Commentary

Conclusion Self psychology has added several dimensions to working with difficult oral patients in group psychotherapy. Elucidation of selfobject transferences provides a new understanding of members' linkages to the therapist, to one another, and to the group-as-a-whole. The emphasis on the process of narcissistic injury and repair has shed light on subtle processes that precipitate provocative, self-defeating behaviors that are compatible with dynamic constellations subsumed under the rubric of oral character neurosis.Glatzer paved the way for further advances when she accurately began to explore many facets of these individuals' characteristic behavioral patterns and their underlying dynamics. She provided a sound treatment base, using available theory, for patients who had been previously thought to be unacceptable or untreatable in group psychotherapy.One of the challenges that lies ahead is development of satisfactory evaluation of our treatments. Unless we can begin to demonstrate that long-term treatment is necessary and that group treatment is cost effective, extended insurance support for these deserving individuals will disappear. If our dynamic formulations are accurate, these personality malformations are not amenable to brief interventions, although acute symptoms might be alleviated. In light of our current knowledge, significant change will only take place with extended treatment.