Comment on “The Angry Patient”

This article formulates the main problem of the angry patient treated by Dr. Curtis as one of poor ego functioning. This is possibly of neuropsychological origin. Treatment would be training to strengthen ego functions and the patient–therapist relationship would be task oriented. The anger is not dealt with directly except as it interferes with the training. It is predicted that as the ego becomes stronger, the anger will become more controllable. There is some question of whether this patient would be able to cooperate with such a program.     

The future of the American Group Psychotherapy Association: whither we goest?

The author describes his perspective about what the future holds for the American Group Psychotherapy Association (AGPA). Utilizing Nitsun's (1996) construct of the "anti-group" as an organizing metaphor, he delineates the destructive forces both within and outside the organization that are currently affecting it, and then describes how they can be transformed into instruments for positive development. He suggests that the AGPA can and must continue to provide a "holding environment" (Winnicott, 1960) for professionals interested in working with people in groups. In addition, he asserts that the organization will build upon its remarkable response to the September 11, 2001 debacle in the United States to expand its services to those who have been traumatized. Beyond this, he underscores the importance of the AGPA consolidating and expanding its various educational offerings into a coherent package that will meet the needs of any and all who are interested in learning about how to work effectively with groups. In these and other ways, he contends that the AGPA will thereby confirm Nitsun's assertion that anti-group forces can be transformed, and that organizations that confront these forces constructively can not only survive but thrive.     

Real Relationship: The “Something More” of Psychotherapy

Although it often operates silently, the personal relationship is a part of everything that transpires between therapist and client. Following the psychoanalyst Ralph Greenson's (1967) early lead, the term Real Relationship is used to capture this personal aspect of psychotherapy. It is divided into two elements, realism and genuineness; and both these elements are further divided into magnitude and valence aspects. Research on the real relationship is almost nonexistent, and to an important extent this is due to the lack of a reliable, valid, and convenient measure. The author is involved in a research project aimed at developing such measures from both the client and therapist perspective. Examples of items are provided.     

The Play’s the Thing: Improvisation in Group Psychotherapy

Study of improvisational theater suggests practices that can help us respond more fully in a therapeutic way. Improvisation is a powerful tool that emphasizes present-centered awareness and spontaneity. It helps us respond effectively to present moment processes, a key requirement for psychodynamic group psychotherapy. It enhances our ability to communicate with our patients when traditional interventions fail. Improvisation requires a readiness to play and a willingness to be open to the challenges of non-rational modes of relating. This article provides clinical examples of improvised group interventions.     

Adolescent Patients’ Responses to Interpretations Focused on Endings in Short-Term Psychoanalytic Psychotherapy

Discussing endings is a crucial part of the work of short-term psychoanalytic psychotherapy with adolescents, but there are different views on how best this should be done and whether it is helpful or appropriate to link endings to interpretations of the transference. This study looks at how adolescent patients suffering from moderate to severe depression respond to interpretations around endings in a 28-session long, manualized psychoanalytic psychotherapy. Data come from a randomized clinical trial in which all sessions were audio-recorded. Purposive sampling was used to identify four sessions with four different adolescents in which therapists raised the issue of upcoming endings, explored the patients’ emotional responses, and linked these to the transference. The four extracts were transcribed and analysed using conversation analysis. Findings show that patients either emphasized or diminished the importance of their relationship to the therapists and the consequences of the separation from them in response to transference interpretations. They managed the conversational exchange by either “trouble-telling” or “story-telling.” The authors reflect on the implication of patients’ responses for treatment technique and consider whether transference work with adolescents should be paced and adapted more flexibly in short term psychoanalytic psychotherapy.     

The Haunting of Men: Commentary on Thomas Burkhalter’s “Foregrounding Masculinities in Psychoanalytic Psychotherapy”

Thomas Burkhalter’s paper opens an important conversation about the fate of White masculinity in post-Apartheid South Africa. The commentary celebrates the nuance and complexity of the analysis but also suggests that social and historical context would deepen its reach. This concerns taking account of the ways in which the therapeutic moment described owes its formation to a historically and socially specific form of White liberal masculinity. The implications of this for women gendered as female are explored.     

Response to DiNunno's “Long-Term Group Psychotherapy for Women Who Are Survivors of Childhood Abuse”

Trauma impels people both to withdraw from close relationships and to seek them desperately. The profound disruption in basic trust, the common feelings of shame, guilt, and inferiority, and the need to avoid reminders of the trauma that might be found in social life, all foster withdrawal from close relationships. But the terror of the traumatic event intensifies the need for protective attachments. The traumatized person therefore frequently alternates between isolation and anxious clinging to others [Herman, 1992, p. 56].     

Difficult Days: The Continuing Evolution of Relational Group Analysis: Discussion of “Taking the Sting Out: Manifesting Aggression and Containing Difficult States in a Relational Group Psychotherapy”

Raufman’s paper is located in the ongoing integration of relational concepts into the world of group analysis. Raufman’s difficult days of therapeutic impasse in her group are regarded as emblematic of the theoretical bind that she and other group analysts find themselves in, caught between older, more classically based theory that inheres in much group therapy and theory and the recent embrace of relational concepts. An alternate reading of the group enactment is offered from the perspective of an unobtrusive relational group analyst with a focus on the conductor’s negative capability and capacity to companion the group’s organic psychological language and idiom in a process of enactive co-narration. It is suggested that when Raufman killed the wasp, the group finally found the vitalizing, enlivening, and companioning object in the leader, that it had been seeking all along.     

The Man of the House: Commentary on Thomas Burkhalter’s “Foregrounding Masculinities in Psychoanalytic Psychotherapy”

Thomas Burkhalter is complemented on so vividly bringing the reader into his personal struggles to find a true masculinity in the unforgiving context of contemporary South Africa where White masculinity is associated with apartheid. The struggle to be free of old identifications with the patriarchal order and gender binaries saturate the paper, and attention is drawn to the lingering presence of older conceptions of masculinity as a monolithic concept that leaves women as victims and nurturers and the male as dominant. Burkhalter’s clinical vignette is examined and found to illustrate well his struggle and to capture the vulnerability to genderized enactments and the enduring presence of the old order manifested by a reliance on defense analysis that constrains his construal of Mr. Jones’s statement that he is “after all the man in the house.” Potential alternative meanings of this phrase that foreground grief, hope, and a plea for companioning in pain are offered and a deeper engagement with Mr. and Mrs. Jones’s conscious and unconscious worlds is encouraged.