Small Groups: Studies in Social Interactions Edited by A. Paul Hare,F. Borgatta,and Robert F. Bales

Abstract

A large body of literature has supported the application of attachment theory to the understanding of psychotherapy. In addition, a more recent social psychological literature is exploring the application of attachment theory to the area of group dynamics and group process. The current study is designed to integrate these two distinct bodies of literature. In a preliminary fashion, we examined the relationship between group therapists’ group attachment styles and their assumptions and expectations of their patients’ attitudes about group psychotherapy. Seventy–six therapists completed the Smith, Murphy &; Coats (1999) measure of group attachment style. They also completed the Revised Group Therapy Survey (Carter, Mitchell, &; Krautheim, 2001) from the viewpoint of a typical patient they treat. As hypothesized, therapists with more group attachment anxiety assumed that patients would hold more negative myths and misconceptions about group treatment than therapists with less group attachment anxiety. The utility of a group attachment construct in future research and practice is discussed.     

Passion, Containment, and Commitment-Essential Elements of Groups Across the Lifespan in Bruce Springsteen's Work

Abstract The group, with its intensity, interaction, roles and dynamics, is an important unit of experience in everyday life, in psychotherapy groups, and in Bruce Springsteen's music. This paper explores experiences of and ideas about real life groups throughout the lifecycle through Springsteen's music, framed in concepts from a broad group literature including clinical psychology, social psychology, group psychotherapy, sociology, anthropology, and organizational psychology. The lifecycle includes adolescence and the role of the group to contain all its passions; the work world with its excitements and disillusionments; encounters with loss, and the holding power of the group; experiences of dissolution of the group, and possibilities for recommitment; and the passion and support of the group during celebrations. Themes of passion, containment, and commitment weave throughout the narrative.     

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.     

Group therapist as social scientist, with special reference to the psychodynamically oriented psychotherapist

The recent literature suggests a lowering of tensions between psychotherapy practitioners and researchers in the decades-long "psychotherapy war." The author analyzes reasons for the thawing and suggests that the time is ripe for clinicians to assume greater authority in the work of developing models of the psychotherapy change process. The article highlights the unique positioning of the psychodynamic group psychotherapist for advancing this work. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Money and psychodynamic group psychotherapy.

Money may be the most upsetting and therefore the most avoided topic in group psychotherapy. To overcome this resistance, the leader must secure prospective members' willingness to speak openly about financial matters. Financial issues particular to group therapy emerge when money is normalized as a topic for discussion. These include lowering or not raising fees, rescheduling, leaves of absence, combined and conjoint therapy, and nonverbal behaviors. Several case examples are provided. Members' strong feelings toward the leader around financial transactions often find expression in angry accusations. Suggestions for dealing therapeutically with countertransference reactions to these accusations are offered.     

Financial and Ethical Considerations for Professionals in Psychology

The profession of psychology is one of many entities affected by the current economic recession. The question of what to do when clients cannot pay agreed-upon charges will need to be answered. Ethical issues related to setting the fee for psychotherapy, insurance coverage, abandonment, pro bono psychotherapy, and lack of resources are addressed in light of the 2002 American Psychological Association's Ethical Principles of Psychologists and Code of Conduct and other relevant literature. The impact of the Mental Health Parity Act on the financial complexities that professionals in psychology now face is also discussed. Several recommendations are made for psychologists, calling them to be proactive in their communities, to be advocates for their clients, and to critically evaluate their financial practices.     

A Mother,A Baby,and Two Treatment Approaches: Discussing A Switch Case from CBT and Mentalization Perspectives

ABSTRACT

As the literature on perinatal depression and anxiety grows, there is an increased need for dialogue among theoretical approaches for mother-infant mental health. This article describes a community mental health program incorporating a range of treatment models for pregnant and postpartum women experiencing issues during the transition to parenthood. Perinatal distress can affect parenting practices, from breastfeeding to health care access, creating the need for targeted, practical, and concrete interventions. Interventions that aim to foster secure attachment relationships and mentalization capacities can also help increase maternal sensitivity and attunement and joy in caregiving, and reduce withdrawn/hostile behaviors that may be associated with perinatal distress. The article describes psychotherapy with a mother and her newborn that began from a cognitive-behavioral approach and transitioned to a psychodynamic mentalization-focused treatment. Working principles and examples of two additional components of treatment, a group psychotherapy and research measures, are discussed. The case helps demonstrate how attachment theory can inform treatment and build a bridge between alternative approaches.     

The masochistic personality organization: Dynamic,etiological, and psychotherapeutic factors

Individuals with a masochistic personality are both very common and very frustrating to work with in psychotherapy. The purpose of this paper is to introduce the reader to this complex personality style by discussing a brief history of the term, its dynamics, etiology, and techniques in psychotherapy. The paper combines theoretical material from the literature with personal clinical observations and specific techniques for psychotherapy with these individuals.     

The developing ego in group psychotherapy

Analytic group psychotherapy offers the potential for developing ego functions and enhancing identity formation. The nature of the interaction in group psychotherapy forces participants to deal with their perception of reality and revise their perceptions. After a brief review of the literature, focusing on the theoretical basis and ego development in analytic group psychotherapy, the paper discusses the following ego functions and gives an example of each: adaptation to reality, judgment, drive control, object relations (relationships with others), thought process and communication, defenses, affect differentiation, autonomy, mastery-competence, regulation of self-esteem, and frustration tolerance. The paper concludes with an example of assessing ego functions from a clinical vignette taken from one group psychotherapy session.     

Acting out in group psychotherapy

Acting out is a common occurrence in group psychotherapy. After a brief review of relevant psychoanalytic and group psychotherapy literature, this paper presents various kinds of acting out by the individual group members and the handling of such acting out by the therapist, discusses acting out by the group as a whole, and gives a brief overview of acting out by the group therapist. Specific examples are given of acting out and ways of dealing with it.     

Psychodynamic Group Therapy with Hispanic Migrants: Interpersonal,Relational Constructs in Treating Complex Trauma,Dissociation, and Enactments

ABSTRACT

This article introduces an interpersonal, relational approach to group therapy for Hispanic migrants with significant histories of violence, abuse, multiple losses, and recurrent trauma. Psychodynamic group psychotherapy may help to address trauma symptoms, insecure/disorganized attachment, grief, and isolation with newly arrived migrants. How the relational paradigm in group psychotherapy is contributing to current theories of complex trauma and dissociation is reviewed. Using this modality conveys the importance of examining trauma-driven enactments, dissociation and symbolization involving the members of the group, the group-as-a-whole, and the group leader. Clinical examples and group therapy interventions used to address powerful dissociative enactments are discussed.     

Psychotherapy: Definitions, Mechanisms of Action, and Relationship to Etiological Models

In this paper, we define psychotherapy as a modality of treatment in which the therapist and patient(s) work together to ameliorate psychopathologic conditions and functional impairment through focus on the therapeutic relationship; the patient's attitudes, thoughts, affect, and behavior; and social context and development. The possible mechanisms of action and active ingredients of psychotherapy in children and adolescents are discussed, with an emphasis on the above-noted domains. The adult psychotherapy literature strongly supports the central roles of the therapeutic relationship and therapeutic empathy; this has been much less intensively explored in the child and adolescent psychotherapy literature. Similarly, there have been few studies examining the mediation of treatment effects by impact on specific domains. Ideally, treatment studies should gather data that can be informative about the impact of putative mediating and moderating psychosocial and biological variables on outcome and course. The results of such studies can aid further refinements in both theories of etiology and improvement in treatments for children and adolescents.     

Researcher and clinician: Role conflict and resolution

Group therapy investigations are often conducted by researchers rather than by experienced clinicians who also possess research expertise. Given the fact that doctorally prepared clinicians must demonstrate research competence in their education programs, it is surprising that there is not more research on group therapy. The literature indicates that research and group psychotherapy practice are considered quite separate entities. However, there is much that both processes have in common. The principal investigator's experience during a group psychotherapy research project suggested that the conflict between the roles of researcher and clinician may not be due to differences in the external processes but rather to difficulties in trying to combine them within one person. The value of the researcher-clinician is elaborated, and recommendations are offered.This paper was supported by a grant from the Group Psychotherapy Foundation.     

Therapists' group attachments and their expectations of patients' attitudes about group therapy

A large body of literature has supported the application of attachment theory to the understanding of psychotherapy. In addition, a more recent social psychological literature is exploring the application of attachment theory to the area of group dynamics and group process. The current study is designed to integrate these two distinct bodies of literature. In a preliminary fashion, we examined the relationship between group therapists' group attachment styles and their assumptions and expectations of their patients' attitudes about group psychotherapy. Seventy-six therapists completed the Smith, Murphy & Coats (1999) measure of group attachment style. They also completed the Revised Group Therapy Survey (Carter, Mitchell, & Krautheim, 2001) from the viewpoint of a typical patient they treat. As hypothesized, therapists with more group attachment anxiety assumed that patients would hold more negative myths and misconceptions about group treatment than therapists with less group attachment anxiety. The utility of a group attachment construct in future research and practice is discussed.     

Modifications of Yalom's interactional group therapy model as a mode of treatment for alcoholism

As a result of a review of the literature and especially Brown and Yalom's (1977) clinical report, it is suggested that the preferred mode of treatment for alcoholism is group psychotherapy. The group's ability to provide support, structure and reinforcement for abstinence make it a powerful catalyst in the recovery process. In measures of time, efficacy and recovery, group psychotherapy generally succeeds where other treatment modalities frequently fail.     

Confronting death: Group psychotherapy with terminally ill individuals

A model for group psychotherapy with terminally ill patients is proposed, one in which the group is homogeneous and open-ended. Cancer and HIV infection are used as examples of chronic, terminal illnesses, and the relevant literature on group psychotherapy with these conditions is reviewed. Treatment with both sets of patients has been characterized by considerable variation in the structure, composition, and duration of the group. Being diagnosed with a terminal illness is traumatic and leads to denial, which may be adaptive or maladaptive depending upon its behavioral manifestations. The homogeneous, open-ended group encourages adaptive denial, which fuels hope and the will to live. The mechanism through which this occurs involves the unconscious identification with the group as an entity. This causes the emergence of a fantasy of a mother-infant dyad, within which can occur reworking of the depressive position. Scheidlinger, Turquet and Anzieu are cited to demonstrate this unconscious function of the group. Finally, clinical implications of such a model are highlighted.     

Cost Effective Assessment Models in Providing Patient-Matched Psychotherapy

Examined are various models of assessing cost-effectiveness in the use of psychological measures employed for screening patient pathology through psychological testing as a precursor to providing psychotherapy. Actual and simulated quality assurance studies are provided. The authors caution that cost-containment limited to financial incentives may have negative consequences for patient care. Systems analysis and program restructuring designed to better balance the service system through levels of care may be more clinically sound, and less costly. Clinical algorithms and critical pathways are discussed, as are recommendations that incorporate psychological testing services as an ingredient in providing contemporary psychotherapy.     

Group Psychotherapy Research Studies That Therapists Might Actually Read: My Top 10 List

Much like a bad marriage, the longstanding split between psychotherapy practitioner and researcher continues, each partner feeling unappreciated by and blaming of the other: Therapists are criticized for not reading research and, in turn, criticize researchers for their pursuit of studies that seem irrelevant to the clinical enterprise. In the present article, the author proposes that a shift in the design of psychotherapy research, away from pure outcome studies to models that focus on process, may serve to bridge the divide. Ten research designs exploring aspects of the process of group psychotherapy are illustrated from the recent literature, with the aim of furthering the dialogue between practitioner and researcher.     

Religious doubt,financial strain,and depressive symptoms among older Mexican Americans

A number of studies suggest that various positive aspects of religion help older people cope more effectively with stress. However, the literature further indicates that religion may have negative as well as positive influences in the stress process. This suggests that instead of enhancing coping efforts, religion may also exacerbate the effects of stress. The purpose of this study was to see if one negative aspect of religion (i.e., religious doubt) exacerbates the effects of financial strain on depressive symptoms among older Mexican Americans. A nationwide survey of 1005 older Mexican Americans was conducted. The findings suggest that the effects of financial strain on depressive symptoms are stronger for older Mexican Americans who have more doubts about religion. This study aims to contribute to the literature by assessing the negative aspects of religion with data provided by an ethnic group that has been largely overlooked in the literature.     

Crisis Theory and Therapeutic Change in Small Groups: Some Implications for Community Mental Health Programs

Abstract

The role of sibling dynamics in group psychotherapy has received relatively little attention in the literature. Our clinical experience suggests that sibling issues regularly arise in the practice of group psychotherapy. This article provides an integrative view of sibling relationships from a family systems and self psychology orientation to group therapy. Special emphasis is placed on developmental and cultural differences as they affect sibling dynamics and the group leader’s role. A number of case examples are offered to illustrate ways to view clinical challenges in a manner consistent with the influence of sibling relationships on group members and group process.