Aliveness in the work of the group: a subjective guide to creative character change.

The subjective response of aliveness in the work of the group may be a valuable signal on the journey toward creative character change in group therapy. In order to promote change in others, the group therapist must engage deeply and use internal responses as guides during interactions with group members as well as in relation to the group as a whole. Subjective awareness of increased aliveness that is linked with a sense of the work of the group may guide both therapist and group participants in the midst of inevitable anxieties and passions aroused during this quest for new vitality and freedom in relationships in the group. Winnicott's concept of potential space as well as group-relations theory about the primary task provide a conceptual foundation for this approach not only on the level of the individual member within the group but also on the level of the group as a whole.     

Intensive Group Psychotherapy by George R. Bach

Emotional insight, is essential in order for therapeutic change to take place. Profound resistances to experiencing expressing, and understanding emotions are present in group members, the group as a whole, and the group therapist. Reasons for the three types of resistances are described. Specific therapist attitudes and therapeutic techniques are suggested to understand and effectively work through resistances at individual, interpersonal, and whole-group levels. Examples are given from an ongoing therapy group to illustrate the processes of understanding and working through resistances. Resistances on the part of the group therapist are identified and their possible effects on the group's resistance are explored.     

Zombie states: reconsidering the relationship between life and death instincts

Where the dialectical relation of life and death instincts has become dissociated, zombie states result-in which individuals inhabit deadness as if it were a full experience of aliveness. Bypassing reservations about the speculative nature of these instincts, this paper reconsiders their relation in order to highlight certain types of clinical phenomenology that could otherwise be lost to current ways of conceptualizing aliveness and deadness. A clinical vignette illustrates particular countertransference difficulties associated with dichotomizing issues of psychic aliveness and deadness, as well as the powerful contagion associated with what the author terms zombie states.     

Avoiding Colonizer Positions in the Therapy Room: Some Ideas About the Challenges of Dealing with the Dialectic of Misery and Resources in Families

Some authors have argued that certain acts of family therapists—despite their best intentions—may represent a form of colonizing the family. When acting as a colonizer, a therapist is understood as becoming overly responsible for the family and focusing too strongly on change. In so doing, the therapist disrespects the family's pace, and neglects their own resources for change. This paper aims to highlight the need for therapists to be hypersensitive both to the resources of families entering therapy as well as to the impact of prevailing ideologies on their own positioning in the session. The kind of sensitivity advocated here is dialectical in the sense that every family is understood as having potentials promoting dynamism, happiness, and well-being as well as potentials contributing to stagnation, unhappiness, and misery. In this article, using illustrations from clinical practice, we present some ideas for resisting the tendency by the therapist to assume a colonizing position as a professional solver of problems for families. Our main aim here is to redirect the therapist toward connecting with the family's suffering, as well as with the resource repertoire it has developed for navigating and negotiating its way through life.     

Family Themes: Transmission and Transformation

This article describes a method for doing therapy that uses multisystemic themes that combine meaning and action to facilitate therapeutic change. By identifying central themes that operate at the individual, dyadic, triadic, whole family, inter-generational, and sociocultural levels, the therapist is able to develop effective interview questions and design useful interventions. In this method, behavioral symptoms are framed as a current manifestation of an overarching theme. This orientation enables family and therapist to de-pathologize symptoms and work collaboratively toward change. Case examples from a wide variety of families with differing presenting problems, interactional patterns, three-generational histories, and cultural backgrounds, illustrate the efficacy of the method.     

From Dead to Alive: Desire,Dissociation and Passion in the Analytic Dyad

When patients present in a deadened state, the analyst may feel a sense of futility and shame in his efforts to have impact. This may cause him to withdraw and contribute to an enactment in which both participants purge themselves of wanting anything from the other, sapping the treatment of purpose and aliveness. The author presents a model in which the analyst can reawaken his desire for recognition and connection and utilize it to introduce the patient to his or her own dissociated longings. This involves fortitude on the therapist’s part, since he must withstand the rejection that had caused him to withdraw in the first place, and also be sensitive to the patient’s fear of retraumatization. But if the analyst can do this, he can not only break through the impasse, but enliven the patient and infuse the treatment with a sense of purpose and hope.     

Unity in duality: The synthesis of individual and group psychoanalytic psychotherapy

Contrary to the notion that individual and group therapy tap differing psychic functions, developmental levels, or therapeutic goals, in this paper the two modalities are seen as parts of an integrated whole, to be understood via the metaphorical and symbolic communications in each; each is a holographic reflection of the whole, the two together being internally consistent. Different levels of defensive operations may be observable in each, but taken together they reflect the entirety of the patient's psyche. The group's developmental level as well as the active use of this integrative approach by the therapist are also important. Clinical illustrations are presented.Paper presented at the Xth International Congress of Group Psychotherapy, Amsterdam, August 1989. The author acknowledges with gratitude the numerous invaluable contributions by Ms. Anna Aragno in the preparation of this paper.     

Pre-group preparation model for long-term group psychotherapy in a private practice setting

In this paper the authors describe a method of pre-group preparation which has the function of establishing and maintaining a working alliance between the client and the therapist, reducing unproductive anxiety, generating hope for future productive therapeutic work, as well as providing the therapist with a screening technique for assessing the type of group composition that would be most beneficial for the client.We are grateful to our colleague, the late Walter Gruen, whose comments on this paper contributed to the final product.     

Hatred in Group Therapy: A Rewarding Challenge

Hatred is a powerful affective experience that can be disruptive to the work of a therapy group, yet it may also enhance a member's capacity to deal with strong affects. This paper explores a particular aspect of hatred, the hate directed at one member of a cotherapy team. An effort is made to explore the experience from an intersubjective and motivational systems perspective, focusing primarily on the therapist and one patient. The impact of the cotherapy relationship is also considered, as well as the whole group's capacity to contain and work with this powerful affective response. The way that the group managed this explosive situation speaks to the power of group therapy in healing and transforming its members.     

A resocialization group for the socially impaired psychiatric outpatient

The advantages as well as the practical problems encountered in a supportive psychotherapy group for nonpsychotic patients with moderate social ineptness are described. The most effective group methods for this population included: high levels of therapist activity, constant support, mild confrontation, and other versatile techniques. The group was found to be successful in producing change. Members became more socially adept, self-initiating and productive, as well as less dependent and self-destructive. The therapeutic ingredients of such a group are speculated about, and further writings and studies on similar groups are suggested.     

Development through interruptions and reparations – A case study of a dual challenging psychotherapy

The aim of this study was to understand how relational difficulties in psychotherapy may be handled to represent possibilities for change. Temporary interruptions and subsequent reestablishment of contact were chosen as the strategic focus in one severely challenging case of long term psychodynamic psychotherapy where outcome was known to be good. Interruptions and reestablishments were conceptualised by how the informants gave meaning to them. The choice of focus represented a strategic selection of events in the course of therapy where the regulation of the alliance by the therapist as well as by the patient was at stake. A detailed case record was studied and interviews with patient and therapist were conducted. A hermeneutical-phenomenological approach was used to analyse the material. The narrative dimension was important in structuring and interpreting the data. It was shown how important relational difficulties, such as mutual incompatible expectations and demands was handled both on a structural and interpersonal level, and some important steps and hallmarks of the healing process was identified. Close inspection of the course of events in psychotherapies is seen as a promising method for bringing a better understanding of how change processes unfold.     

THERAPIST DEFENSIVENESS AND MARITAL THERAPY PROCESS AND OUTCOME

Abstract

This study examined the effect of couple socioeconomic status (SES); pretherapy marital adjustment; and therapist, husband, and wife defensiveness during the third session of marital therapy on posttherapy marital adjustment. Participants were 22 therapists and 88 couples. Each therapist treated 4 couples, 2 from the middle SES level and 2 from the lower SES level. Path analyses revealed that for husbands higher marital satisfaction before therapy was associated with higher adjustment at the end of therapy, but defensive therapist behavior during therapy was associated with lower posttherapy adjustment. A similar pattern was found for wives, but this should be interpreted with caution owing to potential dependencies in the wives' posttherapy adjustment scores. Neither SES nor pretherapy adjustment predicted therapist defensive behavior in therapy, and SES did not predict marital therapy outcome variance. Results suggest that therapist defensive behavior may reflect a style or characteristic of some marital therapists.     

Index to Volume 49

Abstract

I introduce an approach to group that has remained undeveloped in the literature, but represents an essence of relationally oriented group psychotherapy. Evolving from the verbalizations and enactments through which the group symbolizes and becomes known–a nuclear idea takes shape. It emerges from the nucleus of the group process: co-created from intersubjective forces and locations that cannot be fully specified, yet may be possible to observe, name, and utilize clinically. Groups organize themselves by developing nuclear ideas, with the therapist’s active participation. They are vehicles through which a group comes to think about its thinking: not only what it thinks, but also how it thinks, or chooses not to think, and when and why. Developing the nuclear idea provides a framework for how the therapist–and the group itself–goes about the task of containing. With its emphasis on meaning and the development of meaning as transformational, the concept of the nuclear idea supplements the whole group, interpersonal, and intrapsychic lenses through which the therapist comes to understand group experience and base interventions. Clinical vignettes illustrate how the therapist may develop nuclear ideas thematically, conceptualize further, and negotiate meaning with the co-participation of other group members.     

Parting gifts: termination rituals in group therapy

A patient's termination from group therapy is a powerful experience for the departing patient, the therapist, and all group members. Unless the feelings evoked are channeled into constructive expression, they may undermine this potentially valuable phase of both the departing patient's group treatment and the life of the group as a whole. A termination ritual, styled by a particular patient according to his or her own need, therapy goals, and personality may help the patient achieve a more clearly defined sense of self. The authors suggest that the group therapist's careful attunement to and thorough exploration of the significance of any termination ritual or gift will help to extract maximum therapeutic benefit for the departing member and the group as a whole.     

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.     

Therapist Self Disclosure in Group Psychotherapy from an Intersubjective and Self Psychological Standpoint

The history of therapist self disclosure is traced from the early struggles of Ferenczi and Burrow to its valued, yet still ambivalent, contemporary status. The symmetry of self disclosure by therapist and group members is differentiated from the parity of their different roles and responsibilities. Using a case example, the process is discussed through which a therapist's self disclosure fosters task-appropriate satisfaction of selfobject needs as it also helps group members articulate and loosen archaic selfobject binds. The therapy group is described as a transitional space within which a therapist's disclosure offers members an intersubjective bridge to the therapist as well as a model for members' own active participation in the group's work.     

Dilemmas and countertransference considerations in group psychotherapy with adult children of alcoholics

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she "understands" because of having also grown up in an alcoholic family); (b) the "will to restore," which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a "rush to recovery" on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) "countertransference goodness and availability" as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

Introduction to Group-Analytic Psychotherapy by S. H. Foulkes

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she “understands” because of having also grown up in an alcoholic family); (b) the “will to restore,” which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a “rush to recovery” on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) “countertransference goodness and availability” as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

The Jerusalem TeleRehabilitation System, a new low-cost, haptic rehabilitation approach.

Survivors of brain injury or stroke can improve movement ability with intensive, supervised practice. Since the hours of supervised therapy with a physical or occupational therapist are limited, telerehabilitation will enable patients to greatly expand the hours that they practice therapeutic exercises. The Jerusalem TeleRehabilitation System (JTRS) consists of patient and therapist systems plus a central server and database connected via the internet. The system can work in two modes: (1) a cooperative mode in which the therapist and patient are online at the same time, and (2) a stand-alone mode in which the patient uses the system on his own. In both cases, the system will monitor the status and progress of the patient and various parameters of his movement abilities, and prepare reports for the patient and for the therapist. From the clinic, the therapist will be able to change the screen seen by the patient and change the level and types of tasks, as needed. Compared to existing systems, our system will have the following advantages: (1) inexpensive and easy to use; (2) remote monitoring and control of the patient's computer by the therapist in the clinic; (3) more detailed analysis of patient status and progress; (4) a "smart" system which self-adapts to the patient's capabilities in real time, increasing or decreasing the difficulty of the exercise as needed; and (5) a central, international database which, by gathering data on many patients over time, will provide the basis for "smart" therapy and will also facilitate coordinated multicenter research studies.