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.     

Acting out in the treatment situation

More and more frequently the deficiencies and deprivations of early life are seen in the inability of patients to utilize psychic process to ameliorate conflict and painful affect. As a result, the tendency to act out anger and violent feelings in the external world in ways that are destructive and damaging is a prominent symptom. In the course of therapy, this somatic expression enters the treatment situation itself, often directed to the person of the analyst as the transference object. Understanding dynamics of what is actually being reenacted and using this information to convert somatic language to psychic process is the central focus of this paper. Acting out is defined and what places it apart from other pathological symptoms is described, along with associated ego functions, triggering mechanisms, affects, narcissistic and preoedipal factors, speech and symbolization, and stability and quality of mental representations. Acting out has been linked to somatization in recent years, and is understood as a defense against hostile wishes and impulses in an attempt to eliminate internal dangers from awareness. Treatment focuses on moving acting out into the realm of talking out, free association, dream interpretation, and interpretation in general with the proper timing in assessing the patient's ability to transfer experiences with early objects onto the analyst.     

On gratitude and gratification

Expressions of gratitude from the patient may be regarded by the analyst as a much-needed validation or affirmation of competence. The analyst's need for gratitude may be a relatively silent presence when things are going smoothly or when the analyst's efforts are openly appreciated by the patient. Ungrateful patients, however, are likely to force the analyst to confront his or her unconscious background wish to enact a longed-for mode of relatedness as part of the daily work of psychoanalysis. The analyst's wish for a specific form of object relationship involving a selfless, devoted helper and an appreciative patient who acknowledges having been helped may be thwarted by certain patients at every turn, knowing they are depriving the analyst of a particular form of gratification in their work. For patients of this type, failure may mean success. The implications of this particular form of clinical stalemate are outlined, and a clinical example illustrates some of the challenges encountered in psychoanalytic work with ungrateful patients.     

Affect and delay of gratification

Three experiments investigated the influence of positive and negative affect manipulations on children's preferences for small immediate versus large delayed rewards. Positive and negative affect were induced via verbal instructions to imagine happy and sad experiences. Elementary school children were randomly assigned to a control condition or to one of several treatment conditions consisting of two affect manipulations: a positive followed by a negative, the reverse, and (in the third experiment) two positives or two negatives. In some conditions (in the second and third experiments) measurement of delayed reward preference followed the first and second affect inductions whereas in other conditions (in the second and third experiments) measurement followed only the second affect manipulation. As predicted, negative affect subjects chose fewer large delayed rewards than did positive affect subjects during the first assessment (p < .02). At the second assessment, comparison among treatment and control conditions revealed the influence of a prior commitment effect which negated the potential influence of a second affect manipulation on preference for delayed rewards.     

Attraction and delay of gratification

The present study examined the degree to which differential attraction to the prizes could explain children's decisions in a delay of gratification situation. After rating the attractiveness of prizes, each child responded to four delay choice situations. While significant effects were obtained on only one choice pair, the results generalized to the other choices: nondelayers consistently perceived less discrepancy in attraction between the immediate and delayed rewards than did delayers. In general, the smaller discrepancy among nondelayers was due to a greater attraction to the immediate prize. As predicted, these results held only for “inconsistent” children and not for children who consistently delayed or did not delay across all four choices. The implications of this finding for trait-situation explanations of delay are discussed. While it was predicted that differential attraction would explain previously reported SES differences in delay tendencies, middle and lower SES children responded similarly, both in level of attraction to the prizes and actual delay behavior.     

Menstrual hormone changes and instinctual tendencies in dreams

Seventeen female college students completed dream questionnaires for every dream recalled over two menstrual cycles. Scales were devised to measure obvious and symbolic maternal and heterosexual dream content. Menstrual cycles were divided into follicular (progesterone-absent) and luteal (progesterone-present) phases for comparison within each subject. There were higher obvious and symbolic maternal scores in the luteal phase. It was concluded that hormones influence instinctual tendencies as expressed in dreams.