Peers and siblings: their neglect in analytic group psychotherapy

Peer and sibling history, transference, and theory construction, have been neglected in analytic group psychotherapy. One main reason for this neglect has been the belief that current psychoanalytic theory, individual and group, sufficiently accounts for the understanding of peer and sibling phenomena. Furthermore, peer transferences in the therapy group have been considered derivative of transferences to the leader. An argument is made for considering peer and sibling history, transference, and theory construction important in their own right. This argument is supported by a therapy group example. Implications for practice and theory are discussed.     

On psychoanalytic figures as transference objects

One of the tasks that analysts and therapists face at a certain stage in their career is how to develop a way of psychoanalytic thinking and practising of their own. To do this involves modifying or overcoming the transferences established during their training or early career. These transferences are to one's teachers or training analyst, investing them with authority and infallibility, and to received theory, which is treated as though it were dogma. The need to free oneself from such transferences has been discussed in the literature. There is, however, another kind of transference that the developing therapist also needs to resolve, which has received little attention. This is the transference made on to a key figure in the psychoanalytic tradition. Such a psychoanalytic figure will be seen as the originator of or embodiment of those theoretical ideas to which one becomes attached, and/or as standing behind one's training analyst or seminal teachers who become a representative of that figure. The value of an investigation of one's relationship to a psychoanalytic figure is that it is an excellent medium for revealing one's transference, as the figure in question is not a real person but only exists through his/her writings. The body of the paper consists of an extended example of such an analysis, that of my own transference on to the figure of Winnicott. In this example I illustrate how my evaluation of Winnicott's ideas changed from seeing them as providing answers to all my clinical questions to no longer satisfying me in some areas of my work. This change in my relationship to Winnicott's theory went hand in hand with a modification in my transference on to the figure of Winnicott, from seeing him as endowed with authority and goodness to an appreciation of him as a still sustaining figure but now with limits and flaws. In the final part of the paper several questions arising out of my analysis are posed. Can the pull of writing such an account in terms of dramatic rupture rather than gradual and partial change be avoided? Should my account be regarded purely as a form of self‐analysis or does it have anything to say about Winnicott himself and his theory? And do some psychoanalytic figures attract more intense or sticky transferences than others?     

Use of the Group Therapist's Personality Via the Countertransferences

Rather than use the term therapist personality, the author uses an operational definition of countertransference to examine the intersubjective field between group therapist and individual patients, the group, and subgroups. Differentiating between objective and subjective countertransferences, the author traces their sources to the transferences and resistances that arise from individuals, subgroups, and the group-as-a-whole. The transferences, resistances, and their related countertransferences are then integrated with enactments and history to create interventions. The charismatic leader makes no differentiation between the countertransferences and primarily acts on impulse or a rigid system.     

When Daughter Becomes Mother: Inferences from Multiple Dyadic Parent–Child Groups

In this paper, I describe how new mothers can be preoccupied with their mothers and can replay their relationship with them transferentially with professionals and nannies, who become surrogates for their mothers. New mothers need affirmation from their mothers and from mother surrogates because, in their new role, they experience a sense of helplessness and anxiety and have difficulty tolerating aggression, ambivalence, and conflict. Stern's “motherhood constellation” and “good grandmother transference” are useful constructs for understanding how to best approach and help new mothers and their babies. From observations in multiple dyadic parent–child groups at the Pacella Parent Child Center, I have distilled two factors that help new mothers address their anxieties—the bonds these mothers make with one another and their transferential bond with the group leader and other professionals at the center. I critically discuss and compare theoretical inferences derived from individual psychoanalytic or psychotherapeutic work (as exemplified by Balsam's work) with the inferences derived from Stern's dyadic model and with inferences derived from psychoanalytically informed group situations. I consider the implications of the ubiquity of ambivalence conflicts, especially around aggression.     

Psychoanalysis and the Growth of Knowledge

This paper discusses two kinds of complexities inherent in psychoanalysis' concept of transference. The first kind: transference emotions usually appear in the shape of polarities—that is, an emotion is accompanied by its opposite that may be manifest or latent. This is true both of emotions that are split off and ambivalent. In addition, two or more such polarities often co-exist, running like parallel tracks, e.g., an aggression polarity together with a dependence polarity. A clinical vignette illustrates this train of thought. The second kind: Starting from Winnicott's concept of transitional phenomena, the epistemologicaI status of the transference concept is discussed. Transference phenomena take place in an intermediate area between reality and phantasy, and between past and present. The ensuing paradoxes that will characterize the concept-formation have to be accepted and respected. Some technical consequences of these complexities are discussed.     

Food and violence: Childhood violence and emotional abuse as complicating factors in the inpatient treatment of eating disorders

SUMMARY

This paper considers the treatment, on an inpatient eating disorders ward, of patients who have suffered violence and emotional abuse during childhood. The complex web of relationships surrounding these patients is discussed, and it is suggested that there are multiple transferences — to the institution, to various members of staff, and to other patients — and that splitting of these transferences is inevitable. Staff experience powerful countertransference feelings, related to the patient's violent history. A central task for the staff team as a whole is to understand and contain the patient's disturbance — taking on, tolerating, and processing the projections. This demands the close working-together of the members of the multidisciplinary team, so that staff can together openly examine the patient's interaction with them and their own emotional responses to the patient and to other members of staff. If these responses are not understood by the ward staff, they can lead to conflict and inappropriate decisions. On the other hand, if the staff team together can build up a picture of the patient's relationships on the ward, and their meaning for the patient, this picture, like a particular projection of the world in an atlas, provides a ‘map’ of the patient's inner world. This ‘map’ can be used by the staff team in navigating their interactions with the patient. It can also assist the psychotherapist in her work to help the patient recognise and, eventually, own the split-off parts of herself.     

Depth of Transference in Groups

An ongoing controversy in the field of group psychotherapy is whether transference regression is greater in groups than in individual treatment. There appears to be a general consensus that group behavior may be understood as operating on at least three levels—the conscious–rational, the oedipally determined transference, and the preoedipal maternal transference level. The more rational levels are associated with transference dilution, whereas the more primitive levels accompany transference intensification. Dilution occurs as a result of reality demands and inputs of the group situation and because of multiple targets of displacement. Transference intensification is a product of mutual stimulation, contagion effect, frustrating inputs, and support of the group theme. Certain patients benefit most from the dilution features of a group, and others profit most from intensification. The therapist's technique and the patient's pathology are the main determinants of which aspect gets emphasized and utilized.     

The wish to be soothed as a resistance.

As the analyst makes the correct interpretations of resistance in the opening phase of an analysis, the patient begins to feel understood, often for the first time. This feeling allays anxiety and depressive affects, and the patient comes to experience the analyst as a soother. These initial exchanges may lay the foundation for a positive transference which acts as a buffer against turbulent transferences. In some patients this positive transference develops rapidly, often with prompt symptom remission. In others--children as well as adults--the analyst must persistently interpret defensive regressions before a stable, positive transference can emerge. In either case, in order to avoid the analysis of conflict, some patients become resistant to the analysis of the wish to be soothed. Many of these patients have had a childhood filled with traumatic parental stimulation or rejection. Two clinical accounts illustrate these contentions.     

Changeover of a Mental Hospital Unit into a Therapeutic Community

This paper explores some clinical implications of combining individual and group psychotherapy for children functioning at different levels of ego development. More highly structured children are able to observe the continuity and discontinuity that inevitably exist between the two modalities. Bridging of the two therapeutic contexts—integrating split off object representations—enriches the transference and strengthens the therapeutic alliance. In working with ego impaired children the goal in combining treatment modalities is to provide a therapeutic structure capable of containing unintegrated affects and perceptions. The therapist's challenge is to provide the opportunity to regulate emotional distance while at the same time maintaining the experience of a nurturing relationship. While potential hazards exist, with proper precautions taken, combined treatment can provide significant opportunities to establish or strengthen a therapeutic alliance with children, particularly those most in need and yet most resistant to treatment.     

Psychoneurotic Art: Its Function in Psychotherapy by Margaret Naumburg

This article describes group psychotherapy with nursing home residents, ages 64-96, which utilizes the nonverbal and symbolic activities of drama therapy to facilitate an orientation to insight and transference phenomena, in contrast to the purely supportive techniques often used with the elderly. A case study of a long-term therapy group is described with examples of how the patients confronted their physical limitations, the death of their parents and of themselves, and transferences to the therapist. The media of creative drama, by concretizing and symbolizing difficult feeling states, and thus encouraging verbalization, may be a useful aid in extending the benefits of expressive psychotherapy to the impaired elderly.     

Reflections on Preparing the Group Leader for an Analytic Perspective

Preparation of group therapists for an analytic perspective involves awareness of unconscious processes at the group and individual levels. The adequately prepared group leader should have familiarity with dream interpretation and group-as-a-whole transferences. Training in the use of long-term treatment methods is useful whether or not the practitioner uses these methods in actual practice. The ideal training program would include didactic seminars, weekly supervision, the experience of conducting a long-term (at least two years) therapy group, as well as personal analytic group therapy. Previous individual analytic therapy is also encouraged.     

A current look at transference in combined analytic therapy

This article examines transference from the vantage point of combined analytic therapy, a model that starts the patient in individual analytic treatment, then introduces him/her to group with the same therapist. Definitions of transference in the psychoanalytic literature are noted, as is the designation of transference interpretation as the distinguishing characteristic of psychoanalytic treatment. Working with transference is examined clinically, with attention to archaic transferences as well as more developed responses. In comparison with individual treatment, combined therapy offers an enlarged arena for the transference to emerge, because of the reexperiencing of the family gestalt in the group, and the more immediate stimulation in the group of envy and competition. Communications in the individual session enlighten the therapist further about what has gone on in the group.     

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.     

Induced emotional reactions and attitudes in the psychoanalyst as transference in actuality

The long hiatus between Freud's seminal paper on countertransference in 1910 and the contributions of the 1950s on totalistic countertransference is analyzed in terms of historical factors and others intrinsic to psychoanalysis. Induced reactions in the psychoanalyst as transference in actuality is differentiated from classical countertransference and the growing literature on totalistic countertransference, as well as from transferences involving the usual displacement and projective mechanisms. Several cases are discussed to indicate the wide range of psychopathology in which induced reactions occur and their value in reconstruction. The reasons for the confusing use of the concept, countertransference, for a variety of psychological processes in the analyst are cited, and a new model of five categories centering around modes of communication are posited: empathic transitory identifications, preconscious associations and imagery, induced reactions to transferences, induced reactions as transference in actuality, and classical countertransference. The relationship of induced reactions to classical countertransference is discussed, as well as implications of induced reactions as transference in actuality for internalization theory, and implicitly for the psychology of the self. Finally, some clinical issues in the use of induced reactions are eluciated.     

Narrative as a hermeneutical relationship to the unconscious

In this article, what seems to have been two central tenets in contemporary psychoanalytic narrative theory are challenged. The one—propounded by Roy Schafer—is that the goal of psychoanalytic work is to furnish the analysand with an alternative narrative. The other—propounded by Donald Spence—is that any story will do, if only it is coherent, consistent, persuasive and encompasses the known “facts”. Basing his critique of the mentioned standpoints on an intersubjective understanding of psychoanalytic work and a concept of interpreting inspired by the existential hermeneutics of Martin Heidegger, the author discusses the nature of the analytic dialogue and the role of transference together with the ethical basis of truth in the analytic project. Finally, it is indicated that there is a limit to analytic working-through, where the analysand's narrative activity must come to a halt and room be left for a resolve, where the analysand may undergo a fundamental transformation.     

Transferences in parent–infant psychoanalytic treatments

In parent–infant treatments, babies sometimes exhibit symptoms such as screaming, clinging, and fearful gaze avoidance of the analyst. The paper investigates if such phenomena may be regarded as transference manifestations, and if so, if they appear both in younger and older infants. Based on three case presentations, it is concluded that some babies are capable of forming both brief and enduring transferences. The term “indirect infant transference” refers to when a baby reacts emotionally to the analyst as long as the parent's transference remains unresolved. “Direct transference” refers to when a baby reacts in a non‐mediated way to the analyst. The necessary tool of investigation for discovering these phenomena is a psychoanalytic method with an explicit, though not exclusive, focus on the baby. Discerning them in the clinical encounter may help us understand the baby's predicament and when and how to address the baby or the parent. These treatments constitute an empirical field awaiting more extensive clinical and theoretical investigation. Already now, they suggest that transference may be rooted in, and may appear during, very early developmental stages. The paper's positions are compared with those put forward by other parent‐infant clinicians.     

An Aesthetics of the Ordinary: Wittgenstein and John Cage

Comparisons of Ludwig Wittgenstein and John Cage typically focus on the “later Wittgenstein” of the Philosophical Investigations. However, in this article I focus on the deep intellectual sympathy between the “early Wittgenstein” of the Tractatus Logico‐Philosophicus—with its evocative and controversial invocation of silence at the end, the famous proposition 7: “Whereof we cannot speak, thereof we must be silent”—and Cage's equally evocative and controversial work on the same theme—his “silent piece,” 4′33″. This sympathy expresses itself not only in the common aim of the two works (a mystical appreciation for the ordinary, everyday world that surrounds us) but also in a shared methodology for bringing about this aim (tracing the limits of language from within in order to transcend those very limits). In this sense, I argue that Cage's work gives a concrete, performative reality to Wittgenstein's early conception of language as well as the mystical revelation that lies behind it.     

Five Issues in Training Edited by Irving R. Weschler and Edgar H. Schein

This case study illustrates how combined therapy (individual, group, and marital) by the same therapist was used to resolve a woman's narcissistic transference. The author's position is that combined therapy creates a psychologically stimulating environment, which uniquely elicits a depth and range of transference feelings, thereby generating multiple therapeutic opportunities to experience and work through transference resistance in the here-and-now. Highlights of the treatment demonstrate how the synergy of three modalities is used to elicit, modulate, and resolve positive and negative aspects of the narcissistic transference. Four guidelines are suggested for treatment of patients in combined therapy.     

Self psychology,intersubjectivity, and group psychotherapy

The basic concepts of self psychology are presented. The three self-object transferences of mirroring, idealizing, and twinship are described and applied to group therapy. The therapist's role is: 1) to accept the patient's need to idealize the leader, the group, or the specific members; 2) to receive recognition and admiration; and 3) to understand the patients search for twinship. The group therapist also has the responsibility of teaching group members to have empathy for one another.