Oppression by Tadeusz Grygier

The treatment of character pathology in group therapy becomes ever more relevant in the current climate of health care delivery with the mounting awareness of the importance of the long-term treatment needed for such problems. This article reviews the psychodynamic meanings of character pathology and addresses the specific ways that psychodynamic group therapy is suited to its treatment. Clinical examples are offered to illustrate how the resolution of character difficulties occurs in group therapy.     

Confronting death: Group psychotherapy with terminally ill individuals

A model for group psychotherapy with terminally ill patients is proposed, one in which the group is homogeneous and open-ended. Cancer and HIV infection are used as examples of chronic, terminal illnesses, and the relevant literature on group psychotherapy with these conditions is reviewed. Treatment with both sets of patients has been characterized by considerable variation in the structure, composition, and duration of the group. Being diagnosed with a terminal illness is traumatic and leads to denial, which may be adaptive or maladaptive depending upon its behavioral manifestations. The homogeneous, open-ended group encourages adaptive denial, which fuels hope and the will to live. The mechanism through which this occurs involves the unconscious identification with the group as an entity. This causes the emergence of a fantasy of a mother-infant dyad, within which can occur reworking of the depressive position. Scheidlinger, Turquet and Anzieu are cited to demonstrate this unconscious function of the group. Finally, clinical implications of such a model are highlighted.     

Disavowal and assessment for psychotherapy

The concept of disavowal is described and its part in the pathology of a certain group of patients is discussed. Particular emphasis is placed upon the difficulties posed by the pervasive use of this defence mechanism during the assessment of such patients. Clinical vignettes from assessment interviews are presented. The longer-term psychotherapeutic management of these patients is discussed and this is illustrated by clinical material.     

Observations on the Meaning of Behavior in Groups of Chronic Schizophrenics

Abstract

In the United States, there is currently an increase in admissions to psychiatric hospitals, diagnostic heterogeneity, briefer stays, and a lack of inpatient research. Most traditional group therapy models are constructed for longer-term homogeneous patients. Diagnostically homogeneous groups even outperform heterogeneous groups. However, changes in health care have created a clinical dilemma in psychiatric hospitals where groups have become characterized by brief duration, rapid turnover, and diagnostic heterogeneity. A literature review offered little in the way of treatment recommendations, let alone a model or empirical basis, for facilitating these types of groups. Common factors from group therapy studies were extracted. Based on an integration of these studies, a process-oriented psychoeducational (POP) treatment model is recommended. This model is theoretically constructed and outlined for future study.     

Change after long-term psychoanalytic psychotherapy

Psychoanalytic psychotherapy in clinical practice is traditionally a long-term treatment conducted by well-trained psychotherapists. However, very few studies have been published that evaluate the effects of such treatment. To redress this lack of studies, 55 individuals selected for long-term psychoanalytic psychotherapy (average, 3 years) were invited to participate in a naturalistic study. The psychotherapists had a mean of 15 years of professional experience. The 36 patients who completed psychotherapy manifested a substantial reduction in symptomatic suffering and decreased levels of character pathology, as measured by the Karolinska Psychodynamic Profile (KAPP) and the Karolinska Scales of Personality. Generally, such changes were not found in the individuals who did not engage in treatment. In the therapy group, improvements were found on eight KAPP subscales defining different aspects of character: Intimacy and Reciprocity, Frustration Tolerance, Regression in the Service of the Ego, Coping with Aggressive Affects, Conceptions of Bodily Appearance and their Significance for Self-esteem, Sexual Function, Sexual Satisfaction, and Personality Organization. The results indicate that individuals who engaged in psychotherapy improved their capacity to handle crucial aspects of life and reduced their symptomatic suffering.     

Interaction Process Differences between Groups of Paranoid Schizophrenic and Depressed Patients

Group psychoanalytic treatment has special value for helping people form intimate attachments, in particular, for enabling them to resolve lifelong unconscious resistances to closeness. The group serves both as an amphitheater and as an agent for change.

As group therapists, we may break the task down into three stages. First, we bring the character resistances into play; second, we resolve the fears underlying them; and third, we empower our patients to develop mature ways of expressing intimacy.

Our task requires that we establish a contract with our patients so as to study any breach as a possible resistance to intimacy with other members. We study these resistances, which are expressed in words and attitudes. Beneath such resistances lie various fears, which we bring to the surface. As our patients resolve these fears, they begin to act toward each other as they did toward significant figures in their formative years. We work with these vestigial modes of relating, and help our patients turn them into mature modes of expression.     

Meta—Realization in Horney and the Teaching of Psychoanalysis

Horney was the first psychoanalyst to develop a comprehensive framework for understanding character structure and character pathology, and the first to do so in experience-near terms. She uncovered the often hidden metapsychological assumptions of classical analysis and created a deeper meta-level thinking about psychological splits, including how splits can develop between assumed opposites. In the clinical moment, insight into meta-level process rests on an epistemological change in the relation between subjective and objective. Horney was an early pioneer in examining the dialectical unity of these presumed opposites. A specific proposal for training and teaching candidates in the science of subjectivity will be advanced. Systemic clinical insights in the assessment and treatment of patients are offered, as well as systemic uncovering of cultural assumptions of Western society which can impede analytic exploration of psychic conflict.     

Short-term homogeneous group therapy for schizophrenic inpatients: A questionnaire evaluation

Traditional, insightoriented group therapy with a heterogeneous patient population has not been effective in the short-term inpatient setting. We have experimented with a homogeneous group therapy format where all of the patients have been acutely psychotic schizophrenics. Clinically, this approach has been found to be useful. Questionnaires filled out by the patients at the time of discharge have supported this conclusion. The patients valued the group more as a place to express their feelings and learn ways of interacting with others than as a place to test reality or receive advice on practical issues.     

People in groups: Dynamic and therapeutic aspects

The author differentiates between a sociological-interactional (horizontal) axis and a psychological-motivational (vertical) axis in the group, and discusses the socio- and psychodynamics both of and in the group from each of these points of view. In group therapy, five phases are described: 1) exploratory contact; 2) regression; 3) catharsis; 4) insight; and 5) social learning. Group psychotherapy with large diagnostically heterogeneous groups in a hospital setting, small diagnostically homogeneous groups, and group discussions with patients' relatives are all described. In addition, attention is paid to experiential psychodynamic group process groups (analytic self-experience groups), which provide young psychotherapists with the opportunity to gain insight into both groups and the psychodynamics stimulated within this framework. The training of group therapists should include, after academic studies, clinical experience, individual psychotherapeutic training, an experiential group, cotherapy, group therapeutic work under expert supervision, and theoretical training.     

Comparison of Dreams in Individual and Group Psychotherapy

This article gives specific reasons and evidence why group psychotherapy is the treatment of choice for addictions. Utilizing object relations theory and the self-psychology of Kohut, the authors present a model of group psychotherapy that combines these perspectives with those of Yalom's interactional group psychotherapy. Agreeing with Kohut and other object relation theorists, the authors view addiction as a condition that is the result of a person's misguided attempts at self-repair because of deficits in psychic structure. Vulnerability of self is the consequence of developmental failures and deprivation. Substance abuse only exacerbates this condition leading to exaggerated difficulty in regulation of affect, self-care, and characterological pathology. Abstinence is usually required as the first step in arresting this process and establishing a treatment regimen that will allow the vulnerabilities of the self to be altered and restored. This article suggests that this recovery and treatment process is best accomplished in a group therapy setting that is conducted within the guidelines of the principles of object relations theory and a modified version of Yalom's interactional group therapy format.     

An atypical anxious‐impulsive pattern of social anxiety disorder in an adult clinical population

An atypical subgroup of Social Anxiety Disorder (SAD) with impulsive rather than inhibited traits has recently been reported. The current study examined whether such an atypical subgroup could be identified in a clinical population of 84 adults with SAD. The temperament dimensions harm avoidance and novelty seeking of the Temperament and Character Inventory, and the Liebowitz Social Anxiety Scale were used in cluster analyses. The identified clusters were compared on depressive symptoms, the character dimension self‐directedness, and treatment outcome. Among the six identified clusters, 24% of the sample had atypical characteristics, demonstrating mainly generalized SAD in combination with coexisting traits of inhibition and impulsivity. As additional signs of severity, this group showed low self‐directedness and high levels of depressive symptoms. We also identified a typically inhibited subgroup comprising generalized SAD with high levels of harm avoidance and low levels of novelty seeking, with a similar clinical severity as the atypical subgroup. Thus, higher levels of harm avoidance and social anxiety in combination with higher or lower levels of novelty seeking and low self‐directedness seem to contribute to a more severe clinical picture. Post hoc examination of the treatment outcome in these subgroups showed that only 20 to 30% achieved clinically significant change.     

Acceleration of the therapeutic process with group

This paper deals with the impact of adding group to individual treatment of patients with neurotic character problems and attempts to illustrate the efficacy of this dual approach. The formidable task for the individual therapist is to make these patients see that their habitual ways of reacting are pathological and stem from repressed intrapsychic conflicts. This task is facilitated in a group in a number of ways since the group setting becomes an arena that affords wider therapeutic scrutiny. Having become aware that behavioral characteristics disguise anxiety, other group members initiate independent efforts to extract the underlying meanings for their fellow members. Their interventions are often more effective and acceptable because they are less likely than the therapist to be perceived in the projected image of the bad parent.Copyright, 1980, Washington Square Institute for Psychotherapy and Mental Health, which published this paper in No. 7 of the Group Psychotherapy Monograph Series, after the paper had been presented at the Seventh Annual Conference of the Group Psychotherapy Department.     

The Chicken Soup Group: Peer Supervision for Orthodox Jewish Therapists Treating Orthodox Jewish Clients

This article describes an ongoing peer supervision group, to which the author belongs, comprised of Orthodox Jewish mental health professionals, all in full-time private practice and specializing in the treatment of Orthodox Jewish patients. The benefits of this group experience are described together with some of the unique features of clinical work with Orthodox Jewish patients.     

Affect in early memories of borderline patients

Psychoanalytically oriented observers using the framework of object relations theory noted that patients with borderline personality organization manifest serious pathology in their capacity to use internalized imagery to cope with the vicissitudes of separation-individuation. This study examined one source of such imagery, the affect associated with a specific sample of early memories, including the earliest recollections of parents. Patients with borderline personality disorder were compared with paranoid schizophrenics and patients with neurotic character pathology. Forty-five outpatients, 15 in each group, participated in the study. It was found that borderline patients had significantly fewer positively toned early memories than neurotics or paranoid schizophrenics. Only the neurotic group, had a majority of affectively positive memories. The results are generally consistent with object relations theories of borderline psychopathology.     

An investigation of the effects of comorbid Axis II pathology on outcome of inpatient treatment for unipolar depression

DSM-based research on comorbidity has suggested thatdepression andpersonality disorder frequently occur together and that the combination of syndromes is associated with a poor response to treatment for depression. The present study was designed to explore the effect of comorbid Axis II pathology for a sample of 45 inpatients who received treatment for major depression. Both categorical and dimensional ratings of personality disorder were used in the statistical analysis. Positive categorical diagnosis of Cluster C (anxious-avoidant) disorder, as well as higher dimensional rating of Cluster A (odd-eccentric) pathology, was predictive of a poor response to treatment (p<.05), as measured by change in pre-post clinical ratings on the Montgomery-Asberg Depression Rating Scale. These results were construed as indicative of a significant Axis II comorbidity effect in the context of an inpatient, multimodal treatment setting for depression. The results also spotlight the influence of techniques of measurement in determining the outcome of statistical analysis.     

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.     

Short-term psychodynamic intervention in an urban health clinic: A case report

This paper describes the application of short-term dynamic therapeutic techniques to treat both symptom disturbance and character pathology in an urban mental health clinic. Short-Term dynamic psychotherapy focuses extensively on the subjectivity and inner life of the patient with emphasis on repressed anger, sadness and desire. Methods to overcome patient ambivalence and resistance to psychotherapy are presented. The clinical psychodynamics associated with early life trauma are illustrated with a case of an African-American patient.Acknowledgments for support & critical feedback are expressed to Christine Baker, Ph.D., John Swanson, ACSW, Duncan Walton, Ph.D., and Isabelle Beveridge (Graphics).     

Chicken Soup Group: Peer Group Supervision for Therapists Treating Orthodox Jews

This paper will discuss my personal experience as an Orthodox psychiatrist engaged in the treatment of Orthodox clientele and how our peer group supervision has facilitated the resolution of clinical problems in the treatment of this special subgroup of patients. As other group members address possible areas of overlap and potential conflict between dynamic psychology and Judaism, I, as an MD who prescribes medication, will focus on particular issues that this raises for the Orthodox Jewish community. I will demonstrate how the peer group forum has enabled me to deal with some difficult clinical problems.