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PubMed1998

Metaclinical issues in the treatment of psychopolitical trauma.

Metaclinical implications of psychotherapy with individuals traumatized by violent political repression are explored, with an emphasis on ethical concerns in treatment. Issues addressed include the relevance of the sociopolitical context in the conceptualization of the trauma, the challenge of transcending cultural frameworks, the clinician's role in the reversal of collective denial, the interplay of motivation and countertransference, and the impact of questions of purpose and meaning in both survivors and clinicians interacting with trauma.

Adaptation, Psychological↗
PubMed2003

Working with the psychological effects of trauma: consequences for mental health-care workers--a literature review.

This literature review explores how interacting with seriously traumatized people has the potential to affect health-care workers. The review begins with an introduction to post-traumatic stress disorder as being one of the possible negative consequences of exposure to traumatic events. The report proceeds with examining the concepts of vicarious traumatization, secondary traumatic stress, traumatic countertransference, burnout and compassion fatigue, as potential adverse consequences for workers who strive to help people who are traumatized. The differences between these concepts are also discussed. The notion of compassion satisfaction is examined as findings have demonstrated that it is a protective factor which can be used as a buffer to prevent the aforementioned concepts. Conversely, findings have shown that a history of previous stressful life events in helpers is a potential risk factor. The review concludes with an overview of the concepts considered, but cautions against generalization of the findings owing to the dearth of longitudinal studies into the issues raised and also the lack of investigation into the many different types of trauma.

Burnout, Professional↗
PubMed2001

["I dreamed that I dreamed": some notes on the clinical evaluation of therapist interventions, exemplified by Deserno's case study (session 290)].

In No. 8, 48th year, August 1998, of the journal "Psychotherapie--Psychosomatik--Medizinische Psychologie" the tape recorder transcription of the 290th session of a long-term analysis was studied by three methods (BIP, Frames, ZBKT). The paper presented here was stimulated by this publication. From the author's viewpoint substantial clinical aspects of evaluation could be added by applying a clinical evaluation method developed by R. Langs and his corresponding concept of interpretation. Clinical vignettes exemplify the possibility to resolve pathological countertransference by using this evaluation method. With the help of this method the presented transcription of the 290th session is evaluated partially.

Countertransference↗
PubMed2003

[Emotional reactions of staff-members managing highly aggressive mentally ill patients].

Highly aggressive behaviour of psychiatric in-patients often provokes intense emotional reactions and countertransference-feelings in staff especially when it is necessary to control aggression in psychiatric emergency units. We investigated the emotional reactions immediately after the manifestation of a patient's aggressive behaviour in a group of 53 staff members. The amount of aggression was measured with the help of the "Modified Overt Aggression Scale" (MOAS). The type and intensity of the staff-emotions can be adequately described by using a special self-rating questionnaire: "Eigenschaftswörterliste" (EWL 60 S). Using principal component analysis, three factors were differentiated: experience of stress, experience of sovereignty and experience of calmness. Several independent variables were identified as selectively increasing the probability of priority of each emotional factor mentioned above. In addition, a subgroup of staff members who have a raised risk of stress experience compared to the other staff members was compiled by cluster analysis. Based on an aggressiveness sequence model, useful strategies were discussed which directly aim to improve the coping abilities of staff members dealing with their emotional over involvement.

Adaptation, Psychological↗
PubMed1989

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 leader's 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.

Countertransference↗
PubMed1990

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 one's individual patient. The author shows how raising this question: (1) alters the therapeutic field whether or not the patient joins; (2) can sharpen the therapist's 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.

Countertransference↗
PubMed1991

The Axis II group: treating severely characterologically disturbed patients.

Treating the chronically mentally ill involves not only working with patients suffering from schizophrenia and other prolonged or recurrent psychotic illnesses, it also means providing treatment for patients with severe personality disorders. Many of these patients are also active substance abusers. This article examines the therapeutic and management issues raised for outpatient clinicians who work with these patients. Consideration is devoted to the special problems in treating the dual diagnosis patient, issues of patient and therapist safety, limit setting, splitting dynamics, and countertransference reactions. A set of recommendations is offered for conducting outpatient group therapy, specifying what is needed from both the clinicians and the facility in which this type of treatment is provided.

Acting Out↗
PubMed1992

The place of self psychology in group psychotherapy: a status report.

This article reviews the growing contribution of self psychology to group psychotherapy. The basic self-psychological concepts as they are applied to group dynamics and the treatment process are explored. Transference, countertransference, and self-restitutive patterns are illustrated in a clinical vignette that includes a "difficult" patient's impact upon the interactional and group-as-a-whole processes. Several directions for future investigation are described.

Adult↗
PubMed1992

Group rational-emotive and cognitive-behavioral therapy.

The theory of rational-emotive therapy (RET) and of cognitive-behavioral therapy (CBT) is briefly explained and is applied to group therapy. It is shown how RET and CBT therapy groups deal with transference, countertransference, levels of group intervention, process versus content orientation, identifying underlying group process themes, here-and-now activation, working with difficult group members, activity levels of therapist and group members, and other group problems. Although they particularly concentrate on people's tendencies to construct and create their own "emotional" difficulties, RET and CBT group procedures fully acknowledge the interactions of human thoughts, feelings, and actions and active-directively employ a variety of cognitive, emotive, and behavioral group therapy techniques.

Cognitive Behavioral Therapy↗
PubMed1992

Money and psychodynamic group psychotherapy.

Money may be the most upsetting and therefore the most avoided topic in group psychotherapy. To overcome this resistance, the leader must secure prospective members' willingness to speak openly about financial matters. Financial issues particular to group therapy emerge when money is normalized as a topic for discussion. These include lowering or not raising fees, rescheduling, leaves of absence, combined and conjoint therapy, and nonverbal behaviors. Several case examples are provided. Members' strong feelings toward the leader around financial transactions often find expression in angry accusations. Suggestions for dealing therapeutically with countertransference reactions to these accusations are offered.

Adaptation, Psychological↗
PubMed1993

Control and power in supervision.

This article explores the dynamics of the supervisory process focusing on the factors effecting the balance of power between the supervisor and supervise. The assignment of inherent roles, issues of transference, countertransference, and the parallel process with all the risks involved for both parties are reviewed. Recent developments in the shifting supervisory equilibrium are analyzed and specific suggestions are offered to avoid the common pitfalls present in many contemporary supervisor situations.

Countertransference↗
PubMed1993

Groups for the chronic mental patient and the legacy of failure.

Group treatment of the chronically mentally ill has often been a fruitless and exasperating experience. The intense emotional responses of group leaders in working with this chronic population reinforces a spiral of repetitive failures. An attempt to intervene in this chronic spiral will be presented by the author's experience in leading a training group of mental health workers who, in turn, lead groups of chronic patients. In particular, the effects of projective identification on various holding environments will be examined by using the methodology of object relations. Understanding and utilizing countertransference responses of the training leader illuminate the unconscious aims of chronic patients to perpetuate their internal and interpersonal lives by their effect on the group leaders who work with them and on each other. This understanding can lead to interventions that have more constructive outcomes.

Caregivers↗
PubMed1996

Limiting time-unlimited group psychotherapy.

For a number of reasons, we decided to bring three long-term, open-ended psychodynamic therapy groups to termination. We examine the process that began with the announcement of the change to a time-limited format, and concluded with the termination of the group. The transition had a powerful impact on the members and the group-as-a-whole. The therapists used supervision to deal with the intensity of the group process and the countertransference demands posed by the transition. Groups facing a similar change due to economic pressures may benefit from these observations.

Adult↗
PubMed1996

Termination in inpatient groups.

This article provides the therapist with a three-factor framework for understanding and constructively responding to members' termination in the inpatient group. The first factor is the context in which the inpatient group takes place. It will be argued that how the broader system defines and treats termination affects the group process at the time of termination. The second factor is the therapist's countertransference. Three especially common reactions (disappointment, abandonment anxiety, and powerlessness) will be described. The third factor is the characteristic need of inpatients at termination time. Each factor is described in terms of its potential impact on the termination process. Techniques and suggestions are offered that aim to mitigate the destructive forces of each factor and to enhance the therapeutic value of the termination event for the patient.

Countertransference↗
PubMed1996

Termination in group psychotherapy from the perspectives of contemporary object relations theory and self psychology.

Throughout the development of object relations theory and self psychology, the importance of attachments, availability, absences, limitations, and endings have been factors that have informed theory and practice. This article examines the multiple meanings and impacts of terminations in group psychotherapy at the intrapsychic, interpersonal, and group-as-a-whole levels, from the perspective of contemporary object relations theory and self psychology. Emphasis is placed on the initiation of a mourning process, with the dynamics of guilt, shame, and aggression toward objects who are separate or inaccessible, and the experience of a shortcoming or absence, associated with a loss of self-object oneness, soothing, and idealization from the narcissistic sector of the personality. Therapeutic opportunities afforded by terminations and the importance of resolving countertransference reactions are highlighted.

Adult↗
PubMed1998

Different patterns of change in narratives of men and women during analytical group psychotherapy.

Narratives of men and women concerning their interactions with other people were evaluated before and during analytically oriented group psychotherapy using the Core-Conflictual-Relationship-Theme (CCRT) method (Luborsky & Crits-Cristoph, 1990). Relationship patterns of men and women developed differently during therapy. Some gender stereotypes persisted, others changed. During therapy the proportion of negative responses in the narratives increased in the men. Change in the narratives was not related to change in self-reported symptoms. For group treatments, the results suggest that the gender of the patients has to be taken into account. Knowledge of different developmental patterns for men and women in groups can be important in regard to the expectations of therapists and their countertransference.

Adult↗
PubMed2000

The use of the self in group leadership: a relational perspective.

This article, written from a relational perspective, describes a shift that is taking place in the thinking of many psychodynamically oriented psychotherapists regarding the practice of therapy and the implications it has for group therapists. The shift, from one-person to two-person and multi-person theory, has particular importance for group leaders since it recommends making the subjective involvement of the therapist in the interactional field of the group much more a part of the treatment process. Theory and research on the use of countertransference, non-interpretive interventions, humor, and spontaneity by the leader are reviewed and vignettes are presented to illustrate the application of these ideas. Guidelines regarding the application of such ideas in group therapy are also discussed.

Countertransference↗
PubMed1979

An interpersonal communication analysis of relationship in psychotherapy.

In psychotherapy theorty, research, and practice, relationship has remained a controversial and elusive construct. Psychoanalytic theorists highlight transference-countertransference factors as central theoretical and technical components, but have yet to translate these constructs into a scientifically useful format. Rogerian theorists have consistently specified the relationship factors of positive regard, empathy, and congruence as "necessary and sufficient conditions" for constructive personality change in therapy and have evolved operational anchorings (e.g. Rogers, Gendlin, Kiesler, and Truax, 1967). Behaviorists (e.g., Wilson and Evans, 1978) conceptualize relationship factors as nonspecific variables which are important in enhancing the social influence and eliciting power of the therapist as an agent of change, while considering most client emotional responses toward the therapist as random factors which are generally irrelevant to the therapeutic process. My purpose in this paper is to offer a conceptual and empirical analysis of relationship in human behavior and in psychotherapy from an interpersonal communication perspective.

Communication↗