Course of Treatment During a Cohort-Based Inpatient Program for Posttraumatic Stress Disorder

This study examined one group of veterans with post-traumatic stress disorder (PTSD) over the course of a four month inpatient treatment program. The aim of the study was to examine treatment process factors that may contribute to the generally poor outcome reported in previous studies. Group members made weekly ratings in the domains of PTSD symptoms, morale, interpersonal relationships, and physical problems. Results contrasted with clinical assumptions usually made regarding the treatment process in these programs. Despite an appearance of cohesion among group members, variation of scores on functional domains was explained largely by individual differences. Progress through the program showed a strongly linear pattern, with no phase effects. Somatic complaints did not increase during the phase when traumatic material was explored. Degree of improvement or worsening was best predicted by level of PTSD symptoms at admission, indicating that more symptomatic veterans did worse in the program. Additional factors of race, combat exposure, childhood abuse, and application for disability had no effect on the process variables measured.     

The Edge of Chaos: Enactment,Disruption, and Emergence in Group Psychotherapy

The author outlines his approach to the theory and practice of group psychotherapy. The emphasis is on therapy by the group rather than therapy in the group. The therapist's task is to help the group itself become the agent of change. The group is conceived as being composed of many multiple selves. The process of group psychotherapy unfolds through enactments that involve the whole group and the group therapist entering into the grip of repetitive and unmentalized self-states. These enactments are resolved when the group members, with the therapist's help and containment, can access alternative self-states that allow for new and unformulated experience to emerge. This dialectical movement between the rigid “familiar chaos” of enactment and the reflective and related working through is compared to the dynamic systems theory articulation of the tension between rigidity and chaos captured by Kauffman's notion that “life exists at the edge of chaos.” A group session is described that involves a painful enactment. It illustrates how the therapist allows the enactment to unfold by holding and containing intense affect and how the group members are helped to find their own meaning and new experience in interaction with each other.     

The Silent Majority: Understanding and Increasing Majority Group Responses to Discrimination

Although strong norms exist against discrimination, majority group members are surprisingly unlikely to respond assertively to discrimination when they witness it. A number of factors contribute to majority group members' nonresponse, including lack of intergroup contact, motivation not to see discrimination, unsupportive social norms, and the sense that only members of affected groups are entitled to respond to discrimination. This paper reviews the published evidence supporting this pattern and presents a model of targeted social referencing, whereby majority group members look to, and are uniquely influenced by, the opinions of minority group members in the domain of discrimination. This article reviews the causes and implications of targeted social referencing and proposes interventions aimed at increasing majority group responses to discrimination.     

The process of scapegoating in a neonatal nurses' group

This paper reviews the literature on scapegoating, elaborating on the underlying mechanisms before describing the process of scapegoating as it occurred in a neonatal nurse support group. Illustrative vignettes are used to discuss how scapegoating was used by group members to avoid painful feelings arising from their care of extremely ill infants. Group process is related to the stages of the group's development as feelings were addressed more directly and the need to use scapegoating as a defense decreased.     

Treatment contracts in long-term groups with alcoholic outpatients: A group case study

This paper describes the process of treatment contracting in a long-term group with alcoholic outpatients — relating the contracting process to the dynamics of the group and to the total treatment context. The material presented highlights the ways in which the contracting process (in particular, grappling with the issue of who should set the terms of the contract) may serve as a model for helping group members better understand and cope with problems in assertiueness and limit setting.     

Symbolization of experience in the process of group development

This paper applies some of the concepts of the theory of experiencing (as developed within the client-centered school of thought) to psychotherapy process in the small group. The ideas of Rogers and Gendlin regarding how change occurs in psychotherapy are applied to the process of development in the group-as-a-whole. The role of perception and symbolization of experience in the process of group development is examined. A case example from group psychotherapy is used to illustrate the process of formation, the change of shared perceptions among the group members, and the importance of these perceptions to the functioning of the group.     

Man on a Pendulum by Israel J. Gerber

Group therapy provides the ideal arena for helping individuals cultivate the observing ego—that part of the sensorium that has the power of witnessing oneself in the world. The essence of our method is to employ the group as a temporary observing ego, out of which members may develop their own observing egos. A five-step process is presented to (1) help the members see how they are affecting others when they do not see this themselves, (2) help the members see how they produce this effect, (3) help the members see the self-injurious nature of their behavior, (4) resolve resistances to seeing any of this, and (5) help the members arrive at new modes of behavior.     

Rotten apple or rotten barrel? Social identity and children's responses to bullying

Recent research has suggested that bullying behaviour may be understood as a group process, where those involved act in ways predicted by social identity theory ( Ojala & Nesdale, 2004 ). One relevant phenomenon is the black sheep effect, whereby individuals evaluate deviant members of their in‐group more negatively than that of an out‐group. To examine this process, a study was conducted (N = 60) in which 10‐ and 11‐year‐old children were randomly assigned to a high‐status, peripheral or irrelevant group. They were then read a scenario in which a member of the high‐status group bullied a person outside the group and was supported by other high‐status group members. It was found that assigned group membership affected judgements of the acceptability of the bullying behaviour and the likeability of both (a) the high‐status group and (b) the high‐status group member. Specifically, evidence of a black sheep effect meant that high‐status group members showed less liking for the high‐status group member than for the high‐status group, and believed that this member deserved greater punishment than the high‐status group as a whole. Peripheral group members differentiated between the high‐status group member and the high‐status group in terms of liking but not punishment, while members of the irrelevant group did not make a distinction on either measure. Implications for the conceptualization of bullying are discussed.     

Humour is serious: Minority group members’ use of humour in their encounters with majority group members

This article adds to the social psychological literature on how minority group members seek to manage their interactions with majority group members. Specifically, it focuses on minority group members’ use of humour in interactions where they anticipate or actually experience prejudice. The data on which our analysis is based originate from interviews conducted with Roma in Hungary (N = 30). Asked about their interactions with majority group members, interviewees reported using humour as a means to (a) manage embarrassment; (b) gather information about the other's intergroup attitudes; and (c) subvert taken-for-granted understandings of social relations. The humour involved was diverse. Sometimes it entailed the telling of (Roma-related) jokes. Sometimes it involved the exaggerated performance of roles and identities that ironised majority–minority social relations. The significance of humour as a tool for minority group members to exert some control over their interactions with majority group members is discussed.     

The impact of group psychotherapy on the self-image and self-feelings

Group psychotherapy is presented as an effective way of changing the self-image and self-feelings; the image of the self and feelings about the self being brought into awareness by the group process. After a brief review of relevant literature, group-specific experiences that affect the self-image and self-feelings are described. These include: the mirror phenomenon and triadic relationships; resonance; direct confrontations and challenges from other members; comparing oneself with, and differentiating oneself from, other members; and experimentation with new, different ways of relating to other group members. Some of the experiences of group members and, finally, the significant role of the therapist in this process are described.     

The Importance of a Comprehensive Clinical Diagnosis for Group Psychotherapy of Borderline and Narcissistic Patients

This article presents a psychoanalytically oriented model of group treatment for female adult survivors of childhood sexual abuse. Two key treatment, issues—the survivor's struggle to trust her own mind and her tenacious allegiance to an omnipotent, all-bad self-representation—are used to illustrate ways in which the transference/countertransference matrix of the group permits members to enact, identify, and work through central internalized relational configurations. The group therapist's role is to maintain transitionality, a focus on process, and the capacity for play.     

The Utilization of Cotherapists and of Group Therapy Techniques in a Family-Oriented Approach to a Disturbed Child

This paper presents theory and technique developed over a thirteen-year period with a group of chronically disturbed psychotic patients. When psychotic patients enter a group, the potential dynamics that develop within the group process mobilize psychotic resistances which become the dominant group feature. Resistances can retard group development, destroy cohesion, and result in repetitive role behaviors. Therapist interventions, especially those that join with the resistance, can promote the movement and integrity of the group while discovering aspects of primitive individual identity for the group members. Case material is included, illustrating both group resistance and group leader intervention strategies.     

A Model for Communication Skills Group Using Structured Exercises and Audiovisual Equipment

Long-term psychiatric patients who are transitioning out of the hospital often lack the social skills necessary to adapt to work and leisure situations. The behaviors that are appropriate in a hospital environment are radically different from behaviors expected in the community. This paper describes a short-term, 12-session, audio-visual group developed for an inpatient psychiatric population. The group's purpose is to provide a laboratory for members to look at their interactional styles and to develop improved social skills. Focused feedback and videotaped exercises allow group members to do this within a supportive atmosphere. The tasks introduced are designed to coincide with the developmental states of the short-term group. As the sessions proceeded, we utilized sequential exercises that would help members to feel safe, to problem solve as a group, and to practice communication skills.     

Expectation of outgroup behaviour: can you trust the outgroup?

Outgroups are usually viewed with suspicion and expected to discriminate against the ingroup. The present study demonstrated that ingroup members attributed past discriminatory behaviour committed by individuals of unknown group membership more to outgroup members than to either ingroup members or members of a neutral group. In contrast, past egalitarian behaviour was attributed less to outgroup members than to members of a neutral group. Ingroup members also expected more discrimination from a future outgroup allocator than from a future neutral group allocator. Finally, the study showed that ingroup members' own behaviour in allocating money became more biased in favour of ingroup members vis-á-vis outgroup members when the future allocator was from an outgroup rather than from a neutral group and when they had witnessed the discriminatory behaviour of an allocator in the past.     

The effect of essentialism in settings of historic intergroup atrocities

Three studies tested the effects of essentialist beliefs regarding the national ingroup in situations where a perpetrator group has inflicted harm on a victim group. For members of the perpetrator group, it was hypothesised that ‘essentialism’ has a direct positive association with ‘collective guilt’ felt as a result of misdeeds conducted by other ingroup members in the past. Simultaneously, it was hypothesised to have an indirect negative association with collective guilt, mediated by perceived threat to the ingroup. Considering these indirect and direct effects jointly, it was hypothesised that the negative indirect effect suppresses the direct positive effect, and that the latter would only emerge if perceived ‘ingroup threat’ was controlled for. This was tested in a survey conducted in Latvia among Russians (N = 70) and their feelings toward how Russians had treated ethnic Latvians during the Soviet occupation; and in a survey in Germany among Germans (N = 84), focussing on their feelings toward the Holocaust. For members of the victim group, it was hypothesised that essentialism would be associated with more anger and reluctance to forgive past events inflicted on other ingroup members. It was proposed that this effect would be mediated by feeling connected to the ingroup victims. This was tested in a survey conducted among Hong Kong Chinese and their feelings toward the Japanese and the Nanjing massacre (N = 56). Results from all three studies supported the hypotheses. Copyright © 2009 John Wiley & Sons, Ltd.     

Terminations

Whether the person leaving the group is a group member or a group therapist, the basic dynamics of separation are the same, involving the separation process as well as mourning. Terminations evoke ambivalent feelings of both separation-pain and hope. Group members and the departing person experience a loss, which reminds them of other losses, and the departing person (group member or therapist) may also experience some guilt. Any termination will have an effect on the-group-as-a-whole, as well as on the individual members, and must be dealt with prior to the actual leaving, as well as after the termination.     

Transference in Gerontologic Group Psychotherapy: Studies in Gerontologic Human Relations IV

For a number of reasons, we decided to bring three long-term, open-ended psychodynamic therapy groups to termination. We examine the process that began with the announcement of the change to a time-limited format, and concluded with the termination of the group. The transition had a powerful impact on the members and the group-as-a-whole. The therapists used supervision to deal with the intensity of the group process and the countertransference demands posed by the transition. Groups facing a similar change due to economic pressures may benefit from these observations.     

The Bulimia Workshop: A Unique Integration of Group Treatment Approaches

The time constraints of weekly group therapy and the slow evolution of group cohesion attenuate the direct confrontation that is essential with bulimic patients. Consequently, a three-phase, multidimensional group program was devised to accelerate the treatment process. Treatment begins with an intensive weekend workshop during which members formulate contracts for interrupting the binge–purge cycle and changing symptomatic behavior. During a follow-up session problems in fulfilling the contracts are dealt with and successes are reinforced, in the final phase, group members convene without their therapists to provide peer support, reevaluate contracts, and share feelings regarding treatment progress. The unique implications for treatment process and therapist interventions prompted by this new format are discussed, and preliminary research findings are highlighted.     

Countertransference in the Group Psychotherapist

This report describes a pilot study of a waiting-list group (preliminary process group [PPG]) that provided treatment for applicants to a university affiliated, urban mental health center. All individuals on the treatment waiting list were informed of the PPG. This semistructured group, meeting weekly, began with members presenting their problems, followed by free discussion, and ending with goal setting for the next week. Approximately one seventh (35 out of 262) of the clinic's applicants during a 4½-month period chose to enter the PPG. They differed from those who chose not to particpate (wait list) by being older and less educated. Approximately 80% of both wait-list and PPG participants subsequently entered therapy. Significantly more PPG patients than those on the wait list entered group treatment. The PPG served clinic needs by providing prompt service for self selected individuals and by supporting the group therapy program.     

Group climate in a stress discussion group for medical interns

In order to better characterize group process, the short form of the Group Climate Questionnaire (GCQS) was used to study a stress discussion group for medical interns. This group was found to be significantly different from a normative psychotherapy group sample along three major dimensions: Engaged, Avoiding and Conflict. The group members were cohesive, involved and open, yet respectful of each other's privacy. These results are discussed with respect to the group's goals and leadership.The authors thank George Fein, Ph.D., for statistical assistance.