The Relation between Individual and Group Conflicts in Psychotherapy

Abstract

I describe three constellations of group life and group process: resistance, rebellion, and refusal. In resistance, an individual or group remains antagonistic to conscious but not unconscious thinking, the latter manifested in derivatives, including symbol and symptom formation, transference–countertransference, and enactment. Rebellion functions on the level of conscious thinking, manifested in challenge, defiance, and the possibility of sociopolitical action. The basic premises and values of the group and/or leader are at the center of the controversy, to be addressed on that level. Refusal establishes a mental boundary between what is considered appropriate and inappropriate. Unconsciousaswellasconscious processes of feeling, thinking, and meaning making are refused entry, left undeveloped, rejected, or obstructed. Working with refusal requires appreciating how and why the mind and its thinking operations are being suspended. The theoretical framework is applied to a case example.     

Comparison of Dreams in Individual and Group Psychotherapy

This article gives specific reasons and evidence why group psychotherapy is the treatment of choice for addictions. Utilizing object relations theory and the self-psychology of Kohut, the authors present a model of group psychotherapy that combines these perspectives with those of Yalom's interactional group psychotherapy. Agreeing with Kohut and other object relation theorists, the authors view addiction as a condition that is the result of a person's misguided attempts at self-repair because of deficits in psychic structure. Vulnerability of self is the consequence of developmental failures and deprivation. Substance abuse only exacerbates this condition leading to exaggerated difficulty in regulation of affect, self-care, and characterological pathology. Abstinence is usually required as the first step in arresting this process and establishing a treatment regimen that will allow the vulnerabilities of the self to be altered and restored. This article suggests that this recovery and treatment process is best accomplished in a group therapy setting that is conducted within the guidelines of the principles of object relations theory and a modified version of Yalom's interactional group therapy format.     

The Effect of Group Psychotherapy in Reducing Resistance to Individual Psychotherapy: A Case Study

Abstract

Cohesion in group treatment of spouse abusers plays an important and often overlooked role. Involuntary abuser groups can benefit from cohesion, but due to their unique structure, cohesion may develop differently than in voluntary psychotherapy groups. Initially, abuser groups may develop premature levels of cohesion that can make group members unwilling to express conflict, develop intimacy, and take responsibility for their actions. Understanding the abuser personality and the unique characteristics of involuntary abuser groups can shed light on why cohesion develops the way it does and the importance it plays in abuser groups. Developing effective interventions that target premature cohesion can help the group members express conflict, develop intimacy, and take responsibility for their actions, thus bringing about therapeutic levels of cohesion.     

个体心理治疗的复杂性

本文尝试从复杂适应系统理论的角度对个体心理治疗的复杂性加以阐述。依据复杂适应系统理论,心理紊乱并不必然是心理健康的敌人;在个体心理治疗的动力发展过程中,治疗师与来访者相互适应突现配对联盟,来访者的心理变化或新的心理结构的突现具有不可预测性;心理治疗的目标是使得僵化有序、封闭、适应不良的系统朝向日益复杂、开放、灵活适应的状态转化。复杂适应系统理论为探索人类的心理体验与发展提供了新的思路和方法。     

Clinical Expertise in Psychotherapy: How Expert Therapists Use Theory in Generating Case Conceptualizations and Interventions

Case conceptualization is a primary skill that may be the linchpin of clinical practice as it sets the framework for making sense of a patient’s difficulties and guides a path toward change. Providing meaning and structure to often ambiguous and nuanced clinical information, an apt case conceptualization facilitates the therapist’s complex integration of core therapeutic skills to produce expert performance. Rooted in the cognitive sciences literature on expertise, we introduce the concept of metabolizing theory to capture expert therapists’ capacity to use theoretical and clinical knowledge in an intuitive, flexible manner that responds and adapts to the unique and complex context of the treatment.     

Group Counseling and Group Psychotherapy with Rehabilitation Clients

An instrument designed to measure components of two distinct alcoholism aftercare treatments was developed and evaluated for reliability and validity. Trained judges reliably rated audiotaped samples of coping skills and interactional group therapy sessions. Coping skills groups engaged in significantly more education and skill training, problem solving, and role playing. Interactional groups showed more interpersonal learning, expression/exploration of feelings, and here-and-now focus. Groups that employed more education and skill training, less expression and exploration of feelings, and less her e-and-now focus were associated with fewer members reporting subsequent drinking-related problems. None of the ratings of group activities was related to abstinence.     

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.     

The Borderline Schizophrenic in Group Psychotherapy

SAGE is a group program developed for the community elderly. Groups led by professionals were compared to those led by the elderly, who were supervised SAGE graduates, and both of these groups of participants were compared to a wait-control group of elderly. A series of pre- and postmeasures on goal attainment scales and physical and mental health indices were used to evaluate the impact of the SAGE program. Professionally led groups had greater impact on improvement of mental health indices compared to the peer-led groups. These findings are discussed in the context of a framework used to analyze the differences between professionally conducted therapy, paraprofessionals, and peer-led self-help groups. Implications for the role of professionals in self-help are examined.     

An Introductory Course in Group Psychotherapy in The Netherlands: Use of a Knowledge-Sampling Test

Abstract

We offer comments regarding two articles in this issue, one titled “Bridging the Practitioner-Scientist Gap in Group Psychotherapy Research” and a complementary article providing the results of a survey, entitled “A Survey of Canadian Group Psychotherapist Association Members” Perceptions of Psychotherapy Research.’ We also make several recommendations for collaborative research between practitioners and scientists, such as the inclusion of clinicians on the research team, practice research networks, and improved approaches to communicating clinically relevant research findings. Also discussed are reflections and recommendations from the authors’ experience as scientist-practitioners.     

Transference,Catharsis, Insight and Reality Testing during Concomitant Individual and Group Psychotherapy

The authors argue that shame is a core issue for many men who assault their partners. Shame must therefore be addressed in treatment groups. This article outlines how one intervention, “the confession,” elicits shame and how that shame is negotiated through the various stages of group development.