Towards an integrated model of group psychotherapy with the elderly

Three current approaches to the group therapy of the cognitively intact, depressed elderly are reviewed. Examination of the strengths and limitations of these three models--self psychology, developmental considerations such as reminiscing and life review, and cognitive-behavioral therapies--points in the direction of the usefulness of an integrated model. The main objectives of an integrated approach include: stabilization of the individual's sense of self, establishment of interpersonal competence, and enhanced mastery over the affects of depression and demoralization. Clinical illustrations are provided to demonstrate the practical considerations in this model of group therapy.     

Concurrent group and individual psychotherapy in a psychiatric day hospital for depressed elderly

Concurrent psychotherapy is used in various settings for patients of different diagnoses and ages. The concurrent group and individual psychotherapy of older adults with depressive disorders in a psychiatric day hospital is described, emphasizing phases of treatment and transference and countertransference themes uniquely relevant to working with depressed elderly patients in a day hospital. Case examples are offered to illustrate these issues. The special technical considerations that need to be utilized when multiple therapists and settings are present are described. The model employs the use of an integrative, interactive group therapy, along with various other group treatments and antidepressant medication, with individual therapy serving a subordinate but organizing role.     

The developing ego in group psychotherapy

Analytic group psychotherapy offers the potential for developing ego functions and enhancing identity formation. The nature of the interaction in group psychotherapy forces participants to deal with their perception of reality and revise their perceptions. After a brief review of the literature, focusing on the theoretical basis and ego development in analytic group psychotherapy, the paper discusses the following ego functions and gives an example of each: adaptation to reality, judgment, drive control, object relations (relationships with others), thought process and communication, defenses, affect differentiation, autonomy, mastery-competence, regulation of self-esteem, and frustration tolerance. The paper concludes with an example of assessing ego functions from a clinical vignette taken from one group psychotherapy session.     

The narcissistic personality in group psychotherapy

The author presents an interesting version of the Narcissus myth which she combines with the legend of Peter Pan for a better understanding of the narcissistic personality in group therapy. A lively case is presented of a young man named Jeffrey, whose narcissistic defenses were dismantled during a three-year group participation. A particular encounter between Jeffrey and another client and a powerful intervention by the therapist is described. The therapeutic importance of the group therapist as a firm but protective parent for these clients is emphasized. Definitions of narcissistic are given and some generalizations about these personalities in group therapy are explored.She has completed a book entitledChange in the Context of Group Therapy to be published by Brunner/Mazel in 1984.     

The curative fantasy in group psychotherapy

The concept of a curative fantasy includes patient's conscious and unconscious hopes and expectations of what is necessary for their relief of suffering. On entering group psychotherapy these elements emerge in the treatment matrix. This paper describes how patients with significant deficits in their intrapsychic organization express their curative fantasies through the development of selfobject transferences. The concept illuminates aspects of patients entering and forming a group as well as some elements in unanticipated terminations.     

The Janus face in group psychotherapy

Combined therapy offers the practitioner a rich data field for observation and research. Seeing the same patient in the group and in individual analytic therapy raises certain questions such as how differently does the patient present him- or herself, what does the difference or lack of difference mean, and is it prognostically meaningful. Based on ego theory, the author hypothesized that different therapeutic environments ought to evoke different levels of response. This adaptive quality was thought to be prognostically significant and indicative of a greater possibility for structural change. A small clinical sample showed a tendency in that direction.     

The issue of sexuality in group psychotherapy

Sexuality is an underlying, but often unspoken and ignored issue in group psychotherapy. Within the context of how a group reacts to and uses sexuality, the authors focus on three relationship areas: client/client, client/therapist, and therapist/therapist. Some of the hazards of failing to deal with sexually laden conflicts and intimacy issues in these relationships are explored. Some of the advantages of an open and honest approach to uncovering sexrole related stereotypes and behaviors are proposed. The authors attempt to demonstrate that recognition of therapists' and group members' sexuality must be appreciated as an important element in the therapeutic process.     

Sustained empathic focus and the clinical application of self-psychological theory in group psychotherapy

The concept of focus can provide a meaningful bridge between theory and practice. The authors' aim in this paper is to demonstrate that for theory to be clinically useful, it should provide a sense of focus and organization for clinical work. They illustrate how their particular use of a self-psychological/intersubjective model leads to an emphasis on what they refer to as "sustained empathic focus." The authors' choice of concepts leads them consistently to stress the patient's subjective experience and emerging vulnerability.     

The written summary in group psychotherapy revisited

This paper addresses the use of the weekly written summary with patients in group psychotherapy. In an effort to stimulate group process and effect cotherapist communication, the authors instituted this group recording in an ongoing psychodynamically oriented mixed adult group. While the utilization of this device did, in fact, stimulate the group process and became an important part of the group's life, the therapists additionally saw significant effects upon their working alliance. These included increased focused dialogue upon group dynamics, more purposeful planning for group interventions, and heightened awareness of the significance of interventions in the group.Ms. Bosman-Clark is formerly Clinical Instructor, Department of Psychiatry, Baylor College of Medicine.