J. Scott Rutan

An Analysis of AGPA Institute Groups

ABSTRACTFifty-three 2-day training groups were studied with process and outcome measures. When the eight most successful groups were compared to the eight least successful groups on factor analytically derived dimensions, the formers leaders were characterized as more caring, charismatic, skillful, and less inhibiting, and the successful groups were described as more cohesive and less defended and superficial. The group climate results were compatible with the expectation that the better outcome groups would progress more rapidly through early group developmental tasks. A group climate measure of engagement obtained at the end of the first 3½ hour session was predictive of final outcome; interestingly, success was not achieved by avoiding conflict. The general psychodynamic process groups were viewed as more defended and inhibited than topic-centered specific interest groups.

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.

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.

The demonstration group: a tool for observing group process and leadership style.

Abstract Demonstration groups, a major modality for observing group process, have not been addressed in the group psychotherapy literature. This article defines the demonstration group and describes and discusses its various components: the volunteers (group members) and their recruitment, the demonstration group itself, group member debriefing, and the didactic component. Discussion of the physical setting, group agreements, and boundary considerations, as well as leadership tasks, challenges, and pitfalls are illustrated with examples. Leadership tasks in demonstration groups are compared with those in therapy groups. Guidelines that are likely to promote successful demonstration group experiences are provided. The leader’s facility with the unconscious defense mechanism of projective identification is stressed.

Group therapy for eating disorders: A step-wise approach

Group therapy is emerging as a favored treatment for eating disorders. Open-ended psychodynamic group therapy is an effective treatment for the underlying conflicts in eating-disordered patients, yet these groups are difficult to form. The authors suggest a specific sequence using time-limited psychoeducational groups initially for symptom control, then offering an open-ended group for patients who are ready to address deeper issues in a group therapy setting.

Things I Have Learned: 45+ Years of Group Psychotherapy

Abstract The noted humorist Dave Barry, in looking back over his life and thinking of things he had learned, said one of the things he learned was that “There is a very fine line between ‘hobby’ and ‘mental illness’” (1998, p. 182). Following in Dave Barry’s path, I would like to look back over the 45+ years I’ve been practicing group therapy and see if there is anything to be learned by what I have learned over those years.

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.

An Object Relations Theory Perspective

ABSTRACT If one begins with the assumption that human beings have an innate drive to be in relationships, then one understands behavior that seems counter to that goal as defensive behavior learned to protect against anticipated injury in the interpersonal world. This leads to a leader focus on the ways group members relate to one another, underlining and working with those behaviors that invite intimacy and those that do not.

The Benefits of Group Therapy Observation for Therapists-in-Training

ABSTRACT The authors contend, based on a survey of group therapy trainees, that observing an ongoing psychotherapy group in vivo provides an exceptional learning opportunity. Clinicians often experience resistance and anxiety regarding therapy group leadership, and group therapy is notoriously challenging to teach. Trainees consistently described the Group Observation course as one of the most effective training experiences that they have had. The observation group model mitigates many concerns that trainees have about group leadership and inspires enthusiasm and confidence for leading groups. Group observers learned vital group leadership skills, most notably: the ability to bear affect and trust the group process, the ability to follow and use group themes, metaphors, and underlying dynamics, and the ability to highlight attachment themes, work in the here and now, and promote immediacy.