Group therapy as psychic containing

This article will examine how the psychoanalytic idea of containing can be used in group therapy to form a conceptual bridge such that the group dynamics are not simplistically reduced to individual dynamics, nor that the individual is lost in the "group-as-a-whole" concept. I take the concept of "containing" as versatile in the sense that Bion (1970) meant it to be-that is, the psychological phenomenon of containment is manifest at various system levels: intrapsychic, interpersonal, group, and societal. This article will explore how far this "bridging concept" can be pursued to understand groups theoretically. The article will review various forms of containing, following Bion's ideas, and in particular a therapeutic, or flexible, form in contrast to rigid and fragile forms.     

Self psychology and group therapy

This paper illustrates how the theories of Heinz Kohut elucidate the curative aspects of group treatment. Group therapy is an ideal milieu in which mirroring, idealizing and alterego transferences can be experienced and worked through. Transmuting internalizations, or psychic structure building, occur when optimal frustration of these needs can be provided by available selfobjects. In group therapy a patient can use the group-as-a-whole, the individual members as well as the leader as potential selfobjects. With the help of individual sessions to reflect on group encounters, a patient can gain a more fully integrated therapeutic experience.The author wishes to acknowledge Susan Sands, Ph.D., Jane Jordan, M.S.W., and Ruth White, Ph.D., for their help.     

Inpatient group processes parallel unit dynamics.

The authors conducted a quantitative examination of parallels between milieu and therapy group dynamics on a short-term inpatient unit. The Ward Atmosphere Scale was used to assess the milieu, and the Group Climate Questionnaire-S to measure processes in key groups. Assessments were made by patients and staff once each week for 10 months. The authors found clear parallels between ward and therapy group processes. The parallels reflected the impact of patterns utilization of the unit, its treatment philosophy, and the emotional dynamics of its constituents. Examination of these associations also revealed limitations of the treatment setting, clarified the potential impact of particular staff interventions, and demonstrated biases in the rating methods. Study of parallel process on the psychiatric unit is a rich source of information on the nature of inpatient treatment.     

T-Group Theory and Laboratory Method: Innovation in Re-Education Edited by Leland P. Bradford,Jack R. Gibb,and Kenneth D. Benne

The authors conducted a quantitative examination of parallels between milieu and therapy group dynamics on a short-term inpatient unit. The Ward Atmosphere Scale was used to assess the milieu, and the Group Climate Questionnaire-S to measure processes in key groups. Assessments were made by patients and staff once each week for 10 months. The authors found clear parallels between ward and therapy group processes. The parallels reflected the impact of patterns utilization of the unit, its treatment philosophy, and the emotional dynamics of its constituents. Examination of these associations also revealed limitations of the treatment setting, clarified the potential impact of particular staff interventions, and demonstrated biases in the rating methods. Study of parallel process on the psychiatric unit is a rich source of information on the nature of inpatient treatment.     

Editorial

Group dynamics are the elements that make group psychotherapy unique. When applied to the inpatient group, they illuminate various aspects of milieu treatment. Because of this linkage, the therapy group can be used to educate trainees about (1) systems dynamics on the psychiatric unit and their administrative implications, (2) the vicissitudes of the patient's treatment alliance with the hospital staff, and (3) the psychodynamics of severe psychopathology. In the group, individual defensive operations stand out with special clarity. Their expression is fueled by the group's dynamics. Here, internal object relations are reenacted and the defense of projective identification becomes vivid. The focus of this paper is not on the teaching of group psychotherapy itself, but rather on the use of this modality for the general training of future professionals.     

Group-as-a-whole systems theory and practice

Group-as-a-whole systems theory is presented and applied to the practice of group psychotherapy. The individual and the group are conceptualized as two isomorphic systems in a hierarchy of living systems. The basic component of the group-as-a-whole is its subgroups, which exist independent of individuals whose subgroup memberships may change while subgroups remain stable. Subgroups come together around similarities and separate on differences, and contain differences for the group-as-a-whole to integrate in relationship to primary and secondary goals. The primary goals of system survival and maturation take precedence over the secondary goals, which relate to the environment. Goal achievement and individual change is explained as a function of group dynamics. In a therapy group, the dynamics of each phase of group-as-a-whole development serve as a major therapeutic force. Within each member, salient developmental issues are aroused, which resonate with the issues that the group is in the process of mastering. The task of the group-as-a-whole therapist is to facilitate the developmental process at both the group and the individual level. Therapeutic interventions are designed to facilitate the discrimination and integration of information at the boundaries between systems and subsystems: within the individual member system (intrapersonal) and between individual member systems (interpersonal), within the group-as-a-whole system, within subgroups, between subgroups, and between all systems in the relevant hierarchy and their environments.     

Group-as-a-whole interpretations in short-term group psychotherapy

The usefulness of therapists making group-as-a-whole interpretations in long-term group therapy was actively debated in the 1960s and 1970s. Advantages and disadvantages were delineated. An often-cited survey study of therapy groups that had emphasized group-as-a-whole interpretations found that many patients were dissatisfied with the therapist’s technique and the outcome of therapy. Although group-as-a-whole concepts subsequently became a part of the theory of many orientations of group therapy, there has appeared to be reluctance among many therapists to make group-as-a-whole interpretations, especially in short-term group therapies. Contrary to this tendency, an argument is made and a case illustration presented, which advocate the use of group-as-a-whole interpretations in short-term group therapies.     

TRANSITIONAL EMPLOYMENT PROJECT

McLean Hospital is a private, non-profit psychiatric hospital in Massachusetts. It is an extensive treatment facility providing outpatient care, patient hospitalization, and an inpatient bed capacity of 328. The psychiatric modalities used are traditional milieu structuring, individual and group psychotherapy, behavior therapy interventions, family and couples therapy, psychopharmacology, and rehabilitation treatment strategies. As in other psychiatric hospitals, vocational rehabilitation treatment strategies were severely challenged in the 1970s with the Supreme Court decision in the case of Souder versus Brennan. In essence, the findings in this class action suit construed traditional, clinical/vocational programs as forms of employment, not therapy. Thus, the issues of work adjustment and employment preparation for the psychiatrically disabled client needed to be creatively readdressed. Rehabilitation staff were called upon to redefine the activities presented to clients not only from the viewpoint of desired therapeutic interventions but also in terms of the new legal constraints. The shortened length of inpatient hospitalization also highlighted the need for aftercare rehabilitation opportunities. Responding to these needs, the Rehabilitation Services Department of McLean Hospital developed an independent transitional employment corporation called Everywhere Limited.     

The group-as-a-whole approach in Foulksian group analytic psychotherapy

The group analytic group-as-a-whole approach of Foulkes privileges the concept of the group matrix. The term matrix is a metaphor for the network of all individual mental processes, the psychological medium in which they meet, communicate, and interact. The developing group matrix acts both as a container and as a holding environment for the psychic processes of the individual members in the group context. The concept of coherency is evoked to describe the process of the developing capacity of a group to be therapeutic. The concept of coherency is applied both to conscious and to unconscious mental process.     

Developing the group mind through functional subgrouping: linking systems-centered training (SCT) and interpersonal neurobiology

This article introduces the systems-centered concept of the "group mind" by linking systems-centered thinking and interpersonal neurobiology, building on Siegel's definition of mind as the process of regulating the flow of energy and information. Functional subgrouping, the systems-centered group method for resolving conflicts, discriminates and integrates the flow of energy and information within and between group members, subgroups, and the group-as-a-whole, thus potentiating survival, development, and transformation. This article uses the interpersonal neurobiological framework to discuss functional subgrouping as a tool for developing the group mind: considering how functional subgrouping facilitates emotional regulation, creates a secure relational context, and potentiates neural integration.     

Microcomputerized clinical and research laboratories in psychiatric inpatient,settings

Microcomputers have become increasingly useful in clinical settings, performing functions ranging from test administration to composition of narrative reports. They may in the near future be involved in therapeutic procedures. Clinicians and researchers have begun to wonder whether a microcomputer can take over a wide range of functions in clinical psychiatric settings, becoming a versatile and cost-effective tool. This paper describes the development of a comprehensive system for research and clinical data management on a psychiatric inpatient unit. The core of the system is an Apple II-Plus microcomputer equipped with PASCAL, standard peripherals, and an inexpensive custom interface. The system has met the current data management needs of the unit, and its expandability allows planning of assessment-and treatment-related research.     

A family-oriented psychiatric inpatient unit.

This article presents the structure and policies of a psychiatric inpatient unit that was developed with the goal of fully integrating family-oriented treatment approaches into its therapeutic program. There is an explanation of different methods to involve families in the hospital treatment process and delineation of a variety of treatment techniques specific for families of inpatients. The role of the nursing staff is described as well as some of the contradictions and paradoxes that are inherent in this type of inpatient unit.     

Single-gender group psychotherapy: A “women's group” for adolescent inpatients

This paper describes an attempt at forming and conducting a unique single-gender psychotherapy group with severely disturbed female adolescents on a long-term, psychotherapeutically oriented co-ed inpatient unit. The focus of this group was assisting the female patients in negotiating the tasks and conflicts specific to their gender and developmental stage. The therapeutic approach and the role of female coleaders are described, emphasizing particular modifications made to meet the needs of this group. Clinical examples are offered to high-light salient group themes of identity formation and separation and individuation. Finally, group therapeutic factors specifically enhanced by single gender membership are discussed and observations regarding the group/milieu interface are explored.     

Theory of the invisible group applied to individual and group-as-a-whole interpretations

The theory of the Invisible Group explains the dynamics of groups in terms of four separate systems, hierarchically and isomorphically related, which enable the therapist to view group from four different perspectives and to interpret four different dimensions of group process. Person and member interpretations apply to aspects of the individual system; group-role and group-as-a-whole interpretations apply to aspects of the group system. Clinical examples illustrate how the psychotherapist can modify the dynamics of the group at the individual or at the group-as-a-whole level by modifying interpretations.     

The Therapeutic Community Sing: Music Therapy Inpatient Group Process

Early psychoanalytic authors and music educators in both Europe and the United States pointed to the contemporary use of music therapy as a powerful modality in an inpatient psychiatric unit. The inpatient community sing is discussed in its capacity to address both individual and group goals. A clinical vignette from such a group is presented and discussed.     

Dreams as portraits of self and group interaction

Dreams presented in group psychotherapy portray different aspects of the dialectic between the group and the individual. A self psychology perspective emphasizes the interplay between the current self-state of the group-as-a-whole and the selfobject needs of the individual. With this focus in mind, the therapist should help the group to deepen its awareness and capacity to reflect on emerging new abilities ("forward edge") which dream imagery conveys and the needed human responsiveness that can actualize these abilities and thus help the individual and the group to break and transform chains of repetition compulsion. We illustrate this approach with two clinical examples.     

Broaching and exploring the question of combined group and individual therapy

Combined therapy is defined as concurrent dyadic and group therapy with the same therapist. This paper focuses on a neglected aspect of combined therapy: broaching and exploring this question with one's individual patient. The author shows how raising this question: (1) alters the therapeutic field whether or not the patient joins; (2) can sharpen the therapist's understanding of the indications and contraindications for group membership; (3) offers untapped therapeutic approaches and opportunities to classify issues in the individual treatment; and (4) stirs up countertransference issues related to issues of profitability, the transference of the patient in individual treatment, and the transference of the group-as-a-whole. Several case examples are provided.     

Perceptions of Turkish psychiatric inpatients about therapeutic factors of group psychotherapy

Many studies on therapeutic factors in group psychotherapy were done during the 1970s and 1980s, primarily with Western samples, The present study was carried out in a psychiatric inpatient clinic in Turkey. Using Yalom's (1975) therapeutic factor questionnaire administered at discharge, patients rated existential factor, instillation of hope and self-understanding as the most helpful factors and identification as the least helpful. There were significant differences among patients with regard to gender, age, education, comorbid personality disorder, but not with Axis I diagnosis or number of attended sessions. Patients' and psychiatrist's rating showed significant differences. Differences between this Turkish sample and those reported in common Western literature are discussed under the light of relatedness psychology, which is an important concept of cross-cultural psychology.     

The team meeting on a rapid turnover psychiatric ward: clinical illustration of a model for stages of group development.

This article illustrates stages of group development in a semi-structured team meeting of staff and patients in an inpatient psychiatric unit. Clinical material drawn from such a group at the Massachusetts Mental Health Center is presented in support of the view that, even in a rapid-turnover ward, group process in a mixed-level, mixed-diagnosis "ward meeting" follows some predictable lines and responds to the articulation of certain predictable concerns. Garland's (1981) model of group development is adapted to show the cyclical nature of group process in a teaching hospital, where doctors as well as patients may make only brief stays. Effective leadership strategies are suggested.