Group Intervention Methods -2 – Dr. Sarah Hazan -2007/8

Group Intervention Methods -2 – Dr. Sarah Hazan

21/10/2007

-this course has 2 components:

• semester 1 = theories
• semester 2 = mentoring/skills development of group therapist

Theoretics

-so, we will speak about unconscious processes in groups.

->It even begins in the group building stage!

-the 1^st semester: speaks about building the group and the group processes.

-groups tend to lie on axis between content and process

• content – task based
• process –focuses on what is happening within the group

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5/11/2007

-you can use many tools – but they have to serve a certain goal-oriented function. Each group has a coherent goal/function

->i.e. a walking group is not therapeutic – but can be used for other therapeutic goals

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Now, we will try to build a theoretic model which will help us build how we see the group

article: the visible and invisible group:

-we see reality through a theory we have in mind

-so a group is a number of people together

Field theory

Curt Levine: the field theory: a field with a donkey in the middle. There is a stick on one side of the field and a carrot in the other. The donkey would of course rather go to the carrot than the stick. There are vectors in the field each pulling us a different way– in short - some powers which motivate us within the context – not only in the internal life of the person

Systems theory:

-There is a system of people with a collective goal

-the context of the individual is in the collective system

• hierarchy – i.e. group is part of a social club for schizophrenics
• inputs and outputs
• borders: the group needs borders in order to preserve it
• balance - the balance is supposed to preserve the unit– the therapy tries to break the current balance and create a better one

object relations theory

Axioms:

1. inborn need for a relationship with others

->in the group sense, we can assume that people want a relationship. There is a group contract which inherently brings forth the hardships in interpersonal relations b/c of that, and that is the therapeutic work

2. mom-infant unit

->this theory focuses on the reality of the situation. Thus there is no «just infant» – there is an infant and mom. Just like the group where the group moderator is analogous to the «mom» part of the dyad… more on that later

3. developmental element

-the developmental element of object relationship is also analogous to the group development. For example, in beginnings, groups might seem chaotic/unclear. Then with time, beginning of separation

[3 elements; representations of me/other/relationship b/w us]- first, everything is seen as «awesome!» – then when you realize there are some bad things, and they are projected onto others – they are bad, not us. In groups, the therapist could be seen as bad, since she does not calm, and does not react – is passive – so it is easy to project bad stuff onto her/ at the end of this process, I can see the good and bad elements of therapist, since I can also se good and bad things in me. Thus, ambivalence is tolerated. The maturity peak is when a person can show empathy

4. there is a unit of äðçééä – has 3 elements
   1. holding
   2. handling
   3. object presenting

12/11/2007

Holding: the baby does not have his own thinking processes. He lives on the perception level. The mom's job is to contain the baby's feelings (i.e. his stomach ache), to help begin the symbolization processes, to make kid realize that he has a name. with time, kid makes the connection b/w mom's voice and calming – this is the translation of feelings to thoughts [beginning of symbolization?]. without a good holding process, the child gives up the learning process. Parallel to the group is the role of the group mentor: the mentor is supposed to build the «space» of the unconscious group processes. Then the mentor translates/interprets those unconscious contents for the group mentors. The skill here is not only to contain the group's perceptions but to translate those unconscious events into words

Handling: physical actions in caring for the child (feeding/sleep/etc…) in a group context, the group mentor is supposed to deal with the group setting (i.e. closed vs. open/ permanent place for the group meetings/physical boundaries of the group, etc…)

Object presenting: the mirroring task of the mom: i.e. what does baby see when he looks at mom? He sees himself as mirrored in her face, while admiring the mom. In less good cases, the mom is too busy with herself->the baby fits himself to her. They become amazing observers, since they have to learn at which time they have «a place» and at what times they have to give up themselves. At even worse cases, baby can't predict when whatever will happen. Thus he grows up in chaos. Thus he gives up: he loses trust in human relations as a whole

Analogy to group: the question of whether the group mentor is free to mirror the group, or is he too busy with his own contents? (i.e. to look smart/accepted/appease the group?) And in those cases, the group mentor is not succeeding in his job

Linear theories:

-theories assuming that there is a linear process:

-i.e. beginning->struggle->resolution->intimacy

Spiral theories:

-dealing with same issues over and over again

Those theories do not contradict each other. They can be handled together in working w/ a group

Bion

• working group
• «basic assumption» group: there are fantasies of the group members:
  • Dependency: the group mentor has the ability to solve all of our problems. This assumption is eventually shattered
  • «fight-or-flight«: also related to the group mentor: how I deal with him
  • Pairing: the fantasy that from this group, the ultimate solution will come: there will be a «messianic» pairing where the savior will come from. This

->the group mentor's job is to do interpretations on those group's fantasies in order to let the group continue their work so that the group will not get sidelined by those assumption

Foulkes

-looks at the matrix of the group

Matrix: when a group of people create intimate relations between them, there is a phenomenon of a field of mental interactions between them

->sounds kind of like the seen and unseen group

Transpersonal processes: those processes between the people

-i.e. when someone said something and it was ignored: it didn't fit the matrix. Yet when someone else says something, and it takes up a lot of discussion – it did fit the matrix

-The the group is the context of the individual, and the individual contributes to this group

preexisting assumption that the things that happen n the group is not random: i.e. talking a half an hour about the weather means that he is not something he is not talking about

object relations: questioned the Freudian assumption that it is only in his mind: we also need others for object relations. Over this backdrop, Foulkes said what he did

-also what said to others is part of the person – so is this theories, there is no need to distinguish b/w inside of person and context

Example: black sheep in a group:

-there is a sort of projection of the group towards an individual. This projection is intolerable to the group. There is a question amongst the theoreticians abut how much the individual internalized that.

-how much does the individual have a say: view: no! group is overpowering of the individual. The group chooses the weakest or the one closest to the projection.

Example: in groups of adolescents – there is always someone called «the gay person» b/w at this age, if the youths can't deal with their still developing sexual identity, they project the conflicts onto someone

Resonance: äãäåã

-if something happens to one in a group, it influences the others in the group

->i.e. if group therapist deals with one member's issues, the mentor should ask where this specific conflict touches the other group members

->because this is a core issue in the matrix

New topic:

Group building

-this topic is too neglected – and then it strikes through the group mentor's back door

Population

-social workers work in organizations. Each organization has a population, whether a broader or smaller population. In any case, there are 2 factors: the social worker who is about to create a group needs a rational to making a group ->a goal and behind that choosing a therapeutic tool

Whitiker: there is the current situation and the goal situation

->so when you make a group, you have to think about: 1) what issues are bothering issues of the specific population and 2) if a group is the best tool

-so the group needs to be homogeneous in its goals but not necessarily homogeneous in its population: i.e. you can have schizophrenics and depressives dealing with a joint specific problem

Class:19/11/2007

Visible and invisible groups

-this is a metaphor: you can either see what you see. The invisible is the processes within the group

Factors in group building:

1. population
2. goal
3. group factors

group factors:

goals:

Important questions:

1. is there something to change?
2. Is the group therapy the best tool to do this specific change?
3. Is the goal clear to the given population?
   1. So I need knowledge of this population/their needs

Group factors

Metaphor: mom and baby relationship – there is a rhythm to it. The main thing in such a relationship is the consistency – this includes time and place.

1. Time – i.e. when do we finish out internship? Note – some goals do not fit our time limits! Also: how long the group meets every time/how many sessions
   1. Length of group's life – if you have internal logic to it, you do not need the standard 12 meeting groups. You can have an ongoing group (i.e. Alcoholics anonymous) or a one time group meeting.
   2. Length of meeting – the standard is hour and a half. For some populations, it is too long – you can make it shorter – i.e. 45/60 minutes
   3. Frequency = higher frequency = group has more room in the person's life. If we want the person to adopt a more patient role, we recommend a higher frequency group. Yet we don't want him to b/c a chronic patient, so we might want to focus on short-term groups w/ a limited number of meetings (i.e. 12) – so that we give the implicit message that at a certain point, we expect the person to overcome the problem. Up to each 2^nd week, we can call it a group. Less than that is not group – it loses its processes
2. Place –needs to be the same place – for consistency's sake. This gives the necessary security. We also need a closed door!!! (a room without door is not adequate for a group). The room has to be parallel to the size of the group: too big room: members «get lost». Too small room: people «choke»: - forced intimacy

We're still talking about group building:

-a group is within a context:

• Organization
• Members' family
• Community

->there is interaction b/w the group and the above context factors

So, we need to take the following interaction factors into account:

Class 26/11/2006

Until now, we spoke about: population ->goal->group variables->setting(time/place)->group environment (systems around the group)

Clientele

Not free to choose their own. Are they able to say no? on their own accord? So even after there is agreement on clientele's willingness to join group, we still have to account for unspoken goals. So many people leave the group b/c they had an implicit goal which was not answered

Another context issue of client – family system

-they have their own systems. i.e. in a marriage w/ one member being addicted to drugs, there is an unspoken contract: you spend our money and I treat you. If the husband changes, then the contract is breached, and the other partner will protest the addict's change. We have to realize this, as therapists. We might not deal with this issue, but we definitely need to be aware of such issues w/ individual group members of the group we run.

Organization:

-i.e. if there are a lower # of clients, then there tends to fight over the clients. Other questions come up when there is a client both in a group and individual treatment, the question that may come up is «who's client is it»? the answer is «both!»

Choosing the population: Homogeneous vs. heterogeneous

-both therapists meets everyone eligible and interviews

Homogeneousness: there needs to be a common theme – (some do not want be defined by the label that the group gives - («I don't want to be recognized as a mom to a schizophrenic»)

Heterogeneousness: we do want to have people w/ some internal variance. You do not want many people w/ same personal solutions to their problems. There will be no one except therapist who will show alternatives, and this position is too hard to b in as a therapist.

Demographic variables

• we need everyone to be able to speak the language. This point is exacerbated in immigrant receiving countries
• we will not have a minority group of 1 person in the group – 10 men to 1 women. Many young, 1 old… etc…When the problem is major – i.e. cancer, this unifies many diff. populations. But in other things, i.e. parents to hard children ->you need the kids to be at same place in life. Parents to infants is not same thing as parents to adolescents. So you do not want to have 1 person in the group to take on an additional role… this could suck for him
• education differences: is the gap is too big, it could be a problem. Preference: those w/ better verbal skills

interview

• initial acquaintance
  • so we can ask him how he feels groups/friends – this gives us an idea of how he will deal w/ groups. i.e. if he reports that he always was rejected, then you can ask how he would feel in such a setting
  • we should see if he has basic trust. Lack of this means he is not ready for a group
  • is you see his anxiety is too high t be in a group –and he doesn't want to– let him go
  • if the question comes up: «how can others with the same problems as I help me?» the answer goes something like: «well, lets see how they dealt with it!»
  • «will the group accept me as I am?»

• Initial contract:
  • We want to give a place of listening/sensitive to others/we need to be on time [not from a discipline level but on the mutual responsibility level] – if you have a more sensitive tone, they accept it

->phrasing positively is better «in the group, we will work on the strengths that we have» – but saying «we will work on motivation» – has a implicitly blaming tone

-the interview can last 30 minutes, and even less

Our goal is:

1. to see if they fit a group
2. how will the whole group look
3. see they are interested

Where does therapist get help/aired out?

-Almost all therapists have mentors

-the co-therapist is one person who can give you this support. We also have to build our own internal mentor – so we need the ability to reflect.

->when I write down what happened – it organizes our thoughts, and this is also supportive

Preparing for the group <->building a co-therapist relationship?

-here, we are exposed to another professional. So we need to work at the relationship. Good co relation is not something that happened but needs to be worked at

-the co-therapists are not a friendship kind of a relationship

So first, the therapists has to ask himself:

1. what characterizes me as a therapist?
   1. passive-active
   2. supportive vs. confronting
   3. nervous vs. calm

-i.e. what do I do when I am stressed out?

->in short, you need to get to know yourself

2. what do I expect myself to be as a therapist?
   1. Are they real? Do I expect myself to be a savior
3. what do I expect of my co-therapist?
   1. Passive? Active
   2. Will there be competition?

2-fold question

1. so we need to ask first ourselves those questions
2. are we able to expose our answers to others?

->then you got to speak w/ the co-therapist about how we will work together/express what I am strong or weak at? What do I wan and fear in the group/Communicate w/ each other? When going's tough, how do we communicate?

->we have got to get used to bringing up the tough issues

Read 2 articles - Dick/Berger

Class – 3/12/2007

For test:

Articles: all articles until, and including #14

-2 components – bibliographic, and vignette

Work at end of year: 1) description, 2) theoretic (approved by lecturer) 3) personals

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Now we will finish the group-building issue.

Co-therapist issues

-this is a very exposing job – someone else in the profession sees you at work

-this is not a friendship relationship. It is a work relation which must include a feedback/constructive criticism component

History of co-therapy

-until 60s, it was not an accepted thing to do a co-therapy. It was only done for hard cases of personality disorders. Concurrently, there was a trend to have marital partners run the group

Value of the relationship b/w therapists for the group

1. enriches the experience – exposure to interaction styles – and the people of the group sees how the co-therapists solves the problems among themselves
2. technical and not –it is a chance for each therapist to take on other roles – i.e. one goes into depth and one is supportive, or while one is more active, the other is observing – he is giving a view of what is not easy to see while other is active. other combination is one looking at whole group while the other looks at the individual elements
3. family paradigm – you have a chance to bring up triad themes of mom/dad/child – this is harder w/ 1 therapist in the group. The therapists have a parental role: also give borders and also support. You also have a chance to bring on oedipal questions
4. holding the group – i.e. borders/dealing with aggression in the groups

benefits to the therapists:

1. support each other
2. chance to grow – get the constructive feedback/get new experience

negative sides of co-therapist

1. more expensive
2. more time consuming – more mentoring meetings
3. Sometimes the relationship is not good – there are conflicts which may come up. Common issues are: how much activeness each one comes has/styles which are overly different. The group feels this – especially if the conflict is denied. Sometimes there is a unconscious contract b/w therapists that allows each one to function w/ industrial calm

So you need to build a strong co-therapists basis:

1. first, there needs to be a commitment not agree to work frankly with each other, with open communication.
2. Preferably, there needs to be some similarity of status – i.e. similar seniority.
3. Also, we need to develop a way to speak about disagreements.
4. The ability to give and receive criticism is important. But this is hard because we associate our reactions with our self-esteem! We also need to be aware of everyone's needs to be viewed positively. So there might have competition over the love of the group! (by the therapists!) – so one needs to look into oneself to see where my competitiveness is. Those power-competitions are normative, but needs to be dealt with. Also, at least in the beginning, it is important to have a mentor for the co-therapists in order to work out issues.
5. Another issue that needs to be worked out is each therapist's theoretical orientation

-so, in light of all of this, you need a strong basis need to decide whether we are going to do a co-therapy or a single-therapist group therapy

-issues usually start off intra-psychic – i.e. our self-esteem. How much room is there for me? For the co therapist? Who will «succeed» more?

Once some basic trust is established:

-there is a mutual development w/o anyone feeling he has to give up something – so that the difference b/w the therapists become an advantage and not a bother

10/12/2007

Exercise: hypothetical group building

• Population: post psychotic
• ages: 19-43 (note: huge age gap)
• purpose: increasing interpersonal communication and improving social skills
  • sub-purposes: first impressions, stigmas, feedbacks
• tools: arts
• time and place: in a community center

we will speak about issues today:

• beginning of group -the individual's connecting to the group
• «anti-group«

Beginning of group

-this stage is anxiety-filled. The analogy is to mom-child: since there is no integration, there is anxiety (as the baby doesn't know where he starts of finishes). The other people in the group are strangers to me. So it seems like that the people are functioning. The answer questions – but internally, they feel like the group may fall apart - there is no feeling of integration – of a coherent group. Like the survival-fear of the baby. When people first come to therapy, there is a magical wish that someone will take care of all my problems harmoniously– (read: symbiosis with the other – kinda like the fetus). This is a «together» feeling that is sometimes seen in individual therapy. But this is not so in a group – not everything fits me, my personality and my speed. So, basic trust is not established yet (read: the question of how much will others be for me) – so those fears of not having a place for me. The therapist can't promise that everyone will agree and support the individual. So there is anger at the group-therapist for not supporting. Just like the kid who can not deal w/ the aggression, so he projects it outwards to others. In the beginning, it is not projected onto the therapist b/c of the dependency needs. And since the individual cannot project onto the therapist, since he is a calming object, so he projects it onto the group. In later stages, the aggression/anger is directed straight onto the therapist. Bu still – in the beginning stage, the therapist can't be bad – yet the others ruin it for me – they ruin my chances of getting the «all-good» stuff from the therapist

-another thing seen in the beginning stages of the group is dropouts. This is because people ask the question of whether costs outweigh benefits. This weakens the group since it raises the question a notch stronger for those who stay: «well – other people thought that this group sucks, maybe it does suck?» So the therapist has to organize the group: time/place/information [it reduces ambivalence, and thus anxiety] – give some continuance and cohesion to what is happening

->you can say something: «not everyone feels comfortable in groups – so they left» – this gives the calming message of the group still being there for those who stayed – and it calms them down a bit. There has to be a calming message (i.e. remind them of our purpose). -so when someone drops out, the group therapist needs to relate to the dropout in the group – how people are reacting.

->so the therapist acts as a model as someone who speaks what bothers him and not place it under the carpet.

-with time, the «dependency» to the therapist decreases. He should NOT try to decrease it

-> it will happen when the group process is ready.

-there is competition in the group over «who is most _____________». It is more important to relate to the process.

We must ask why the things came up – what did the person really try to say – beyond the content. We, as therapists, have to relate to it in ways that the person can hear, and not as people in his life has been reacting until now to him.

17/12/2007

Starting the group's life

-we can use the mom-child as the analogue – the baby is not integrated and needs the mom's help in self-integration

2 central themes:

1. decomposition anxiety
2. huge dependency on the therapist
   1. so, therapist has 2 roles
      1. the therapist should allow this at first. So he should not stop the thought of the therapist with all the answers – let the trust build up first. The hope of the savior therapist will shatter - but it is an important stage
      2. reduce anxiety ->the therapist should also have an intro part – what we expect. Reference to what was spoken in the past [i.e. interview to the group] ->after all, this info reduces anxiety [especially decomposition anxiety] – you can refer to the decomposition anxiety ->even if people agree that a group is good for them, there is also an anxiety thing as well – how will it be? How will I be exposed? Can I say everything? – so the therapist needs to be able to give the comfortable message that here, there is room for everything

Intro games:

-good idea, but you have to choose the game carefully – i.e. some people might be offended at being asked to play a «childish» game. There is usually anxiety behind it. So, when choosing a game, you have to think through where to thing. Caution is the key. But if the group is resistant, then there is no point to an intro game. It should be an opening thing, and not a goal onto itself. So if the group resists, then that is food for analysis. The process is of essence and not the content.

Anti-group

Nitsun –coins the anti group in the 80s. It is a destructive force in the group – i.e. drives, emotions and approaches which are seek to destroy the group. Though if we deal with them right, the group an its individuals will grow – their strengths will develop.

-they appear in the beginning of the group's life, and possibly before it starts. This may be so because people are disappointed because they want individual and not group therapy. So the offer to join a group is seen as less good/even bad. This also happens when new people join the group. So the more senior group members are angry at the change, and «revolt» the group's existence.

Group dropout also weakens he group – people start thinking: «perhaps this group is not as good as I thought». People stay in any therapy w/ the «cost vs. benefit» calculation. So when people drop out, it emphasizes the cost part to the remaining group members. Nitsun claims that those who leave the group represent the anti-group of the remaining group members. Those dropouts take on the voice of the group of those who do not want the group.

The point is: anti-group is a defense mechanism which is meant to express that voice of wanting the protecting dyad of early infancy.

The therapist should not assume that the dropout is b/c of his incompetence as a group counselor but rather that this dropout expresses those early yearnings

Class 24/12/2007

Resistance

-resistance is a term central to the therapeutic field. Problems w/ the term is its seen as negative, and conscious.

-in practice, it is that infantile voice which does not want to deal w/ the pain which the conscious, mature part of the person wants to deal w/ it. Resistance allows the person not to deal w/ the pain but leads to fragmentation, as opposed to integration. It weakens the personality. There are many ways to resist – i.e. avoid hard content. Inherent to therapy is to bring integration, and part of that means to accept and deal with those hard/disavowed content. So the therapist represents the integrative approach and the patient takes the «disintegrative» voice. Thus, what was an intra-psychic conflict now b/c an interpersonal thing. Even w/ people who have a rational wish to fix their disposition, they also have a more emotional element of wanting to keep homeostasis/resistance to change

-resistance is avoiding the painful emotions. People want control over their lives. So they avoid things which might overwhelm them – so they try to get anxiety to «tolerable» levels. This is true for individual therapies but also group therapy. In the matrix of everyone in the group, people toss onto the group things that they disavow themselves. So, also resistance to change is tossed onto the group matrix, and the group voices the individuals' resistance. Sometimes, a whole group is silent. Example: the therapist could bring up an issue and no one answers. Black sheep is another group resistance phenomenon. Another example is a group who lets 1 speak so that no real group process will occur. Yet another example of resistance is a group who keeps on claiming that the therapist can not help. This is also resistance since it claims failure before the process even stared, and may stem from envy of the therapist – I will negate your skills ->those are a few examples of group resistance.

-There is a wrong assumption that we will overcome resistance and then start working. The truth is that resistance is a core part of the therapeutic content. Dealing with resistance is part of the therapeutic content.

-it is important that the therapist will identify the resistance: therapist feelings of:

• feeling that there is no movement in therapy process
• feeling boredom
• no variety of opinions – can't be that everyone has so similar opinions!

31/12/2007

How do we deal w/ resistance as therapists?

-ideally, people in the group react to others' resistance

-but in reality, in the beginning of the group, the therapists socialize the people to react to the resistance. Also, sometimes, the resistance is so strong that members are unaware of them- so therapist should bring it up.

-there is precedence to dealing w/ resistance over other issues. i.e. if homework not done, first deal w/ that, b/f dealing w/ content of homework

-sometimes, therapist is critical of resistance, the person feels you are criticizing him – since resistance is his way of «survival» – you have to look for empathy

->don't forget, what is apparent to you is not apparent to the group. i.e. if someone is used to projecting (the other one sucks!), then throwing the content of projection back at him won't work – «why should I deal with something that is yours?»

Observing ego = that part of us which reflects onto us – how we were/how we look

->so in resistance, we try to get the observing ego going – i.e. that there seems to be a certain phenomenon happening, and it seems to be related to something uncomfortable for you speak about.

-in some groups, the projecting is so tough, that they devaluate in order to not deal w/ something [i.e. resistance]

->some beginning group therapists think that an experienced therapist could deal w/ it better – but this is not true – the resistance is this tough for experienced group therapists too

-if the resistance is «against the therapist», you can wait for a chance to say «if seems like you feel that this place is worthless – wanna explain more about that?»

->one you see their response, you can see the underlying emotions and how those reactions used to be previous ways of survival, yet are now unnecessary, or even hindering to the current situations

In cases of violence/suicide

-there is a precedent to deal w/ that before contractual stuff

-i.e. mention something about how it is hard to XXX/broken fantasies/etc… the answering is done on the group level

->b/c if not, it could break up the group, since violence/suicide is extreme cases of resistance

In short:

Ask the person to clarify a «resistance-looking» statement, and try to bring to the group the hardship which the resistance-voice is saying

Ormont – resistance to intimacy:

The basic assumption of the article is that there is a basic axiom – that people seek attachment – an authentic, intimate relationship w/ others. And out job is to undo the barrier to such goals.

-now, we all have some «scratches» to us. We have our fears of intimacy, and in dyad relationships, we can always leave. Yet in a group, there is a contract saying that we have to be intimate to each others by being open to tough/deep things. So there are barriers which come up, which is based on our fears of intimacy. In dyadic therapy, the therapist fits himself to the patient. Now this does not happen in the group – the group members do not fit themselves onto others, and thus those barriers come up. So group therapy is an awesome chance to see what could not be seen in dyadic psychotherapy.

2 ways of resisting b/c close to each other:

1) b/h which is distancing other people

2) verbally distancing other people

Characteristics:

1. making conditionals: «if you'd only say ____»
2. create fights in order to create distance
3. people b/c detached/withdrawn
4. people busy with themselves
5. lack of trust in others: «they all are interested only in themselves»

-people see that this is not authentic – that this is b/c he doesn't want to del w/ the issues at hand.

4 fears of intimacy

1) impulsivity – expression of drives

2) fear of ðúéùä

3) fear of enmeshment (opposite of ) – and will lose his identity

4) fear of vulnerability – fear that weak sides will

7/1/2008 – last class of semester

Test – several questions and choice 4/5

-today, we'll speak of transference/countertransference

Transference

Definition:

When we speak of transference, we speak on an unconscious mechanism where characteristics of previous relationships, i.e. fantasies, behaviors, defenses emotions, etc.. are displaced onto current actual relations. This has several characteristics:

• its unconscious
• it has an intense emotional component which is unrelated to the current situation
• repetitiveness of it. – b/c the patient tries to «fix» his past. The object relations will say it is not an attempt to fix a past problem but rather repeats the relationships he knows

common transference objects

• parental figures – a nurturing object – the spectrum of this ranges from over-nurturing to the neglecting. The best is somewhere in the middle
• borders: spectrum range is from total obedience and giving up one's own component to lack of borders and its chaotic characteristics

-the question is how much the transference takes place in current relationships. It is an important element of them, but the question is how flexible it is. Transference also happens in the group of equals, i.e. siblings –i.e. so a person could learn to take a leadership role or more passive role, getting lost, etc…. – this is influenced by the family and number of kids, as well as the conclusions that the individual in question came to

-so we can study those intuitive feelings that one has about other people as see where they came from

Recommended book

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-Freud was the first to relate to transference. He was at first very cautious of it and thought it was hindering therapy. Later, he realized that if you wok through the transference, then you also fix things from the patient's past

-Transference also allows us to see the developmental stages of patient. i.e. healthier patients will transfer more complete objects and more pathological patients will transfer more partial objects. i.e. you are either bad or good [according to day]

-transference could also be seen in functionality of patient – i.e. come to pour and leave w/o getting something from –i.e. I come to you as my garbage can and not more –»part object transference»

Treating transference in group

• We need to identify it first as therapists.
• Then we will try to subtly bring it up: «I notices that this and that happens to you every time»
• Hopefully

Transference in group

• each of the co-therapists
• the triad – the 2 co-therapists vs. me
• other group members
• the whole group – seen as a pre-oedipal mom – dependency/wishing to be listen to/enmeshing into the group – and then the feeling of not enough of this «holding« feeling

-hopefully, we can also study through the transference how the group member came to this pattern– how is was survival-based/useful in previous situations and how it is less so today – that he has other options today. We can speak about this on the group level or on the individual (and the group will also derive benefit from this since the others will also relate and process the issue which might also relate to them)

Counter-transference

-there is a debate over definitions: is it:

1) everything that the therapist feels or thinks about the patient and situation –more broad definition

–or-

2) only his own conflicts (i.e. over control) – this is the more narrow definition

Role relationship

There some complementary – see how the therapist and patient tango together – this is the middle definition – b/w the two above definitions

-the question is how the therapist deals with his role – does he have a control issue? intimacy issues (i.e. can he only see the group as intimacy – and when the group meets outside the group setting for coffee, does he feel that his intimacy is threatened?) What about authority? Aggression? Eroticization?

->sometimes, there is an eroticization of the transference? Eroticization could be a cover to aggression or attempt at closeness

Pressures on the therapist

-sometimes there are pressures on the therapist for the organization – i.e. to be mature/organized/etc… but this is hard in tough cases

-pressure from the situation – i.e. the patient screaming all over the institution – what will others think?

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19/2/2008

Choose a topic

-speak about theories - be specific to the population!!!

->2/3 articles outside the syllabus – from 90. – and has to refer to group – but go beyond case-description

parts

1) theory

2)case description

3) personal elements

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Interventions in the class

-attempts to change something persistent

Roberts:

-some things are more unstable – little change =the balance is undone

-other things are more stable –more change is needed to question the balance

-there is a flowchart of yes-no's to get to the current situation – the question is whether the current situation requires change or not, and if this change is possible given the circumstances. The next question is what processes needs to be done in order carry on the change. The next question is if I have the tools to do this change. The last question is if now is the right time to do the change

Factors of intervention

1. structure – keeping a healthy group structure
2. process -allowing the process to happen
3. content – uncovering the latent content

kinds of intervention

1. holding – borders/time – who is in and who is out/what kind of behaviors are acceptable – deal with the structure
2. allowing/open – tries to allows the dynamics in the group – but not geared to the unconscious – i.e. «where does this meet you»?. This is not based on content
3. allowing/directed – directed by the group therapist's hypothesizing
4. interpretation – geared t/w making the unconscious conscious

-The therapist's reactions or lack of reaction also influences the weight that the group gives it

5. activity level of the therapist
6. self-disclosure of the therapist– «I feel that there is a heavy feeling here». Revealing a way of thinking: «self-meaning is in yourself – not in XYZ»
7. modeling: how to check himself and not blame others/luck/etc. modeling of interpersonal relations. Modeling of empathy
8. therapist's temperament
9. the empathic ability of the therapist – even to the co-therapist?

Beliefs

-various people have various beliefs – i.e. how and when to intervene in the group

-i.e. how to view autonomy vs. dependency.

->so we have to be aware of our views and how we idiosyncratically react

->and how we tend to think that we are the norms

On the individual level, the person wants a place to speak ->we have to establish the atmosphere where everything is acceptable to speak about. On the group level, there us a sense of wanting coming in order to get something out of it.

Most classes until the end of the year were practical – mock groups

17/3/2008

-every therapeutic intervention has an ending

1. people eave before the formal ending –this causes some feeling of the group dissipating ->people vote with heir feet cause people to ask the cost-vs.-benefit question. i.e. the alcoholic got benefit from the alcohol, so the benefit of the therapy must be bigger than the cost of giving up alcohol ->so people generally leave prematurely b/c the cost is too high
2. in open-ended groups, people leave when they get their goals. But most groups are limited in time (limited number of meetings). People may also leave b/c they had latent goals, which are unanswered

-even if people knew from the start that the group has a limited time-scope, they do feel abandoned when ending comes up ->that the group therapists are abandonimg ship b/f the therapeutic processes could be complete!

-ending of group = loss of group +group therapists = set processes of loss (bereavement).

Bereavement stages

1. denial
2. negotiation
   1. feelings of:
      1. guilt
      2. anger
3. acceptance (hopefully)

->therapy is also meant to meet and processes such processes (possibly for the first time in life?)

Ending phenomenon:

• dropout – leave you before you leave me
• devaluation: so that the «loss» is smaller
• symptom return: regression
• dropping the bomb: right before ending of group, say something drastic that has been withheld from the group – timing does not allow group to deal with it… DO NOT DEAL WITH IT – but rather deal with its timing –i.e. how no one ever heard the person and how it is now replayed in how the person chooses to bring it up
• end-party syndrome – work on a party in stead of work out the processes of ending ->denial of upcoming ending

Ending stage elements:

• process the ending
  • parting emotions
  • adaptation to future
• group member's evaluation: is a cognitive element of what we achieved
  • what did I achieve vs. what I wanted?
    • People who came every time obviously got something, despite denial
  • How was it for me?
  • How was I vs. the therapist? Could I hear feedback from the therapist?