Group Therapy DVD
Title: Balance and Integration in Psychoanalytic Group Therapy

Robert M. Gordon, Ph.D., ABPP
Presented at the Philadelphia Area Group Psychotherapy Society – 2005

The six “group therapy patients” are actually experienced group therapists role playing various types of patients.

Dr. Gordon would like to thank the therapist-role players:

Chris Dematatis, Ph.D.,
Fran Gerstein, LCSW,
Steven Kay, Ph.D.,
Michael Remshard, Ph.D.
Susan Shollander, LCSW
Laura Silverstein, LCSW,

This film was produced in keeping with the APA Ethic’s Code.

Selection for The Psychoanalytic Group

Members need to be sufficiently psychologically minded and be able to conform to the ground rules of confidentiality, boundaries, payment and attendance.

Balancing the Group

A function of the leader is to help regulate balance and integration within the group and within the individual’s personalities.

Two Minute Check In
Use a two minute check-in at the beginning of group so that the group starts out in balance. All members get a chance to speak uninterrupted for two minutes about how they are doing. It introduces the themes and issues of the members.

Balance Between Here and Now and There and Then.
Keep the discussions moving between the here and how, and there and then unconscious self defeating patterns.

Balance between thoughts, feelings and behavior.

Balance conscious and unconscious motives and perceptions.

Balance between the interpersonal and intrapsychic systems.

Integrate conflicts in the Here and Now and the There and Then with Interpretation and Empathy.

Two Minute Check In
Members begin focusing on surface symptoms or they are in denial of them.
There is little insight at this point.

33:22
Member expressed symptoms and another member offers a superficial solution. The superficiality infuriates another member. His aggression energizes the group.

33:40
Therapist goes after the affect.

35:28
The lack of insight in group (here and now) reminds a member of the kind of women he picks (there and then).

36:43
Member interrupts to deflect aggression. Her anxiety is in reaction to the aggression in the group. This gives us a hint that a cause of her anxiety is the fear of her own aggression. Her projected aggression makes her frightened of the world. Therapist begins to work on her recognizing her aggression.

At 37:45 – Superficial solutions is counter to learning to deal with emotions and using insight to resolve conflicts.

39:15
The therapist keeps the group on task using questions, clarifications, confrontations, interpretations and reconstructions. Use supportive interventions sparingly for crisis situations, or when the member is too upset and not ready for an interpretation.

39:30
Member gives accurate but hostile feedback.

40
Constructive confrontation by another member

41
Therapist reminds the group of the nature of the group and its task; this is a clarification in reaction to the defensiveness.

41.40
Therapist goes after affect under the defense. The goal is to get members to better understand and tolerate affects.

42
Sweetness as a reaction formation against aggression; without aggression she has a hard time with intimacy. Intimacy requires aggression tamed by concern.

43 .45
Showing how a pattern in the here and now is related to her pattern in the there and then. She distances in group as she does outside group. But now she can self reflect how and why she does it.

44.46
Therapist does not over confront defenses and only points them out early in the treatment. The therapist then moves to a quiet member to help balance the group.

45:52
Member is depressed and demoralized. Therapist brings his self centeredness into group with the question about how he feels about therapy. Therapist keeps the group on task with psychoanalytic interventions.

46:30
It is easier for group members to see defensiveness in others than in themselves. This begins to help individuals identify their own defensiveness. The group’s capacity to deal with affects and anxieties eventually helps individuals tolerate their own affects and anxieties, and increases self-reflective and self-soothing capacity.

47:25
This member’s intervention was due more to impatience than to bring a deeper level of introspection. It would have been better at this point to share his aggression versus giving a suggestion.

48:38
Enduring dysfunctional traits are not helped by pleasant pastimes but through committed therapeutic relationships.

48.50
Here and now rescue of a depressed member lets us see how he sets himself up for unsatisfactory relationships when he dates.

49:12
While some members express too little anger, this member expresses too much. What he says is accurate and useful, but he is hurtful and alienating.

49:40
Therapist’s question is used to change the focus from the angry transference at the ineffectual mother figure to his internal anger and hurt.

50:30
Therapist is encouraging the group to work through their issues with transference with him. Without this clear encouragement members might continue to internalize their aggression or scapegoat each other.

51:30
Therapist is prepping the member for interpretations of unresolved issues about his first care giver. The therapist lets the member know that his aggression might be related to old hurts. This is only introduced but at this early point not pushed.

51.47
Member gets some of his own medicine when he is defensive. This is an important confrontation.

51:55
The group is split over when to challenge defenses and when to support defenses.

52.20
Therapist is balancing the group by going after a member’s aggression. She needs to express more of it.

53:05
Therapist states that we will return at a later time. This shows both concern for the member while keeping him on task.

53.40
Member expresses fear of aggression, a source of her anxiety.

53:55
Psychoanalytic therapy helps improves the ego’s capacity to understand, manage and appropriately express aggression and sexuality. Anxiety can be seen as a sense of dread about one’s vulnerability and fears of internal conflicts that are projected out as external dangers.

54:26
Sub-grouping is acting out against the group. Outside conversations among the members need to be discussed in the group.

55:30
Therapist clarifying to use the group as a safe container for mastering affects.

56.08
Sometimes it’s OK to repeat a point and at others times it is better to ask the group to try to remember what they heard.

56:10
Therapist is formulating a reconstruction about the origins of defenses. If parents were poor containers of a child’s affect a person will have a difficulty in containing and self-soothing their own affects. This brings about silence. In this case it might signal the beginning of mourning which is necessary for personal growth.

57:00
Therapist senses that a member is sitting on feelings and goes to him. After introducing the group as a safe place to deal with feelings a group member confronts the therapist with here and now hurt feelings. This both tests the relationship and allows him to master aggression and intimacy.

57:10
Group member felt laughed at. This is perhaps transference from having been put down in childhood.

57.48
Therapist models non-defensiveness by being curious and interested in his feelings.
Now is not the time to interpret the transference, but model non-defensive constructive behavior. The therapist offers an apology. Later, if it is indeed a transference it will happen again as a clear pattern of distorting relationships based on internal conflicts. Then the therapist can make a well timed constructive interpretation of the transference that can eventually bring about a healthier capacity for intimacy. The therapist interpreting transference at this point would indicate a counter-transference based reaction.

58:29
We can see the same oversensitivity with another group member which supports the hypothesis that this is a transference.

The fighting is also a defense against self reflection at this point.

58.57
A member clarifies the history. There was humor and interpretation but no devaluing. This is a good use of clarification. Clarification of reality is often necessary before an interpretation.

58.59
Now the depressed member feels safe expressing his anger after he saw how anger is going to be worked on and handled in the group.

59:50
Member repeats the use of apology and concern despite his over sensitivity and defensiveness.

1:00
Member using the defense of splitting the world into black and white, men and women, bad and good.

1:00:51
This is an example of an interpretation.
The therapist interprets that the compulsive need to take care of others may be to avoid depending on others for help.

1:01
Therapist came back to an apology to reestablish mutual respect in the here and now relationship. The next step was to clarify the reality that was distorted. Only when both seem to be accepted by the member, the therapist then went on to interpret the unconscious pattern.

1.02
Therapist is balancing individual interpretations with group as a whole interpretations. This encourages the group to identify with the task of increasing self reflective ability and constructive expression of affects.

1.02.4
Therapist summarizes the group themes at the end of group and ends the group on time. Starting and ending on time creates a secure structure.

1:31.37

Two Minute Check In

1:33
This two minute check in shows that the members are more evolved. They are less defensive and can both acknowledge their progress and their conflicts. The role of the therapist’s silence expresses the capacity to contain patient’s affects, shows respect and concern on a non-verbal level.

1.37.42
The group has become a safe place to work on aggression, which is fundamental to intimacy.

1.38.58
Aggression needs to be recognized, experimented with and then modulated or else intimacy suffers.

1:40.3
Therapist is balancing a member’s reaction in the group to his memory of his own father’s hostility. The therapist interprets that he is acting like his own father.

1.42.15
The therapist goes between using the here and now relationship and the member’s relationship with his father to show an unconscious pattern.

1.42.57
The therapist moved away from going after the member’s pain about his father. The member was not ready to go there yet. The therapist wondered who was there in the role to support his emotions, since there are so many defenses now. The member shares “my nurse mother” who offered superficial Band-Aids for a serious problem. This helps us understand his transferences earlier. Many patients react to superficial therapy by leaving early. Symptom focused treatments often reinforce the same lack of empathy that the patient experienced in childhood.

1:44.4
This member is sharing that he didn’t recognize how much aggression he has toward a parental figure. So much has been denied and turned inward as depression.

1:46.50
The group moves away from painful memories from the past and moves into splitting again by talking about male-female differences. The group moves into a defensive period.

1:49
It is much better for the therapist to be quiet and let the interpretation come from a group member. Only after being patient for awhile and the interpretation does not come from the group then it should come from the therapist.

1:51.15
The therapist tries to bring the energy back into the room by focusing on the here and now emotions while the members try to resist this.

1:54.57
This member is beginning to bring up direct issues to another member in group. This shows great progress for her. She is having transference to him.

1.55.48
The therapist questions the member’s defense of trying to stay away from aggression.
Questions should be raised only to deepen self reflection.

1:56.17

Therapist uses the metaphor of the bedroom as a safe container for the healthy aggression. This is an analogy of the group as a safe container of primitive feelings. The therapist interprets her fear as a fear of her own wishes.

1:57.35
The therapist brings the description of a symptomatic relationship into the room.

1:58.27
The member appropriately defends his boundaries and refocuses her to her own sexual issues and her complaining about others as a defense.

1:59:01
Therapist supports member’s boundaries, but goes after the affect and encourages free expression.

1.59.32
Therapist is using patient’s language as a metaphor for encouraging assertiveness.

2.01.4

Therapist is ending the group on time, summarizing themes and appreciating the courage and work of the group members.