Three Phases of Treatment with Borderline and Psychotic Patients

Three distinct, yet overlapping, phases of treatment emerge when working with some borderline and psychotic patients. This are patients who test the ordinary limits of psychoanalysis, but can profit from its deep exploration. The first phase is colored by acting out, interpersonally and intrapsychically. An analytic envelope of containment is necessary to sustain the treatment. Interpretive holding and containing help the patient find a psychic receptacle capable of detoxifying violent projections. Many of these patients terminate prematurely. The second phase is centered around the patient's defensive use of the death instinct to extinguish or destroy certain parts of their mental functioning. This difficult standoff between parts of the patient's mind becomes replicated in the transference. The third phase reveals the more fundamental problem of paranoid～schizoid anxieties of loss and primitive experiences of guilt. These include fears of persecution and annihilation. Some patients abort treatment in the first or second phase and never work through the phantasies and feelings of loss. Nevertheless, much intrapsychic and interpersonal progress is possible. Given the instability and chaotic nature of these patient's object relations, the analyst must be cautiously optimistic in their work and realize the potential to help the patient even when presented with less than optimal working conditions.     

Selection of Patients for Group Psychotherapy

The concept of projective identification is reviewed, and its application to family and group systems is noted. Projective identification is then applied as a construct central to couples' groups, particularly useful in sorting out dynamics within couples, between couples, and toward the group-as-a-whole and its leader(s). Clinical examples are provided from a couples group co-led by the author, with indications of how this perspective on disavowal, interaction, and containment can be utilized therapeutically to provide a stimulus for intrapsychic and interpersonal change. The couples group offers a unique forum for working with projective identification, where this process presents a challenge to the therapist regarding the multiple levels from which to select appropriately and to “contain” skillfully.     

A Follow-up Study of Group Psychotherapy Patients

The usefulness and efficacy of group psychotherapy with a variety of adolescent problems has been well documented. Far less has been reported with respect to group treatment approaches for youthful depressives, however. Currently available treatments lack specificity, making replication difficult. Additionally, they often focus on a narrow range of deficit areas rather than addressing the multifaceted range of dysfunction characteristic of depression in adolescents. This paper critically reviews the available literature on group treatments with depressed adolescents, explores some of the shortcomings inherent in these reports, and suggests alternatives for future group protocols. It is proposed that subsequent interventions be manualized and that they target affective, behavioral, and cognitive aspects of adolescent depression. Such an approach would be more amenable to scientific investigation, replication, and comparison with alternative approaches.     

Group Psychotherapy and Rehabilitation of Long-Stay Patients

Abstract

Bulimia is a complex disorder that can significantly interfere with psychosocial functioning. It is a particularly significant problem among adolescents and young women in college and university settings. The preponderance of literature on group therapeutic approaches for this disorder is from a cognitive–behavioral perspective. In this paper, we present a psychodynamic group therapy approach for female university students, informed specifically by self psychological and relational frameworks. Through clinical illustrations, we demonstrate how the group provides selfobject experiences, including mirroring, idealizing, twinship, and adversarial experiences, and how the group becomes the arena through which group members can experience, express, and understand emotions. The interpersonal context of the group uniquely provides opportunities for members to examine their bulimic symptoms in relation to interactions that take place outside of or within the group.     

青少年抑郁症患者的团体人际心理治疗

青少年抑郁症患者的团体人际心理治疗是建立在人际心理理论基础之上,具有循证医学理论依据的心理治疗方法.它是将原本应用于治疗成人抑郁症的人际心理治疗理论和程序经过修正后应用于青少年抑郁症的治疗.实践表明,青少年抑郁症的团体治疗目标明确,实施领城广泛,具有校为明显的疗效和多方面的积极作用.但是该疗法仍然有许多未解决的问题,需要更进一步的理论突破和实务研究.     

Characteristics of the Group Process in Long-Term Psychodynamic Group Psychotherapy for Patients with Psychosis

This study aimed to investigate the development of the group process through group climate parameter dynamics during long-term psychodynamic group psychotherapy for 30 outpatients with psychosis. The group process in four groups was monitored using MacKenzie’s Group Climate Questionnaire-Short Form (GCQ-S) that was completed by the therapist after each session over the two-year period. The trends of engagement, avoidance and conflict parameters differed between groups, and no clear indicators of the development phases were found. The results suggested that these groups remained in the first developmental phase during the observation period, and highlighted the characteristics of resistance and difficulties in establishing social relations in patients with psychosis.