Anne Alonso

Common dilemmas in combined individual and group treatment

The treatment of patients in combined individual and group therapy presents a challenge in terms of theory and technique. The inevitable paradoxes that arise in this modality can confound even the most experienced clinician. This paper delineates some of the conflicts, examines some of the advantages and disadvantages of combined treatment, and addresses the contraindications for some patients.

Sequential cotherapy of groups for training and clinical care

Cotherapy has often been used as the leadership model in group therapy. The literature is full of contradictory data and impressions as to the efficacy of this model. In this article a new form of cotherapy is presented which may offer some of the assets attributed to the cotherapy leadership model while at the same time reducing some of the liabilities. Sequential cotherapy refers to cotherapy when each of the therapists leads sequentially rather than at the same time. The pros and cons of such an approach are discussed from both the perspectives of training new group therapists and of service to patients in groups.

Some guidelines for group therapists

Psychodynamic group psychotherapy works on the basis of two major premises: 1) Individuals will present themselves, complete with strengths and weaknesses, in a group in fundamentally the same ways as they live out their lives; and 2) the various behaviors that occur within groups are interconnected via group associations and group contagion. A brief example will serve to illustrate both points. Let us suppose a group of eight strangers is meeting for the first time. All eight individuals will adopt their own characteristic styles for coping with that situation. One may boisterously assume dominance by helping with introductions, acting as chairperson, and generally presenting a self-confident image. Another individual may sit mutely throughout the meeting. Still another member may demonstrate and speak of the anxiety of the situation. Yet another may plead or demand that the leader assume more responsibility for the meeting. In other words, from the very moment they enter the group room, individuals will begin to demonstrate their characteristic styles for coping and living. One may presume that the initial meeting of a therapy group presents each member with a fairly constant stimulus. The situation evokes for everyone, including leaders, issues of basic trust. Will this be a safe situation? Will I be treated with respect or abuse? How can the blind lead the blind? Will there be enough time and attention for me? What can I do to protect myself and to gain something for myself? Do I dare risk allowing others and myself to know what I feel? The individuals cited above indicated their first-line defenses against these concerns. We noted a counterphobic refusal to acknowledge the fear, or at least an attempt to master it by active assertiveness; we saw a regression to a mute, totally passive position; we noted one member acknowledged the anxiety verbally and behaviorally; and we noted one member who demonstrated a pervasive dependency and entitlement that implied it was the responsibility of the leader to remove the anxiety. From the moment the group begins, the patients not only talk about their problems, they have them, not just in the transference but in the real interactions within the minicommunity. We may assume that the styles presented by individuals in groups are not newly developed for just this situation, but rather that we are privy to observing styles that have been historically utilized by these individuals.

Group therapy for bulimia: Clinical experience and practical recommendations

The authors identify and describe three major types of group therapy for patients with bulimia. Psychodynamic treatment, cognitive-behavioral treatment, and self-help group treatment are techniques with different theoretical bases. Implications for group membership, time frame, leadership, contract, content, and goals are discussed for each type of group treatment. Outcome studies are reviewed, and recommendations are offered for a rational approach to the group treatment of patients with bulimia.

T groups: An essential model in the training of group therapists

This paper argues for the T group (training group) model as the preferred experiential aspect of training in group psychotherapy. The rationale for preferring the T group model centers around aspects of: 1) contractual clarity; 2) the management of the learning regression; 3) the effectiveness of the T group as a professional holding environment; and 4) the development of a professional identity as a group therapist. Some difficulties with the model are also noted, and some case examples are offered to illustrate various aspects of the work within the T group model.

AGPA and the Village Well

This article is based on the authors presidential address, which was presented at the 50th anniversary meeting of the American Group Psychotherapy Association in February of 1992. Using the metaphor of the village well, Dr. Alonso argues that AGPA faces both the opportunity and challenge to serve as the leader in facilitating communication among four diverse groups: colleagues in other professional organizations; academia and its training programs; the world of managed care and third-party payers; and, the consumers of our services, our patients.

Brief report: On becoming a group therapist

Clinicians have become group therapists via many routes, either voluntarily or not. Group psychotherapy itself has had a checkered history, in that it has often been seen as an ancillary or a second choice form of treatment. Indeed, we know that there is a growing number of well-respected clinicians who are not only not ambivalent about being seen as group clinicians, but embrace this reality as a primary clinical identity. It has occurred to us that no one has looked deeply at this developmental path or what facilitates or inhibits movement along this path. This article is a preliminary attempt to initiate this line of study.

Clinicians’ Love/Hate Relationship with Clinical Research

It’s a rare pleasure to be invited to put forth my thoughts about clinical research. It is usually assumed that a practitioner has neither familiarity nor interest in the area. While this is not the case, it is also fair to say that I have not actively sought to join in this conversation. The divide serves us all ill, so I welcome the chance to explore resistances on both sides.

Reprise: Some Guidelines for Group Therapists

Publisher Summary This chapter provides some guidelines for group therapists. Psychodynamic group psychotherapy works on the basis of two major premises: individuals present themselves, complete with strengths and weaknesses, in a group in fundamentally the same ways as they live out their lives; and the various behaviors that occur within groups are interconnected via group associations and group contagion. The role of the group therapist is to help patients understand themselves by understanding their interactions in their therapy group. A major problem that confronts group therapists, perhaps uniquely, is the difficult task of selecting the most useful data from the massive amount of data that is generated by a therapy group. A major reason why there is a paucity of literature on this matter is that the process of a therapy group is entirely too unpredictable to allow for stereotypic “rules” for leaders to follow.This chapter provides some guidelines for group therapists. Psychodynamic group psychotherapy works on the basis of two major premises: individuals present themselves, complete with strengths and weaknesses, in a group in fundamentally the same ways as they live out their lives; and the various behaviors that occur within groups are interconnected via group associations and group contagion. The role of the group therapist is to help patients understand themselves by understanding their interactions in their therapy group. A major problem that confronts group therapists, perhaps uniquely, is the difficult task of selecting the most useful data from the massive amount of data that is generated by a therapy group. A major reason why there is a paucity of literature on this matter is that the process of a therapy group is entirely too unpredictable to allow for stereotypic “rules” for leaders to follow.

Activity/nonactivity and the group therapist: “Don't just do something, sit there”

The abstinent stance of psychoanalytically-oriented clinicians is often confused with passivity or coldness toward the patient or the group. Given the current move toward more active, shorter-term treatment, this paper offers a reaffirmation of the value of the abstinent analytic stance. The theoretical rationale for the technique is reviewed, and some specific arguments are made to illustrate the continuing importance of the method in the treatment of patients in psychodynamic group psychotherapy.