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CHAPTER TEN: Technique in group psychotherapy of narcissistic and borderline patients

Walter N. Stone Karnac Books ePub

Walter N. Stone and James P. Gustafson

Advances in theory regarding narcissistic and borderline disorders have reawakened interest in the group treatment of patients in those diagnostic categories. Even though theoretical points of view vary, often to the point of polarization, for the group therapist the translation of theory into technique remains in a nascent stage.

The interplay between theory and technique is seldom made explicit, but therapists use their theoretical base to organize the diverse material presented in the group and then intervene in accordance with theoretical understanding. Nevertheless, theory can be constricting for therapist, since it may offer the security of the familiar and therapists may thereby avoid the complexity of exploring new possibilities for understanding patients. In addition, there is a risk that patients will conform their responses to the theories of the therapist. A useful theory would provide the group therapist with ways of organizing the material and his approaches to his patients while minimizing the constrictions.

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CHAPTER ELEVEN: Affect and therapeutic process in groups for chronically mentally persons

Walter N. Stone Karnac Books ePub

Walter N. Stone

Abstract: A dynamic group treatment model for chronically ill persons allowing them to determine the frequency of attendance empowers the members and po tentiates group development. This format respects patients’ needs for space as represented by missed meetings. In this context, absences are f ormulated as self-protective and self-stabilizing acts rather than as res istance. In an accepting supportive environment, members can be helped to explore affects and gain insight into their behaviours. A clinical example illustrates patients’ examination of the meaning of missing and attending sessions, with particular focus on intensity of involvement, autonomy, and control. In the process of the therapist and group, members show capacity to gain insight into recent in-group and extra-group behaviours.

The ravaging effects of schizophrenic and bipolar illness on though and affect remain a therapeutic challenge. The multiple biolog ical, social and emotional needs that are the basis and consequence of severe and persistent mental illness defy simplistic so lutions. Medication may alleviate some of the chaos but fails to reverse or halt impairment in essential areas of human functioning—relations with the self and with others from which come a sense of wellness and comfortable regard.

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CHAPTER ONE: Contributions of the psychology of the self to group process and group therapy

Walter N. Stone Karnac Books ePub

Walter N. Stone and Roy M. Whitman

Recent contributions by Kohut and his co-workers to the psychology of the self (Kohut, 1966, 1968, 1970, 1971; Ornstein, 1974; Gedo and Goldberg, 1973) and the vicissitudes of narcissism (Kohut, 1972) have direct relevance to the understanding of certain aspects of relationships of group members with one another and the leader as well as group formation, (group) cohesion, and (group) fragmentation. In this paper we propose to integrate the implications of narcissistic transferences as they emerge in group process laboratories and group therapy. We do not mean to negate other developmental and interactional considerations of the individual and group but are adding narcissism as a hitherto not clearly recognized central area.

Developmental models of therapy groups patterned after Freud's initial contribution (1921) and elaborated particularly by Bion (1960), and Bennis and Shepard (1956) emphasize the “object-love” relationships with the leader and subsequent “object-love” relationships with co-members. Their understanding of group behaviour was based on the model of transference neurosis. The relationships between the members of the group and in particular with the leader were considered object directed transferences involving libidinal and aggressive drives. Understanding the nature of the relationship with the help of the structural model, it is assumed that the group leader is experienced as a separate “object” who is loved or hated, or who, by his behaviour, or indeed by his mere presence mobilizes defenses against such strong feelings. The model for this approach to group behaviour is the oedipal model in which the leader (father) is seen as a person stimulating an intense, positive, erotic or, conversely, intense negative, hostile transference. As additional implication of this model is that the group members are seen as siblings who also relate along the lines of object-love. The opportunity to engage in multiple object-love or object-hate relationships, both vertically and laterally, has been an oft-stated advantage of group therapy over individual therapy.

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CHAPTER TWO: The group self: A neglected aspect of group psychotherapy

Walter N. Stone Karnac Books ePub

Sigmund Karterud and Walter N. Stone

Abstract: The authors explore and expand on Heinz Kohut's concept “the group self”, which is related to, yet different from the concepts “intersubjective field” and “group matrix”. The group self is defined as a collective project with inherent ambitions, ideals and resources. From this perspective the authors discuss group-as-a-whole phenomena, empathy, aspects of group development and the kind of discourse which is appropriate for group psychotherapy. This particular discourse should contain multiple selfobject functions as well as aspects of otherness not accounted for by the selfobject concept. Partaking in this discourse has a beneficial effect by itself which justifies a concept of “discoursive selfobject function”. This selfobject function is of a partial supraindividual nature. Two clinical vignettes illustrates aspects of group self development and fear of depletion of the group self.

Key words: The group self, self psychology, group psychotherapy, group-as-a-whole, selfobject function.

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CHAPTER FOUR: Dreams as portraits of self and group interaction

Walter N. Stone Karnac Books ePub

Walter N. Stone and Sigmund Karterud

Abstract: Dreams presented in group psychotherapy portray different aspects of the dialectic between the group and the individual. A self psychology perspective emphasizes the interplay between the current self-state of the group-as-a-whole and the selfobject needs of the individual. With this focus in mind, the therapist should help the group to deepen its awareness and capacity to reflect upon emerging new abilities (“forward edge”) which dream imagery conveys, and the needed human responsiveness that can actualize these abilities, and thus help the individual and the group to break and transform chains of repetition compulsion. We illustrate this approach with two clinical examples.

From the time of Freud's classic monograph (1953/1900), dreams have been regarded as avenues into the unconscious world of wishes, conflicts, and defences. The interpretative task, with the aid of the patient's associations, was traditionally to decode unconscious elements that the dream disguised. In contrast, self psychology has focused its attention upon the dream's representation of the self and self in relation to others, others in the past and the here-and-now. As Ornstein (1987) wrote, “The dream is always about the self; that is, the dream always presents various aspects of self-experience to the dreamer's attention” (p. 101).

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