Significant events in a psychodynamic psychotherapy group for eating disorders

This qualitative pilot study was designed to identify and explain significant events for patients participating in a psychodynamic psychotherapy group for eating disorders. Specifically, seven members of a mixed (i.e., anorectic, bulimic, obese) eating disorders group recorded what they perceived as the three most significant events in group meetings for 14 weeks. In addition, group members were instructed to record why each event was significant. Manifest and latent content analyses of the data revealed that members found feedback and observing others the two most common types of significant events, and emotional experience, insight, and relationship the reasons these events had such impact. The implications of these results for working with the eating-disordered patient in group, as well as their implication for general group theory and practice, are discussed.An earlier vesion of this paper was presented at the 1991 meeting of the American Group Psychotherapy Association, New York. This paper was funded, in part, by a California State Faculty Support Grant and a Santa Barbara Cottage Hospital Research Grant awarded to the first author. The authors would like to thank Sean T. Casey, Sally Barton, Dr. Allison Wollitzer, Tom Knowlton, Craig Park, and Beth Buxton for their assistance in the preparation and execution of this study.     

Through their own eyes: a media-based group approach to adolescent trauma

This paper describes the process of two groups of students from high schools located in the immediate vicinity of the World Trade Center grappling to make sense of the events of September 11 through the creation of a documentary chronicling their experiences. The process of creating these videos mirrored the process and curative factors of a psychotherapy group in a non-stigmatizing, innovative, and accessible format, one generated by the students themselves with the assistance of professionals in the visual and performing arts. After reviewing the literature on the potential impact of violence on adolescents and the use of group treatment, especially in school settings, as an optimal choice for this population, we describe the distinctive process of the two separate groups of students, each culminating in different expressions of their very personal experience of September 11. We understand and contextualize their process through the lens of the therapeutic dynamics and elements of group work.     

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.     

The fundamentality of group principles and perceived group entitativity

We argue that the level of consensus about a set of social identity principles, and their perceived fundamentality, can influence the degree to which members perceive their group as an entity. This idea was explored through an experiment in which participants judged the entitativity of specific (in)groups on the basis of the distribution of the opinions held by their members about three identity-related principles that participants had previously rated for fundamentality. The results demonstrated that the more fundamental a principle was judged to be in comparison to other principles, the more important consensus about that principle was for producing group entitativity, relative to consensus about other principles.     

The group as a resource: reducing biased attributions for group success and failure via group affirmation

Self-affirmation theory proposes that people can respond to threats to the self by affirming alternative sources of self-integrity, resulting in greater openness to self-threatening information. The present research examines this at a group level by investigating whether a group affirmation (affirming an important group value) increases acceptance of threatening group information among sports teams and fans. In Study 1, athletes exhibited a group-serving attributional bias, which was eliminated by the group affirmation. In Study 2, the most highly identified fans exhibited the most bias in terms of their attributions, and this bias was eliminated by the group affirmation. These studies suggest that groups can serve as resources from which people can draw in response to threatening group events.     

Psychotropic medication from an object relations theory perspective: an analysis of vignettes from group psychotherapy

In this article we explore the content and dynamics of patients' verbalizations within a "living with medications" group. Patients' perceptions of their psychotropic medications are interpreted and classified within the framework of object relations theory. One's perception of the role of medication in one's life can serve as a gateway to one's inner world and the way that he or she perceives authority figures, peers, and oneself. We suggest that working through patients' relationships with their medications can help them to achieve better integration of internal object relations. Discussing patients' views about medications should therefore be seen as an important part of psychotherapy with many individuals. Such a discussion may enhance and improve efficacy of both psychotherapy and pharmacotherapy. It is of particular importance in group therapy, within milieu environments and with individuals reluctant to explicitly discuss interpersonal matters. Vignettes from the group sessions illustrate the way in which discussing medication advances group process.     

GUICO: a synthesized group approach

The guico (guidance and counseling) approach synthesizes various elements of group guidance and group counseling in order to achieve developmental-social and remedial problem-solving goals in group settings. Co-counselors share responsibility for group leadership, provide structure for group events, and act as models in role-playing situations. Group members carry out assignments based on hierarchically ordered events and chart their progress throughout the group's life cycle.     

DHPG activation of group 1 mGluRs in BLA enhances fear conditioning

Group 1 metabotropic glutamate receptors are known to play an important role in both synaptic plasticity and memory. We show that activating these receptors prior to fear conditioning by infusing the group 1 mGluR agonist, (R.S.)-3,5-dihydroxyphenylglycine (DHPG), into the basolateral region of the amygdala (BLA) of adult Sprague–Dawley rats enhances freezing normally supported by a weak footshock. This effect of DHPG was blocked when it was co-infused with either the general group 1 mGluR1 antagonist, (R,S)-1-aminoindan-1,5 dicarboxylic acid (AIDA), or with the selective mGluR5 antagonist, 2-methyl-6-(phenylethynyl)-pyridine (MPEP). These results support previous findings by Rodrigues and colleagues that mGluR5s in the lateral region of the amygdala make an import contribution to fear conditioning. More importantly, they support the general ideas embedded in the concept of metaplasticity, as per Abraham, and the synaptic-tagging hypothesis per Frey and Morris—that the processes that specify the content of experience can be experimentally separated from those needed to acquire the memory.The last decade has seen an increased appreciation of the view that the plasticity state of neurons—their ability to be modified by experience—is not fixed. Instead, the effect of experience depends on the physiological or biochemical state of the neurons or synapses that receive and store information contained in the experience, and this state is variable. This perspective is captured by the concept called “metaplasticity” (Abraham and Bear 1996; Abraham and Tate 1997; Abraham 2008), which recognizes that prior events can change the general plasticity or modifiability of neurons and synapses that will potentially store information contained in a subsequent target experience. This idea is also embedded in the synaptic-tagging hypothesis (Frey and Morris 1997, 1998) that will be described in some detail in the Discussion section. This view is important because it recognizes that the processes that specify the content of experience can be experimentally separated from those that are needed to store the memory for the experience.As reviewed by Abraham (2008), the range of prior events that can potentially determine a neuron''s state of plasticity is quite large and can be mediated by their effects on many components of the machinery that supports changes in synaptic strength. They include modification in NMDA-receptor function, AMPA-receptor trafficking, neuronal excitability, and epigenetic modifications.One way that the potential for plasticity can be altered is by activation of group 1 metabotropic glutamate receptors (mGluR1s and mGlur5s) (Abraham 2008). A number of reports based on the in vitro long-term potentiation (LTP) methodology suggest that activating this class of receptors prior to the delivery of a relatively weak inducing stimulus can transform a normally short-lasting form of LTP into a more persistent form (Cohen and Abraham 1996; Cohen et al. 1998; Raymond et al. 2000). For example, an infusion of (R.S.)-3,5-dihydroxyphenylglycine (DHPG), a group 1 mGluR agonist, into the bathing medium 30 min prior to the delivery of a weak inducing stimulus can significantly enhance the persistence of the resulting LTP, while having no effect on the baseline response (Cohen et al. 1998; Raymond et al. 2000). This effect of DHPG, however, is blocked (Raymond et al. 2000) when its administration is accompanied by an infusion of the group 1 mGluR antagonist, (R,S)-1-aminoindan-1,5 dicarboxylic acid (AIDA).Group 1 mGluRs also have been implicated in fear conditioning. For example, Rodrigues et al. (2002) reported that one subtype, mGluR5, is localized in dendrites and spines in neurons in the lateral nucleus of the amygdala, and fear conditioning can be significantly impaired if the mGluR5 antagonist, 2-methyl-6-(phenylethynyl)-pyridine (MPEP), is infused into the lateral nucleus prior to conditioning.These findings, from the studies of synaptic plasticity and fear conditioning, provide the empirical basis for the hypothesis that motivates the experiments reported here—that the plasticity potential of neurons in the amygdala that support fear conditioning can be increased by activating group 1 mGluRs prior to the conditioning experience.To evaluate this idea, we followed a strategy similar to that used to study the role of mGluRs in LTP (Cohen and Abraham 1996; Cohen et al. 1998; Raymond et al. 2000). In these in vitro LTP experiments, a relatively weak inducing stimulus was used to generate a short-lasting LTP. Infusing the group 1 agonist DHPG prior to the delivery of the inducing stimulus transformed this short-lasting LTP into a more persistent form. Their results suggest that the activation of group 1 mGluR1 receptors independently initiates processes that make an important contribution to long-lasting LTP. To apply this strategy to fear conditioning, we used a very low level of shock—one that by itself produced an almost undetectable level of conditioned fear (as measured by freezing, the innate defensive response of rodents). We then determined if the activation of group 1 mGluRs prior to the conditioning experience would transform this outcome and produce a stronger level of freezing. DPHG was infused into the basolateral region of the amygdala (BLA) to activate the mGluRs.     

The class that would not read: utilizing Bion's affect theory in group.

While Bion's group theory continues to inspire contemporary group psychotherapists, his theory of human emotion is not as well known. Bion also introduced a system of alphabetical and mathematic symbols to offer a shorthand for his epistemology in order to make his ideas accessible, flexible, and practical for the working clinician. This article presents aspects of Bion's theory and metapsychological shorthand to conceptualize effectual dimensions of group process, thinking operations, and countertransference. The constructs considered include Klein's paranoid-schizoid and depressive positions; manic defenses; basic assumptions; "proto-mental" and "pre-monitory" emotions; instinctive drives L, H, and K (plus or minus); beta elements; and alpha functioning. With these ideas, the author was able to work through aspects of a group experience in which, as leader, he unknowingly found himself at an opposite affective pole from the members.     

Dominance bonding through the good old boys sociability group

Informed and illustrated by observational and interview data on two sample groups, a model of one particular form of male social groups was elaborated. Because of the characteristics of its members and its operating principle, the ideal type was labeled the Good Old Boys Sociability (GOBS) group. Members of GOBS groups share successful class and gender histories, and plan and engage in events that reflect dimensions of masculine play learned in boyhood. The GOBS group was found to perpetuate masculine identity and male privilege through dominance bonding, i.e., a process of collective alliance in which members affirm and reaffirm their superiority.     

Group climate and group development in a community meeting on a short-term inpatient psychiatric unit

Group climate and group development of the community meeting on a short-term inpatient psychiatric unit are examined. The Group Climate Questionnaire (GCQ) was administered to all staff and patients present at the weekly community meeting on an acute treatment unit in a teaching hospital over a 12-week period. Results show that staff and patients perceive the community meetings in relatively similar ways, that the group climate of a community meeting can attain a positive working state, and that, at times, the meeting can progress through developmental stages of group process. Behavioral observations support the GCQ as a measure of group interaction.The authors gratefully acknowledge the assistance of Mary Pat Donnelly with the statistical analyses and the cooperation of all staff and patients who participated in this study.     

The group attribution error

There is a parallel between our tendency to infer the attitudes of an individual on the basis of his or her behavior, regardless of the external constraints (Jones & Harris, 1967; Ross, 1977), and our tendency to infer the attitudes of a group on the basis of the group's decision, regardless of the group decision rule. The present research focuses on this latter process. What we term the group attribution error consists of the tendency to assume that group decisions reflect members' attitudes. This assumption can be erroneous because group decision rules, in addition to members' attitudes, can influence group decisions. In Experiment 1, members of a community in which a water conservation law was or was not instituted were assumed to have correspondent attitudes, regardless of how the community decision was made. In Experiments 2 and 3, subjects inferred a greater correspondence between out-group decisions and out-group attitudes than between an in-group decision and in-group attitudes. The fourth experiment found that subjects committed the group attribution error because they attended as much to the outcome of a recall election as to the actual proportion of voters for and against the recall. Finally, Experiment 5 showed that subjects' inferences of jury members' attitudes were influenced not only by the final jury vote but also by the actual decision, which was determined by the vote plus the decision rule by which the jury was bound. The results are related to previous research on the fundamental attribution error, stereotyping, and polarized appraisals of out-groups.     

Characteristics of unsafe events involving a motor vehicle for group riders in Western Australia: A naturalistic study

Little is known about the safety issues affecting non-professional group riders. This study aimed to identify the most common unsafe events involving a motor vehicle that occurred while group riding, describe their characteristics and suggest potential preventative measures. A naturalistic study collected video footage from cameras attached to the bicycles of group riders who rode on-road for training, fitness or recreation in Perth, Western Australia. Fifty-two riders from 40 different riding groups, recorded footage of 126 group riding trips, resulting in 135 h of video. A total of 108 unsafe events (‘near-crashes/ crash relevant events’ and ‘close passing only events’) involving the group riders and a motor vehicle were observed. The most common type of unsafe event involved a motor vehicle attempting to pass/ overtake the group (65.7%). For 39.4% of the passing events, the presence of road infrastructure ahead (e.g. roundabout, traffic island) prevented safe passing and led to an unsafe event. Motorists were at fault for 83.3% of all unsafe events and reckless behaviour by the motorist was observed for 13.3% of these at-fault events. Aggressive communication on the part of the motorist or rider/s was observed for 15% of all unsafe events. This study highlighted that motorists were at fault for the majority of unsafe events involving group riders but only a small proportion involved reckless behaviour. Further research should examine the effectiveness of motorist education as well as infrastructure modifications on popular group riding routes, for reducing unsafe events involving group riders.     

Confidentiality and privileged communication in group psychotherapy

The concept of confidentiality is fundamental to all forms of psychotherapy. The idea of protecting confidential material goes as far back as the Hippocratic Oath in ancient Greek history. Centuries later, authors continue to assert that "only by maintaining confidentiality can the essential groundwork of trust in treatment be developed" (Hough, 1992, p. 106). Others have even argued that without confidentiality, psychotherapy has no value (Epstein, Steingarten, Weinstein, & Nashel, 1977). Confidentiality in group psychotherapy is more complicated than in individual therapy because self-disclosure is at the core of group therapy and there are numerous people hearing the disclosures. Confidentiality in group therapy, once ignored in the literature on ethics, is gaining more attention as this modality becomes more widely practiced; so too is an acknowledgement that ethical dilemmas surrounding confidentiality in groups are commonplace. This article discusses the major considerations and dilemmas on confidentiality in group psychotherapy. We first review confidentiality broadly and discuss the ethical principles that are related to confidentiality. In the next section, we discuss the complexities of confidentiality in group psychotherapy. Finally, we review research on confidentiality in groups and describe common ethical dilemmas.     

Applying "group" contingencies to the classroom study behavior of preschool children

A group of 12 children were enrolled in a preschool class. During the first experimental stage they participated in special events contingent on token earning. Tokens were acquired by engaging in a variety of study behaviors. After a level of study behavior was established under this contingency, the special events were provided noncontingently. Study behavior declined throughout the noncontingent stage. Reestablishing the original contingencies produced an immediate return to the initial level of study behavior. Noncontingent special events reduced the amount of independent study, group participation, and cooperative study. The study behavior of each child was altered in the same direction, though differences in the magnitude of effects from child to child were observed.     

The group as an object in the cultural field

This paper illuminates the interplay between group and individual processes by exploring members' notions of the group itself. What members hold in common about the "group" is understood as an object in the cultural field, which is a particular kind of transitional phenomenon (Winnicott). The paper connects this notion to Bion's concept of "basic assumptions," and describes members' motivations for creating the "group" as well as its role in the psychotherapy group. The object in the cultural field is then further elaborated in its more general role in the relation between the individual and the group, which leads to a consideration of psychotherapy groups in terms of their value in facilitating living in the social world.     

The function of the new member in an adolescent group

SUMMARY

In this paper we examine, through clinical examples, the impact a new member makes in an adolescent group. We were prepared for the disadvantages we felt would be experienced by the introduction of new members. However, we were clinically and theoretically interested in the way that new members brought extra space to the group, rather than diminishing it.     

Applications of object relations theory and self-psychology in current group therapy

In an effort to explore how group therapists can apply psychoanalytic theory in the group modality to advantage, two major developments in analytic theory are examined. 1) Kernberg stresses the neutral interpretive stance and utilizes concepts of protective identification and splitting in dealing with borderline pathology. This paper illustrates concretely how such theory can be used by the group therapist to encourage working through in the group situation. 2) Kohut's work stresses the empathic, nurturant analytic stance and focuses upon idealization, the grandiose self and the self-object. An understanding of these concepts helps the group therapist avoid obstacles in the treatment of narcissistic patients and can enrich the therapeutic work. The paper concludes that treatment of the difficult patient may be enhanced by the group situation in combination with specific psychoanalytic concepts.     

Good behavior game: effects of individual contingencies for group consequences on disruptive behavior in a classroom

Out-of-seat and talking-out behaviors were studied in a regular fourth-grade class that included several "problem children". After baseline rates of the inappropriate behaviors were obtained, the class was divided into two teams "to play a game". Each out-of-seat and talking-out response by an individual child resulted in a mark being placed on the chalkboard, which meant a possible loss of privileges by all members of the student's team. In this manner a contingency was arranged for the inappropriate behavior of each child while the consequence (possible loss of privileges) of the child's behavior was shared by all members of this team as a group. The privileges were events which are available in almost every classroom, such as extra recess, first to line up for lunch, time for special projects, stars and name tags, as well as winning the game. The individual contingencies for the group consequences were successfully applied first during math period and then during reading period. The experimental analysis involved elements of both reversal and multiple baseline designs.     

Student cotherapists as facilitators for group patients

This article discusses the clinical training of group therapists, the conditions under which students function as cotherapists, and the ways in which having a student trainee as cotherapist to an experienced group therapist can enhance or facilitate the therapeutic process for group members. Such enhancement can be brought about directly by: stimulating the emergence of new material; providing different perspectives and different reactions; providing different models; bringing out different transferences; affecting the working alliances; and requiring patients to deal with the loss of the cotherapist. It is brought about indirectly by: each therapist picking up on the blind spots or distortions of the other; each perceiving and discussing in supervisory conferences the other's countertransferences; and using weekly supervisory conferences to develop an increasingly cooperative relationship.