Group Work with Aggressive Men: Group Within a Group Within a Group

Psychodynamic group therapy offers many opportunities for members to identify, understand, and change the underlying problems, which lead to their aggressive behavior. In addition, group therapy can help to improve the members’ interpersonal relationships. The “Coping with Aggression” is comprised of three groups. A psychodynamic group of assaultive men made up the first group. The second group consisted of two leaders and a consultant whom the group members knew about but never actually met. The observers who sat outside the group made up the third group. Therapy contracts, boundaries, and leadership, and group process are discussed.     

Treatment contracts in long-term groups with alcoholic outpatients: A group case study

This paper describes the process of treatment contracting in a long-term group with alcoholic outpatients — relating the contracting process to the dynamics of the group and to the total treatment context. The material presented highlights the ways in which the contracting process (in particular, grappling with the issue of who should set the terms of the contract) may serve as a model for helping group members better understand and cope with problems in assertiueness and limit setting.     

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.     

Course of Treatment During a Cohort-Based Inpatient Program for Posttraumatic Stress Disorder

This study examined one group of veterans with post-traumatic stress disorder (PTSD) over the course of a four month inpatient treatment program. The aim of the study was to examine treatment process factors that may contribute to the generally poor outcome reported in previous studies. Group members made weekly ratings in the domains of PTSD symptoms, morale, interpersonal relationships, and physical problems. Results contrasted with clinical assumptions usually made regarding the treatment process in these programs. Despite an appearance of cohesion among group members, variation of scores on functional domains was explained largely by individual differences. Progress through the program showed a strongly linear pattern, with no phase effects. Somatic complaints did not increase during the phase when traumatic material was explored. Degree of improvement or worsening was best predicted by level of PTSD symptoms at admission, indicating that more symptomatic veterans did worse in the program. Additional factors of race, combat exposure, childhood abuse, and application for disability had no effect on the process variables measured.     

Premature termination: A clinical study

Ten patients who terminated prematurely from 10 different therapy groups were interviewed using a semistructured interview protocol. Half the subjects were patients in private therapy groups; the other half were patients in clinic therapy groups. Among the issues inquired about were subjects' initial attitudes about group treatment; the nature of the preparation process; subjects' experience of the group therapist, other group members, and the group process; their reasons for leaving their groups; and the nature of the termination process. The findings reported focus on patients' perceptions of therapists' motives; the importance of establishing appropriate treatment goals; the handling of negative feelings about the group and/or the group therapist; the issue of narcissistic injury; the experience of the balance between giving and receiving; the difficulties caused by unresolved conflicts within groups; and the problems posed by inadequate preparation for the group experience. Guidelines for practices aimed at minimizing premature terminations are offered.     

The metabolization of primary process in groups

Groups cope with the unbridled character of primary process by assigning to certain members roles that are designed unconsciously to contain and to metabolize those parts, both of the group and individual psyches, that group members, for defensive reasons, must reject. This group process occurs isomorphically throughout the layers of social organization, from society at large, down to small therapy groups.This paper is based on a presentation at the Washington Square Institute Conference on Madness, November 1988.     

Ethnicity, Culture, and Group Psychotherapy

Ethnicity and culture have great therapeutic import in the practice of group psychotherapy, especially given the increasing diversity of the population of North America, and this issue has not received appropriate recognition in the literature. In this paper these terms are defined, and the literature is reviewed. Ethnicity, culture, and psychopathology are discussed, focusing on treatment issues including transference, countertransference, resistance, group cohesion, group process, and multi-ethnic groups. The group therapist must be knowledgeable about ethnic and cultural issues in the lives of the group members in order to promote group cohesion and therapeutic effectiveness. The recognition and exploration of ethnic/cultural differences enhances the work of the group. Recommendations for treatment are discussed.     

The initiation and development of a group for relatives of patients with chronic emotional disorders

This paper describes the initiation and development of an educational discussion group for relatives of patients with chronic emotional problems and the process by which it became transformed into a group combining a self-help, modified therapy model with a primary focus on the members' interaction with their patientrelatives. The group offered the opportunity to ventilate pent up emotions in a supportive, reality-oriented context and provided information and education about the nature of emotional disorders. Generally this helped family members to effect positive changes in their interactions with their patient-relatives; to accept with greater understanding their relatives' illness; and to better evaluate the quality of treatment their relatives were receiving. The group chose this model over an educational model or traditional psychotherapy model or multifamily model, all of which were phases of this process. The positive results are supported by recent reports in the literature of similar groups.Formerly on the staff of The New Britain General Hospital Mental Health Clinic.     

Verbal Participation and Improvement in Group Therapy

The challenge of group treatment with ego impaired children is to provide a situation in which their maladaptive efforts to organize volatile affects and impulses can be tolerated and structured. This article addresses the process of culture building in group and how it can provide a cohesive structure for affective expression that is acceptable and tolerable to the defensive, resistant child. In particular, the author will argue that it is through the sense of normality and commonality engendered by indigenous peer culture that the members initially develop a structure and language for affiliation, play, and mutual identification. By facilitating the cohesion of indigenous peer culture, the therapist creates a sufficient holding environment to begin a dialogue involving both verbal and nonverbal communication. For children who are difficult to engage in discussion, let alone treatment, this dialogue is the essential process for creating a corrective emotional experience. Through a concise case study, the author describes the process by which the children's efforts to express and create their own culture are cultivated, managed, and understood.     

Sigmund Freud: Four Centenary Addresses by Ernest Jones

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their “typical” outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication.

Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.     

The Helping Process As Contractual

Virtually all counseling is governed by implicit contracts that define both the treatment goals and procedures and the client-counselor relationship. This article discusses the implications of both types of contracts for counselors, presents a rationale for making these contracts deliberate and overt, and suggests some guidelines for doing so.     

The Tempo of Verbal Interaction in an Open Therapy Group Conducted in Rotation by Three Different Therapists

This article examines the experience of new members joining an ongoing psychotherapy group. The group's stage of development and the new member's personality development are suggested to be important variables in this significant event. The experience of joining is found to share some things in common with the beginning phase of group for the group as a whole, but also noted are some unique elements. The process of joining is viewed as a highly anxious event for the new member, with antecedents in the individual's life experience. The new member is compromised by not knowing the group members, nor their shared history, norms, and dynamics. Concurrently, the group may experience a range of fears, wishes, and anxieties about the new member. Developmental considerations for the new member and the stage of group help to inform intervention strategies.     

Countertransference in the Group Psychotherapist

This report describes a pilot study of a waiting-list group (preliminary process group [PPG]) that provided treatment for applicants to a university affiliated, urban mental health center. All individuals on the treatment waiting list were informed of the PPG. This semistructured group, meeting weekly, began with members presenting their problems, followed by free discussion, and ending with goal setting for the next week. Approximately one seventh (35 out of 262) of the clinic's applicants during a 4½-month period chose to enter the PPG. They differed from those who chose not to particpate (wait list) by being older and less educated. Approximately 80% of both wait-list and PPG participants subsequently entered therapy. Significantly more PPG patients than those on the wait list entered group treatment. The PPG served clinic needs by providing prompt service for self selected individuals and by supporting the group therapy program.     

The impact of group psychotherapy on the self-image and self-feelings

Group psychotherapy is presented as an effective way of changing the self-image and self-feelings; the image of the self and feelings about the self being brought into awareness by the group process. After a brief review of relevant literature, group-specific experiences that affect the self-image and self-feelings are described. These include: the mirror phenomenon and triadic relationships; resonance; direct confrontations and challenges from other members; comparing oneself with, and differentiating oneself from, other members; and experimentation with new, different ways of relating to other group members. Some of the experiences of group members and, finally, the significant role of the therapist in this process are described.     

Large groups in treatment and training settings

A review of published work over the past decade and a half supports the effectiveness of the large group in clinical settings. Greater sophistication among practitioners has led to combining administrative, psychotherapeutic, and sociotherapeutic large groups and to the use of effective treatment teams and clearly defined contracts in inpatient hospital work. Some research findings suggest that large treatment groups are as effective as small therapy groups with some patient populations. There appears to be a movement toward convergence in the techniques employed by individual, small group, and large group therapists in practice, while not in theory. This positive trend in the mental health field may lead to more flexible practitioners.He is also on the board of the A. K. Rice Institute and a faculty member of the Cincinnati Psychoanalytic Institute. He would like to thank Walter Stone and Peter Herr for their comments and Lorna Volk for editing.     

Expectation of outgroup behaviour: can you trust the outgroup?

Outgroups are usually viewed with suspicion and expected to discriminate against the ingroup. The present study demonstrated that ingroup members attributed past discriminatory behaviour committed by individuals of unknown group membership more to outgroup members than to either ingroup members or members of a neutral group. In contrast, past egalitarian behaviour was attributed less to outgroup members than to members of a neutral group. Ingroup members also expected more discrimination from a future outgroup allocator than from a future neutral group allocator. Finally, the study showed that ingroup members' own behaviour in allocating money became more biased in favour of ingroup members vis-á-vis outgroup members when the future allocator was from an outgroup rather than from a neutral group and when they had witnessed the discriminatory behaviour of an allocator in the past.     

Cognitive and affective patterns of alcoholics: Implications for group therapy

Alcoholics bring unique problems with them into treatment. This paper reviews the research on their cognitive and affective patterns of behavior. These include a low expectation of success in interpersonal relationships, the use of denial, insensitivity to mood states, and faulty attribution patterns. These difficulties hamper the expressive dimensions of their relationships with others and manifest themselves in the group therapy setting. Recommendations for facilitating group cohesion and developing an agenda are presented. Also discussed are the interactional means by which the work of the group is done. The supportive interchange is noted as a method by which group members gain access to the deeper layers of each other. The remedial interchange is the interactional means by which group members challenge each other and resolve conflicts.     

Significant treatment factors in short-term group psychotherapy

The author briefly describes an approach to short-term group psychotherapy based upon an adult developmental model. By means of a clinical case example significant treatment factors are examined. Such an approach to planned short-term group therapy may force group members to confront and deal with important existential issues.     

Manipulation of Verbal Behavior of Chronic Hospitalized Schizophrenics in a Group Therapy Situation

This paper describes a semistructured, time-limited model of group treatment for latency age children. The members, all of whom came from reconstituted families, had a variety of reactive, somatoform, and characterological problems. With help from the therapists, each member constructed his or her own genogram which was then discussed by the group as a whole. Because this format incorporated a technique for mapping family structure into a traditional model of children's group therapy, it focused the group's manifest communication on changing family roles and relationships, both as they had occurred in reality and as they were symbolically reenacted within the group process. Feelings of shame, guilt, anger, and loss were markedly ameliorated as the group members studied the structure of their extended families within an environment which encouraged normative peer interaction and progressive emotional development. A brief review of the recent literature on time-limited, theme centered groups for children is included to provide a context for understanding the group.     

Group climate in a stress discussion group for medical interns

In order to better characterize group process, the short form of the Group Climate Questionnaire (GCQS) was used to study a stress discussion group for medical interns. This group was found to be significantly different from a normative psychotherapy group sample along three major dimensions: Engaged, Avoiding and Conflict. The group members were cohesive, involved and open, yet respectful of each other's privacy. These results are discussed with respect to the group's goals and leadership.The authors thank George Fein, Ph.D., for statistical assistance.