Some Methods of Dealing with Delusions in Group Psychotherapy

Group psychotherapy evidenced a growth spurt in the decade of the 1930s and prior to World War II. Following upon the pioneering efforts of the psychoeducators (Pratt, Marsh, Lazell) and the writings of the early analysts (Freud, Adler, Dreikurs, Burrow), the next wave of practitioners and theorizers popularized and expounded the use of the group treatment modality in hospitals, clinics, and private practice. A review of the seminal ideas and efforts of Jacob Moreno, Louis Wender, Paul Schilder, Lauretta Bender, Alexander Wolf, and Samuel Slavson continues the historical overview begun earlier in this Journal (Ettin, 1988).

In a continuing effort to call up the wisdom of the past in the service of the work of the present, the emphasis in this paper will be on practical application. Representative quotes will be embedded in the text to capture the tenor of the times, and special attention will be given to (1) theoretical underpinnings such as the proposed advantages, curative variables, and therapy goals of a group treatment; (2) the basic logistics of practice, including optimum group size, composition, membership and exclusion criteria, and length, frequency, and structure of the meetings; and (3) technical considerations, such as the role of the therapist and the techniques, procedures, and processes of the ongoing group endeavor, as well as the interface between individual and group sessions. In conclusion, it will be argued that group psychotherapy matured just in time to respond to the pressing need for efficient mental treatment mandated by the coming of the Second World War.     

Day,Night, or Dawn: Commentary on Paper by Steven Stern

It was in the years immediately following World War II and through the 1950s that the psychoanalytic establishment officially defined psychoanalysis as a subspecialty of psychiatry, and it was in that context of the professionalization of American medicine that they codified the distinction between psychoanalysis and (psychoanalytic) psychotherapy. In this commentary on Steven Stern's “Session Frequency and the Definition of Psychoanalysis,” I deconstruct a series of binaries that was built into the analysis/therapy distinction and that has plagued our discipline. It is argued that psychoanalysis identified itself with the culturally “masculine” and heterosexual values of autonomous individuality (the intrapsychic), while it split off all that was relational and social (interpersonal), marked as “feminine,” homosexual, and “primitive,” onto psychotherapy, which it then devalued. The paper then examines the implications for practice and psychoanalytic education.     

Shifting from nervous to normal through love machines: Battle exhaustion,military psychiatrists and emotionally traumatized soldiers in World War II

At the onset of World War II, both military and civilian psychiatrists were keen on designating internal factors, such as, cowardice, an overbearing mother, or a henpecked father as determinants of war neuroses. By the end of the war, the notion that anyone could break down under extreme pressure displaced most other explanations of war neuroses. In this paper, using feminist emotional geographies as a framework, I look at how love contributed to this shift. I read three types of texts created through the practices engaged by military psychiatrists in the Canadian Army during World War II at three different sites—in units treating only exhaustion, at a convalescent depot, and at a field dressing station. These texts as both the outcome and record of Canadian military psychiatric practices in World War II form the basis upon which I read how love as a machine (a lá Gilles Deleuze and Félix Guattari) passes through both psychiatry and the military as it contributes to enacting a reality in practice (a lá Annemarie Mol).     

Aktueller Stand der Gruppenpsychotherapieforschung

In view of an increasing importance of group therapies and the intention in healthcare politics to support group treatment, it seems appropriate to provide a review of the current research efforts in this field. In this review, several research traditions are described with a clear focus on the effectiveness of group treatment. Both systematic narrative reviews and recent meta-analyses clearly demonstrate that group treatment of various disorders is equally as effective as individual psychotherapy. Besides outcome research there are other developments in the field, such as the improvement of manualized and focused group therapies even outside cognitive behavioral concepts. Studies related to feedback in groups, specific patient characteristics (especially alexithymia and attachment) as well as the construction of new measures seem to be characteristic for group research during recent years. There is still a need for research related to group dynamics and process aspects of small groups as well as the group leaders and their behavior. In total, research on group psychotherapy has clearly progressed, which justifies the support of this treatment setting.     

Compulsive "helpfulness": or, how I learned to stop working so hard and love the group

Compulsive helpfulness, an anxiety-laden need by the therapist to feel helpful, akin to the notion of rescuing others, is a potential pitfall in developing an effective psychotherapy group. It can be regarded variously: (1) as a reaction formation against feelings of boredom and frustration stimulated by such phenomena as group resistance or the enactment of inauthentic relationships in the group; (2) as a therapist style driven by a transferential reaction to be regarded as competent and worthy; (3) as an induced countertransference enactment tied to group members' frustration and passivity about their own interpersonal inadequacies; (4) and as a manic defense against despair over the feeling that one's loving has not done any good. In this essay, the author explores his struggle to identify and come to terms with compulsive helpfulness as a dominant theme in the early stages of his tenure as leader of a psychotherapy group.     

Essential theory, processes, and procedures for successful group psychotherapy: Group cohesion as exemplar

With few exceptions or at the very least cautions (cf. Burlingame, MacKenzie & Strauss, 2003) group psychotherapy has proven to be an effective and efficient treatment for a number of psychological disorders (Burlingame, Kapetanovic, & Ross, 2005). This article will briefly describe a theory that underlies successful group therapies. In addition, certain group processes—those elements that occur during the group itself that appear to be necessary conditions for improved patient outcomes—will also be addressed, although unfortunately, the sufficient conditions tying moment-to-moment process to actual outcome (improved patient functioning by the end of therapy, and at 6-month follow-up, for instance) are not quite as easily delineated. A closer study of the group therapeutic factor cohesion will be utilized as an example of these practice and research dilemmas. Finally, suggestions for future directions, which might more clearly uncover important connections between process and outcome, are addressed.     

Psychotherapy Supervision in the New Millennium: Competency-Based, Evidence-Based, Particularized, and Energized

Psychotherapy supervision has increasingly become or is on the fast track to becoming competency-based, evidence-based, particularized, and accountable. In this paper, I explore how that appears to be so by: (1) briefly considering the concepts of ??competencies?? and ??evidence-based practice?? as preeminent guides for psychotherapy supervision practice and training; and (2) briefly reviewing the current status, pressing needs, and future possibilities of psychoanalytic, cognitive-behavioral, humanistic-existential, and integrative psychotherapy supervision. Based on my examination, the following conclusions are proposed: (1) the supervision relationship, individualization, developmental differentiation, and self-reflection (for supervisee and supervisor) appear to be crucial cornerstones for the conceptualization and actuation of supervision process and practice across psychotherapy-based supervision approaches; (2) all indications suggest that three emphases??competency-based supervision, evidence-based practice, and accountability??will continue to substantially influence, affect, and inform psychotherapy supervision practice for its near and distant future; (3) psychotherapy-based supervision approaches will need to be and indeed appear to now be in the process of becoming increasingly particularized in how each of their respective approach-specific competencies are defined and explicated; and (4) psychotherapy supervision has come to be increasingly viewed as an educational process and practice that is best facilitated by: (a) a rich and enriching supervision training environment that vigorously addresses and attempts to meaningfully integrate declarative, procedural, and reflective knowledge bases throughout the supervisory endeavor; and (b) the considered and deliberate utilization of facilitative technology that has the potential to substantially enhance and expand the value of the supervisee??s training/supervision experiences. Some discussion is provided about those four conclusions, and a retrofitted psychotherapy supervision for the new millennium is considered.     

The Hope,Promise, and Possibility of Psychotherapy

In this paper, five values—diversity, science, education, practice, and spirit—(a) are examined within the professional context of psychotherapy, (b) are presented as forming the foundation of much if not all that is psychotherapy, and (c) are considered as binding values that join us as a community of practicing, theorizing, and researching psychotherapists. Some of the positives of each value are reviewed. Diversity has heightened our sensitivity to and respect for individual and cultural differences. Science has kept us focused on empirically challenging and empirically informing our practice. Education has maintained emphasis on providing solid training/supervision in psychotherapy and transmitting its culture. Practice has provided us with opportunities to increasingly implement and expand on our role as helpers and healers. Spirit has been the guiding light—the heart and soul—that supports, infuses and informs all of our therapeutic endeavors and gives them meaning. What follows is a celebration of sorts—(a) capturing some of what we have done and are doing right in psychotherapy, (b) reflecting some of the weight of those “right” efforts, and (c) conveying some of the inherent hope, promise, and possibility that forever guide us in our work.     

THE FINAL CHAPTER IN THE STRUGGLE FOR CULTURAL AUTONOMY

This article describes the efforts made by Yiddishist intellectuals to rehabilitate Yiddish culture after the Second World War and turn it into an organising element of the ethnic identity of diaspora Jewry—especially in America. The article investigates the efforts to establish a world organisation for Yiddish culture and make Yiddish the lingua franca of diaspora Jewry. In addition, it traces the renewed discussion in Yiddish journals in America, especially Di tsukunft, on the status of Yiddish worldwide as the language of the Jewish people, focusing on the rising status of Palestine and the establishment of the State of Israel as a central component of this discussion. The emphasis here will be on the importance that this debate attributed to the status of Yiddish in Israel.     

Operationalisierte Basisdokumentation von Gruppenpsychotherapien

It can be assumed that group psychotherapy will play an increasingly more important role for both inpatient and outpatient basic care not only due to health economic considerations. This means that new methods of documentation, quality management and optimization of group-specific therapy processes and results have to be developed. The present system for operationalized basic documentation of group psychotherapy (OBG) is not only meant to be a starting point for research on dynamics and efficacy of group psychotherapy but could also serve as an instrument for standardized documentation of clinical progress, quality assurance and, in combination with the accompanying manual, as an aid for education and further training for psychotherapists. The contents of the documentation system are based on the current state of scientific research and, as far as possible, were implemented irrespective of specific psychotherapeutic approaches referring to particular schools of thought. Particular consideration was given to the practice guidelines for group psychotherapy of the American Group Psychotherapy Association (AGPA) published in 2007. The system structure is based on a model of anatomy and physiology of a group according to Burlingame et al., which ascertains patterns and processes within groups. In addition to general thematic and methodological aspects, several items on group dynamics are included, such as distribution of roles, formation of subgroups, development of group norms, conflict management, interpersonal feedback, self-disclosure, cohesion and other so-called therapeutic factors. Clinical testing in different settings is currently being carried out. Results and further developmental possibilities of the OBG system will be reported soon.     

Merleau-Ponty,Marx, and Marxism: The problem of history

At the present time, Europe, particularly eastern Europe, is still immersed in a major political transformation, the most significant such change since the Second World War, arising out of the rejection of official Marxism. This unforeseen rejection requires meditation by all those concerned with the relation of philosophy to the historical context. Marxism, that follows Marx’s insistence on the link between a theory and the context in which it arises, cannot be indifferent to the rejection of Marxist theory in practice. In respect to the usual tendency to pass rapidly over practice for a theoretical analysis of social theory, Merleau-Ponty stands out for his concern to evaluate the theoretical claims of Marx and Marxism against practice.     

Rashomon Revisited: A Re-analysis of the Film and Implications for Mass Psychology

The author notes that the title of the film has been used to identify a social-psychological concept that has been widely applied in the literature. The author gives a synopsis of the film. In order to debunk the standard interpretation of the film and provide a new one, the author places the making of the film in an historical context. This requires an explication of the absorption of the samurai into modernized Japan and the country’s history before, during, and immediately after World War II. The perception of the Emperor as a deity and his de-deification are central to understanding the culture and the problem of managing aggression in that society. The social structure of the society can be described as massification. The effects of these sociocultural issues on psychotherapy in Japan are discussed along with the implications for group psychotherapy.     

Integrating clients' moment‐to‐moment ratings into psychotherapy research: A novel approach

Counselling and psychotherapy researchers have considerably advanced the field's understanding of psychotherapy processes and how they relate to treatment outcomes. Despite these advances, little is known about the client's perspective of changes in psychotherapy processes that occur throughout a given session (i.e. micro‐processes). To address this gap, this article describes the novel application of methods that assess participants' moment‐to‐moment ratings to psychotherapy research. This method entails recording psychotherapy session content that clients and other potential raters (e.g. therapists, researchers) later review while simultaneously providing continuous ratings of psychotherapy processes (e.g. helpfulness, alliance). In addition, moment‐to‐moment ratings can facilitate significant events research by prompting researchers to elicit client feedback about the moments that are rated the most and least positively. However, few studies have used these methods in the context of psychotherapy research. Studies incorporating these methods may yield findings that advance psychotherapy research, training efforts and clinical practice. For example, studies may examine how the magnitude and timing of clients' moment‐to‐moment ratings of psychotherapy processes are associated with treatment outcomes, therapist ratings and physiological processes (e.g. heart rate variability). Trainee therapists and their supervisors may also use clients' moment‐to‐moment ratings to facilitate attunement to verbal and non‐verbal indicators of moments perceived more positively and negatively. Last, these methods can produce findings that are highly relevant to clinical practice, where therapists routinely navigate fluctuations in psychotherapy processes (e.g. alliance ruptures) that can be assessed using moment‐to‐moment ratings.     

Heinz Kohut and Virginia Satir: Strange bedfellows?

Both Heinz Kohut, the psychoanalyst, and Virginia Satir, the family therapist, are products of the humanistic influence in psychology that developed after World War II. Both have had an important influence on the practice of psychotherapy. Kohut expanded the scope of psychoanalysis so that more different kinds of people could be treated by psychoanalysis than had been possible heretofore, while Satir taught a whole generation of therapists what it means to be experience-near to their clients. This paper deals with some of the similarities and differences in their work.This paper was prepared at the invitation of John Banmen and Virginia Satir for inclusion in their forthcoming book entitledApplications of Virginia Satir's Theories and Practice of Family Therapy and was submitted to this journal with their courteous agreement.     

Issues in psychotherapy with lesbians and gay men. A survey of psychologists

In 1984, a task force of the American Psychological Association (APA) Committee on Lesbian and Gay Concerns was charged with investigating bias in psychotherapy with lesbians and gay men. The task force surveyed a large and diverse sample of psychologists to elicit information about specific instances of respondent-defined biased and sensitive psychotherapy practice. Open-ended responses were used to separately identify major themes of biased and sensitive practice and to illustrate each with concrete examples. Results suggest that psychologists vary widely in their adherence to a standard of unbiased practice with gay men and lesbians. To bring individual practice into accord with APA policy will require continued and expanded efforts to educate practitioners about sexual orientation.     

Supervising Integrative Psychotherapy in the 21st Century: Pressing Needs,Impressing Possibilities

Supervisors and teachers who are interested in advancing integrative psychotherapy in the 21st century have the dual task of surveying the range of treatment approaches that have been developed and distilling these approaches down to a manageable number of influences that have been found to have the greatest impact on clinical practice over time. It has been proposed that there are four bona fide schools of psychotherapy that would be most useful for comprehensive training and supervision that would contribute to either (a) case conceptualization or (b) the process of clinical interviewing: psychodynamic psychotherapy; cognitive-behavioral psychotherapy; family systems therapy; and, humanistic/client-centered therapy. The goal for such broadly based clinical instruction would be for students, trainees, and interns to have an ability to provide a multi-level case conceptualization for any of the psychotherapy cases for which they are providing treatment. Thorough instruction in clinical reasoning and decision-making in this type of multi-level case formulation can provide some of the most valuable tools for novice and experienced clinicians alike.     

Transcultural histories of psychotherapy

Abstract

Both proponents of and critics tend to assume psychotherapy’s origin and status as a ‘Western’ practice. The history of the emergence of psychoanalysis and psychotherapy are far more complex than this picture allows for. Today as we enter a more multipolar era of world history, the easy identification of psychotherapy with ‘the West’ will become increasingly difficult to sustain, as Bangalore and Shanghai are likely to rival Hampstead and Manhattan as centres of influence for the development of therapeutic practice and theory in the coming decades. Adapting to this new world will necessitate a different conception of the role of ‘culture’ than we have been used to in recent discussions in psychotherapy. Rather than simply seeing ‘culture’ as a factor that needs to be added to discussions to counteract the alleged ethnocentrism of ‘Western’ psychotherapy, we will need to begin to pay more careful attention to the work that is done by appeals to the ‘culture concept’ in different contexts. In particular ‘culture’ can be constructed as an object of evaluation that makes it part of the ‘check-list’ of skills that characterise the reconception of psychotherapy in an era of neoliberal instrumental manualised therapy training and practice.     

Suggestion,persuasion and work: Psychotherapies in communist Europe

Abstract

This article traces what recent research and primary sources tell us about psychotherapy in Communist Europe, and how it survived both underground and above the surface. In particular, I will elaborate on the psychotherapeutic techniques that were popular across the different countries and language cultures of the Soviet sphere, with a particular focus upon the Cold War period. This article examines the literature on the mixed fortunes of psychoanalysis and group therapies in the region. More specifically, it focuses upon the therapeutic modalities such as work therapy, suggestion and rational therapy, which gained particular popularity in the Communist countries of Central and Eastern Europe. The latter two approaches had striking similarities with parallel developments in behavioural and cognitive therapies in the West. In part, this was because clinicians on both sides of the ‘iron curtain’ drew upon shared European traditions from the late nineteenth and early twentieth centuries. Nevertheless, this article argues that in the Soviet sphere, those promoting these approaches appropriated socialist thought as a source of inspiration and justification, or at the very least, as a convenient political shield.     

Chapter 1 Pluralism,Pragmatism, and the Therapeutic Endeavor in Brief Dynamic Treatment

Abstract

This article places representative formulations of brief dynamic psychotherapy in the larger context of psychoanalytic thought, reviews relational perspectives that inform contemporary approaches to time-limited treatment, and identifies tasks in continued development of theory, research, and practice. In doing so, it emphasizes the need to consider a broader range of psychopathology, dysfunction, and need in formulations of brief intervention and to develop more flexible and realistic approaches in treatment of vulnerable and underserved populations. The growing emphasis on theoretical pluralism and pragmatism in therapeutic practice generally should facilitate efforts to broaden the base of brief dynamic treatment.     

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.