Jerome S. Gans

Silence in group psychotherapy : A powerful communication

ABSTRACT Silence in a psychotherapy group, including leader, member, subgroup, and whole-group silence, is a common phenomenon with many possible forms, uses, and meanings. Five common sources of silence in group psychotherapy are described: situational factors, individual dynamics, member-to-member interactions, group dynamics, and leader-related dynamics. Silence can reflect defenses or indicate conditions favorable to intensified group work. Silence, sometimes mistaken for psychological inactivity, should be viewed as significant communication.

Broaching and exploring the question of combined group and individual therapy

Combined therapy is defined as concurrent dyadic and group therapy with the same therapist. This paper focuses on a neglected aspect of combined therapy: broaching and exploring this question with ones individual patient. The author shows how raising this question: (1) alters the therapeutic field whether or not the patient joins; (2) can sharpen the therapists understanding of the indications and contraindications for group membership; (3) offers untapped therapeutic approaches and opportunities to classify issues in the individual treatment; and (4) stirs up countertransference issues related to issues of profitability, the transference of the patient in individual treatment, and the transference of the group-as-a-whole. Several case examples are provided.

Hostility in group psychotherapy.

To run a psychodynamic group therapeutically, the leader must understand the meanings and functions of hostility. Fundamental to this task is the leaders awareness of his or her bias toward hostility as a constructive or destructive feeling and willingness to serve as a lightening rod for it. This paper discusses the sources of hostility during different stages of group development. The therapeutic handling of hostility is discussed under the following topics: theoretical considerations, defensive functions, and communicative functions. Case examples illustrate the proper handling of contractual violations, scapegoating, and narcissistic injury. Countertransference reactions to anger and rage in the group are discussed.

The Leader's use of metaphor in group psychotherapy

This article discusses the leaders use of metaphor in outpatient, psychodynamic group psychotherapy. Four clinical examples are provided that illustrate how the phase of group development informs the leaders use of metaphor. Therapeutic features and uses of metaphor include (1) the development of ego skills that transform passivity into activity and foster the examination of unhealthy norms; (2) the modulation and rechanneling of potentially destructive affect and the intensification of affect that is denied, minimized, or avoided; (3) the creation of a verbal play space in which shared group language evolves; (4) and the provision of various levels of concreteness and abstraction as well as differing perspectives. Abuses of metaphorical interventions are discussed.

Patient selection for psychodynamic group psychotherapy: practical and dynamic considerations.

Abstract Most group therapists rely on clinical interviews to screen prospective group members’ suitability for long-term, open-ended, psychodynamically oriented group therapy. Faulty selection is detrimental to everyone involved and can even lead to the demise of the group. In order to avoid, or at least significantly limit, premature terminations or problematic mismatches between a patient and the rest of the group, pre-group screening needs to examine reality factors, resistance, ambivalence, and their interplay. Therapists need to be aware of countertransferential pressures that affect the screening process. The careful exploration of six specific areas during the clinical interview process increases the likelihood of optimal patient selection and participation. A selective literature review and clinical examples are provided.

A plea for greater recognition and appreciation of our group members' courage.

Abstract Courage–a mental act that involves a decision to face and deal with emotional pain as honestly as possible without any guarantee of a positive outcome–resides at the heart of the therapeutic alliance and the work of psychodynamic group therapy. The author’s experience suggests that group therapists tend to take for granted or underestimate the courage required to join and participate in a psychodynamic therapy group. Written from the perspective of self-psychology, this article provides a theoretical rationale for courage recognition as a central and crucial leadership function. Examples of courage are presented and contrasted with behaviors that appear courageous but are not. A detailed case example discusses the courage it takes for dyads to work through reciprocal negative transferences. Suggestions are offered to assist the group therapist in recognizing and calling attention to courageous behaviors. The author discusses some of the pitfalls of our profession’s preference for value–free language and then shows how and why the occasional and judicious use of non–neutral language, courage being an example, can facilitate and deepen group work.

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.

The Group Therapist's Shame: A Much Undiscussed Topic

Abstract The topic of shame in group therapy has received limited attention in the group therapy literature. When the topic has been addressed, the focus has been on the shame of the group members. The shame of the group leader and its effect on leadership efficacy and group process has received inadequate attention, given what seems to be its power and prevalence. In this article we examine shame and the group therapist with regard to (1) potentially shameful topics and (2) dynamics that evoke shame. Suggestions for both the mitigation of shame and the enhancement of the leader’s self-esteem in dispatching the role and functions of group therapist are offered. In discussing this subject, we propose to normalize group therapist shame by emphasizing the challenges and complexity of group leadership. While the examples illustrate an array of emotions, our purpose is to focus on their shameful elements because they are (1) frequently ignored or overlooked; (2) not made explicit; or (3) discussed in other terms, such as narcissism. In doing so, we invite the reader to consider the clinical utility of the hypothesis that shame has a powerful presence and impact on our leadership image and effectiveness.

The Leader's Use of Indirect Communication in Group Therapy

Indirect Communication (IC) is a leadership technique designed for those situations in which the leader must respond immediately but doing so directly might be a clinical mistake. As defined in this report, IC refers to times when the leader addresses someone by speaking about that person to someone else or by thinking aloud while speaking to no one in particular. The author distinguishes IC from other modes of indirect communication. Pitfalls of direct communication and ways in which IC avoids them and provides therapeutic alternatives are discussed. The leaders use of IC helps achieve two major goals: (1) the creation of an enlarged work space, safe enough for patients to express their more irrational and distressing feelings, and (2) the therapeutic handling of these uncivilized parts of each member as they emerge. Several clinical examples are presented. Misuses of IC are discussed.

The Courage of the Group Therapist

Abstract This report strives to legitimize for the field of psychodynamic group therapy the reflection on and study of courage. The authors surveyed group therapy leaders, asking them to describe courageous moments in their own group practice, and then explored the common themes arising in these examples, including openly confronting their mistakes, facing their own and group members’ anger, and dealing with unexpected moments in group sessions. Attending to courageous leader moments—and the feelings of hope and pride that they engender—help to neutralize the negative emotions that group leaders are constantly invited to contain. Paradoxically, accessing courageous moments can also evoke feelings of shame in the leader. If we are to require ourselves to embrace the sometimes terrifying challenge of journeying into the unknown with our patients, we must learn to be honest not just about our mistakes and our weaknesses, but also about our successes and our strengths.