applications of the network technique designed to sustain abstinence and describes means of stabilizing the patient's involvement. Some specific techniques discussed include ambulatory detoxification, disulfiram and naltrexone administration, relapse prevention, and contingency contracting. Also discussed are recent research on the use of psychiatric residents and counselors for treatment, and use of the Internet in dissemination.     

Food for thought: the use of food in group therapy with children and adolescents.

This article highlights the significance food may have in group therapy with children and adolescents and its meanings for particular group members. It focuses on the interactions between the group members and leaders in response to food. Along with providing actual nutrition, food represents emotional and symbolic nurturing, and may trigger salient conflicts and issues with which group members are struggling. An essential role of the group leader is to manage conflicts that may be evoked by the provision of food. Examples are provided to illustrate themes and meanings related to food in group therapy with children and adolescents.     

Reconstructive group therapy with HIV-affected people

This paper describes reconstructive group therapy with people affected by AIDS. It begins with the therapeutic need as we defined it in the AIDS-affected community and the practicalities of the group therapies we offered. The reconstructive perspective, based on personal construct theory, is then explored and applied to interpret both the psychosocial functioning of AIDS-affected people and group therapy. The group therapy process is described: client engagement and group beginnings, goals, group rules, leadership roles, group experiments, group issues and endings. Some problems that arose are then identified; and a sample of group process is provided. Finally, the appropriateness of the reconstructive perspective and of group therapy for these clients is discussed, together with the identification of the major ethical issues and some recommendations for its use.     

Group therapy for school-aged children who stutter: a survey of current practices

Although group therapy is recommended for school-aged children who stutter (CWS), it is not widely researched. This study aimed to explore this provision, using a postal survey which investigated the current practices of Speech & Language Therapists (SLTs) in the UK. Seventy percent of SLT services provided some group therapy, but the level of provision was variable. There was a lack of consensus on what the main aims of group therapy should be. Important barriers to group therapy provision were identified, including a perceived lack of clients' interest in group therapy, and insufficient numbers of clients able to travel to group venues. This study enhances the profession's understanding of the provision of group therapy for CWS by identifying patterns of service delivery and highlighting areas of need. EDUCATIONAL OBJECTIVES: Readers should be able to: (1) Provide a rationale for the provision of group therapy for school-aged CWS; (2) Summarize the factors affecting group therapy provision for school-aged CWS; (3) Summarize the aims of therapy identified by the respondents to this survey.     

Parataxic Distortions in the Initial Stages of Group Relationships

Abstract

This article highlights the significance food may have in group therapy with children and adolescents and its meanings for particular group members. It focuses on the interactions between the group members and leaders in response to food. Along with providing actual nutrition, food represents emotional and symbolic nurturing, and may trigger salient conflicts and issues with which group members are struggling. An essential role of the group leader is to manage conflicts that may be evoked by the provision of food. Examples are provided to illustrate themes and meanings related to food in group therapy with children and adolescents.     

A model for group therapy with latency-age boys

This paper describes a model of group therapy with latency-age boys 9 through 12 years old. Usually parents and families are involved in family therapy while a boy is in group therapy. The model described here is appropriate for outpatient or inpatient treatment and has been used extensively by the author in a variety of settings.     

Reflections on using group therapy as a treatment modality—Why,how, for whom,and when: A guide to clinicians,supervisors, and instructors

This paper emphasizes the potential of group forces for benefit or harm in group therapy as well as human development. Clinical, experimental-historical, and experiential evidence is cited in order to assess methods for harnessing group forces effectively. Ways in which group therapy is particularly valuable for enabling individuals to develop interpersonal skills, resist group pressure, improve communicative skills, deal with problems of inferiority and pessimism, be responsive to feedback, deal with resistance and transference, and manage problems in the working through phase of therapy are focused on. Another emphasis is on how group therapy technique differs from, supplements, and improves on the effectiveness of individual therapy alone. Crucial problems of patient selection and placement are explored, as is the idea that doing group therapy helps the therapist deal with countertransference problems and increases overall effectiveness and personal growth.Dr. Fenster is Professor of Psychology and was founding Chairman of the Psychology Department at John Jay College of Criminal Justice. This paper was written while he was on sabbatical leave and serving as Coordinator of Group Therapy in the Psychiatry Department at Brookdale Hospital Medical Center.     

Integrative time-limited group therapy for bulimia nervosa.

This article presents an integrative group therapy model for the treatment of bulimia nervosa (BN) and describes the 12-session format, incorporating components of cognitive-behavioral therapy (CBT), psychoeducation, interpersonal therapy (IPT), and relational therapy (RT), in detail. Previous reports have found CBT, IPT, and RT to be effective approaches for BN when used separately. The integrative approach may have the advantage of achieving symptom reduction by two different mediating mechanisms, those that directly affect eating behaviors and those that address the interpersonal and relational context in which the disordered eating has developed. The group approach makes use of the peer group in providing new opportunities for self-exploration and self-correction. One advantage of an integrative model is patients' exposure to several different treatment modalities from which they can identify specific approaches that are most helpful to their recovery. This identification is valuable in directing future treatment, if needed. Pilot data for this approach are presented.     

ABSTRACTS OF LITERATURE

This theoretical essay offers a critique of individual psychotherapy versus the advantages of family therapy. Theories of family pathology, models, techniques, and indications, are reviewed and the relationship of family therapy to behavior therapy, multiple-impact therapy, home visits, crisis therapy, network therapy, and multiple-family group therapy are discussed.     

Aging families: The personal, permanent group

Later life families present a very special instance of group psychotherapy with older adults. This paper describes the challenges faced by later life families, including major life events to which multiple family members must adapt, and the increasing dependency of some elderly members. A developmental framework for later life problems is offered as a therapy frame useful to families. Key aspects of therapy process with later life families are also presented. Goals, strategies, structures of therapy, and the therapist’s role are all shaped by the long and intimate history of the members of this special form of group.     

Holding in mind: Theory and practice of seeing children in groups

ABSTRACT The authors will describe their therapy group for children in a Child and Family Consultation Centre. They will discuss the rationale for this treatment. An account will be given of the group processes with special reference to different feelings as they emerge in the transference relationships. Issues concerning the dynamics of co-therapy will be addressed. The work on the ‘reflective function’ by Fonagy and Target, which the authors think is an important contribution to understanding the therapeutic process in the group, will be discussed.

What literature there is on group therapy for children suggests that it is an effective form of treatment. This article describes the way in which the children's issues come alive in group therapy and in this way can be addressed quickly, in comparison with individual therapy where the process is sometimes slower. It will be emphasized that structure and boundaries are essential for containment of children so that psychoanalytic reflectiveness can take place. This reflectiveness includes understanding of the group process as well as the inner world of the child.     

Application of social identity theory in group therapy with stigmatized adults.

Social identity theory was applied in group therapy for adults with mild mental retardation. Social identity theory suggests that social group membership, also called collective identity, has an impact on self-esteem. Individuals will try to maintain self-esteem by viewing their social groups positively. This may not be possible for individuals who are members of a stigmatized group. However, it may be possible to enhance self-esteem by broadening one's awareness of collective identity. Furthermore, being able to positively view other individuals who are co-members of one's own stigmatized group can also have positive consequences for self-esteem. A clinical vignette demonstrates this process in group therapy. Results are discussed as being applicable to members of various stigmatized groups.     

Neuroimaging Measures to Assess the Effectiveness of a Two-Day Marathon Group of Individuals with Early Developmental Trauma: A Pilot Study

Group therapy can be effective with individuals with developmental trauma who re-experience intense physiological traumatic distress and struggle with terror and despair. This modality can address the long-term ramifications of developmental trauma, including problems with perceptions, trust, emotional regulation, and loss of sense of self. Neuroimaging techniques can be combined with group therapy interventions as a way to empirically validate the effectiveness of group psychotherapy on brain structures and networks impacted by trauma. The neuroscience explaining overpowering traumatic responses and related emotions will be reviewed. Results of a pilot study combining group therapy with neuroimaging are presented.     

An on site stress workshop for teachers: The creation of a therapeutic group environment

This paper describes an ongoing stress workshop conducted for 5 years in an elementary school. The school was located in an economically deprived area in the Bronx, New York. Similarities and differences between on-site workshops and therapy groups are discussed. The developmental stages of the group and its corresponding issues are analyzed in terms of group process, transference, and resistance. Illustrative vignettes are presented. The positive effects of group dynamic and group therapy interventions on the participating group as well as on nongroup personnel is demonstrated. Suggestions for adapting group therapy methods in school settings are also presented.This paper was presented as a poster at the Annual Conference of the American Group Psychotherapy Association held in Atlanta, Georgia, February 1995.     

Inpatient adolescent group therapy as a social system

This paper describes a method of group therapy that 1) utilizes open systems theory to describe the social structure of group therapy, and 2)presents interventions drawn from Masterson's ideas for treating borderline personality disorders. Illustrations from a group therapy program for chemically dependent adolescents in a short-term, inpatient treatment unit of a general hospital are offered. It is proposed that under constrained conditions of treatment, such as those described, group therapy can be effective if there is precision about the system boundaries of task, role, time and place, and if group interventions are based upon a theoretically and clinically consistent model such as Masterson's.