Differential Reactions of Patients Receiving Group Psychotherapy with Concomitant Somatic and Drug Therapies

The embeddedness of combat aggression, violence, survival, and antiauthority dynamics in the psychic organization of Vietnam veterans in groups shape the treatment enterprise. Inherent in treatment interactions and dynamic processes of the Vietnam therapy group are the reactivations of Vietnam-historical reenactments. These involve strong affective reactions toward superiors and toward fellow combatants (“grunts”), with an attendant sense of group danger, unconsciously reminiscent of Vietnam's guerrilla war terrain. This paper notes that because of the tendency of the group to repeat actual events (as opposed to fantasied events), these groups require divergent conceptualizations and technical management. An innovative model comprising a series of developmental phases is presented. This model, called “the curvilinear regressive-progressive model” of treatment with Vietnam veterans, focuses on both peer- and leader-centered dynamics in working through guilt-driven defenses in members. The leader plays a pivotal function in monitoring levels of affect tolerance in the group, and is expected to manage countertransference reactions, and to have sensitivity to the effects of combat stress on self structure. As the Vietnam therapy group members relive the history of the Vietnam conflict in the group, the leader utilizes a flexible, phase-sensitive system of interventions to reactivate arrested development by creating a healing climate where developmental tasks can be mastered and integrated by group members.