Analytic Group Psychotherapy Research Articles

Group analytic therapy for compulsive users of internet pornography

Increasing numbers of patients presenting problems with internet pornography have led to changes in the culture and practice of group analytic therapy at the Portman Clinic. The addictive element of this new form of artificial, sexual stimulation has to be recognised as part of the harm it produces. Group members spontaneously develop some of the principles and practice of established methods of addiction treatment, especially the 12-step programme, by helping each other manage their compulsion. This self-help function of the group coexists alongside the psychodynamic perspective, in which the meaning of harmful sexual behaviour is explored and understood. Certain individuals are more vulnerable to excessive use of pornography because of early developmental problems and current difficulties in their sexual relationships, resulting from internal conflicts about their sexuality. The group provides intimacy without sexualisation, primarily through a sibling transference. The therapist embodies an ability to think about the complexity of the sexual abuse that the pornography portrays. He or she works towards a truer perception of reality for group members, in which the false solutions of compulsive sexual behaviour are seen to be what they are: impediments to healthy development.

Group analysis and eating disorders: a study of the therapeutic impact of group-analytic psychotherapy on women suffering from anorexia and bulimia nervosa

Group analysis and eating disorders: a study of the therapeutic impact of group-analytic psychotherapy on women suffering from anorexia and bulimia nervosa

Analytic versus systemic group therapy for women with a history of child sexual abuse: 1‐Year follow‐up of a randomized controlled trial

This randomized prospective study examines durability of improvement in general symptomatology, psychosocial functioning and interpersonal problems, and compares the long-term efficacy of analytic and systemic group psychotherapy in women 1 year after completion of treatment for childhood sexual abuse. Women (n = 106) randomly assigned to analytic or systemic psychotherapy completed the Symptom Checklist-90-R, Global Assessment of Functioning, Global Life Quality, Registration Chart Questionnaire, and Flashback Registration at pre-treatment, post-treatment, and at a 1-year follow-up. Post-treatment gains were significant for both treatment modalities on all measures, but significantly larger after systemic therapy. Significant treatment response was maintained 1-year post-treatment, but different trajectories were observed: 1 year after treatment completion, improvements for analytic therapy were maintained, whereas they decreased after systemic therapy, resulting in no statistically significant difference in gains between the groups at the 1-year follow-up. Despite maintaining significant gains, more than half of the patients remained above cut-off for caseness concerning general symptomatology at post-treatment and at 1-year follow-up. The findings stress the importance of long-term follow-up data in effect studies. Different trajectories were associated with the two treatments, but improvement in the two treatment groups did not differ significantly at the 1-year follow-up. Implications of the difference in trajectories for treatment planning are discussed. Both analytic and systemic group therapy proved efficient in improving general symptomatology, psychosocial functioning, and interpersonal problems in women with a history of CSA and gains were maintained at a 1-year follow-up. Despite maintaining statistically significant gains at the 1-year follow-up, 54% of the patients remained above the cut-off for caseness with respect to general symptomatology, which may indicate a need for further treatment. Different pre-post follow-up treatment trajectories were observed between the two treatment modalities. Thus, while systemic group therapy showed a significantly better outcome immediately after termination, gains in the systemic treatment group decreased during follow-up, while gains were maintained during follow-up in analytic group therapy.

Group Analysis and Eating Disorders: a study of the therapeutic impact of group-analytic psychotherapy on women suffering from anorexia and bulimia nervosa

The therapeutic evolution of two women, one with anorexia nervosa (AN) the other with bulimia nervosa (BN), which took place for three and two years respectively in a heterogeneous once-a-week slow-open group-analytic group, was analysed. The group was conducted following modified group analysis by integrating cognitive-behavioural, psychoanalytic and object relations perspectives. Results indicated the elimination of two patients’ anorexic and bulimic episodes and a better integration of their bodily image and self due to the introjection of the group conceived as a good enough mother or selfobject mainly on its archaic and projective stages on pre-Oedipal level. However, both patients had difficulties with the group’s mature reality stage and the phase of termination on Oedipal level, linked with separation-individuation processes and mourning, and terminated early by preparing a brief farewell (BN) or by interrupting (AN). The implications for further investigation of the group analysis of eating disorders were discussed.

Hope, Envy, Illusion, and Reality in Analytic Group Therapy: An Essay and a Vignette

In this article, the author discusses some ideas about the process of hope in relation to envy and illusion and hope's contextual position within “reality” in the analytic group therapy experience. He presents some thoughts on hope, envy, and illusion and then gives a clinical example of their dynamic appearance and treatment in a clinical group.

‘Make sure you keep our house safe!’ Thematic analysis of a children's psychotherapy group

This paper describes a systematic thematic analysis of one particular latency-aged children's group and includes a discussion about potentially helpful outcomes measures. The impetus for our small, practice-based qualitative research project came from the two papers by Reid (1999) and Canham (2002) about children's psychotherapy groups, particularly Canham's (2002) paper, ‘Group and gang states of mind’. Canham and Reid used Bion's theories of group functioning as the basis of their technique with children's groups. We felt that it would be an interesting follow-on from Reid and Canham's findings to explore in some detail the specific therapeutic factors involved in a shift from paranoid–schizoid to depressive functioning in group therapy. We hoped that this might give us some helpful clinical indications as to the circumstances in which group rather than individual psychotherapy and parallel parent work should be considered as the treatment of choice. The paper concentrates exclusively on group work with latency-aged children, therefore referring mainly to the limited number of papers published about psychoanalytic group therapy with this age group.

Gruppenanalytische Praxis heute: relationale und intersubjektive Perspektiven

Charakteristika, Probleme aber auch Chancen ambulanter analytischer Gruppentherapie werden diskutiert. Der Autor arbeitet heraus, wie gerade die Gruppentherapie eine wichtige Antwort auf die Probleme heutiger Patienten im Bereich von Bindung, Liebesfähigkeit, Selbstwert und Sinnfindung darstellen kann. Moderne intersubjektiv-relationale Theorien berücksichtigen diese Problemkonstellation in besonderer Weise und stellen gleichzeitig eine essenzielle Weiterentwicklung der psychoanalytischen Theorie dar. Das intersubjektive Paradigma kann eine Brückenfunktion zwischen den verschiedenen psychoanalytischen Schulen übernehmen und lässt sich gleichzeitig sehr gut mit bekannter gruppenanalytischer Theorie, insbesondere Foulkes´scher Provenienz verbinden: Sowohl in der Einzelsituation als auch in der Gruppe ergibt sich ein dynamisches, von Patient(en) wie auch Analytiker geprägtes Feld, das die Wiederholung der pathogenen Erfahrung und gleichzeitig deren Überwindung in neuen Objekterfahrungen ermöglicht. Zentrale Konzepte dieser Theorie werden vorgestellt und anhand von Fallvignetten aus analytischen Gruppen veranschaulicht.

‘The Bad Enough Group Analyst’: Authenticity and Emotional Responsiveness in Group Analysis’. A Response to Farhad Dalal’s Foulkes Lecture

The group can be a moral place only if it can contain moral challenges. For this, the group needs a sort of freedom to relate in which the group can move between poles of injury and regret, and between impassivity on the one hand and concern on the other. The emotional involvement of the all members with each other is a pre-condition for the ethical situation of the group. Emotional responsiveness entails authenticity. The authentic expression is spontaneous and unexpected (Nitsun, 1996). Sometimes it is impulsive, emotional, enacted and surprising. It can break through blockages of withholding. An authentic expression can be loving or hurtful. In group analytic psychotherapy, it is not only the excessive responsiveness of the therapist to the weakness and the suffering of the members which is the therapeutic factor. When each member is attuned to himself and to the other, the group fulfils its most important therapeutic quality. In this article I suggest that in order to develop these strengths the therapist must be able to be a ‘bad enough’ therapist with the group members. It would be better to claim that therapist non-responsiveness is necessary for the formation of the group, as a body which gives meaning to each one of the participants. In a certain way it invites each of the members to be present and in another way it creates a situation in which the members are nearly forced to be present through the responsiveness of each of them in the lack of a satisfactory individual response of the conductor. I suggest that the analyst’s authentic response corresponds with what Dr. Dalal calls ‘emotional responsiveness’. This is in fact the ‘bad enough participation’ on the part of the analyst, which leads to a breakthrough in the therapy. The morality of the therapist is expressed in his willingness to move from the neutral analytic position and see himself as a reason for part of what is going on in the group.

Bipolar Affective Disorders and Group Analysis

Group-analysis historically developed from psychoanalysis but it added a multipersonal or social dimension, which is important in the understanding and management of patients suffering from bipolar affective disorders—as they often experience significant relationship difficulties. There is empirical evidence that homogeneous therapy groups for bipolar patients are beneficial, particularly those using psychoeducational and integrative approaches. There is additional evidence from process and case studies research that bipolar patients can benefit from group-analytic psychotherapy. However, the group conductor has to work harder than usual to make the group into a therapeutic tool. This may require that the therapist is especially vigilant on boundaries and limit setting. Transference interpretations may need to aim at translating the, at times, difficult behaviour of the bipolar patient into the language of interpersonal problems. This article includes clinical material from a heterogeneous analytic group, which was pushed to breaking point by a 40 year-old bipolar patient.

The Analytic Group as an Arena for the Resolution of Shame

Although shame has been extensively explored in recent psychotherapeutic literature the role of shame in group analysis as described by Foulkes remains unclear. Based on a narrative literature review conducted for a master’s degree (Rathbone, 2010), the author draws together theory and evidence and explores its relevance to the practice of group analytic psychotherapy. She argues that the social nature of the original trauma and the particular configuration of the analytic group gives it the potential to be an ideal arena for a reparative ‘good enough’ experience of attunement and thus for resolution of shame-based psychopathology. She concludes that this may be considered an additional therapeutic factor alongside socialization, mirroring, activation of the collective unconscious and exchange, which Foulkes identified.

The ‘Impossible’ Group: an Experience of Long-term Group Analytic Psychotherapy for Autistic People

This work describes an attempt to challenge the prototypical isolation of autistic individuals with the psychotherapeutic group. The challenge is to group people who avoid people, either because of constitutional deficits or due to a life-long history of deficient approaches to their specific patterns of interaction. Here an account of a successful intervention of group analytic psychotherapy will allow a better evaluation of the potential of the group as a therapeutic means of helping severely disabled individuals to live better lives.

Can the Clinician–Researcher Gap be Bridged? Experiences from a Randomized Clinical Trial in Analytic/Dynamic Group Psychotherapy

This article describes how four seasoned clinicians and group analysts working in public mental health services, experience their participation in a randomized trial of short-term versus long-term analytic group psychotherapy (20 or 80 sessions). The design makes it possible to integrate the research with regular clinical practice, and participation gives the institutions the opportunity to fulfil obligations of doing research, that are imposed on the Community Mental Health Centres. The experiences are mainly described from the clinicians’ position, but some comments from the research director are included. The collaboration across approximately five years is found to be interesting and rewarding. Based on the assumption that further steps are made to strengthen and develop the qualitative aspects of such projects, the clinicians recommend such collaboration as a feasible and useful way to build and maintain a bridge across the gap that too often seems to separate researchers and clinicians. This is assumed to be profitable for everyone involved, not least the patients.

P-1157 - Group milieu in systemic and analytic group therapy

A recent meta-analysis also concluded that psychotherapeutic approaches are beneficial for adult with a history of CSA and maintained for at least six months follow-up. The results suggest that different characteristics of therapy moderate the therapeutic outcome. We found in a randomized study of systemic versus psychodynamic group therapy, that the short-term outcome for patients who received systemic group psychotherapy was significantly better than the outcome for patients who received psychodynamic group psychotherapy. The current study assessed the group milieu in both groups. This randomized prospective study included 106 women: 52 assigned to psychodynamic group psychotherapy and 54 assigned to systemic group psychotherapy. The Group Environment Scale (GES) was filled in the mid phase of therapy and analysed in three dimensions and 10 subscales. The systemic group was characterized by statistically significant highest scores on Relationship (ES = 1.27) and System Maintenance / Change Dimension (ES = 1.08), while the scores for Personal Growth Dimension were comparable in the two groups. Group S had statistically significant higher scores on the following subscales: Cohesion (p < 0.05), Leader support (p = 0.001), Expressiveness (p < 0.001), Task Orientation (p = 0.01) and Order and Organization (p < 0.001). Substantial differences in the group milieu were seen. The systemic group turned out to be evaluated as the most structured therapy and also to be most supportive of expressiveness. The results will be discussed according to the therapeutic philosophy.

P-1137 - Efficacy of specialized incest group psychotherapy in reducing symptoms of PTSD: 5 year follow-up of a randomized trial

Objectives Several studies have found that women who have experienced child sexual abuse (CSA) develop Post-Traumatic Stress Disorder (PTSD) related to their victimization experiences. The current study evaluated the presence of PTSD symptoms five years after discharge among adult women suffering from sequalae from CSA. Methods This randomized prospective 5-year follow-up study included 106 women: 52 assigned to psychodynamic group psychotherapy and 54 assigned to systemic group psychotherapy. PTSD symptoms were evaluated at baseline, discharge and 1 and 5 years after discharge, using the crime-related post-traumatic stress disorder scale (CR-PTSD) from the Symptom Checklist-90-Revised (SCL-90-R). ANOVA was performed using treatment group as a between factor and the four time points as repeated measures. Results PTSD symptoms were significantly reduced during therapy for both groups (P 0.005). No difference in reduction of PTSD symptoms was found between groups at 1 and 5 year follow-up. Conclusions Symptoms of PTSD were reduced in women with a history of CSA participating in both analytic and systemic specialized incest group psychotherapy. Improvement was maintained for both groups at 5-year-follow-up. The trajectories of PTSD symptoms for the two groups differed significantly, however. Implications of the difference in trajectories for treatment planning will be discussed. The findings in the present study stress the importance of long-term follow-up studies in evidence-based research.

Peers and Siblings: Their Neglect in Analytic Group Psychotherapy

Peers and Siblings: Their Neglect in Analytic Group Psychotherapy

Introduction to the Special Issue

GROUP, Vol. 35, No.4,Winter 2011 Introduction to the Special Issue JohnCaffaro1 Ithas takenmanyyearsforourfieldto understand whatsiblings meanto one another. Morethan65years(roughly 1890-1955) passedbefore themodernfield ofpsychotherapy acknowledged thefullimpact ofthefamily onthedevelopment oftheindividual, although references tofamily influence werealways present in thepsychoanalytic literature. Oncefamily therapy begantomakeheadway, itwas almost another 30years (1955-1982) before theimportance ofsibling relationships wasmorefully developed byBankandKahn(1982). Specific references totheimportance ofsibling relationships anddynamics tothe theory andpractice ofgrouppsychotherapy weresimilarly absent from theliterature . A comprehensive search ofthecontents oftheInternational Journal ofGroup Psychotherapy from theyear1980through 2003revealed onlyfour articles directly related tosibling issues.Oneofthoseearly papers(Rabin, 1989)hasbeenreprinted with permission inthisvolume. I willsaymoreaboutthisseminal paperlater. A bodyofliterature hasemerged overthepast30years that provides clearand convincing evidence that brothers andsisters havea majorinfluence onhuman development andbehavior (Bank& Kahn,1997; Brody, 1996;Caffaro & Conn-Caffaro, 1998; Dunn,1988; Schachter & Stone, 1987; Whiteman & Christiansen, 2008).Despite this knowledge, a prevailing buterroneous biasthat parents andpeersmatter more continues tokeepsiblings andsibling dynamics ingroups invisible. Fewgraduate programs inclinical psychology orsocialworkoffer substantive training inadult sibling dynamics. Asa result, many group psychotherapists areunderprepared tohelp group members copewith thecomplexities oftheir bondswith sisters andbrothers. Nonetheless, clinicalexperience suggests thatsibling issuesregularly ariseinthe 1 Distinguished Professor, California School ofProfessional Psychology, Alliant International University, Los Angeles, and private practice, DelMar, California. Correspondence should beaddressed toJohn Caffaro, PhD, California School of Professional Psychology, Alliant International University, LosAngeles, CA91803, E-mail: jcaffaro@alliant.edu. ISSN 0362-4021©2011 Eastern Group Psychotherapy Society 273 274 CAFFARO practice ofgrouppsychotherapy. Grouptherapy offers anarray ofpossibilities for clients tointeract with leadersandmembers asthey onceinteracted with brothers andsisters. Sibling re-creations orfrozen roles, whenchallenged andconstructively addressed, provide group members with opportunities for increased awareness and for experimentation withnewbehavior (Caffaro & Conn-Caffaro, 2003). There aretwoaspectsofbeinga sibling that havedoggedtheliterature andtoo easilyconjured up rigidandfixed associations aboutourfield ofinquiry: rivalry andbirth order. Thebirth order hypotheses fuel popular assumptions aboutsibling rolesandbehaviors (e.g.,oldersaremoreresponsible andconventional, whereas youngers often becomerebels andhavemorefun)andalsoreducethecomplexity ofsibling relations tosometimes unrecognizable proportions. Important contextual variables, suchasgender, ethnicity, culture, andthefunctional rolea childoccupies ina family, getlostordiminished intheprocess. Thediscovery that siblings experiencetheir livesdifferently, though they areraisedinthesamefamily environment, highlights theimportance ofattending toeachgroup member sindividual reaction togroup events. Sibling experiences mayvary greatly, buttheevidence isclearthat sibling relationships matter a great deal.According toanearly longitudinal study ofsuccessful, well-educated men(including theHarvard classesof1938-1944), the single bestpredictor ofemotional health atage65years washaving a closerelationshipwith onessibling incollege; this wasmore predictive thanchildhood closeness toparents, emotional problems inchildhood, orparental divorce - more predictive, even,thanhaving hada successful marriage orcareer (Vaillant, 1977). Thisissueofthejournal begins with anearly article exploring theneglect ofpeer and sibling transferences in analytic grouptherapy byHerbert M. Rabin(1989). Theauthor usescaseexamples toexplore therichness ofworking through peerand sibling transference material ingroupwork. Asa supervising analyst overseveral decades,Rabinmakesthediscovery thatmosttherapists aremuchmoreattuned tothehistory ofthepatients relationship tohisorherparents thantohisorher relationships tosiblings andpeers.His efforts toaccountfor whythismaybe the case inevitably leadhimdirectly toFreud.Rabinunderscores theimportance of Freudsthinking regarding siblings andpeersas secondary actors withsuperficial rolestoplayinthedramaofthepatients narrative. ForFreud, everything points to either oedipal(three-person) orpreoedipal (two-person) dynamics. Rabinsetsoutto examinetheclinicalutility ofFreudshypothesis through exploration ofa groupcaseexample. Hisfocusonthefundamental importance of sibling dynamics intheworking through oftransference material for several patients demonstrates thevitality ofhisapproach. Rabinconcludes thatrather thanviewingpeerandsibling grouptransferences as derivative (ordefensive), they should beconsidered as sometimes central intheir ownright, with their ownexplanatory power.Thepoweroftheseearlyinsights has had considerable influence on the training anddevelopment ofa newgeneration ofgrouptherapists. Henceweare Introduction tothe Special Issue 275 pleasedto havetheRabinarticle serveas an important historical reminder and stimulus for thisspecialedition ofthejournal. Nextis Eva D. Papiasvilis"Sibling Transference Phenomenain Experiential ProcessGroups," which, building on Rabinswork, suggests thatsibling transferencescan also be manifested towardthegroupleader-therapist ortowardthe group-as-a-whole. Papiasvili, in herreviewoftheanalytic literature, notesthat, recently, Mitchell (2003)andVivona(2010)haveattempted toposita newspatial metaphor, addingthelateral (sibling) dimension tothevertical (parent-child) one astwointersecting challenges ofdesire andidentity. Sheexplores anddeepensour understanding oftherichness ofsibling transferences byreferring tothecontemporary analytic literature (Balsam, 1988; Des Rosiers, 1993; Vivona, 2010)addressing important distinctions between siblingderived parental transferences andsibling transferences intheir ownright, suggesting thattheformer reflects a pressure by thepatient tobeseenasa better sibling, whereas thelatter conveys competitiveness, specialunderstanding, andsolidarity. In "Family Systems Practicein Residential HealthCare:A Case forUsinga Sibling-Informed GroupIntervention," SusanRegas, RondaDoonan,John Caffaro, andJohn Bakaly takea family systems approach togroup intervention andexplore theremarkable impact that thedeath ofa child hasonthestaff ofa residential facility designed toprovide careforfamilies witha childsuffering from a critical illness. Thestrong emotions activated inresidential caregivers related tobothcurrent attachments andunresolved previous lossareheldinsharp relief under thetraumatic stress associatedwiththedeathofa child.Theauthors, as family psychologists, further...

The Evident, the Secretive and the Mysterious in Analytic Group Psychotherapy

Three dimensions of human consciousness—the evident, the secretive and the mysterious—are reflected in the analytic therapy group. The aim of my article is to demonstrate this by discussing each dimension’s origin, quality and function in the group and their influence on each member and on the group matrix. I will illustrate my ideas with anecdotes from my analytic group and will also draw on excerpts from the novel, Laish (1994), by Israeli author Aharon Appelfeld. I will also make brief reference to certain relevant ideas of Plato.

Group-Analytic Psychotherapy with Low-Income Patients in Brazil

The first analytic groups formed in Brazil were a psychiatrist initiative in the late 1950s to meet the substantial demand for psychotherapeutic care for a large population with inadequate access to material resources. Although group-analytic psychotherapy arrived in private practice a few years later with great success, such therapy has always been a privilege in public institutions that provide free care for low-income populations. This article reports the development of a group-analytic psychotherapy process performed for over 4 years with a neurotic low-income patient group in the psychiatric ward of a major urban hospital in Rio de Janeiro. The department is responsible for clinical education and training of psychiatrists and psychologists. The treatment provided is preferably performed in the group setting. The group report illustrates how group-analytic psychotherapy is delivered in public institutions in Brazil, presenting both its difficulties and specificities.

Freud's Mexico: Into the Wilds of Psychoanalysisby GalloRubén, Cambridge, Massachusetts, Massachusetts Institute of Technology (MIT) Press, 2010, 408 pp., $32.95 (hardcover).

Freud's Mexico: Into the Wilds of Psychoanalysisby GalloRubén, Cambridge, Massachusetts, Massachusetts Institute of Technology (MIT) Press, 2010, 408 pp., $32.95 (hardcover).

Group analytic psychotherapy (im)possibilities to research.

In the course of group analytic psychotherapy, where we discovered the power of the therapeutic effects, there occurred the need of group analytic psychotherapy researches. Psychotherapeutic work in general, and group psychotherapy in particular, are hard to measure and put into some objective frames. Researches, i. e. measuring of changes in psychotherapy is a complex task, and there are large disagreements. For a long time, the empirical-descriptive method was the only way of research in the field of group psychotherapy. Problems of researches in group psychotherapy in general, and particularly in group analytic psychotherapy can be reviewed as methodology problems at first, especially due to unrepeatability of the therapeutic process.The basic polemics about measuring of changes in psychotherapy is based on the question whether a change is to be measured by means of open measuring of behaviour or whether it should be evaluated more finely by monitoring inner psychological dimensions. Following the therapy results up, besides providing additional information on the patient's improvement, strengthens the psychotherapist's self-respect, as well as his respectability and credibility as a scientist.