Some Aspects of Group Dynamics

The authors examine the nature of the relationship between the group members and the group therapist and discuss the reasons underlying therapeutic frame failure. It is argued that competing viewpoints concerning the nature of the therapeutic relationship in group therapy have eventuated in problems in articulating a generally accepted frame definition. The authors propose a formulation of the frame for long-term groups that embraces therapist anonymity, total confidentiality, and neutrality. Finally, instances of frame violation are viewed as stemming from the therapist's need for objects, the attempt to forestall various types of transference, and the need to provide an avenue for the therapist's narcissism. Clinical material is used to illustrate group members' responses to therapist-induced frame failures.     

A Japanese Perspective on Client Inaction: Removing Attitudinal Blocks Through Morita Therapy

Seven self-defeating attitudinal factors contributing to client inaction and procrastination are discussed from the Morita therapist's perspective. Morita therapy is briefly described, and ways of facilitating desirable action and reducing self-preoccupations are suggested. The suggested approach challenges the client's assumption that resisting and removing the unwanted feelings and imperfect psychological conditions is a prerequisite for implementing necessary action. The counselor's reinforcement of clients' mood-governed action style is also discussed as a factor contributing to the client's inaction.     

Spontaneous Personality Synthesis in Group 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 clarify 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.     

Psychotherapeutic work with refugees: Understanding the therapist's countertransference

Abstract

Most therapists are chosen to work with refugees because they speak the language or come from the same cultural or racial background and/or have had experiences which resonate with those of the client. They are often people who can easily understand the clients' experiences, which creates interesting and potent therapeutic dynamics. They can offer a great deal of support to the person, but often with the high risk of over-identification. This paper is an attempt to examine from the therapist's perspective the complex dynamics involved in working with refugee clients. It is a collection of thoughts and feelings expressed in psychotherapeutic and supervisory work by different types of refugee mental health workers. It is an attempt to understand the therapeutic relationship further by focusing on the therapist's psychological response to the client. The paper will outline briefly some of the common themes reported by refugees, but the primary aim is to focus on the therapist's countertransference feelings. Countertransference in this context is defined as a personal psychological response, as well as consisting of socio-political components.     

Love in the counter-transference: The uses of the therapist's excitement

SUMMARY

The psychoanalytic tradition has always had difficulty with the question of the therapist's sexual feelings toward the patient. This paper traces that difficulty: from Freud's original struggle to replace moralism with a psychoanalytic mode of understanding, to the more recent literature on countertransference which still seems particularly averse to the possibility of the therapist's sexual experience. By way of a discussion of a psychoanalytic psychotherapy, I argue for the sometimes central therapeutic role of the therapist's experiencing, and then containing, excitement.     

‘The Ancient Cult of Madame’: when therapists trade curiosity for certainty

An experience in which the author followed his own objectives rather than the patient's, leading to a tragic end, is evoked as a frame for the presentation and discussion of a family treatment where the therapeutic process led by the therapist may have exceeded the needs and expectation of the family members. This is followed by a discussion about potential problems caused by a therapist's fascination for family stories, since its effects may be epistemologically discontinuous from, if not contradictory to, Cecchin's recommendation for ‘curiosity’ as a central dictum of the therapist's stance.     

Reply to Panel Follow-up Questions

When both therapist and client share a traumatic event, there are multiple levels of vulnerability to traumatization for the therapist. Our personal vulnerability is not only a backdrop for our clinical work but also an acknowledged fact in many therapeutic relationships, a situation that changes the frame of the work. In addition to clinical challenges, shared trauma increases a therapist's vulnerability to vicarious traumatization; VT is defined as the negative transformation of the therapist's inner experience as a result of his or her empathic engagement with and responsibility for a traumatized client. Emphasizing the importance of awareness, self-care, meaning, and community, the article summarizes important steps to anticipate, address, and transform the therapist's experience of vicarious traumatization.     

A Psychotherapist's Reaction to His Patient's Death

ABSTRACT: A case history of a patient who died during the course of psychotherapy is initially presented in the form of an essay. Three therapeutic points (one related to the therapist's awareness of his anger toward the patient) are focused on in regard to working with the dependent, suicidal patient: the importance of being in touch with one's own anger toward the suicidal patient; the need to vary one's attitude and approach toward the dependent patient as he travels through different emotional phases; the importance of promptly involving significant friends and relatives in close observation of and relating to the acutely suicidal person. The emotions and psychodynamic factors in the author and other psychotherapists in response to the death of a patient are then examined, with particular emphasis on the therapist's allowing himself to mourn the personal loss.     

Trips as a Treatment Tool in Activity Group Therapy

The authors provide an overview of the growing body of literature on women's groups and then report their own experience with such groups. Their main focus is on a transference-countertransference constellation that becomes the central area of resistance, interpretation, and therapeutic change. They argue that the group participants engage in a collusion to expose what they believe is the therapist's incompetence and then console her for it. This dynamic is conceptualized as a projection of the devalued self-representation. The dynamic of devaluation and the enforced symbiosis tend to evoke powerful countertransference feelings in the therapist. The authors discuss interventions to work through these issues. This article is subsequently discussed by members of the Editorial Committee of the Journal.     

Improving our understanding of therapeutic failure: A review

This paper argues the need to consider carefully the phenomenon of therapeutic failure in counselling and psychotherapy. The scant literature on therapeutic failure is reviewed, this literature suggests that there are large individual differences in therapists' overall effectiveness. A conceptual model of therapeutic failure is proposed, organized around the assumption that failure results from a therapist's inability to meet the needs of a particular client. Suggestions aimed at reducing the likelihood of therapeutic failure are offered.     

The Edge of Chaos: Enactment,Disruption, and Emergence in Group Psychotherapy

The author outlines his approach to the theory and practice of group psychotherapy. The emphasis is on therapy by the group rather than therapy in the group. The therapist's task is to help the group itself become the agent of change. The group is conceived as being composed of many multiple selves. The process of group psychotherapy unfolds through enactments that involve the whole group and the group therapist entering into the grip of repetitive and unmentalized self-states. These enactments are resolved when the group members, with the therapist's help and containment, can access alternative self-states that allow for new and unformulated experience to emerge. This dialectical movement between the rigid “familiar chaos” of enactment and the reflective and related working through is compared to the dynamic systems theory articulation of the tension between rigidity and chaos captured by Kauffman's notion that “life exists at the edge of chaos.” A group session is described that involves a painful enactment. It illustrates how the therapist allows the enactment to unfold by holding and containing intense affect and how the group members are helped to find their own meaning and new experience in interaction with each other.     

Overcoming My Model of Goodness as a Psychotherapist

Summary

The case of Tina is presented to examine one therapist's countertransference issues with a female client who had features of a Borderline Personality Disorder. The therapist's emotional reactions to this client's raw expression of anger and frustration are explored. The discussion also emphasizes the struggle of the therapist in resolving her discomfort with this client and in setting therapeutic boundaries.     

The function of the therapist's affect in therapeutic conflict in groups

Group psychotherapy theory and technique are presented with the goals of helping group practitioners working with difficult clients: 1) develop a treatment plan; 2) create a therapeutic alliance; 3) foster a responsive group climate; and 4) utilize the therapist's countertransferential reactions in dealing with therapeutic conflict. Historical modifications of the analyst's role in the development of group psychotherapy are noted. Emphasis is give to the recognition of therapist-client identifications in order to separate feelings induced in the therapist from countertransferential reactions, to enable the practitioner to respond appropriately to the affective and inspirational substratum of therapeutic groups.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

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.     

Spitting,kicking and stripping: technical difficulties encountered in the treatment of deprived children

The technical difficulties posed for the child psychotherapist working with children who have themselves experienced violence and abuse are addressed. A distinction is drawn between violence in the service of communicating about such experiences and violence that arises from more perverse aspects of the patient. The therapist's need to pay close attention to his counter-transference is emphasized. From an example of a single session we see the therapist's struggle to receive the communicative aspects of extreme acting-out behaviour at the same time as creating a safe setting in which thinking can take place.     

The Group Therapist's Absence and the Substitute Leader

When a group is led by a single individual the therapist's absence creates a management problem. This article presents several options for the solo leader. The author has used a substitute leader, and this experience is presented and evaluated. Discussion includes selection of a substitute, group preparation, ongoing use of the substitute, and benefits of this alternative for the management of the leader's absence.     

Freud

The author explores the evidence-base and selection criteria for a short-term supportive dynamic approach for patients whose psychological mindedness and quality of object relationships is low. Illustrating this approach with a case example he outlines the central features of Supportive Dynamic Therapy. He describes a psychodynamic conceptual and developmental framework that can be used to guide the therapist's interventions and responses, and modulate the patient's anxiety. A dynamic focus presented in the form of a central issue is shown to have a significant function both in containing the patient's anxiety, and in giving shape to the therapist's efforts to support the patient's ego-strengths and adaptive abilities. The therapeutic work can be seen to result in an alteration in the trajectory or reiterating pattern of the patient's life.     

Counsellors’ and psychologists’ experience of working with male survivors of sexual trauma: a pilot study

A qualitative study was undertaken to enhance awareness of the therapeutic needs of the male survivor of sexual trauma through exploration of counsellors’ and psychologists’ experience of working with this client group. The participants were 32 counsellors and psychologists who work for an NHS Trust department. Interpretative Phenomenological Analysis was used to analyse the data which was gathered by means of a postal questionnaire. Six categories emerged from the analysis that highlighted prevalent experience. These were: (a) that the therapist's gender was important, (b) professional concerns, (c) the importance of the relationship, (d) transference/counter transference, (e) that male and female abusive experiences are the same and (f) attention to client's presenting problems. The main conclusions derived from these results and implications for practice are considered.