Medication dynamics in group psychotherapy

The use of medications in insight-oriented groups has not been adequately investigated. We report a group in which the anxiolytic buspirone appeared to be associated with attractiveness to the group in the face of impending therapists' termination. We feel that in this group, medications became a variable associated with group cohesiveness, served as a vehicle for the expression of group dynamics, and as an indicator of regression within the group. These observations suggest that, under certain circumstances, medications may become an important variable in the process and expression of group dynamics.They would like to thank Myron Pisetsky, M.D., for reading the original draft of this paper, and are also indebted to Daniel O'Neil, Ph.D., for his input.     

Sibling dynamics and group psychotherapy

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.     

The dynamics of individual resistance and techniques for handling these manifestations in group psychotherapy

The dynamics of individual resistance in group psychotherapy are described under two classifications: 1) extragroup-session resistance, and 2) intragroup-session resistance. The different kinds of resistances in each classification are explained and examples from group sessions are given to demonstrate each.The author acknowledges with thanks the editorial assistance and suggestions made by Aaron Stein, M.D., F.A.G.P.A., Clinical Professor, The Mount Sinai School of Medicine, C.U.N.Y., and Attending in Charge, Group Psychotherapy Division, Department of Psychiatry, The Mount Sinai Hospital, New York.     

Therapist authenticity in group and individual psychotherapy with college students

Summary The importance of humanistic qualities of the therapist as a crucial factor in counseling has been explored. Rogers had discussed the necessity for congruence between the counselor's techniques and his own personality. Counseling is far more than a skillful administration of techniques. It has been suggested that the counselor's honest emotional expression, and his ability to explore his own feelings of despair, joy, anger, anxiety, may well be the crux of successful group and individual encounters. As Truax (1968) has pointed out, the humanistic qualities of empathy, warmth and genuineness may span across all therapeutic approaches, psychoanalytic, client centered, behavioristic, eclectic, and therefore consciously or unconsciously be the primary determinant of therapeutic success or failure. The psychotherapy experiences described here suggest that maximum benefit from the psychotherapeutic experience, both for the student and the counselor, accrues when the counselor is open in expressing his feelings and not just encouraging the student's expressions of feeling.Read at the annual meeting of the American Society for Group Psychotherapy and Psychodrama, April 25, 1969.     

Medicine as metaphor and medium in group psychotherapy with psychiatric patients

A conceptualization is presented which encourages a renewed exploration of the way in which psychiatric patients discuss their medications in the group therapy setting. It is suggested that process-oriented group therapists tend to harbor subtle prejudices which may inhibit examination of this material. If we listen to medication-related discourse more carefully, we find that patients disclose important information about hopes and fears about treatment, self-efficacy, attitudes about control and authority, and other sensitive or disowned parts of experience. The process of interactions about medicines often reveals interpersonal difficulties, particularly around intimacy. Suggestions for intervening more effectively with this type of material are presented. The importance of medication attributions in revealing curative fantasies is discussed.     

Combined individual and group psychotherapy: guidelines at the interface

The development of combined individual and group psychotherapy is split between the "separationists" and the "integrationists" with regard to therapists' handling of the interface between the individual and group sessions. To bridge the impasse, a high-benefit--low-risk series of guidelines is offered for therapists that includes techniques for analyzing patients' "cross-references" to the other component modality. The four guidelines provide for a harmonious balance that preserves the confidentiality of the individual sessions vis-à-vis the group, while enhancing the group interaction rather than draining it. The therapist guidelines maximize patient initiative in integrating parts of the self expressed in the individual and group sessions, while employing the least intrusive methods necessary to best integrate the processes into a unified combined modality.     

Individual psychotherapy as an adjunct to group psychotherapy

This paper describes a form of combined psychotherapy in which the individual sessions are used as an adjunct to group therapy. Each group member is seen regularly in individual sessions to focus primarily on the member's ongoing group work. The individual sessions are scheduled on a rotating basis. Typically, each group member is seen in an individual session once every four weeks. Additional individual sessions are available only when immediate attention is appropriate and necessary. The group is viewed as the primary therapeutic component. A cost-effective therapeutic approach that uses both individual and group methods, this modality lends itself well to a clinic and to a private practice setting.     

Unity in duality: The synthesis of individual and group psychoanalytic psychotherapy

Contrary to the notion that individual and group therapy tap differing psychic functions, developmental levels, or therapeutic goals, in this paper the two modalities are seen as parts of an integrated whole, to be understood via the metaphorical and symbolic communications in each; each is a holographic reflection of the whole, the two together being internally consistent. Different levels of defensive operations may be observable in each, but taken together they reflect the entirety of the patient's psyche. The group's developmental level as well as the active use of this integrative approach by the therapist are also important. Clinical illustrations are presented.Paper presented at the Xth International Congress of Group Psychotherapy, Amsterdam, August 1989. The author acknowledges with gratitude the numerous invaluable contributions by Ms. Anna Aragno in the preparation of this paper.     

The ghost in the group room: countertransferential pressures associated with conjoint individual and group psychotherapy

Conjoint individual and group therapy is a commonly used, effective psychotherapeutic treatment. The relationship between the conjoint therapists significantly influences the treatment. This article examines countertransference dilemmas of the group and individual therapists arising from the real and fantasied conjoint relationship. Case examples illustrate specific countertransference dilemmas. Therapists are encouraged to consider the possibility of difficulties with each potential conjoint treatment. Consultation and supervision are recommended to help the conjoint therapists identify and manage countertransference pressures.     

Complications in group psychotherapy with AIDS patients

AIDS has a unique set of characteristics that makes group psychotherapy more complex than with other populations: (1) the threat of an early death, (2) a highly variable course of illness, and (3) stigma related to the illness and to the preexisting lifestyles of most patients. The specific ways in which the three factors seriously interfere with establishing and maintaining group cohesion are discussed, and clinical guidelines are suggested. In addition, a model for understanding and working with these and other issues in group psychotherapy, based on Erik Erikson's interpersonal theory of development, is presented. Finally, particular countertransferential difficulties are discussed in relation to the heightened emotionality common to AIDS psychotherapy groups.