The history of large group phenomena in relation to group analytic psychotherapy: The story of the median group

This paper presents a history of the large group approach in relation to Foulkesian group analytic psychotherapy, including the nature of this approach in relation to Foulkesian principles. Much of the theory reflects Foulkes's attitude, but there are also clear distinctions made, notably a new stance in our thinking about groups as a result of the increase in size (i.e., a membership of about 20), the introduction of the cultural dimension which this increase entails, and the question of what happens after the resolution of Kleinian, oedipal and familial conflicts has been achieved in psychoanalysis and small groups, no-tably what happens once “exile” has been achieved. The approach presented proposes to handle the frustration and hate that these conflicts engender in the form of negative or antilibidinal energies, and their transformation into psychic energy, through dialogue leading from hate to the establishment of koinonia, or impersonal fellowship, and of microcultural influences which promote rather than inhibit communication. Being neither small nor large, a group of about 20 members has become known as a “median” group.     

Psychodynamic group psychotherapy.

The author provides an overview of critical factors in the working phase of group psychotherapy from the perspective of psychodynamic theory. The discussion is organized around a clinical vignette to illustrate various types of intervention such as past, here and now, future; individual, interpersonal, group as a whole; in group--out of group; affect-cognition; and understanding--corrective emotional experience. The critical "windows into the unconscious," transference, counter-transference, and free association, are also discussed in terms of the clinical example. The author concludes his article with a few thoughts about the future of psychodynamic theory in relationship to group treatments.     

Joining group psychotherapy: developmental considerations.

This article examines the experience of new members joining an ongoing psychotherapy group. The group's stage of development and the new member's personality development are suggested to be important variables in this significant event. The experience of joining is found to share some things in common with the beginning phase of group for the group as a whole, but also noted are some unique elements. The process of joining is viewed as a highly anxious event for the new member, with antecedents in the individual's life experience. The new member is compromised by not knowing the group members, nor their shared history, norms, and dynamics. Concurrently, the group may experience a range of fears, wishes, and anxieties about the new member. Developmental considerations for the new member and the stage of group help to inform intervention strategies.     

Money and psychodynamic group psychotherapy.

Money may be the most upsetting and therefore the most avoided topic in group psychotherapy. To overcome this resistance, the leader must secure prospective members' willingness to speak openly about financial matters. Financial issues particular to group therapy emerge when money is normalized as a topic for discussion. These include lowering or not raising fees, rescheduling, leaves of absence, combined and conjoint therapy, and nonverbal behaviors. Several case examples are provided. Members' strong feelings toward the leader around financial transactions often find expression in angry accusations. Suggestions for dealing therapeutically with countertransference reactions to these accusations are offered.     

Feminism and group psychotherapy: an ethical responsibility.

In response to Martin Lakin's (1991) IJGP article, "Some Ethical Issues in Feminist-Oriented Therapy Groups for Women," this article examines recent developments in feminist theory and proposes that a feminist perspective is both ethical and can make significant contributions to the practice of group psychotherapy. The overview of feminist theory focuses on (1) the importance of the social context, (2) contributions and challenges to psychoanalytic and developmental theory, (3) attention to power relations, (4) the connection between the personal and political, and (5) recognition and integration of diversity and difference. Clinical examples illustrate ways in which male and female group therapists can take a feminist perspective and become "ethical advocates."     

Psychodrama: group psychotherapy through role playing.

The theory and the therapeutic procedure of classical psychodrama are described along with brief illustrations. Classical psychodrama and sociodrama stemmed from role theory, enactments, "tele," the reciprocity of choices, and the theory of spontaneity-robopathy and creativity. The discussion focuses on key concepts such as the therapeutic team, the structure of the session, transference and reality, countertransference, the here-and-now and the encounter, the group-as-a-whole, resistance and difficult clients, and affect and cognition. Also described are the neoclassical approaches of psychodrama, action methods, and clinical role playing, and the significance of the concept of behavioral simulation in group psychotherapy.     

Self-structure and self-transformation in group psychotherapy.

This article first outlines a theory of self-structure as a hierarchically organized multiplicity of versions of self. It then describes self-transformation as a two-part process: (Part 1) the articulation and strengthening of individual self-boundaries, and (Part 2) the reclaiming of split-off, denied, or projected aspects of self. Clinically, both parts are products of the communicative interaction among members, the therapist, and the group as a whole. A parallel conception of group development posits that the group, as an object and as a social system, also needs to: (a) articulate and strengthen its boundaries so that it may (b) contain the sustained interdependent, sometimes conflictual, interactivity among members that is essential to the self-reclaiming process.     

Models of group psychotherapy: sifting through confusion.

This editorial introduces a series of articles by leading proponents of the ten major models of group psychotherapy to appear in the International Journal of Group Psychotherapy. These theoretical contributions will be published throughout 1992 as a dedication to the American Group Psychotherapy Association's (AGPA) 50th anniversary. In the present article, the author reports results from a recent survey of senior clinicians within AGPA who expressed their opinions about the central issues that practitioners should understand during the working phase of group treatments. Statistical comparisons among action-oriented, interpersonal, and psychodynamic respondents to the questionnaire revealed striking differences in how therapeutic interventions were conceptualized. These findings are outlined as a preface to the first three articles in the series.     

Brief crisis group psychotherapy versus the initial sessions of long-term group psychotherapy: An exploratory comparison

An attempt was made to specify the therapist behaviors characteristic of the brief crisis group (BCG) approach, to assess how patients experience BCG on dimensions of session impact and group climat, and to describe the changes possible from BCG on measures of outcome by contrasting this modality with the initial sessions of traditional long-term therapy groups in a preexperimental design. Data obtained from four eight-session BCGs and three beginning long-term groups (LTG) were used for analyses. Patients were administered the Session Evaluation (SEQ) and Group Climate (GCQ) Questionnaires at the end of each group session. Two judges sat in on each session and coded the types of therapist interventions using the Therapist Behavior Categories (TBC) system. Aspects of self-esteem and symptomatology were assessed as indices of change over the 8-week period in a pre-post fashion. Therapists in BCG evidenced a distinct pattern of interventions during midpoint group sessions (sessions 3–6), placing a greater emphasis on challenging patient perceptions and providing information than their LTG counterparts. The therapists' use of self as an issue in BCG increased as termination approached and apparently served a more limited function than in LTG. Patients in BCG reported a more rapid development of a working group and experienced greater session benefit. Patients in BCG also reported lower levels of conflict and avoidance and a greater decrease in these resistance behaviors. As expected, BCG patients reported substantially greater improvement on most outcome dimensions at the end of the 8-week period. Results are considered as clarifying the approach to and impact of BCG psychotherapy.An earlier version of this paper was presented at the 15th Annual Meeting of the Society for Psychotherapy Research, Lake Louise, Alberta, June 19–23, 1984.     

Ethnocultural considerations in group psychotherapy.

The increasingly heterogeneous populations of the industrialized countries necessitate a reappraisal of the sociocultural norms and group-therapeutic approaches that were based primarily on White Judeo-Christian values. This author reviews the literature on the treatment of ethnically different patients and discusses socio-cultural phenomena relevant to group therapy that differ from the mainstream culture. The culturally determined contrasts in perception, attitude, communication, and behavior, which minority members may exhibit in the group, are examined. The specific demands on the therapist working with ethnic group members are highlighted along with the modifications in therapeutic technique. Recommendations for a culturally sensitive and broader training of group therapists are offered.