THEORETICAL APPROACHES TO GROUP COUNSELING SIX The Psychoanalytic Approach to Groups 1 ! SE"EN A#lerian Group Counselin$ 1!

% EIGHT Psycho#ra&a in Groups 1'( NINE The E)istential Approach to Groups TEN The Person*Centere# Approach to Groups %+ ELE"EN Gestalt Therapy in Groups ,, T-EL"E Transactional Analysis in Groups + + THIRTEEN Co$niti.e /eha.ioral Approaches to Groups +01 2OURTEEN Rational E&oti.e /eha.ior Therapy in Groups +, 2I2TEEN Reality Therapy in Groups 0( SIXTEEN Solution*2ocuse# /rie3 Therapy in Groups 0 %

chapter six The Psychoanalytic Approach to Groups Introduction Psychoanalytic theory has in uenced most of the other models of group work presented in this textbook. Some of these other approaches are extensions of the analytic model some are modi! cations of analytic concepts and procedures and some ha"e emerged as a reaction against psychoanalysis. It is fair to say that most theories of group counseling ha"e borrowed concepts and techni#ues from psychoanalysis. As a group counselor you may ha"e neither the training nor the moti"ation to conduct analytic groups. $owe"er e"en if you do not use psychoanalytic techni#ues some basic psychoanalytic concepts can become an integral part of your own theoretical approach. This chapter includes an o"er"iew of the psychoanalytic and psychosocial perspecti"es a brief introduction to contemporary trends in psychoanalytic thinking and the stages of de"elopment in an indi"idual%s life. Sigmund &reud made signi! cant contributions to our understanding of the indi"idual%s psychosexual de"elopment during early childhood. $owe"er he wrote little about the psychosocial in uences on human de"elopment beyond childhood. &or this reason I discuss 'rik 'rikson%s ()*+, )*-./ psychosocial perspecti"e which pro"ides a comprehensi"e framework for understanding the indi"idual%s basic concerns at each stage of life from infancy through old age. 'rikson can be considered a psychoanalyst as well as an ego psychologist0 he built on &reudian concepts by continuing the story of human de"elopment where &reud left off. The person credited with ! rst applying psychoanalytic principles and techni#ues to groups is Alexander 1olf a psychiatrist and psychoanalyst. $e began working with groups in )*,- because he did not want to turn away patients who needed but could not afford intensi"e indi"idual therapy. $is experiences increased his interest in this approach and he made it his primary mode of therapy. G2A3 2& T$' A4A35TI6 G728P The goal of the analytic process is restructuring the client%s character and personality system. This goal is achie"ed by making unconscious con icts conscious and examining them. Speci! cally psychoanalytic groups reenact the family of origin in a symbolic way "ia the group so that the historical past of each group member is repeated in the group%s presence. 1olf ()*+, )*9:/ de"eloped group applications of basic psychoanalytic techni#ues such as working with transference free association dreams and the historical determinants of present beha"ior. $e stresses the re;creation of the original family which allows members to work through their unresol"ed problems in the group. Their reactions to fellow members and to the leader are assumed to re"eal symbolic clues to the dynamics of their relationships with signi! cant ! gures from their family of origin. Although these

reactions are taken from the here;and;now there is a constant focus on tracing them back to the early history of the members (Tuttman )*-+/. Some psychoanalytic groups seek to duplicate the original family in many respects. The group leader applies understanding to the family;like connections that arise among the members and between the members and the therapist. Participants in a group often reexperience con icts that originated in the family context. <ecause of the family;like atmosphere the group pro"ides opportunities to e"oke associations to both family;of;origin and present life experiences (7utan Stone = Shay .>>9/. ?ey 6oncepts I4&38'46' 2& T$' PAST Psychoanalytic work focuses on the in uence of the past on current personality functioning. 'xperiences during the ! rst + years of life are seen as the roots of one%s con icts in the present. Typical problems that bring many clients to therapy groups include the following@ an inability to freely gi"e and accept lo"e0 dif! culty recogniAing and dealing with feelings such as anger resentment and aggression0 an inability to direct one%s own life and resol"e dependence and independence con icts0 dif! culty in separating from one%s parents and becoming a uni#ue person0 the approach and a"oidance of intimacy0 dif! culty in accepting one%s own sexual identity0 and guilt o"er sexual feelings. According to the psychoanalytic "iew these problems of adult li"ing ha"e their origin in early de"elopment. 'arly learning is not irre"ersible but to change its effects one must become aware of how certain early experiences ha"e contributed to one%s present personality structure. Although practitioners with a psychoanalytic orientation focus on the historical antecedents of current beha"ior it is a mistake to assume that they dwell on the past to the exclusion of present concerns. 6ontemporary analytically oriented practitioners are interested in their clients% past but they intertwine that understanding with the present and with the future. A common misconception about psychoanalytic work is that it resembles an archaeologist digging up relics from the past. The past is rele"ant only as it in uences the present and the future and in this sense all three ha"e an essential place in group therapy (7utan et al. .>>9/. 3ocke ()*+)/ points out that psychoanalytic group work consists of Bwea"ing back and forth between past and present between present and past. . . . It is essential that the therapist mo"e back and forth in time trying always to recapture the past or to see the repetition in the present and to become aware of the early traumatic e"ent which made for the neurotic pattern of the indi"idual todayC (pp. ,>D,)/. ?ernberg ()**9/ indicatesthat there is an increasing interest in contemporary psychoanalytic therapy to focus on the unconscious meanings in the here;and;now before attempting to reconstruct the past. It is essential that participants understand and use historical data in their group work but they also need to be aware of the pitfalls of getting lost in their past by recounting endless and irrele"ant details of their early experiences. In the "iew of 1olf and ?utash ()*-+/ the recital of yesterday%s e"ents can be uselessly time consuming and can inhibit progress. They see this use of history as essentially a form of resistance and they suggest that talking about

e"ents in one%s childhood is not as useful as dealing with the past in relation to hereand;now interactions within the group. T$' 84624S6I28S The concept of the unconscious is one of &reud%s most signi! cant contributions and is the key to understanding his "iew of beha"ior and the problems of personality. The unconscious consists of those thoughts feelings moti"es impulses and e"ents that are kept out of our awareness as a protection against anxiety. &reud belie"ed that most of human beha"ior is moti"ated by forces outside conscious experience. 1hat we do in e"eryday life is fre#uently determined by these unconscious moti"es and needs. Painful experiences during early childhood and the feelings associated with them are buried in the unconscious. These early traumas are such that conscious awareness would cause intolerable anxiety to the child. The child%s repression of them does not automatically lift with time and the client reacts to threats to the repression as if the anxiety associated with the early e"ents would still be intolerable if these were recalled. Thus the Bshadow of the pastC haunts the present. <y bringing unconscious material to awareness within the group the member realiAes that the anxiety is not intolerable. The trauma was intolerable only to the child0 with an adult perspecti"e on the world the client can handle the memory with relati"e ease. 8nconscious experiences ha"e a powerful impact on our daily functioning. Indeed &reud%s theory holds that most of our BchoicesC are not freely made0 rather forces within us of which we are unaware guide our choices. Thus we select mates to meet certain needs that may ne"er ha"e been satis! ed0 we select a Eob because of some unconscious moti"e0 and we continually experience personal and interpersonal con icts whose roots lie in un! nished experiences that are outside the realm of our awareness. According to psychoanalytic theory consciousness is only a small part of the human experience. 3ike the greater part of the iceberg that lies below the surface of the water the larger part of human experience exists below the surface of awareness. The aim of psychoanalysis is to make the unconscious conscious for it is only when we become aware of the moti"ations underlying our beha"ior that we can choose and become autonomous. The unconscious can be made more accessible to awareness by working with dreams by using freeassociation methods by learning about transference by understanding the meaning of resistances and by employing the process of interpretation techni#ues discussed later in this chapter. The concept of the unconscious has deep signi! cance for analytic group therapy. Although it is true that exhausti"e work with the unconscious determinants of beha"ior and personality reconstruction is beyond the scope of group counseling as it is generally practiced group counselors should ha"e an understanding of how unconscious processes operate. This understanding pro"ides group practitioners with a conceptual framework that helps them make sense of interactions in a group e"en if members do not deal with the unconscious directly.

A4FI'T5 To appreciate the psychoanalytic model one must understand the dynamics of anxiety. Anxiety is a feeling of dread and impending doom that results from repressed feelings memories desires and experiences bubbling to the surface of awareness. It is triggered by something in the en"ironment or within the indi"idual. Anxiety stems from the threat of unconscious material breaking through the wall of repression. 1e experience anxiety when we sense that we are dealing with feelings that threaten to get out of our control. Anxiety is often Bfree; oatingC0 that is it is "ague and general not yet ha"ing crystalliAed into speci! c form. The next section deals with the function of ego;defense mechanisms which are an integral part of the indi"idual%s attempt to cope with anxiety.

'G2;G'&'4S' H'6$A4ISHS 'go;defense mechanisms were ! rst formulated by psychoanalytic theorists as a way of explaining beha"ior. These defense mechanisms protect the ego from threatening thoughts and feelings. 6onceptually the ego is that part of the personality that performs "arious organiAing functions including keeping in contact with reality. The ego should not be e#uated with consciousness. Aspects of the ego are unconscious including much of the functioning of defenses. The ego organiAes and mediates between the impulses of the id the demands of reality and the imagined demands of parental ! gures and others. 1hen there is a threat to the ego anxiety is experienced. Although we may be interested in the growth that comes from facing reality directly we attempt to protect oursel"es from experiencing anxiety. The ego defenses enable us to soften the blows that come with emotional wounding and they are one way of maintaining a sense of personal ade#uacy. Although the ego defenses do in"ol"e self;deception and distortion of reality they are not considered essentially pathological. It is only when these defenses are rigidly used or when they impair a person%s ability to deal effecti"ely with the tasks of life that their use becomes problematic. '"en though these mechanisms are learned and become a habitual mode of defense against anxiety they typically operate outside one%s consciousness. There are many opportunities to obser"e a "ariety of defensi"e beha"iors in a group. Gefenses that we used in childhood when we were threatened often continue into adulthood and are acti"ated when we feel threatened in the group. Through feedback from the group therapist and the other members indi"iduals can become increasingly aware of their defensi"e styles of interaction. 1ith awareness group members are able to be more exible in the use of defenses and they are e"entually able to choose direct forms of dealing with anxiety;producing situations as they emerge in a group.

Se"eral common ego defenses are typically manifested in the pattern of interactions in the therapeutic group@

I 7epression in"ol"es excluding from consciousness threatening or painful thoughts and desires. <y pushing distressing thoughts or feelings into the unconscious people manage the anxiety that grows out of situations in"ol"ing guilt and con ict. 7epression underlies most of the other ego defenses. If adults were physically or emotionally abused in childhood they might well ha"e blocked out the pain and anxiety associated with these traumatic e"ents by pushing the memories into the unconscious. &or example adults may ha"e no recollection of the details of incestuous e"ents that occurred in early childhood. $owe"er as other members experience a catharsis and work through the pain associated with recalled incest a member who has repressed an incestuous experience may be emotionally triggered and unconscious material may surface to awareness. I Genial plays a defensi"e role similar to that of repression yet it generally operates at the preconscious or conscious le"el. In denial there is an effort to suppress unpleasant reality. It consists of coping with anxiety by Bclosing our eyesC to the existence of anxiety;producing reality. In a therapy group members sometimes refuse to accept that they ha"e any problems. They may attempt to decei"e both themsel"es and others by saying that they ha"e Bworked onC certain problems and that they therefore no longer ha"e any concerns to deal with in the group. I 7egression in"ol"es returning to a less mature de"elopmental le"el. In the face of se"ere stress or crisis we sometimes re"ert to old patterns that worked for us earlier. &or instance a man in a therapy group may retreat to childlike beha"iors and become extremely frightened and dependent as he faces a crisis precipitated by a lo"ed one%s decision to separate from him.
ProEection in"ol"es attributing our own unacceptable thoughts feel;ings beha"iors and

moti"es to others. In a group setting members may be "ery able to see the faults of others. They may also attribute to other members certain feelings and moti"es that would lead them to feel guilty if they owned these feelings and moti"es themsel"es. 2f course groups offer many opportunities to "iew proEection in action. Hembers who ha"e dif! culty accepting their aggressi"e or sexual feelings may see other group members as hostile or seducti"e. Group leaders should be aware howe"er that members who do make inappropriate hostile or seducti"e comments often defend themsel"es by labeling as BproEectionC any negati"e feedback they recei"e in the group. I Gisplacement entails a redirection of some emotion (such as anger/ from a real source to a substitute person or obEect. Group members who are frustrated are likely to feel angry. If the leader confronts members for pouting or employing some other attention;seeking beha"iors for example they may lash out in a hostile way toward some member who is relati"ely nonthreatening. Although their anger may be a result of a group leader%s confrontation they pick a safer target on whom to "ent their hostility. I 7eaction formation in"ol"es beha"ing in a manner that is opposite to one%s real feelings. It ser"es as a defense against anxiety that would result from accepting feelings that one is stri"ing to disown. This defense is exhibited in a group by the woman who is Bsugary sweetC

yet really harbors many hostilefeelings that she dares not express. It is also displayed by the man who tries to con"ince himself and others that he does not care if others reEect him either in this group or at home yet who underneath "ery much wants the acceptance of others. These beha"iors co"er up one%s real feelings for dealing with hostility or reEection would be painful. In these cases there is an exaggeration of being sweet or of being emotionally indifferent to reEection. The excessi"e #uality of these beha"iors is what makes them recogniAable as a form of defense. I 7ationaliAation is a defense mechanism whereby we try to Eustify our beha"ior by assigning logical and admirable moti"es to it. Some people manufacture BgoodC reasons to explain away a bruised ego. This defense in"ol"es an attempt to minimiAe the se"erity of disappointment o"er losses or failures. In groups there are many opportunities to obser"e this beha"ioral pattern in action. Hembers may de"ote a great deal of energy to focusing on Bothers out thereC as the source of their problems. '"eryone uses ego;defense mechanisms and they ha"e some adapti"e alue0 ne"ertheless their o"eruse can become problematic. It is true that selfdeception can soften harsh reality but the fact is that reality does not change through the process of distorting those aspects of it that produce anxiety. In the long run when these defensi"e strategies do not work the result is e"en greater anxiety. The group situation is ideal for enabling indi"iduals to learn to recogniAe the indirect methods that they resort to when they feel emotionally threatened. To a"oid Eudging such beha"ior it is possible to work with members in therapeutic ways so that they can increase their tolerance for coping with anxiety and can learn direct ways of dealing with dif! cult interpersonal situations. 7'SISTA46' In psychoanalytic therapy resistance is de! ned as the indi"idual%s reluctance to bring into conscious awareness threatening unconscious material that has been pre"iously repressed or denied. It can also be "iewed as anything that pre"ents members from dealing with unconscious material and thus keeps the group from making progress. 7esistance is the unconscious attempt to defend the self against the high degree of anxiety that the client fears would result if the material in the unconscious were unco"ered. 7utan Stone and Shay (.>>9/ remind us that Bresistance is not a process designed to resist treatment0 it is a defensi"e process designed to resist emotional painC (p. .>+/. As 3ocke ()*+)/ puts it group members need to protect themsel"es against the B ooding of the conscious by the forbidden feeling fantasy or memoryC (p. 9./. 7esistance is the B! ght to maintain the defenseC0 thus it is Bthe defense of the defense.C Gurkin ()*+J/ stresses that resistance is a basic part of the analytic group and she warns group leaders not to be surprised by or impatient with it. She recommends that leaders not "iew resistance as a sign of their own ineptness. There are many kinds of resistances some relating to apprehension about Eoining a group some to participation in the group process and some to the desire to lea"e the group (3ocke )*+)/. 1olf ()*+,/ lists "arious sources of resistance in group members@ fear that one%s pri"acy will be in"aded0 need to BownC the therapist exclusi"ely0 fear of BmeetingC again one%s original family in the groupKnamely recogniAing one%s parents or siblings in

some of the participantsKand ha"ing to deal with the anxiety produced by these encounters0 unconscious fear of gi"ing up neurotic trends0 and anxiety about the freedom that a group offers including the freedom to discuss anxiety. 1olf also identi! es other forms of resistance that surface during the ad"anced stages of group analysis. Some members hide behind the analysis of other members and some engage in lengthy recitations of their life histories thus a"oiding the challenge of facing the present. Additional manifestations of resistance include these beha"iors@ I Typically arri"ing late or not showing up at all I Haintaining an attitude of complacency or indifference I IntellectualiAing I 'xhibiting an exaggerated need to help others in the group I Showing distrust I <eha"ing uncooperati"ely I Inappropriate or impulsi"e beha"ior including comments or gestures of; fensi"e to any group members I 8sing the group for mere socialiAing These are by no means the only manifestations of resisti"e beha"ior0 what they all ha"e in common is the fear of recogniAing and dealing with that part of oneself that is locked in the unconscious. $ow do group therapists deal with resistanceL Gurkin ()*+J/ maintains that to penetrate and work through resistances the therapist needs to enlist the cooperation of members. Therefore he or she must start with the client%s immediate problems as they are manifested through resisti"e beha"iors which should not be "iewed as something to be o"ercome. <ecause resistances are aluable indications of the client%s defenses against anxiety they should be acknowledged and worked through by the therapist and client together with the clear understanding that they are both working toward the same ends. Group therapists should take care not to label or censure group members0 unacceptable criticism will only increase resisti"e beha"iors. It can also be useful to bring other group members into the analysis of indi"idual member%s resistances. T7A4S&'7'46' Transference a basic concept of the psychoanalytic group approach in"ol"es the unconscious repetition of the past in the present. Transference refers to the member unconsciously shifting feelings attitudes and fantasies (both posi;"e and negati"e/ that stem from reactions to signi! cant persons from the past onto the therapist (or other group members/. Transference re ects the patterning of old experiences and earlier ac#uired

distortions as they emerge in present relationships (3uborsky 2%7eilly;3andry = Arlow .>))/. Groups offer many opportunities for the exploration of these transference reactions that ha"e roots in prior relationships (7utan et al. .>>9/. In the analytic setting unlike the original situation the person may experience and express these feelings without punishment. A psychoanalytic group pro"ides a safe neutral en"ironment in which members can express spontaneous thoughts and feelings. This allows the transference process to emerge in a group which clearly contributes to the success of group therapy (?auff .>>*/. If a group member percei"es the therapist as a stern and reEecting father he or she does not recei"e from the therapist the expected negati"e responses. Instead the therapist accepts the member%s feelings and helps the person understand them. Analytically oriented group therapists consider the process of exploring and interpreting transference feelings as the core of the therapeutic process because this work helps the group member achie"e increased awareness and personality change. Group participants tend to compete for the attention of the leaderKa situation reminiscent of earlier times when they had to "ie for their parents% attention with their brothers and sisters. These attempts can be explored to disco"er whether they re ect the member%s need for uni"ersal appro"al and how such a need go"erns the person%s life. Hembers can gain increased awareness of how they dealt with competition as children and how their past success or lack of it affects their present interactions with others. Group therapy also offers the possibility of multiple transferences. In indi"idual therapy the client%s proEections are directed toward the therapist alone0 in group therapy they are also directed toward other members. <y combining indi"idual and group psychotherapy the transference process can be illuminated and explored0 bene! ts of the group format include facilitating separationM indi"iduation pro"iding transference obEects through other members in addition to the therapist and dealing with resistances (?auff .>>*/. The group constellation lends itself to multiple transferences that pro"ide for reenacting past un! nished e"ents especially when other members stimulate such intense feelings in an indi"idual that he or she BseesC in them some signi! cant ! gure such as a father mother sibling life partner spouse exlo"er or boss. The group is a conduci"e milieu in which to reli"e signi! cant past e"ents because Bthe group of today becomes the family of yesterday C says 3ocke ()*+) p. )>./. 1olf ()*+,/ and 1olf and SchwartA ()*+./ obser"e that group members ser"e as transference ! gures for other members and that the main work of the analytic group consists of identifying analyAing and resol"ing these proEections onto family surrogates in the group. The leader has the task of helping members disco"er the degree to which they respond to others in the group as if they were their parents or siblings. Groups can pro"ide a dynamic understanding of how people function in out;of;group situations. <y reli"ing the past through the transference process members gain increased awareness of the ways in which the past is obstructing present functioning. <y interpreting and working through their transferences participants become increasingly aware of their ! xations and depri"ations and of the ways in which past e"ents interfere with their ability to appraise and deal with reality in e"eryday life.

6284T'7 T7A4S&'7'46' The therapist%s own feelings may become entangled in the therapeutic relationship obstructing or e"en destroying obEecti"ity. According to psychoanalytic theory countertransference consists of a therapist%s unconscious emotional responses to a client resulting in a distorted perception of the client%s beha"ior. 7utan Stone and Shay (.>>9/ describe countertransference as Bthe therapist experiencing feelings from the past that are reacti"ated by the patient in the presentC (p. .J*/. In a broader sense countertransference in"ol"es the therapist%s total emotional response to a client. $ayes (.>>J/ refers to countertransference as the therapist%s reactions to clients that are based on his or her own unresol"ed con icts. 4o analytic leader is totally free of in"ol"ement in transference or countertransference (1olf )*-,/. 6omas;GiaA (.>))/ points out that therapists and their clients respond to conscious and unconscious dimensions of their culture. She reminds us that therapists from dominant cultures may not be aware of the cultural ethnic and racial aspects of transference and countertransference@ BIdentifying the cultural parameters of transference and countertransference is central to multicultural psychotherapists. They recogniAe that ethnic cultural gender and racial factors often lead to a more rapid unfolding of core problems in psychotherapyC (p. ::,/. 7elationships between members and the leader and among the members pro"ide fertile ground for exploring a wide range of proEections and a culturally competent group practitioner can in"ite con"ersations on cultural differences and similarities within the group. <y identifying and addressing the "arious aspects of di"ersity in a group members can explore how their experiences pertaining to their differences ha"e in uenced them and may be playing a role in their participation in the group. To the degree that countertransference is present group therapists react to members as if they were signi! cant ! gures of their own original family. Group leaders need to be alert to signs of unresol"ed con icts within themsel"es that could interfere with the effecti"e functioning of a group and create a situation in which members are used to satisfy their own unful! lled needs. If for example a group leader has an extreme need to be respected "alued and con! rmed the leader can become o"erly dependent on the members% appro"al and reinforcement. The result is that much of what the leader does is designed to please the group members and ensure their continued support. It is important to differentiate between appropriate emotional reactions and countertransference. &ollowing are some manifestations of countertransference that can arise in a therapeutic group@ I Seeing oneself in certain members and o"eridentifying with them to the point of becoming less able to work effecti"ely with them I ProEecting onto members some traits that one despises in oneself and regarding such clients as not amenable to treatment or impossible to work with I 'ngaging in seducti"e beha"ior and taking ad"antage of the leader%s role to win the special affection of certain group members

Group therapists% unresol"ed con icts and repressed needs can seriously interfere with the group process and can lead them to abuse their position of leadership. The dif! culty in recogniAing one%s own countertransference and the necessity that such reactions be acknowledged and therapeutically dealt with pro"ide a rationale for group leaders to experience their own therapy. The analytic approach re#uires that therapists undergo analytic psychotherapy to become conscious of their own dynamics and of the ways in which these dynamics can obstruct therapeutic tasks. <rabender ()*-9/ states that countertransference can be an a"enue for understanding the dynamics of a group but she reminds us that group therapists are not immune to feelings of hate en"y guilt admiration and lo"e. $er position is that Bthe full experience and tolerance of all of these therapist feelings within the inpatient group enables group members to realiAe the richness of their humanity in relation to one anotherC (p. :++/. It is essential that the therapist%s feelings be conscious and self;acknowledged. <emak and 'pp (.>>)/ identify ! "e typical countertransference patterns that a group counselor may experience@ ()/ becoming emotionally withdrawn and remaining una"ailable to the group0 (./ passi"ity0 (,/ being o"erly controlling0 (J/ regressing to maladapti"e beha"iors based on one%s own unresol"ed personal issues0 and (:/ being paternalistic and adopting a role as a rescuer. The resolution of countertransference is an essential skill that re#uires systematic re ection and exploration@ BThe group counselor%s countertransference has the potential to be utiliAed as a powerful therapeutic force for the group and its leader gi"en good super"ision and trainingC (<emak = 'pp .>>) p. ,)>/. 6ountertransference pro"ides the group therapist with useful information about group members as well as about him; or herself. 8nderstanding countertransference is a form of self;therapy that is essential for the personal and professional de"elopment of group counselors. <ased on their re"iew of the literature on countertransference in group work and their experience training group counselors <emak and 'pp identify some important aspects of this issue for both group leaders and students@ I 6ountertransference is a phenomenon that group counselors commonly experience. I Gi"en the number of participants in a group there is an increased opportunity and likelihood that group leaders will encounter countertransference. I If group leaders are unaware of their unresol"ed personal issues and their emotional responses it will be dif! cult for them to effecti"ely facilitate a group. I 8nderstanding one%s own countertransference leads to enhanced effecti"eness in facilitating groups and adds to the potential richness of the group experience. I 6ountertransference is often associated with a range of emotionally charged responses such as withdrawal anger lo"e hate annoyance powerlessness a"oidance collusion o"eridenti! cation control and sadness.

I It is essential that graduate programs create a context that facilitates a critical self;analysis of countertransference by student trainees. It is critical that countertransference be managed and used for the bene! t of working with the client. 1hen therapists study their own internal reactions and use them to understand their clients countertransference can greatly bene! t the therapeutic work. $ayes (.>>J/ reports that most research on countertransference has dealt with its deleterious effects and how to manage these reactions and suggests that it would be useful to undertake systematic study of the potential therapeutic bene! ts of countertransference as well. Gelso and $ayes (.>>./ contend that it is important to study and understand all of the therapist%s emotional reactions to the client that ! t under the broad umbrella of countertransference. Theory alone is not enough0 according to Gelso and $ayes Be"idence suggests that theory in conEunction with personal awareness is a key to the therapeutic use of countertransferenceC (p. .->/.

7ole and &unctions of the Group 3eader 3eadership styles "ary among psychoanalytically oriented group therapists ranging from leaders characteriAed by obEecti"ity warm detachment and relati"e anonymity to those who fa"or a role that is likely to result in a collaborati"e relationship with group members. If they remain more anonymous some psychoanalytically oriented leaders belie"e members will proEect onto them more of their own images of what they expect leaders to be images that are seen as expressions of the members% unconscious needs. Strupp ()**./ maintains that transference and countertransference remain the cornerstones of psychodynamic therapy. The group analyst welcomes manifestations of transference in the group as opportunities for fruitful work (1olf )*+,/. 'xploring transference reactions should be done with care so as not to create resistance within the group participant. ?ernberg ()**9/ issues this warning@ BTransference is to be handled like radioacti"e material "ery responsibly and with an awareness of how easily it can be misusedC (p. ../. Although such analysis of transference is still "iewed as a hallmark of psychodynamic therapy in the minds of many practitioners today the model of the impersonal therapist is far from ideal and Brepresents a serious and fre#uently noxious miscarriage of the therapeutic roleC (Strupp )**. p. .,/. A"i" (.>)>/ contends that a neutral nonparticipatory stance is unattainable and that stri"ing toward it may bring the group therapist to an empty and irrele"ant place. 7utan and colleagues (.>>9/ belie"e that Bthe therapist%s role is essentially to react rather than to initiate. The dynamic therapist waits for the group process to occur and then comments on itC (p. )9>/. Therapist roles can be conceptualiAed on a continuum from acti"e to nonacti"e transparent to opa#ue and gratifying to frustrating. Group therapists must remain exible in their approach. As group interaction increases the leader pursues

participants% unconscious moti"ations and in"estigates the historical roots of these moti"ations through analysis and interpretation. According to Strupp ()**./ one of the most signi! cant de"elopments of psychoanalytically oriented therapy is the growing recognition of the central importance of the therapeutic relationship. In contrast to the classical model of the impersonal and detached analyst the contemporary formulation places emphasis on the therapeutic alliance a working relationship in which the therapist Bcommunicates commitment caring interest respect and human concern for the patientC (p. .,/. In addition the group therapist also performs these functions@ I Gi"es support when support is therapeutic and the group is not pro"iding it I $elps members face and deal with resistances within themsel"es and in the group as a whole I Assists members to gain an awareness of the subtle aspects of beha"ior through #uestions and interpretations. To carry out these many functions effecti"ely group leaders ha"e the para;mount obligation of understanding their own dynamics and countertransference throughout the therapeutic process. To do so they may need consultation and super"ision. Personal therapy is "aluable in helping leaders to recogniAe signs of countertransference and in disco"ering how their own needs and moti"ations in uence their group work.

Application@ Therapeutic Techni#ues and Procedures T$' T$'7AP'8TI6 P726'SS The therapeutic process focuses on re;creating analyAing discussing and interpreting past experiences and on working through defenses and resistances that operate at the unconscious le"el. The working;through process represents the ! nal phase of the analytic group and results in increased consciousness and integration of the self. Insight and cogniti"e understanding are important as are the feelings and memories associated with self; understanding. <ecause clients need to reli"e and reconstruct their past and work through repressed con icts to understand how the unconscious affects them in the present psychoanalytic group therapy tends to be a long;term and intensi"e process. Self;disclosure and transparency ha"e become more acceptable to contemporary psychodynamic group practitioners (A"i" .>)>0 7utan et al. .>>9/. Hodern analytic practitioners are lea"ing behind the Bdetached;obser"erC model of classical psychoanalysis for a more intersubEecti"e style called relational analysis (GeAngelis )**+/. 7elational analysis places emphasis on both the therapist%s and the client%s reactions and experiences within the group situation.

A group format that uses psychoanalytic concepts and techni#ues has these speci! c ad"antages o"er indi"idual analysis@ I Hembers are able to establish relationships similar to those that existed in their own families0 this time howe"er the relationships occur in a group setting that is safe and conduci"e to fa"orable outcomes. I Group participants ha"e many opportunities to experience transference feelings toward other members and the leader0 they can identify and deal with these feelings to increase their self;understanding. I Participants can gain a clear sense of how their defenses and resistances are manifested. I Gependence on the authority of the therapist is not as great as in indi"idual therapy because group members also get feedback from other members. I &rom obser"ing the work of others in a group members learn that it is acceptable to ha"e and to express intense feelings that they may ha"e kept out of awareness. I Hembers ha"e many opportunities to learn about themsel"es and others in fact and in fantasy through interactions with peers as well as with the leader. The material for analysis is a"ailable not only in terms of historical recollection but also on the basis of interaction with fellow members. I The group setting encourages members to examine their ego defenses. 7esistance melts away in the atmosphere of mutual re"elation and exploration in a group to a greater extent than is typically true of one;to;one therapy. I Analysis in groups therapeutically challenges a member%s idealistic expectation of ha"ing an exclusi"e relationship with the therapist. The experience of supporting others and the disco"ery of uni"ersal struggles encourage a fuller range of responses than does indi"idual therapy. I Analytic group therapy pro"ides a context for addressing contemporary social issues including class race and cultural differences. 'FP327I4G A4FI'T5 I4 T$' G728P SIT8ATI24 $ow the group leader recogniAes and deals with anxiety both within the indi"idual and within the group as a whole is a key techni#ue in the psychoanalytic group. Anxiety is not something to o"ercome0 it is essential to recogniAe understand and explore the function that the defenses against it ser"e. Anxiety is a necessary by;product of taking risks in the group a process that e"entually leads to constructi"e changes.

&7'' ASS26IATI24

The basic tool for unco"ering repressed or unconscious material is free associationK communicating whate"er comes to mind regardless of how painful illogical or irrele"ant it may seem. Group members are expected to report feelings immediately without trying to exercise censorship and the group discussion is left open to whate"er the participants may bring up rather than re"ol"ing around an established theme. &oulkes ()*+:/ refers to this process as Bfree; oating discussionC or Bfree group association.C 2ne adaptation of free association to groups is the Bgo;around techni#ue C which uses free association to stimulate member interactions (1olf )*+,/. 2nce a good rapport has de"eloped in the conduci"e atmosphere fostered by sharing dreams and fantasies members are encouraged to free;associate about each person in the group. 'ach participant goes around to each of the other members and says the ! rst thing that comes to mind about that person. According to 1olf the go;around method makes all the members adEunct therapists0 that is instead of remaining passi"e recipients of the leader%s insights the participants acti"ely contribute to the interpretation of key meanings. 1olf ()*+,/ contends that if group members say whate"er comes into their heads about another Bthey will intuiti"ely penetrate a resisti"e facade and identify underlying attitudesC (p. .-*/. As a result the participants re"eal inner feelings become less guarded and often de"elop the ability to see underlying psychic con icts. Also all group members ha"e an opportunity to know how the other participants "iew them. 1olf and ?utash ()*-+/ suggest that it is useful when a client reports a dream to ask other members to free;associate with it. In this way members are being acti"e and do not feel excluded as they listen to the details of another member%s dream. The group can explore both the dreamer%s and the other members% associations. In summary free association encourages members to become more spontaneous and to unco"er unconscious processes which leads to the disco"ery of keener insights into their psychodynamics. This procedure also promotes unity and acti"e participation in the group process. I4T'7P7'TATI24 Interpretation is a therapeutic techni#ue used in the analysis of free associations dreams resistances and transference feelings. BAn interpretation is designed to make unconscious phenomena conscious to attach meaning to e"ents beha"iors and feelingsC (7utan et al. .>>9 p. *J/. Group therapists ha"e shifted to a more collaborati"e stance in recent years offering interpretations as tentati"e hypotheses to group members for their consideration. BIn today%s clinical practice an interpretation is a proposal of meaning. It is not a truth but an effort to mutually gain understanding of an indi"idual beha"ior or affect stateC (7utan et al. .>>9 p. *,/. Scheidlinger ()*-9/ maintains that an interpretation is simply a hypothesis and that no matter how elegantly concei"ed it is still subEect to con! rmation or refutation. 1hen group members reEect a therapist%s interpretation it may mean the interpretation is inaccurate not that members are being resistant.

Interpretation re#uires considerable skill. 1ell;timed and accurate interpretations help clients integrate new data that can lead to new insights. 6orrect timing of an interpretation in group therapy is critical. Group therapists need to understand and accept members% readiness to hear an interpretation. Premature interpretations are likely to promote undue anxiety and lead to considerable resistance. If clients are presented with an accurate interpretation at an inappropriate time they may ! ght the therapeutic process and resist other inter"entions. According to Scheidlinger ()*-9/ the way interpretations are phrased and their manner of presentation will certainly affect the degree to which members consider them. If therapists force their interpretations on clients in a dogmatic fashion clients are likely to close off and become increasingly defensi"e. Interpretations cast in the form of #uestions and presented as hypotheses and not as facts are more likely to be considered by group members. &or example Sam keeps making inappropriate inter"entions when other members express intense feelings and thus causes the others to lose contact with their feelings. The leader ! nally inter"enes and says@ BSam you seem to want to con"ince Nulie that e"erything will work out for her. Is it possible that you become uncomfortable when you see a person in pain0 so you rush in trying to take that person%s pain awayL 6ould it be that you%re trying to a"oid painful experiences yourselfLC This comment alerts Sam to a possible reason for his beha"ior in the group. If he thinks about the leader%s interpretation he may disco"er other meanings of which he is not now conscious. 1hether he will respond nondefensi"ely has a lot to do with the manner in which the interpretation is made. In this case the leader%s tentati"e approach doesn%t pose a threat and doesn%t push Sam into accepting something that he may not be ready to accept. In making interpretations a few other general rules are useful@ I Interpretation should deal with material that is close to the member%s awareness so the member will be ready and able to incorporate it. I Interpretation should begin from the surface and go as deep as the mem;ber can emotionally tolerate. I It is best to point out a form of defense or resistance before interpreting the feeling or con ict that lies underneath it. Some therapists direct interpretation to the group as a whole as well as to indi"idual participants. &or example group members may be operating under the unspoken agreement that they will be polite and supporti"e and that they will not challenge one another. <y obser"ing the group process and sharing these obser"ations with the group the therapist can be instrumental in helping the members see their hidden moti"es and reach a deeper le"el of interaction. $ere too how the leader presents the obser"ations is crucial. 2ne of the ad"antages of the psychoanalytic method in groups is that members are encouraged to share their insights about other participants. This process can be "ery supporti"e and can accelerate progress. '"en though the members may not systematically make interpretations lea"ing that function to the therapist they can ha"e a signi! cant effect

on other members by being direct and unrehearsed. The disad"antages of peer interpretations are that they are sometimes ill;timed too super! cial or too deep or inaccurate (7utan et al. .>>9/. <ecause group members may be less defensi"e to hearing feedback from peers than from the group therapist fellow members% reactions may elicit more consideration and thought than those coming from the group therapist. 7utan and colleagues contend that interpretations from peers can ha"e uni#ue power in groups. As members become more familiar with one another they will increasingly be able to recogniAe defensi"e strategies and offer percepti"e obser"ations. G7'AH A4A35SIS &reud ()*::/ saw dreams as Bthe royal road to the unconscious.C Greams express unconscious needs con icts wishes fears and repressed experiences. 1hen a dream is shared in a group and worked through the participant gains new insight into the moti"ations and unresol"ed problems behind it. Some moti"ations are so unacceptable to the person that they can be expressed only in disguised or symbolic form. An ad"antage of working with dreams in a group is that it enables members to deal in a concrete way with feelings and moti"ations that they otherwise would not face. After exploring the "arious facets and possible meanings of a dream in a supporti"e group members may be more willing to accept themsel"es and explore other unresol"ed problems that elicit feelings of guilt and shame. It should be noted that dreams ha"e both a manifest (or conscious/ content and a latent (or hidden/ content. The manifest content is the dream as it appears to the dreamer0 the latent content consists of the disguised unconscious moti"es that represent the hidden meaning of the dream. A psychoanalytic group works at both le"els. <ecause dreams are "iewed as the key that unlocks what is buried in the unconscious the goal is to search for the latent beneath the manifest and to gradually unco"er repressed con icts. In the ! rst session group members are told that sharing their dreams fantasies and free associations is essential to the analysis and understanding of the dynamics behind confused thinking feeling and beha"ing. '"en though therapists may ha"e insight into clients% dreams they generally gi"e little analysis during the early stages of a group. Instead the members are encouraged to offer their own interpretations (Hullan = 7osenbaum )*9-/. The dream experience itself often without interpretation taps unconscious mental acti"ity in a manner une#ualed by most other clinical experiences (?olb )*-,/. According to 1olf ()*+,/ the interpretation of dreams is an essential aspect of the analytic process and should continue throughout the "arious stages of a group. It is an essential techni#ue because the unconscious material that dreams re"eal has a liberating effect on the participants. Hembers are encouraged to interpret and to free;associate with one another%s dreams to reach the deepest le"els of interaction. 1olf reports that the entire group becomes Bengrossed in dream analysis with its attendant associations catharsis sense of liberation and mutuality all of which contribute toward the group unity which is so important in the ! rst stages of treatmentC (p. .-9/. $e stresses the importance of a nonEudgmental attitude on the part of the leader toward the emerging unconscious material. The leader%s

tolerant approach encourages a similar attitude in the members and the group may soon become a compassionate and supporti"e family. <esides their "alue for unblocking unconscious material from the group member%s past dreams also contain a wealth of meaningful material concerning what is going on in the group. Hembers% dreams often re"eal their reactions to the therapist and to other group members (3ocke )*+)/. The dreamer reports the dream and tells the group what meanings and associations it has for him or her. Then the group as a whole responds0 other group members gi"e their reactions to the dream and suggest cross;associations. The result is stimulation within the group. 'xploring dreams in a group has another "aluable aspect. As members analyAe the dreams of others and offer their own associations they also proEect signi! cant dimensions of themsel"es. In other words the group members are both interpreting and proEecting a process that often leads to extremely "aluable insights. 1ishes fears and attitudes are re"ealed as members associate with one another%s dreams. 2ne person%s dream becomes the dream of the whole group a process that is the Btrue essence of dream work in group psychoanalysisC (3ocke )*+) p. ),,/. I4SIG$T A4G 127?I4G T$728G$ Insight means awareness of the causes of one%s present dif! culties. In the psychoanalytic model insight is a cogniti"e and emotional awareness of the connection of past experiences to present problems. As group members de"elop keener insight they become increasingly able to recogniAe the many ways in which these core con icts are manifested both in the group and in their daily li"es. 4ew connections are formed and dominant themes begin to emerge. &or example if in the course of group work some members disco"er that they need to please e"eryone at all costs they come to see the effects of their need for appro"al on their li"es. The analytic process does not end at the insight le"el howe"er. The psychodynamic group Bis an arena in which patients demonstrate their pathologies in great richness and subtletyC (7utan et al. .>>9 p. )>+/ and working through core problems and con icts is an essential aspect of analytically oriented groups and indi"idual therapy. 1orking through in"ol"es repeating interpretations and o"ercoming resistance thereby enabling group members to resol"e dysfunctional patterns that originated in childhood and to make choices based on new insights. If group members hope to change some aspect of their personality they are challenged to work through resistances and old patternsKtypically a long and dif! cult process. 1orking through is one of the most complex aspects of analysis and it re#uires deep commitment. The working;through process in"ol"es reexperiencing the un! nished business in the context of transference (multiple transference in group analysis/. Group participants learn to accept their defenses understand how they ser"ed a "alid function in the past and realiAe that they ha"e become too burdensome in the present. 6on icts stemming from a member%s early life experiences are rarely completely worked through. Host indi"iduals will ha"e to deal again with these deeply rooted issues from time to time. Thus it

is a mistake to think of working through as a techni#ue that completely frees the indi"idual from any "estige of old patterns.

Ge"elopmental Stages and Their Implications for Group 1ork This section describes a de"elopmental model that has signi! cant implications for group work. The model is based on 'rikson%s eight stages of human de"elopment and on the &reudian stages of psychosexual de"elopment. Such a combination pro"ides group leaders with the conceptual framework re#uired for understanding trends in de"elopment maEor de"elopmental tasks at each stage of life critical needs and their satisfaction or frustration potentials for choice at each stage of life critical turning points or crises and the origins of faulty personality de"elopment that can lead to later personality con icts. 'rikson ()*+, )*-./ built on and extended &reud%s ideas by stressing the psychosocial aspects of de"elopment. Although he was intellectually indebted to &reud he did not accept all of &reud%s "iews. 'rikson%s theory of de"elopment holds that psychosexual and psychosocial growth occur together and that at each stage of life we face the task of establishing an e#uilibrium between oursel"es and our social world. Psychosocial theory stresses the integration of the biological psychological and social aspects of de"elopment. 'rikson describes de"elopment in terms of the entire life span which he di"ides into eight stages each of which is characteriAed by a speci! c crisis to be resol"ed. According to 'rikson each crisis represents a turning point in life. At these turning points we either achie"e successful resolution of our con icts and mo"e forward or fail to resol"e the con icts and regress. To a large extent our li"es are the result of the choices we make at each stage. This conceptual framework is useful for all group leaders regardless of their theoretical orientation. Irrespecti"e of the model underlying one%s group practice the following #uestions need to be raised as group work proceeds@ I 1hat are some of the themes that gi"e continuity to a person%s lifeL I 1hat are the client%s ongoing concerns and unresol"ed con ictsL I 1hat is the relationship between this indi"idual%s current problems and signi! cant e"ents in earlier yearsL I 1hat in uential factors ha"e shaped the person%s characterL I 1hat were the maEor turning points and crises in the client%s lifeL I 1hat choices did the indi"idual make at these critical periods and how did he or she deal with these "arious crisesL I In what direction does the person seem to be mo"ing nowL

STAG' )@ I4&A465KT78ST O'7S8S HIST78ST (<I7T$ T2 ). H24T$S/ &reud labeled the ! rst year of life the oral stage0 sucking the mother%s breast satis! es the infant%s need for food and pleasure. According to the psychoanalytic "iew the e"ents of this period are extremely important for later de"elopment. 3ater personality problems that stem from the oral stage include a mistrustful "iew of the world a tendency to reEect lo"e a fear of lo"ing and trusting and an inability to establish intimate relationships. According to 'rikson ()*+,/ an infant%s basic task is to de"elop a sense of trust in self others and the world. Infants need to count on others and to feel wanted and secure. If howe"er parents are not responsi"e to infants% needs they de"elop an attitude of mistrust toward the world especially toward interpersonal relationships. Implications for Group Work . The connection between these ideas and the practice of group psychotherapy seems #uite clear. A common theme explored in groups is the feeling of being unlo"ed and uncared for and the concomitant acute need for someone who will deeply care and lo"e. Time after time group members recall early feelings of abandonment fear and reEection and many of them ha"e become ! xated on the goal of ! nding a symbolic BparentC who will accept them. Thus much of their energy is directed to seeking appro"al and acceptance. The problem is compounded by the fact that being unable to trust themsel"es and others they are afraid of lo"ing and of forming close relationships. Group leaders can assist these clients to express the pain they feel and to work through some of the barriers that are pre"enting them from trusting others and fully accepting themsel"es. 'rikson ()*+-/ obser"es that these clients tend to express their basic mistrust by withdrawing into themsel"es e"ery time they are at odds with themsel"es others or the world. It should be noted that each stage builds on the psychological outcomes of the pre"ious stage(s/. In this regard establishing a sense of basic trust is a foundation for later personality de"elopment. Problems associated with each of these de"elopmental stages may become manifest in an analytic group in which the family of origin is recapitulated. Some regression to beha"iors associated with earlier de"elopmental stages is common in this type of group. &or example in this ! rst stage members may proEect hostile feelings onto the leader or other members. These indi"iduals may feel Eusti! ed in harboring unrealistic fears and may not ha"e enough trust to check such proEections for accuracy. It is essential that leaders do what is necessary to establish a group atmosphere that allows members to feel safe so they can explore possible proEections. If a member does not de"elop this trust he or she could easily become isolated in the group. Analytic group therapists use their knowledge of de"elopmental stages to understand patterns in which the members may be Bstuck.C The group leader%s comments #uestions and interpretations can then be framed to help the participants resol"e ! xations and crises linked to speci! c de"elopmental stages.

STAG' .@ 'A735 6$I3G$22GKA8T242H5 O'7S8S S$AH' A4G G28<T (). H24T$S T2 , 5'A7S/ &reud called the next two years of life the anal stage. The main tasks that children must master during this stage include learning independence accepting personal power and learning how to express negati"e feelings such as Eealousy rage aggression and destructi"eness. It is at this stage that children begin their Eourney toward autonomy. They play an increasingly acti"e role in taking care of their own needs and begin to communicate what they want from others. This is also the time when they continually encounter parental demands@ they are restricted from fully exploring their en"ironment and toilet training is being imposed on them. The &reudian "iew is that parental feelings and attitudes during this stage ha"e signi! cant conse#uences for later personality de"elopment. &rom 'rikson%s "iewpoint the years between ages ) and , are a time for de"eloping a sense of autonomy. 6hildren who don%t master the task of gaining some measure of self; control and the ability to cope with the world de"elop a sense of shame and doubt about themsel"es and their ade#uacy. At this age children need to explore the world to experiment and test their limits and to be allowed to learn from their mistakes. If parents do too much for their children it can keep them dependent and they are likely to inhibit the children%s autonomy and hamper their capacity to feel competent in the world. Implications for Group 1ork <y understanding the dynamics of this stage of life the group leader can gain access to a wealth of useful material. Hany of those who seek help in a group ha"e not learned to accept their anger and hatred toward those they lo"e. They need to get in touch with the disowned parts of themsel"es that are at the bottom of these con icting feelings. To do this they may need to reli"e and reexperience situations in their distant past when they began to repress intense feelings. In the safe en"ironment of the group they can gradually learn ways of expressing their pent;up feelings and work through the guilt associated with some of these emotions. Groups offer many opportunities for catharsis (expressing pent;up feelings/ and for relearning. STAG' ,@ T$' P7'S6$223 AG'KI4ITIATIO' O'7S8S G8I3T (, T2 + 5'A7S/ In &reud%s phallic stage sexual acti"ity becomes more intense. The focus of attention is on the genitals and sexual identity takes form. Preschool children become curious about their bodies. They explore them and experience pleasure from genital stimulation. And they show increased interest in the differences between the sexes and ask #uestions about reproduction. The way in which parents respond "erbally and non"erbally to their children%s emerging sexuality and sexual interest is crucial in in uencing the kinds of attitudes sexual and otherwise their children de"elop. According to the &reudian "iew the basic con ict of the phallic stage centers on the unconscious incestuous desires that children de"elop for the parent of the opposite sex. These feelings are highly threatening so they are repressed0 yet they remain as powerful determinants of later personality de"elopment. Along with the wish to possess the parent of

the opposite sex comes the unconscious wish to displace the parent of the same sex a wish epitomiAed by the slaying of the father in the 2edipus myth. 'rikson in contrast emphasiAes that the basic task of the preschool years is to establish a sense of competence and initiati"e. This is the time for becoming psychologically ready to pursue acti"ities of one%s own choosing. If children are allowed the freedom to select meaningful acti"ities they tend to de"elop a positi"e outlook characteriAed by the ability to initiate and follow through. <ut if they are not allowed to make at least some of their own decisions or if their choices are criticiAed they are likely to de"elop a sense of guilt o"er taking initiati"e. Typically they will refrain from taking an acti"e stance and will increasingly let others make decisions for them. Implications for Group 1ork In most therapy and counseling groups participants struggle with issues related to gender;role identity. Hany indi"iduals ha"e incorporated stereotypical notions of what it means to be a woman or a man and they ha"e conse#uently repressed many of their feelings that don%t ! t these stereotypes. A group can be the place where indi"iduals challenge such restricting "iews and become more whole. <ecause concerns about sexual feelings attitudes "alues and beha"ior are often kept pri"ate people feel "ery much alone with their sexual concerns. Groups offer the chance to express these concerns openly to correct faulty learning to work through repressed feelings and e"ents and to begin to formulate a different "iew of oneself as a female or male sexual being. Perhaps the most important function of a group is that it gi"es clients permission to ha"e feelings and to talk honestly about them. STAG' J@ T$' S6$223 AG'KI4G8ST75 O'7S8S I4&'7I27IT5 (+ T2 ). 5'A7S/ &reudians call middle childhood the latency stage. After the torrent of sexual impulses of the preceding years this period is relati"ely #uiescent. There is a decline in sexual interests which are replaced by interests in school playmates sports and a whole range of new acti"ities. Around age + children begin to reach out for new relationships. 'rikson stresses the acti"e rather than the latent aspect of this stage and the uni#ue psychosocial tasks that must be met at this time if healthy de"elopment is to take place. 6hildren need to expand their understanding of the physical and social worlds and continue to de"elop appropriate gender;role identities. They must also form personal "alues engage in social tasks learn to accept people who are different from them and ac#uire the basic skills needed for schooling. According to 'rikson the central task of middle childhood is the achie"ement of a sense of industry and the failure to do so results in a sense of inade#uacy and inferiority. Industry refers to setting and achie"ing goals that are personally meaningful. If children fail at this task they are unlikely to feel ade#uate as adults and the subse#uent de"elopmental stages will be negati"ely in uenced. Implications for Group Work. Some problems originating at this stage that group leaders may expect to encounter include a negati"e self;concept feelings of inade#uacy relating to learning feelings of inferiority in establishing social relationships con icts about "alues a

confused gender;role identity unwillingness to face new challenges dependency and lack of initiati"e. It is crucial that members learn to recogniAe patterns that originated during childhood because those patterns will ine"itably unfold in a group. To see how the leader%s knowledge of the problems and promises of this period of life can help the therapeutic process let%s look at a participant who suffers from feelings of inferiority. 7achel fears failure so much that she shies away from college because she is con"inced she could ne"er make it. In a group she can be helped to see possible connections between her feelings of inade#uacy and some e"ents that occurred when she was in elementary school. Perhaps she had a series of negati"e learning experiences such as being told openly or not by her teachers that she was stupid and couldn%t learn. <efore 7achel can o"ercome her feelings that she cannot meet the demands of college she may ha"e to go back to the traumatic e"ents of her childhood reli"e them and express the pain she felt then. Through the support of the group she can experience many of these repressed feelings and begin to put the e"ents of her past in a different perspecti"e. '"entually she may also come to realiAe that she doesn%t ha"e to gi"e up an academic career now because of something that happened in grade school. STAG' :@ AG23'S6'46'KIG'4TIT5 O'7S8S IG'4TIT5 624&8SI24 (). T2 .> 5'A7S/ Adolescence is a stage of transition between childhood and adulthood. It is a time for continually testing limits reEecting ties of dependency and establishing a new identity. It is most of all a time of con ict especially between the desire to break away from parental control and the fear of making independent decisions and li"ing with the conse#uences. Adolescence is marked by a resurgence of 2edipal feelings. &rom the &reudian perspecti"e the 2edipus complex is the unconscious desire of the son for his mother along with feelings of hostility and fear toward his father. In &reudian theory adolescence initiates the ! nal psychosexual stage of de"elopment the genital stage which is the longest stage and extends far beyond adolescence. It begins at the time of puberty and lasts until senility sets in at which time the indi"idual tends to regress to earlier stages. 'rikson did not belie"e that personality de"elopment ended with puberty and he separated &reud%s genital stage into four stages of de"elopment beginning with adolescence. $e saw the crisis that characteriAes adolescenceKthe identity crisisKas the most important of life. 1hat does 'rikson mean by identity crisisL $e means that most con icts of the adolescent years are related to the de"elopment of a personal identity. Adolescents struggle to de! ne who they are where they are going and how they will get there. <ecause all kinds of changesKphysical as well as socialK are taking place and because society applies di"erse pressures many adolescents ha"e dif! culty ! nding a stable identity. They often experience con icting pressures and demands. In the midst of this turmoil the adolescent has the task of ultimately deciding where he or she stands in the face of these "arying expectations. If the adolescent fails identity confusion results and the person will lack purpose and direction in later years.

Implications for Group Work. In many groups a good deal of time is de"oted to the exploration and resolution of the dependenceMindependence con icts that are so pre"alent in adolescence. A central struggle in"ol"es the process of separation from one%s parents and mo"ing toward indi"iduality or autonomy. At times one or se"eral members may manifest a rebellious attitude toward the leader. Although challenging the leader often signals a mo"e toward independence attacking a leader may well be a symptom of rebellion against parents or any other authority. It is essential that leaders be aware of their own dynamics and potential countertransferences especially when confronted in this way by members. 3eaders will be less likely to react defensi"ely if they understand the transference nature of this beha"ior. The unresol"ed problems of adolescence are manifest in many of the problems that adults bring to a group. 8ntil adults recogniAe this un! nished issue from their earlier years they cannot effecti"ely meet the challenges presented by other stages of life. STAG' +@ 'A735 AG83T$22GKI4TIHA65 O'7S8S IS23ATI24 (.> T2 ,: 5'A7S/ In 'rikson%s "iew we enter adulthood after we ha"e mastered the con icts of adolescence and established a ! rm personal identity. Guring the sixth stage early adulthood our sense of identity is tested again by the challenge of intimacy "ersus isolation. An essential characteristic of the psychologically mature person is the ability to form intimate relationships. To achie"e true intimacy with others we need to ha"e con! dence in our own identity. Intimacy in"ol"es commitment and the ability to share and to gi"e from our own centeredness0 the failure to achie"e intimacy leads to alienation and isolation. 'arly adulthood is also a time for focusing on one%s interests for becoming established in an occupation and for car"ing out a satisfying lifestyle. It is a time for dreams and life plans but also a time for producti"ity. Implications for Group Work In many adult groups considerable time is de"oted to exploring the members% priorities. Participants struggle with concerns of interpersonal intimacy talk about their unful! lled dreams #uestion the meaningfulness of their work wonder about the future and ree"aluate the patterns of their li"es to determine what changes they need to make. Perhaps the greatest "alue of a group for people engaged in these struggles is the opportunity to take another look at their dreams and life plans and determine the degree to which their li"es re ect these aspirations. If the gap is great the participants are encouraged to ! nd ways of changing the situation. Typically young adults bring to a group the problems related to li"ing with another person and establishing a family. The central struggle of this period is the intimacy crisis a con ict between the need to maintain a sense of one%s own separateness and the need to establish close relationships. The successful resolution of the intimacy crisis in"ol"es achie"ing a balance between taking care of oneself and acti"ely caring for others. Those who fail to strike this balance either focus exclusi"ely on the needs of others thus neglecting their

own needs or are self;centered and ha"e little room for concern about others. The #uality of the young adult%s ability to form interpersonal relationships is greatly in uenced by what took place during early de"elopment. $ow members deal with intimacy within the group re"eals patterns they learned about getting close or keeping distant during their young adulthood. &or many people in groups forming close bonds with others is extremely dif! cult. This pattern of being uncomfortable and frightened of both recei"ing and gi"ing lo"e and compassion is likely to unfold in the group sessions. The group is an ideal place for members who are struggling with intimacy issues to recogniAe and challenge their fears. STAG' 9@ HIGG3' AG83T$22GKG'4'7ATIOIT5 O'7S8S STAG4ATI24 (,: T2 +: 5'A7S/ The se"enth stage is characteriAed by a need to go beyond oursel"es and our immediate family and to be acti"ely in"ol"ed with helping and guiding the next generation. This is a time when we are likely to engage in a philosophical reexamination of how we are li"ing which often leads to a rein"ention of our way of being. The mature years can be one of the most producti"e periods of our li"es but they can also entail the painful experience of facing the discrepancy between what we set out to accomplish in early adulthood and what we ha"e actually accomplished. 'rikson sees the stimulus for continued growth during this stage in the con ict between generati"ity and stagnation. Generati"ity is a broad concept that is manifested in the ability to lo"e well work well and play well. If people fail to achie"e a sense of personal competence they begin to stagnate and to die psychologically. 1hen we reach middle age we become more sharply aware of the ine"itability of our own e"entual death. This awareness of mortality is one of the central features of the midlife crisis and colors our e"aluations of what we are doing with our li"es. Implications for Group Work The changes that occur during this life stage and the crises and con icts that accompany them represent "aluable opportunities for group work. Participants are often challenged to make new assessments adEustments and choices to open up new possibilities and reach new le"els of meaning. ?nowledge of adult de"elopment allows the group leader to watch for the hopelessness that some people experience during middle age and to help them go beyond the destructi"e "iew that Bthat%s all there is to life.C It takes caring and skilled leadership to inspire people to look for new meanings and to Bin"ent themsel"esC in no"el ways. STAG' -@ 3AT'7 3I&'KI4T'G7IT5 O'7S8S G'SPAI7 (A<2O' +: 5'A7S/ The eighth and last stage of life confronts the indi"idual with crucial de"elopmental tasks such as adEusting to the death of a spouse or friends maintaining outside interests adEusting to retirement and accepting losses in physical and sensory capacities. <ut the central task of the ! nal stage is re"iewing the past and drawing conclusions.

According to 'rikson the successful resolution of the core crisis of this stageKthe con ict between integrity and despairKdepends on how the person looks back on the past. 'go integrity is achie"ed by those who feel few regrets. They see themsel"es as ha"ing li"ed producti"e and worthwhile li"es and they feel that they ha"e coped with their failures as well as their successes. They are not obsessed with what might ha"e been and are able to deri"e satisfaction from what has been. They see death as a part of the life process and can still ! nd meaning and satisfaction in the time left. &ailure to achie"e ego integrity often leads to feelings of despair hopelessness guilt resentment and selfreEection. Implications for Group Work 2lder adults are increasingly aware that they ha"e a limited time left to li"e and many of their issues can be producti"ely addressed in a group. They realiAe that the Eoys associated with old age such as wisdom and integrity are limited in a way not recogniAed in earlier years ($enderson = Gladding .>>J/. Themes pre"alent with older adults include loss and grief0 loneliness and social isolation0 po"erty0 feelings of reEection0 the struggle to ! nd meaning in life0 dependency0 feelings of uselessness hopelessness and despair0 the ine"itability of death0 sadness o"er physical and mental deterioration0 and regrets o"er past e"ents. Although these themes present maEor dif! culties for many older people they also ha"e a range of life experiences and personal strengths that are often o"erlooked. Group work with older adults is one way to promote the positi"e aspects of aging as well as helping participants cope with the tasks associated with this stage of life. The interpersonal nature of groups can be therapeutic for older persons especially those who are isolated and lonely ($enderson = Gladding .>>J/. The salient issues of this stage of life ha"e implications not only for group leaders working with older adults but also for those who work with young or middle;aged adults. As people begin to see the years slip by they feel increasing pressure to make something of their li"es. &ears of being alone when they are old or of ! nancial or physical dependency on others begin to surface. Group leaders can help these members prepare now for a satisfying life as they grow older. Asking B1hat would you like to be able to say about your life when you reach old ageLC is a good way to start. 1hat the members say in answer to this #uestion (to themsel"es and in the group/ can in uence the decisions they need to make now and the speci! c steps they must take to achie"e a sense of integrity at a later age.

Contemporary Trends in Psychoanalytic Group Theory Psychoanalytic theory continues to e"ol"e. &reud%s ideas were based on an id psychology characteriAed by con icts o"er the grati! cation of basic needs. 3ater writers in the social;psychological school mo"ed away from &reud%s orthodox position and contributed to the growth and expansion of the psychoanalytic mo"ement by incorporating the cultural and social in uences on personality. Then ego psychology with its stress on psychosocial de"elopment throughout the life span was de"eloped by 'rikson among others. Anna &reud with her identi! cation of defense mechanisms is a central ! gure in ego psychology although she is not particularly associated with the life;span interests of 'rikson.

Psychoanalytic approaches are being applied to both family systems therapy and group therapy and some contemporary psychoanalysts stress the interpersonal dimension more than the insight aspects of therapy. This is true of both obEect relations theory and attachment theory. According to Strupp ()**./ the notion of unconscious con ict is still fundamental to psychodynamic thought. $owe"er more attention is now being gi"en to internal structures of personality that are signi! cantly in uenced by experiences with signi! cant ! gures during one%s infancy and early childhood. Strupp notes that the 2edipus complex is no longer considered a uni"ersal phenomenon. Instead there is an increased focus on disturbances and arrests in infancy and early childhood that stem from de! ciencies in the motherDchild relationship. 2<N'6T 7'3ATI24S T$'275 Psychoanalytic theory expanded to include obEect relations theory in the )*9>s and )*->s. 2bEect relations are interpersonal relationships as they are represented intrapsychically. Although there is no single generally accepted school or theory of obEect relations this approach includes self psychology and relational psychoanalysis. Hany theorists ha"e contributed ideas to an e"ol"ing body of concepts that deal with obEect relations (St. 6lair .>>J/. The term obEect was used by &reud to refer to that which satis! es a need or to the signi! cant person or thing that is the obEect or target of one%s feelings or dri"es. It is used interchangeably with the term other to refer to an important person to whom the child and later the adult becomes attached. At birth the infant has no sense of separateness0 self and other are fused. The process of separationMindi"iduation begins when the infant percei"es that pleasure and discomfort are related to obEects external to the self. The infant at this stage will typically make an attachment to the mother%s breast before any recognition of her as a whole person. Hahler ()*+-/ belie"es the indi"idual begins in a state of psychological fusion with the mother and progresses gradually to separation. The un! nished crises and residues of the earlier state of fusion as well as the process of indi"iduating ha"e a profound in uence on later relationships. 2bEect relations of later life build on the child%s search for a reconnection with the mother (St. 6lair .>>J/. Psychoanalytic practitioners belie"e there is continuity in the de"elopment of selfDother relations from their infantile origins to mature in"ol"ement with other persons. Thus obEect relations are interpersonal relationships that shape the indi"idual%s current interactions with people (St. 6lair .>>J/. The contemporary theoretical trend in psychoanalytic thinking centers on predictable de"elopmental se#uences in which the early experiences of the self shift in relation to an expanding awareness of others. 2nce selfDother patterns are established it is assumed they in uence later interpersonal relationships. This in uence occurs through a process of searching for a type of experience that comes closest to the patterning established by the early experiences. These newer theories pro"ide insight into how an indi"idual%s inner world can cause dif! culties in li"ing in the actual world of people and relationships (St. 6lair .>>J/.

Psychological de"elopment can be thought of as the e"olution of the way in which indi"iduals differentiate themsel"es from others. 2bEect relations therapy is based on the premise that early in life the indi"idual has dri"es that are satis! ed through attachment to speci! c people primarily parents. These early interactions lay the foundation for relationship patterns later in life (Harshall = &itch .>>*/. In group work participants can experience how they are bringing "ery early patterns into their present interactions. &or example a group member who appears closely in"ol"ed with others at one meeting may seem distant and remo"ed at the next lea"ing e"eryone wondering what happened to the le"el of work that seemed to ha"e been achie"ed. This pattern might repeat what Hahler ()*+-/ calls the BambitendencyC of an infant who goes back and forth between wanting to be held by its mother and wanting to be left free to roam and explore. In a therapy group the participants work through self;destructi"e interactional patterns. The primary goals in a therapy group are to create a correcti"e emotional experience and change self;defeating relationship patterns (Harshall = &itch .>>*/. ATTA6$H'4T T$'275 A4G G728P PS56$2T$'7AP5 Nohn <owlby ()*--/ studied the importance of attachment separation and loss in human de"elopment and de"eloped attachment theory one of se"eral extensions of psychoanalytic theory. Attachment in"ol"es an emotional bonding with another who is percei"ed as a source of security (Pistole = Arricale .>>,/. According to <owlby the affectional bonds that the infant has The term obEect was used by &reud to refer to that which satis! es a need or to the signi! cant person or thing that is the obEect or target of one%s feelings or dri"es. It is used interchangeably with the term other to refer to an important person to whom the child and later the adult becomes attached. At birth the infant has no sense of separateness0 self and other are fused. The process of separationMindi"iduation begins when the infant percei"es that pleasure and discomfort are related to obEects external to the self. The infant at this stage will typically make an attachment to the mother%s breast before any recognition of her as a whole person. Hahler ()*+-/ belie"es the indi"idual begins in a state of psychological fusion with the mother and progresses gradually to separation. The un! nished crises and residues of the earlier state of fusion as well as the process of indi"iduating ha"e a profound in uence on later relationships. 2bEect relations of later life build on the child%s search for a reconnection with the mother (St. 6lair .>>J/. Psychoanalytic practitioners belie"e there is continuity in the de"elopment of selfDother relations from their infantile origins to mature in"ol"ement with other persons. Thus obEect relations are interpersonal relationships that shape the indi"idual%s current interactions with people (St. 6lair .>>J/. The contemporary theoretical trend in psychoanalytic thinking centers on predictable de"elopmental se#uences in which the early experiences of the self shift in relation to an expanding awareness of others. 2nce selfDother patterns are established it is assumed they in uence later interpersonal relationships. This in uence occurs through a process of searching for a type of experience that comes closest to the patterning established by the early experiences. These newer theories pro"ide insight into how an indi"idual%s inner world can

cause dif! culties in li"ing in the actual world of people and relationships (St. 6lair .>>J/. Psychological de"elopment can be thought of as the e"olution of the way in which indi"iduals differentiate themsel"es from others. 2bEect relations therapy is based on the premise that early in life the indi"idual has dri"es that are satis! ed through attachment to speci! c people primarily parents. These early interactions lay the foundation for relationship patterns later in life (Harshall = &itch .>>*/. In group work participants can experience how they are bringing "ery early patterns into their present interactions. &or example a group member who appears closely in"ol"ed with others at one meeting may seem distant and remo"ed at the next lea"ing e"eryone wondering what happened to the le"el of work that seemed to ha"e been achie"ed. This pattern might repeat what Hahler ()*+-/ calls the BambitendencyC of an infant who goes back and forth between wanting to be held by its mother and wanting to be left free to roam and explore. In a therapy group the participants work through self;destructi"e interactional patterns. The primary goals in a therapy group are to create a correcti"e emotional experience and change self;defeating relationship patterns (Harshall = &itch .>>*/. ATTA6$H'4T T$'275 A4G G728P PS56$2T$'7AP5 Nohn <owlby ()*--/ studied the importance of attachment separation and loss in human de"elopment and de"eloped attachment theory one of se"eral extensions of psychoanalytic theory. Attachment in"ol"es an emotional bonding with another who is percei"ed as a source of security (Pistole = Arricale .>>,/. According to <owlby the affectional bonds that the infant has with others especially the mother (or another Battachment ! gureC/ are essential for human sur"i"al. Infant attachment relationships can be broadly classi! ed as secure or insecure. The #uality of care an infant recei"es is related to the #uality of that indi"idual%s relationships in later life (Peluso Peluso 1hite = ?ern .>>J/. According to Harshall and &itch (.>>*/ a therapeutic group experience helps members meet their needs for being in"ol"ed with others for feeling attached and for feeling appreciated. Attachment theory which can be considered an offspring of obEect relations theory is a part of the newer relational models within the psychodynamic approach. &lores (.>>-/ belie"es that this theory synthesiAes the best ideas of psychoanalysis cogniti"e sciences child de"elopment research and neurobiology. $e states@ BAttachment is a primary moti"ational force with its own dynamics and these dynamics ha"e far;reaching and complex conse#uences not Eust for de"elopment but also for the importance of the relationship and alliance in treatmentC (p. ).-/. <27G'73I4' A4G 4A76ISSISTI6 P'7S24A3IT5 GIS27G'7S Perhaps the most signi! cant de"elopments of recent psychoanalytic theory in"ol"e borderline and narcissistic personality disorders. The essential features of the borderline personality are an unstable "iew of one%s self and instability in relating to others. 1ith borderline indi"iduals relationships are dominated by the need to defend against the fear of abandonment or reEection. The essential features of narcissistic personality disorder are a per"asi"e pattern of grandiosity hypersensiti"ity to the e"aluations of others and a lack of

empathy. '"ery relationship with a narcissistic indi"idual re#uires adulation and perfect responsi"eness from the partner (Hasterson )**9/. <oth of these personality patterns begin by early adulthood. Among the most signi! cant theorists in this area are ?ernberg ()*9: )*9+/ and ?ohut ()*9) )*99 )*-J/. ?ohut maintains that people are their healthiest and best when they can feel both independence and attachment taking Eoy in themsel"es and also being able to idealiAe others. 2bEect relations theory sheds new light on the understanding of personality disorders. According to St. 6lair (.>>J/ borderline and narcissistic disorders seem to result from traumas and de"elopmental disturbances during separationMindi"iduation. $owe"er the full manifestations of the personality and beha"ioral symptoms tend to de"elop in adolescence or early adulthood. 4arcissistic and borderline symptoms such as omnipotence grandiosity and splitting (a defensi"e process of keeping incompatible feelings separate/ are beha"ioral manifestations of de"elopmental tasks that were disturbed or not completed earlier. <orderline Personality A borderline personality disorder is characteriAed by bouts of irritability self;destructi"e acts impulsi"e anger and extreme mood shifts. People with borderline dynamics typically experience extended periods of disillusionment punctuated by occasions of euphoria. Interpersonal relations are often intense and unstable with marked changes of attitude o"er time. Splitting is a term often attributed to the tendency of people with borderline characteristics to think in Beither;orC categories. &or example a formerly "alued group member (or therapist/ may suddenly be seen as worthless if he or she angers the member who exhibits borderline features. Impulsi"e and unpredictable beha"ior fre#uently can cause physical harm. A marked identity disturbance is generally manifested by uncertainty about life issues pertaining to self;image sexual orientation career choice and long;term goals. ?ernberg ()*9:/ describes the syndrome as including a lack of clear identity a lack of deep understanding of other people poor impulse control and the inability to tolerate anxiety. In recent years a great deal more clarity about indi"iduals with borderline dynamics has emerged especially due to the work of ?ernberg and other theorists. They may be more disorganiAed than neurotics but more integrated than psychotic indi"iduals. People who manifest borderline dynamics ha"e not fully achie"ed separationMindi"iduation and tend to ha"e a chaotic primiti"e personality structure. 1illiam <lau (personal communication Harch ) .>>*/ points out that the diagnosis of a borderline personality is being applied rather broadly in clinical settings. Some authors describe indi"iduals with borderline personality disorder as being characteriAed primarily by the inability to effecti"ely manage emotional intensity which is a less pathologiAing "iew. <lau belie"es people with borderline characteristics are amenable to treatment although their problems may be more dif! cult to resol"e than simple neuroses because they are embedded in relati"ely permanent personality patterns. $e also prefers to refer to borderline BdynamicsC rather than borderline Bpersonalities.C <lau%s "iew is consistent with that of 5alom (.>>:/ who contends that borderline personality disorder does not represent a homogeneous diagnostic category. 5alom states that diagnosing whether a person has a borderline personality disorder depends on the characteristics of the indi"idual being screened rather than on a broad diagnostic category.

Implications for Group 1ork According to 5alom (.>>:/ the core problem of indi"iduals with borderline features lies in the area of intimacy and a group setting offers the therapeutic factors of cohesi"eness and reality testing. $e contends that if these indi"iduals can accept feedback and obser"ations pro"ided by other members and if their beha"ior is not highly disrupti"e the group can offer them supporti"e refuge from daily stresses. Although indi"iduals with borderline dynamics may express primiti"e chaotic needs and fears they are continually confronted with reality through the group process which helps keep these feelings somewhat under control. 5alom writes that people with borderline disorders are referred to group therapy not because they work well or easily in a group but because they are so dif! cult to treat in indi"idual therapy. 6lients with borderline personalities may be treated with a group format de"eloped by 3inehan ()**,b/ which is based on dialectical beha"ior therapy (G<T/. G<T includes some psychodynamic concepts in a cogniti"e beha"ioral framework. G<T skills training groups should be used with borderline clients in conEunction with indi"idual psychotherapy. G<T groups "alidate the client%s beha"ior Bas it is in the moment C confront resistance and emphasiAe Bthe therapeutic relationship as essential to treatmentC while teaching clients skills necessary to change (3inehan )**,b pp. :D+/. This topic is taken up in more detail in 6hapter ), on cogniti"e beha"ior therapy. &or those interested in learning more about treating indi"iduals with borderline personality disorders from an obEect relations perspecti"e see 6larkin 5eomans and ?ernberg (.>>+/. There is a excellent discussion of working with people with borderline and narcissistic disorders in psychodynamic therapy groups in 7utan Stone and Shay (.>>9/. 4arcissistic Personality 6hildren who lack the opportunity either to differentiate or to idealiAe others while also taking pride in themsel"es may later suffer from narcissistic personality disorders. This syndrome is characteriAed by an exaggerated sense of self; importance and an exploiti"e attitude toward others which ser"es the function of masking a frail self;concept. Such indi"iduals tend to display exhibitionistic beha"ior. They seek attention and admiration from others and they tend toward extreme self;absorption. 4arcissism may also present itself as "ery low self;esteem and an o"erreadiness to idealiAe others (see Gabbard .>>>/. ?ernberg ()*9:/ characteriAes people with narcissistic dynamics as focusing on themsel"es in their interactions with others ha"ing a great need to be admired possessing shallow affect and being exploiti"e and at times establishing parasitic relationships with others. $e writes that indi"iduals who are narcissistically oriented ha"e a shallow emotional life enEoy little other than tributes recei"ed from others and tend to depreciate those from whom they expect few narcissistic pleasures. There is also a growing trend to see narcissism as a striking lack of selfesteem. ?ohut ()*9)/ characteriAes narcissistically oriented people as being highly threatened in maintaining their self;esteem and as ha"ing feelings of emptiness and deadness. These indi"iduals are typically searching for someone who will ser"e as an obEect to feed the famished self. ?ohut uses the term selfobEect to refer to a person who is used to foster the narcissist%s self;esteem

and sense of well;being. These clients look for people whom they can admire for their power because they see themsel"es as worthwhile only if they are associated with such selfobEects. 5et their inner "oid cannot be ! lled so their search for con! rmation by others is ne"er; ending. <ecause of their impo"erished sense of self and their unclear boundaries between self and others they ha"e dif! culty differentiating between their own thoughts and feelings and those of the selfobEect. Implications for Group 1ork 5alom (.>>:/ discusses the problems that arise when indi"iduals with narcissistic dynamics enter group therapy. They typically ha"e dif! culty sharing group time understanding and empathiAing with others and forming relationships with other members. These clients ha"e a constant need for center stage. They often assess a group%s usefulness to them in terms of how much time is de"oted to them and how much attention they recei"e from the therapist. They are likely to be bored and impatient while other members are working and they also tend to di"ert the discussion back to themsel"es. These indi"iduals ha"e unrealistic expectations of the other members. They feel that they are special and deser"e the group%s attention yet they are not willing to gi"e attention to others. According to 5alom a maEor task of the therapist is to manage such highly "ulnerable members in the group. The leader must focus on the way members who display narcissistic traits relate to others in the group. In Interacti"e Group Therapy 'arley (.>>>/ pro"ides an informati"e discussion about the challenges of dealing with members who exhibit borderline and narcissistic tendencies. 2ne of the main problems for group leaders is the potential countertransference reactions that are stirred up in them. The intense anger and splitting defenses that people with borderline disorders often display can result in a leader becoming intimidated by the client%s anger or by becoming angry in return. The grandiosity self;centeredness and demeaning comments of a member displaying narcissistic tendencies can also elicit intense feelings of anger in both the leader and the members. 'arley states that members with borderline and narcissistic disorders tend to pro"oke intense reactions in group therapists. This makes it particularly important for therapists to become aware of their reactions toward certain members to a"oid acting on their feelings as much as possible and to seek super"ision when needed. According to N. Hichael 7ussell (personal communication Nanuary )+ .>)>/ countertransference reactions can be of "alue in understanding group members with borderline and narcissistic characteristics. Traits that initially might elicit negati"e reactions can be treated more therapeutically if the group leader%s feelings are understood as resulting from members trying to communicate something about long;standing styles of interaction. &or example a member%s moodiness might be seen as an attempt to communicate the moody nature of some early parental relationship. The spirit of psychoanalysis re#uires taking the time to form a deep relationship with a minimum agenda in a carefully structured frame. Some of the most powerful tools for understanding borderline and narcissistic personality organiAation ha"e emerged within this tradition. This way of working draws from the de"elopmental models of Hahler and the

competing "isions of transference and countertransference put forward by ?ernberg and ?ohut. T$' &8T87' 2& PS56$2A4A35TI6A335 27I'4T'G T$'7AP5 In )**. Strupp wrote that the "arious modi! cations of psychoanalysis Bha"e infused psychodynamic psychotherapy with renewed "itality and "igorC (p. .:/. In his forecast he suggested that this approach would undergo further re"isions and that it would maintain its prominence in indi"idual group marital and family therapy. Although contemporary psychodynamic forms di"erge considerably in many respects from the original &reudian emphasis on dri"es the basic concepts of unconscious moti"ation in uence of early de"elopment transference countertransference and resistance are still central to these newer psychodynamic therapies. Strupp also noted a decline in practices based on the classical analytic model due to reasons such as time commitment expense limited applications to di"erse client populations and #uestionable bene! ts. $e acknowledged that the realities stemming from managed care would place increasing emphasis on short;term treatments for speci! c disorders limited goals and containment of costs. Strupp identi! ed the following trends and predicted some future directions that psychodynamic theory and practice would take@ I The emphasis on treatment has shifted from the BclassicalC interest in curing neurotic disorders to the problems of dealing therapeutically with chronic personality disorders borderline conditions and narcissistic personality disorders. I There is increased attention on establishing a good therapeutic alliance early in the course of psychodynamic group therapy. A collaborati"e relationship is now "iewed as a key factor related to a positi"e therapeutic outcome. I Psychodynamic group therapy is becoming more popular and recei"ing widespread acceptance. This approach pro"ides clients with opportunities to learn how they function in groups and it offers a uni#ue perspecti"e on understanding problems. I There is a renewed interest in de"elopment of briefer forms of psychodynamic group therapy largely due to societal pressures for accountability and cost;effecti"eness. The indications are that time;limited therapy will recei"e increasing attention in the future. Strupp%s assessment of the current scene and his predictions of what was to come were #uite accurate. Toward Integrative Approaches Some efforts ha"e been made to de"elop integrati"e models in contemporary psychodynamic therapy. &or example it is possible to combine techni#ues of the cogniti"e beha"ioral therapies with the conceptual framework of contemporary psychoanalytic therapies. Horgan and HacHillan ()***/ de"eloped an integrated counseling model based on theoretical constructs of obEect relations and attachment theory that incorporates beha"ioral techni#ues. Horgan and HacHillan state that there is increasing support in the literature that integrating contemporary psychodynamic theory with cogniti"e beha"ioral techni#ues can lead to obser"able constructi"e client

changes. If treatment goals are well de! ned it is possible to work through the "arious phases of therapy in a reasonable amount of time. Adapting the conceptual foundation of psychoanalytic thinking to relati"ely brief therapy makes this approach useful in time;limited therapy. Brief Psychodynamic Therapy <rief therapy is one of the Bfuture de"elopmentsC Hesser and 1arren (.>>)/ predicted for psychoanalytic practice. <rief psychodynamic therapy (<PT/ applies the principles of psychoanalytic theory and therapy to treating selecti"e disorders within a preestablished time limit of generally )> to .: sessions. <PT uses key psychoanalytic and psychodynamic concepts such as the enduring impact of psychosexual psychosocial and obEect relational stages of de"elopment0 the existence of unconscious processes0 reenactment of the client%s past emotional issues in relationship to the therapist0 the therapeutic alliance0 and repetiti"e beha"ior. <rief dynamic therapy tends to emphasiAe a client%s strengths and resources in dealing with real;life issues. 3e"enson (.>)>/ notes that a maEor modi! cation of the psychoanalytic techni#ue is the emphasis on the here;and;now of the client%s life rather than exploring the there;and;then of childhood. Also the brief dynamic therapist tends to think psychodynamically yet is open to using a "ariety of inter"ention strategies. <rief dynamic therapy Bis an integrati"e short;term approach that interwea"es maEor principles of time; sensiti"e clinical workC (p. ),/. To limit the duration of therapy therapists acti"ely maintain a circumscribed focus with limited goals (3e"enson .>)>/. A central theme topic or problem is needed to guide the work. The aim of brief psychodynamic therapy is not to bring about a cure but to foster changes in beha"ior thinking and feeling. <rief therapy is an opportunity to begin the process of change that will continue long after therapy is terminated. 7utan and his colleagues (.>>9/ point out that there has been increased emphasis on shorter more cost;effecti"e group treatments. They predict that there will be continuing pressure to pro"ide group treatment as effecti"ely and inexpensi"ely as possible. <PT Bhas an important role in sustaining the "alues of psychoanalytic treatment which is to understand and treat people%s problems in the context of their current situation and earlier life experienceC (Hesser = 1arren .>>) p. -,/. 3e"enson (.>)>/ acknowledges that brief dynamic therapy is not suited for all clients and all therapists. &or example this approach is generally not suited for indi"iduals with se"ere characterological disorders or for those with se"ere depression. Some therapists are not well suited to the interacti"e directi"e and self; disclosing strategies of brief dynamic therapy. Although time;limited groups are not the best choice for all people these groups offer a "iable treatment alternati"e for those who do not want to commit themsel"es to an open;ended longer;term group. &or time;limited groups members must formulate clear and precise treatment goals that are directly related to the organiAing group theme. In these groups the leader assumes a more acti"e role and offers earlier inter"entions than would be typical in a long;term psychodynamic group. $ere;and;now beha"iors and interactions are gi"en more attention and in some "ery brief groups the therapist may focus exclusi"ely on here;and;now

interactions. The working;through process of past con icts would be unlikely to be pursued in these groups. According to 7utan and his colleagues (.>>9/ one ad"antage of such groups is knowing that a time limit exists0 this keeps members focused on addressing speci! c personal problems. 2ne disad"antage is that deeper con icts or underlying problems remain untouched0 members concentrate on more super! cial le"els of understanding. Analytically oriented therapists tend to be skeptical of B#uick ! xC techni#ues and simplistic solutions to complex psychodynamic problems. $owe"er many psychoanalytically oriented group therapists support the mo"e to the use of briefer therapy especially when this is indicated by the client%s needs rather than arbitrarily set by third;party payers. 3e"enson (.>)>/ belie"es brief therapy groups can be "ery rewarding for Bthe work combines an optimistic pragmatic results;oriented attitude with the experience of deep emotional commitmentC (p. ))J/. $a"ing practiced brief dynamic therapy for ,> years 3e"enson notes@ BI ha"e been phenomenally enriched changed and mo"ed in countless small and dramatic ways by the power of being let into someone%s life albeit for a short stayC (p. ))J/. It has been found that most people regardless of their cultural background prefer brief approaches to therapy (3e"enson .>)>/. If you are interested in a more comprehensi"e discussion of brief dynamic therapy I highly recommend 3e"enson (.>)>/.

Applying the Psychoanalytic Approach to Group Work in Schools The de"elopmental perspecti"e addressed in considerable detail earlier in this chapter is useful for group counselors working in schools. Group work with children is enhanced by the counselor%s understanding of the de"elopmental needs and tasks related to themes of industry "ersus inferiority. Adolescent groups function better if the counselor understands core struggles around identity "ersus identity confusion. Groups can be structured to assist the members in learning age;appropriate skills to enhance daily li"ing. The de"elopment of the ego functions can be facilitated by conceptualiAing and structuring a remedial counseling group as a supporti"e surrogate family. The analytic model pro"ides a conceptual framework for understanding a child%s or an adolescent%s current problems. Although the use of psychoanalytic techni#ues is generally beyond the scope of group counseling in the school setting group counselors can draw upon certain psychoanalytic concepts that ha"e been elaborated in this chapter. 'xploring the historical context of an elementary or high school student%s problems is beyond the scope and limitations of school groups. $owe"er understanding how past e"ents may continue to ha"e a present in uence on the problems can reframe the group counselor%s approach. A group leader can be aware of factors such as resistance transference anxiety and the functioning of the ego;defense mechanisms. This awareness will add some depth to the inter"entions the group leader makes e"en though he or she does not encourage excursions into past trauma or unconscious con icts. 8nderstanding these psychoanalytic concepts affords group counselors a way to de"elop empathy and to work compassionately with here;and;now

problems of children and adolescents as is demonstrated by Sheila Paretsky%s (.>>*/ con"ersation group. Paretsky is a director and faculty member of the Academy of 6linical and Applied Psychoanalysis. She drew from psychoanalytic theory and applied psychoanalytic techni#ues in her work with a group of recently immigrated 6hinese high school students who wished to impro"e their spoken 'nglish. The students in this group displayed a host of resistances to being emotionally a"ailable which Paretsky worked through using psychoanalytic group techni#ues. <y the end of the school year these students were able to discuss a wide range of meaningful concerns in 'nglish. Paretsky (.>>*/ concludes@ BI am con"inced that psychoanalytic theory and techni#ue are an in"aluable resource for teachers. It is my hope that uni"ersities and training institutes will create opportunities to offer those in the ! eld of education our treasure. It is my mission to continue to do soC (p. ,::/.

Applying the Psychoanalytic Approach With

ulticultural Populations

1hen considering whether a gi"en theory is appropriate for working with di"erse client populations in a group setting one key criterion is the consistency between the concepts and techni#ues of a theory and the cultural "alues of the group members. 6onsider how well the underlying assumptions and key concepts mesh with the cultural "alues of di"erse client groups. Although the basic concepts of psychoanalytic theory can be applied to understanding people from di"erse cultures the psychoanalytically oriented group therapist must also consider those instances when speci! c psychotherapeutic techni#ues may not ! t with a client%s cultural background. Hany cultural groups place a high priority on family history. A re"iew of a client%s past and of how this past is ha"ing an important bearing on current functioning may be appropriate as a conceptual framework. 1orking in symbolic ways can also be powerful especially with clients who are reluctant to talk about their personal problems. &or example there is "alue in using pictures of the family at different periods of the client%s childhood. The leader might say@ BSelect a picture that has particular meaning for you. Tell me what you remember during these times. As you look at the picture what thoughts and feelings come to youLC 2nce group members begin talking to one another about their memories based on these pictures they are likely to be more open in dealing with emotional material. As we ha"e seen group therapists need to be aware of the ways in which the interpretations they make are in uenced by their cultural background and their theoretical assumptions. Although practitioners can still conceptualiAe the struggles of their clients from an analytic perspecti"e it is critical that they adopt a stance of exibility. Group counselors need to exercise "igilance lest they misuse their power by turning the group into a forum for pushing clients to adEust by conforming to the dominant cultural "alues at the expense of losing their own world"iews and cultural identities. Group practitioners also need to be aware of their own potential sources of bias. The concept of countertransference can be expanded to

include unacknowledged bias and preEudices that may be con"eyed unintentionally through the techni#ues used by group therapists.

!valuation of the Psychoanalytic Approach to Groups C"#T$IB%TI"#S A#& ST$!#GT'S "( T'! APP$"AC' There is much in psychoanalytic theory that I consider of great "alue. All of the theoretical orientations presented in this text ha"e some relationship to the psychoanalytic approach e"en if in some cases the theory is a reaction against some of the basic ideas of this foundational theory. The analytic model pro"ides a conceptual framework for understanding an indi"idual%s history and in this regard group practitioners can learn to think psychoanalytically e"en if they do not practice psychoanalytically. Although some psychoanalytic techni#ues may ha"e limited utility for the group counselor in some settings many analytic concepts help explain the dynamics operating both in indi"iduals and in the group as a whole. I am con"inced that it is important to consider the past to fully understand present beha"ior. Hany of the con icts brought to a group are rooted in early childhood experiences. Although I am not ad"ocating a preoccupation with the past by excessi"ely dwelling on it my contention is that ignoring the in uence of the past can lead to super! cial group work. 8nderstanding this in uence gi"es people more control o"er their present beha"ior. A psychoanalytic concept I ! nd of particular importance is resistance. '"en when members are in a group by their own choice I obser"e resistances especially during the early de"elopment of the group. These resistances are manifestations of "arious fears0 unless they are dealt with they are likely to interfere with the progress of a group. In fact I typically ask members to share with the group the ways in which they expect their beha"ior patterns to interfere with their group work. '"en though resistance is typically unconscious group members will often be surprisingly re"ealing. Some members seem to know #uite well that they may sabotage their best efforts and resist change by intellectualiAing by being o"erly nurturing or o"erly critical with fellow members or by con"incing themsel"es that their problems are not as pressing as the problems of others in the group. If members can recogniAe their a"oidant beha"iors when they occur they ha"e a chance to change them. Some of the more subtle forms of defense may become e"ident o"er time such as displacing feelings and proEecting. The psychoanalytic concepts of anxiety and the ego;defense mechanisms that emerge as a way to cope with this anxiety are most useful for group practitioners. Although in some groups the leader may not interpret and work through these defensi"e structures it is essential to learn to respect defenses and to recogniAe how they de"elop and how they manifest themsel"es in group interactions. Gealing with the defenses against anxiety pro"ides a useful framework for intense group work. Hembers ha"e the opportunity to challenge some of their

defensi"e strategies and in the process of learning how to communicate in nondefensi"e ways they can also learn new ways of responding. Transference and countertransference ha"e signi! cant implications for group work. Although not all feelings between members and the leader are the result of these processes a leader must be able to understand their "alue and role. I ! nd the analytic concept of proEection #uite useful in exploring certain feelings within the group. ProEections onto the leader and onto other members are "aluable clues to unresol"ed con icts within the person that can be producti"ely worked through in the group. The group can also be used to re;create early life situations that are continuing to ha"e an impact on the client. A basic tenet of psychodynamic therapy groups is the notion that group participants through their interactions within the group re;create their social situation implying that the group becomes a microcosm of their e"eryday li"es (7utan et al. .>>9/. In most groups indi"iduals elicit feelings of attraction anger competition a"oidance aggression and so forth. These feelings may be similar to those that members experienced toward signi! cant people in the past. Thus members will most likely ! nd symbolic mothers fathers siblings and lo"ers in their group. These transferences within the group and the intense feelings that often characteriAe them are fruitful a"enues to explore and to work through. "&I(ICATI"#S "( C)ASSICA) A#A)*TIC P$ACTIC! An approach that integrates &reud%s psychosexual stages of de"elopment with 'rikson%s psychosocial stages is in my "iew most useful for understanding key themes in the de"elopment of personality. 1orking solely on an insight le"el will not result in changes0 it is essential to explore sociocultural factors as they pertain to the struggles of indi"iduals at the "arious phases of their de"elopment. 8nless group practitioners ha"e a good grasp of the maEor tasks and crises of each stage they ha"e little basis for determining whether de"elopmental patterns are normal or abnormal. Also a synthesis of &reud%s and 'rikson%s theories offers a general framework for recogniAing con icts that participants often explore in groups. The more recent de"elopmentsKobEect relations theories self psychology and relational psychoanalysisKoffer "aluable conceptions for group therapists. There ha"e been a number of breakthroughs in working with borderline and narcissistic dynamics in group therapy and the group offers some uni#ue ad"antages o"er the one;to;one relationship in working with people manifesting borderline personality characteristics. Hany practitioners who were trained in classical psychoanalysis ha"e modi! ed analytic concepts and techni#ues to ! t group situations. I ha"e encountered a number of therapists who think in psychoanalytic terms but use techni#ues drawn from other therapeutic models. Hany practitioners work with psychodynamic concepts such as the unconscious defenses resistances transference and the signi! cance of the past. Some analytically oriented group therapists demonstrate an openness toward integrating "arious methods.

)I ITATI"#S "( T'! APP$"AC' &rom a feminist perspecti"e there are distinct limitations to a number of &reudian concepts especially the notion of the 2edipus and 'lectra complexes and the assumptions about the inferiority of women. In her re"iew of feminist counseling and therapy 'nns ()**,/ notes that the obEect relations approach has been criticiAed for its emphasis on the role of the motherDchild relationship as a determinant of later interpersonal functioning. This approach gi"es great responsibility to mothers for de! ciencies and distortions in de"elopment whereas fathers are conspicuously absent from the hypothesis. 'nns writes that some feminist therapists ha"e addressed the limitations of psychoanalysis by incorporating family systems work within their psychoanalytic model. In addition to the criticisms of psychoanalysis from feminist writers the approach has been accused of failing to ade#uately address the social cultural and political factors that result in an indi"idual%s problems. Psychoanalytic therapy is less concerned with short;term problem sol"ing than it is with longterm personality reconstruction. In his criti#ue of long; term psychodynamic therapy Strupp ()**./ acknowledges that this approach will clearly remain a luxury for most people in our society. 3ow;income clients generally do not ha"e the time resources or inclination to begin and maintain the extended and expensi"e Eourney of psychoanalytic self;exploration. Instead they are likely to be moti"ated more by the need to ha"e psychological security and pro"ide for their family. This is not to imply that all approaches to psychotherapy are inappropriate for people of limited means. Smith (.>>:/ contends that psychotherapists% willingness and ability to work with poor people is compromised by unexamined classist attitudes and that these attitudes constitute a signi! cant obstacle for practitioners% success in working with the poor. Smith seems to making a case for alternati"e therapeutic models such as psychoeducation counseling pre"enti"e psychology and community psychology rather than traditional psychotherapy for the poor.