HEALING CRITERIA IN PSYCHOANALYTIC GROUP THERAPY

Despite the title of this very post, in psychoanalysis you can’t exactly speak of healing, only of some changes to the psyche. These changes are the main goal of psychoanalytic group therapy.

First of all, group therapy intends to develop the patient’s communication and interaction skills, without losing all of the necessary boundaries. It will provide them with the possibility to develop a sense of belonging, a group sense if you will, which helps them improve by decreasing their paranoid and depressive anxieties.

It’s important that the patients develop a sense of individual identity, as well as a social or group identity, helping them find their own independence and develop a positive relationship with the identification models. This will give them the ability to deal with new situations, as with wins and losses.

The psychoanalytic group therapy also intends to lead a patient to a proper use of his projective identifications, which means, it tries to limit the amount in which a patient tends to distort the signals he receives from others, thus being much more likely to be able to create empathy and have the ability to put himself in other people’s shoes.

And of course, as we are speaking of psychoanalysis, at the end of therapy, the patient should reveal some insight ability and be able to make, in group, some interpretative activity.

COMMUNICATION AND INTERPRETATION IN PSYCHOANALYTIC GROUP THERAPY

Communication is the basis for any kind of psychotherapy, and in group therapy some communication problems tend to appear and present themselves in a more distinctive way, allowing the therapist to recognize the signs and provide treatment for the most frequent disorders.

There is a thin line separating the normal from the pathological, and in regards to communication, that line can be really hard to interpret or establish. Each person has their very own way of communicating and it reflects their personality. However, it’s important to keep in mind that talking is not the same as communicating, as, in truth, it can be used to block the communication and also remember that the non-verbal communication and its many ways and manifestations can tell us a lot about the individual in front of us.

Communication is also very important when it comes to providing data for therapists, that will allow them to develop the interpretative activity which is another major basis of psychoanalysis. In order for this to be the case, the therapist must carefully observe the way the messages from some patient resonate with the other members inside the group.

According to Zimmerman and Osorio (1997), the classic method of interpretation was clearly outdated, so these authors chose to reformulate it, through the following aspects.

1. Discriminating the individualities

2. Having a bigger appreciation of the countertransferential aspects

3. Posing questions, regarding to clarify what the patient means

4. Granting major relevance to the way patients use their ego functions

5. Giving special attention to communication problems

6. Stimulating the patients themselves in exercising an interpretative function

7. At the end of the session, suggesting a synthesis of the main affective experiences that occurred during it, looking for integration and group cohesion.

REFERENCES

ZIMERMAN, David E., OSORIO, Luiz Carlos & Col. (1997). Como Trabalhamos com Grupos. (How to work with groups) Porto Alegre: Artes Médicas.

TRANSFERENCE AND COUNTERTRANSFERENCE IN PSYCHOANALYTIC GROUP THERAPY

These two phenomenons are the basis of any psychoanalytic therapy and in the case of group therapy, there are three vectors to pay attention to: individual – therapist; group – therapist; individual – group.

The therapist role is a bit controversial in this matter, but the majority of therapists seem to accept that they have a great responsibility in the kind of transferential response manifested by the patients. By transference, we’re talking about a phenomenon of repetition of needs that were not satisfied in the past. This phenomenon will produce an effect on the others, through what we call “projective counter-identification”.

On the other side of things, the countertransference can be just as productive as it can be dangerous, being an amazing tool for the development of empathy, or assuming pathologic features, confusing the therapist and having a bad influence on his relationship with the group.

Although they can have a dangerous effect on a group’s development, these phenomenons have an important function: they enable all of the individuals to develop the ability of recognizing the countertransferential feelings arising in themselves and within the other members of the group. This will help every individual ego with its function of distinguishing what is his and what belongs to someone else. It’s absolutely necessary for a person’s growth (even if it’s often painful) that he or she can recognize what they pass on to other people.

RESISTANCE IN PSYCHOANALYSIS GROUP THERAPY

 

Resistance is an important phenomenon in general psychoanalysis and it cannot be ignored in group therapy. By resistance, we mean everything which is in direct opposition to being able to access the unconscious. However, there are two types of resistances, the ones which are totally obstructive to the therapy development and the natural ones, which are a way in which the individual defends himself from his anguishes and needs.

How do we recognize them?

These resistances might manifest in a lot of different ways, all of which the therapist should try and pay attention to. The patient can be late often or even miss most of the sessions or just try to change the setting and conditions. During a session, the therapist may notice the individual involved in intense talking, many times with excessive intellectuality regarding the explored subjects or, otherwise, just a complete silence.

It’s possible for an individual to be excessively focused on reporting the outside reality or make some hypochondriac complaints. He might refuse to approach unconscious matters and keep too many secrets locked away.

Sometimes, there are leaders who arise within a group, with a saboteur role, trying to expel any new element and they tend to promote impasses and negative therapeutic reactions.

Why do they appear?

The main cause of resistances is fear: fear of the unknown (common in paranoid anxiety, for example), fear of the depression, fear of regression or progression, fear of being humiliated… Furthermore, there are patients who may be excessively attached to an illusion, or the ones who experience excessive envy. And, of course, there are the normal resistances to therapy, as a healthy answer to any inadequacies on the part of the therapist.

When do they deserve our attention?

If you’re a therapist, there are some types of patient resistances where you must pay special attention to the patients themselves:

The silent – You need to be patient and stimulate the individual, while, however, trying to avoid putting too much pressure on him.

The monopolist – This kind of patient has the necessity of being seen, he fears becoming anonymous, insignificant or marginalized.

The one who avoid the subject – When he or she realizes there is a risk of someone coming up with an anxiogenic subject, the patient changes the subject.

Acting – This kind is really important, the individual displays actions as a substitute for his desires and tends to conflict verbalization, all while avoiding having to think about the emotional experiences.

Saboteur – This patient will try to prevent growth and change within the group.

Ambiguous – Although he’s, apparently, fully integrated in the group, this one will present you with constant contradictions, as he deals with the problems in a pathological way.

What should we do?

First of all, as a therapist, you must distinguish the obstructive resistances, from the ones that actually reveal the way an individual protects himself and manages to function in real life. It’s also important to know if the resistance comes from the whole group, a fraction of it or even from a single individual, as well as the exact point of the resistance (What is being resisted, by whom and how or why). And finally, the therapist should know his or her role according to the resistance and make sure that he or she does not become allied with it.

THE 7 CORE ELEMENTS OF THE GROUP SETTING IN PSYCHOANALYSIS

The group setting is the set of procedures that will organize and regulate the group. It’s very important to define this setting, so that the practical and everyday aspects of the group’s functioning become easier to manage and this group setting should also be maintained relatively constant (without being absurdly or exceedingly rigid).

Main Elements of the Group Setting

1. Homogeneous or Heterogeneous

You must define how similar the group members should be. It will depend on the presented pathologies and the general goal of the specific group.

2. Open or Closed

After the initial constitution of the group, will it be allowed to remain open so that other people may later join? Generally, in psychoanalysis, groups are left open but it exceptions can sometimes be made when needed.

3. Number of patients

This will most likely depend on the therapist. Usually, the group has six members, but this is not a rule. Although, it never should have less than 4, nor more than 9.

4. Gender and Age

This is a controversy point. A group with both genders seems to have more advantages for the patients, yet, some psychoanalysts contest this point of view due to (accordingly to them) a larger possibility of sexual involvement between the patients.
Regarding the age factor, the divergence in opinion is even bigger. Some therapists prefer all the patients within the same age group, others believe that a more ample, or wider sample of people when it comes to age difference, will allow the sharing of richer, or just overall greater number of, experiences.

5. Duration and number of sessions by week

The duration depends on the number of patients, but in average, each session will last close to 90 minutes. Some therapists prefer one much larger session a week, while other ones prefer 3 sessions, just like in individual therapy.

6. Time duration of the group

This largely depends on whether the group is open or closed. The time duration of a group may be limited (usually in closed institutions) in closed groups or unlimited in the open ones.

7. Observer, co-therapist or supervisor

The possible presence of each one of these aforementioned professionals should be previously defined and/or stated. A disclaimer of the possibility or certainty of the above situation not only commands respect but is also seen as full disclosure, which is very relevant to the group providing confidence.

Observer: The presence of an observer doesn’t directly interfere with the group, as he mostly takes notes and is nowadays usually limited to educational situations.

Co-therapist: This presence can be quite helpful with children, teenagers and families. However, a near perfect harmony between the two therapists is usually required for a good result.

Supervisor: It’s a mandatory presence for beginners, but it can also prove very useful later on, allowing the therapist to expand his horizons and prevent him from getting stuck in a certain, or stereotypical, way of working with a group, or groups.

PSYCHOANALYTIC THERAPY: Group Formation

Schedule

 

Psychoanalytic therapists tend to be very careful in the constitution of a group. Thus, they tend to require that its formation follow three important steps, which will be explained below.

1. Routing

In this step, the therapist tries to give knowledge about the group, in order to achieve a minimum number of members that make it able to work. It’s important, since the very beginning, to have well defined goals, so you can know the kind of patients you want in your group.

2. Selection

This is the second step and it occurs for two main reasons.

The first one is to try to avoid the risk of unpleasant surprises during therapy, such as the countertransferential discomfort or a patient’s economic impossibility or lack of motivation for the treatment, the latter being the primary cause for treatment abandonment.

The second reason is related with the issues of the indications and contraindications of belonging to a therapeutic group. You can check out the examples below:

Indications:

1. Priority for a teenager in a group dedicated to them.

2. When the patient shows preference for this kind of treatment.

Contraindications:

1. Lack of Motivation (some patients are just looking for some social support, rather than treatment)

2. The pathology (some pathologies require more attention and show a higher level of aggressiveness, so a patient excessively depressed, paranoid or narcissistic isn’t usually a good option for this kind of treatment)

3. Intellectual deficiency (a case where it will become too difficult or even impossible to follow along with the development of the rest of the group)

4. Patients in a severe crisis

5. Risk of breaking the secrecy within the group (people that for professional or political motives represent a risk of breaking the secrecy in the group)

6. Therapy abandonment (history of several instances of therapy abandonment in the past)

3. Grouping

In this third step, the therapist should anticipate the interaction between the individuals and the resulting viability for therapy. He or she should do this accordingly to the age group, the eventual relationship between members when outside of the group, their personalities, moments of crisis and any other situation which may end up interfering with the good development of said therapy group.

He should also establish the group rules, not only for the beginning but for the patients who will be inserted into the group at some later stage.

PSYCHOANALYSIS AND GROUP THERAPY

When you´re talking about psychoanalysis, you’re referring to a very wide theoretical current with different schools and different basic principles, however, all of them have a common ground: the unconscious.

In psychoanalysis, the group therapist should have a fairly comprehensive background and he should build upon it, creating his own way of working with the group, keeping his focus on the real people in front of him, at every turn.

The duration and goals underlying the therapy are way too different according to the specific group and the way in which the therapist manages along with the expectations of its members. The group’s goal can be quite different from group to group as well, and very often, group therapy is the only possible choice due to an array of financial reasons (as it’s more accessible and affordable, being cheaper than individual therapy).

The therapy’s goal can be the development of insight, due to changes in the individual, as well as, the simple treatment or relieving of symptoms. Many people look for psychoanalytic therapy as a way of finding their own balance and improving interpersonal relationships.

Psychoanalytic therapy, especially the group therapy, has had a great evolution in the way it faces the current, modern day society. Nowadays, the individual problems go way past simple conflicts between people’s drives and some defense mechanisms. Each one of us is forced to play roles and assume positions in modern life that become a requirement with which we must deal.

The group will help each one of its elements develop a harmonious relationship with the demands that they have to face, taking into account the society where they are inserted.

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