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CHAPTER NINE: The role of the therapist's affect in the detection of empathic failures, misunderstandings and injury

Walter N. Stone Karnac Books ePub

Walter N. Stone

Abstract: Therapists cannot be expected to always understand their patients or the process of their group. Using evolving self psychology and theories of Intersubjectivity, this manuscript explores the affective responses of therapists as a valuable indication that such misunderstanding is occurring. Clinical vignettes will illustrate three specific reasons for therapist misunderstanding: over-adherence to theory, boundary crossing, and inexperience. Additional examples will illustrate how countertransference can disrupt treatment when the group therapist conveys material or affects outside his or her awareness.

Key words: Group psychotherapy, countertransference, therapist's affect; errors; misunderstanding; empathic failures.

Therapists often do not appreciate the potential for their interventions to adversely affect the therapeutic process. They fail to recognize that a well-meaning interpretation, observation, or question may be experienced by the patient as unempathic and hurtful. If a patient rejects an intervention, is it because the comment was experienced as ill timed, or touched an area of vulnerability requiring protection, or was it simply inaccurate? These certainly are knotty problems.

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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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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 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 TWELVE: Strivings and expectations: An examination of process in groups for persons with chronic mental illness

Walter N. Stone Karnac Books ePub

Walter N. Stone

In the past half-century, models for treating schizophrenia have traversed a path from a primary reliance on psychotherapeutic intervention to one that emphasizes medication as the first line of treatment. Concern for patients’ quality of life has been submerged as research became focused on finding medications that alleviated the major (positive) symptoms. A significant breakthrough in phar-macotherapy occurred with the recognition that clozapine impacted upon negative symptoms, providing increased hope for cure. However, the overall outcome for schizophrenia has not altered appreciably, with patients continuing to have considerable deficits in ability to fulfil expectable roles and to engage in emotionally meaningful discourse (Bustillo, Lauriello, Horan, & Keith, 2001).

No single factor can account for the multiple and varied aspects of patients’ deficits. Most likely biological, developmental and social elements contribute to patients’ failures to achieve an average expectable life trajectory. Viewed through a psychosocial/ developmental lens, many children who subsequently will be diagnosed with schizophrenia exhibit developmental peculiarities that evoked aversive responses within the family, school and play, leaving the person emotionally scarred (Walker & Lewine, 1990). When overt symptoms appear, often necessitating hospitalization, adolescents or young adults become further alienated from their peer group and further impaired in their ability to fulfil usual role expectations.

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