Difficult Terminations in Group Therapy: A Self Psychologically Informed Perspective

In group therapy, terminations that are neither planned nor anticipated are sometimes referred to as difficult. This complex issue of difficult terminations is used as a vehicle to challenge the prevailing, though often unspoken, assumption that the goal of the group therapist is to keep the members in the group. The author presents the notion that the leader needs to maintain a balance between the group as a treatment context, and the goal of that context. The goal of group-as-treatment context is to provide for the therapeutic needs of each individual patient in the group. Self psychology provides a basis for redefining the therapy group as a treatment context. A specific rationale, goal, and process of that redefinition is presented along with illustrative case material. With this understanding, unanticipated terminations can be as readily accepted and understood as ones that are planned. All terminations are viewed as further opportunities to understand how a patient defines his or her sense of self, sense of other, and sense of self with other.     

Response to Difficult Patients in Group Analysis: The Personification of I:A/M

The author focuses on the application of Hopper's proposal of an additional basic assumption (I:A/M) using a model of clinicians' theories: bridging theory, psychological theory, and clinical theory (Michels, 1999). This paper will describe the potential for advances in understanding particular group formations seen in clinical practice and other settings.     

Difficult Patients in Group Analysis: The Personification of (ba) I:A/M

Following a discussion of the treatment of difficult patients in group analysis, two theories are proposed concerning a fourth basic assumption in the unconscious life of groups, called Incohesion: Aggregation/Massification or (ba) I:A/M and the personification of basic assumption processes, in particular that of (ba) I:A/M by difficult patients. These theories are illustrated with clinical data. Special attention is given to crustacean and amoeboid forms of encapsulation as a defence against the fear of annihilation within the context of the traumatogenic process. It is suggested that for difficult patients the treatment of choice is dyadic psychotherapy/psychoanalysis followed by group analysis.     

Taking the Sting Out: Manifesting Aggression and Containing Difficult States in a Relational Group Psychotherapy

This paper describes ways of handling aggression and difficulty in containing intense emotional experiences in group psychotherapy. The clinical vignette illustrates how, in cases of overprotectiveness, an external trigger may sometime serve as a vehicle of liberation and ventilation. The therapist’s enactment in response to the sudden penetration of a wasp into the room is discussed by relating to the functions it serves in the process of encountering aggression, as well as the group and therapist’s capacity to move from “twoness” to a “co-created third.” Whereas aggression, in general, is difficult to deal with, in a group it might prove to be extremely threatening, posing dangers unique to groups. Moreover, openly discussing the group conductor’s aggressiveness is especially challenging in a group. The paper illustrates the fruitful intersection of group analytic thinking and relational psychoanalytic conceptualization.     

Difficult Days: On the Use of Theory in Group Psychotherapy Reply to Grossmark and Weinberg

My response to Grossmark’s and Weinberg’s commentaries consists of four parts: The first relates to the use of theory in the analytic endeavor, emphasizing its relational quality, suggesting that our ability to reflect on how we unconsciously use theory is part of the therapeutic process. In the second part I discuss the relations between theory and metatheory, suggesting a possible parallelism between aggression in group therapy, and the existing debate about theorizing aggression. The third part briefly presents the affinity between relational psychoanalysis and the concept of The Social Unconscious. Finally, the fourth part notes the different languages of theory and poetry.     

Inpatient Brief Group Therapy for Anorexia Nervosa: Patient Experience

There is increasing interest in group therapy for the treatment of eating disorders. However, there is a lack of research evaluating group therapy that reflects on patient feedback in order to inform practice and improve treatment. This exploratory qualitative study attempted to evaluate patient feedback about the group therapy offered on a specialist inpatient eating disorders program. This qualitative analysis of patients’ feedback highlights areas for improvement that can be targeted to increase the effectiveness of the psychotherapy groups in the future. The research has implications for making inpatient hospitalization more effectively tailored to patients’ needs. This study also helps to improve qualitative research protocols.     

The Group Life of the Schizophrenic Patient: A Social Work Investigation by Leslie John Shellhase

Abstract

We used a randomized clinical trial to investigate the interaction of two patient personality characteristics (quality of object relations [QOR] and psychological mindedness [PM]) with two forms of time-limited, short-term group therapy (interpretive and supportive) for 139 psychiatric outpatients with complicated grief. Findings differed depending on the outcome variable (e.g., grief symptoms, general symptoms) and the statistical criterion (e.g., statistical significance, clinical significance, magnitude of effect). Patients in both therapies improved. For grief symptoms, a significant interaction effect was found for QOR. High-QOR patients improved more in interpretive therapy and low-QOR patients improved more in supportive therapy. A main effect was found for PM. High-PM patients improved more in both therapies. For general symptoms, clinical significance favored interpretive therapy over supportive therapy. Clinical implications concerning patient-treatment matching are discussed.     

困难撤机

本文讨论国际上困难撤机的时间界定及困难撤机的原因,讨论了困难撤机的常见问题,困难撤机患者脱机模式的管理方法。在近代机械通气撤离新理念方面的发展趋势,尽管机械通气应用水平有很大发展,但在诸多环节上仍存在很多问题,撤机仍需经验,需多学科合作。     

困难撤机

本文讨论国际上困难撤机的时间界定及困难撤机的原因,讨论了困难撤机的常见问题,困难撤机患者脱机模式的管理方法.在近代机械通气撤离新理念方面的发展趋势,尽管机械通气应用水平有很大发展,但在诸多环节上仍存在很多问题,撤机仍需经验,需多学科合作.     

The Patient Self-Determination Act

The Patient Self-Determination Act was signed into law in November 1990 to take effect in December 1991. The Act marked Congress's first legislative action related to life-sustaining medical treatment. It requires every health care facility that participates in Medicare or Medicaid to inform adult patients about advance directives. McCloskey discusses the legislative process leading to passage of the Act; pro-life groups' opposition to federal support of advance directives; provider groups' skepticism toward the perceived administrative burden of federal intervention; and professor Alexander Capron's preference for existing voluntary efforts over premature legislation.