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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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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 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 THREE: Group-as-a-whole: A self psychological perspective

Walter N. Stone Karnac Books ePub

Walter N. Stone

Abstract: As Self-psychology has evolved from exclusively dyadic treatment, it has illuminated transference configurations that are applicable to group treatment. Selfobject transferences not only are directed to individuals and to the whole group. In addition the concept of the group-self, refers to members’ deeply felt inner experience of the group ideals and goals.

Individual's experience of whole group interpretations often stirs a basic ambivalence between group membership and self-expression. Self psychologically informed interventions, understanding and explaining, focus on therapists tasks of empathically understanding individuals prior to explaining (interpreting) the group-as-a-whole. Examples will illustrate transference and coun-tertransference aspects of the treatment process.

Key words: Selfobject; group-self; empathy; interpretative understanding; interpretative explaining.

Emerging from the ferment of interest in group phenomenon, Kurt Lewin (1951) conceptualized a group as a system, different from the sum of its parts. Groups were understood to have unique properties that were embedded in a hierarchy of systems and containing subsystems within their boundaries. Clinicians were thereby provided a conceptual tool with which to understand the interactions (verbal and behavioural) of a dynamic system frequently referred to as the group-as-a-whole. Systems’ views encompass group dynamic perspectives, including goals, boundaries, norms, roles and values.

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CHAPTER SIX: A self psychological perspective of envy in group psychotherapy

Walter N. Stone Karnac Books ePub

Walter N. Stone

It is indeed a privilege to be asked to contribute to the examination of envy, which has received so little attention in the expanding exploration of the psychology of the self. Following receipt of the invitation to respond to Lionel Kreeger's presentation of envy preemption, I enquired if I might have a draft of his manuscript, which he promptly forwarded. I read it rather quickly, and proceeded with my research and my clinical explorations. I was aided in my study by the responses of my patients, colleagues and friends following the announcement of my forthcoming sabbatical leave that included three months in England.

In these circumstances, I recalled a paper by Manny Schwartz (1972), which I initially read with some dismay. He described a training group in which he would pick a theme, and then he would interpret all material along that single dynamic. I remember one theme that he chose was incest. Of course, soon all the students began reporting manifestation of incest occurring in their therapy groups. This process obviously ran the risk of seeing a theme where it did not belong. Discussion of the implications of this model is beyond the goal of this paper, but like the students, I saw envy where I had not seen it before, and my patients began to wonder what I had been studying. In the midst of this exploration, I received a second version of Dr. Kreeger's manuscript. My response was delight and amusement. We were similar; we had common experiences and thought (I too had found myself thinking of the Groucho Marx joke as a defense against being envied). We had addressed similar writing tasks, and I felt an identification with him. My preparatory anxiety diminished—was I experiencing an alter-ego transference.

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