International Journal of Group Psychotherapy

ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20

Psychodynamic Group Psychotherapy J. Scott Rutan To cite this article: J. Scott Rutan (1992) Psychodynamic Group Psychotherapy, International Journal of Group Psychotherapy, 42:1, 19-35, DOI: 10.1080/00207284.1992.11732578 To link to this article: https://doi.org/10.1080/00207284.1992.11732578

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INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 42(1) 1992

Psychodynamic Group Psychotherapy J.

SCOTT

RUTAN, Ph.D.

ABSTRACT The author provides an overview ofcriticalfactors in the working phase ofgroup psychotherapy from the perspective of psychodynamic theory. The discussion is organized around a clinical vignette to illustrate various types of intervention such as past, here and now,future; individual, interpersonal, group as a whole; in group-out of group; affect-cognition; and understanding-corrective emotional experience. The critical "windows into the unconscious," transference, countertransference, and free association, are also discussed in terms of the clinical example. The author concludes his article with a few thoughts about the future of psychodynamic theory in relationship to group treatments.

T

he task of writing about psychodynamic group psychotherapy is a privilege and a challenge. For one thing, there is no single entity, "psychodynamic group psychotherapy." Under the psychodynamic umbrella reside many complex theoretical approaches to understanding personality and group process: classical dual-instinct drive theory, ego psychology, neoanalytic psychology, self psychology, and object relation theory, to mention the most prominent. Furthermore, psychodynamic therapists may alter their techniques depending upon the patient population with which they are working. Even within such diversity, however, there is a common set of hypotheses that undergird the theory and practice of psychodynamic therapy.

ASSUMPTIONS OF PSYCHODYNAMIC THEORY The origins of psychodynamic theory flow from Freud's psychoanalytic theory. Many of the assumptions contained in psychodynamic theory

Dr. Rutan is Director of the Center for Group Psychotherapy, Harvard Medical School- Massachusetts General Hospital, Boston. 19

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remain constant from Freud's earliest theories. These include the conviction that (1) there is psychological determinism, (2) there are unconscious processes, (3) human behavior is dynamic and goal directed, (4) development is epigenetic, and (5) functions of the mind are at work at any given point in time (Alonso, 1989). Each of these postulates is a leap of faith from which the dynamic therapist proceeds.

Psychological Determinism This fundamental principle of dynamic theory holds that all human behavior and thought are lawfully connected. There are no "accidents" in the economy of the psyche. The assumption is made that all human thought and behavior can be understood if we know enough about the individual.

Unconscious Processes Perhaps Freud's most radical hypothesis is that there is an out-ofawareness world, the unconscious, that influences perceptions, beliefs, and behaviors. Through the defense mechanism of repression, events, feelings, and traumas that threaten to overwhelm personality are relegated to this unconscious realm. The goal of psychodynamic therapy is fundamentally an educative one-to help the patient gain awareness of those parts of the unconscious that result in destructive distortions in present-day perceptions. There are only a finite number of windows into the unconscious. The major traditional windows into the unconscious include slips of the tongue, free association, dreams, and transference.

Dynamic and Goal Directed Human behavior, even what seems most bizarre, is goal directed. Different schools within psychodynamic theory posit these goals somewhat differently. For example, classical theorists assume that libido and aggression are the dual drives that propel individuals toward tension reduction while object relations theorists assume that behavior is directed toward gaining relationships and attachments.

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Epigenetic Development In dynamic theory, personality is formed developmentally. An epigenetic model of development is one in which each stage of development builds on the prior stage, and each developmental stage affects the subsequent one. This inevitably results in an emphasis on the importance of the earliest developmental stages since their impact will be felt on all subsequent stages. For therapeutic purposes it is important to note that psychodynamic theory assumes that flaws in earlier developmental stages can be repaired if that stage can be recalled, relived, and affectively reexperienced correctively in the here and now.

Functions of the Mind Dynamic theory assumes that there are distinct structures of the mind that may be in conflict with one another. The classical division of the mind is between the id (the primitive instincts and drives), the superego (the internalization of culture's expectations), and the ego (the monitoring function between id and superego). Modern schools of psychodynamic theory place different value on the importance of the structures of the mind. Self psychology has added the "self" as a new structure. It is important to note that the fundamental starting point of psychodynamic theory, as with all personality theories, is a leap of faith. Dynamic therapists assume the existence of the unconscious. We further assume that helping the patient become aware of his or her unconscious world will free the patient to perceive the here and now more accurately. The goal of the psychodynamic therapist is to look consistently at the world of the patient through the psychodynamic lens, thereby helping the patient gain insight through information about his or her unconscious. We do not believe that the psychodynamic lens is the only one, nor do we believe that it is always correct. For example, though we operate on the assumption that psychologically there are no accidents, we know that in fact there are. By examining all behavior as determined, however, we give our patients the best opportunity to gain insight into possible unconscious activity.

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Theory is important because all good technique flows naturally from theory. As this and subsequent editions of the Journal indicate, there are many theories that attempt to explain how individuals come to suffer and cope with psychological distress and illness. Confusingly, they all seem effective in promoting psychological health. Clearly, we do not have "the answer" yet as to how best to understand human personality. Nonetheless, it is important that clinicians have a solid grounding in a theory that makes sense to them so that they can generate technique based on something less ephemeral than intuition. PROCESS The traditional psychodynamic vehicle for analyzing personality is free association. Here the assumption is that by associating freely the patient will inevitably come to the areas of important conflict. In group therapy this becomes group process. As in free association, there is an assumption that associations are not really "free" and random but are determined. The group therapist assumes that groups never change the subject, but rather that there are unconscious connections between what one patient says and what is uttered next by another patient. The process of a psychodynamic group is a consequence of the theory. The therapist attempts not to set agendas but rather to follow the associations of the group. The conviction is that the group process will inevitably lead to the most important and affect-laden material if allowed to proceed without inhibition. Thus, the beginning of most psychodynamic group sessions is characterized by the leader sitting silently. The only time this is not the case is when the leader has an announcement that affects the group, such as an announcement regarding an upcoming vacation, a new member, a communication from a member, a fee increase, and so on. Otherwise the leader attends to how the group and its individual members begin the session. A psychodynamic assumption is that the group, unless some powerful stimulus has intervened between sessions, will begin with the theme present at the end of the previous session. The group therapist is then confronted with a bewildering array of data. In addition to all the material presented by each individual's verbal and nonverbal communications, there are also data from the various interactions in the group, the subgroup relationships, the group

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as a whole, and the relationship between the group and the therapist. To add complexity, the psychodynamic group therapist has many options as to how to use this data. Let us examine the axes in Figure l. (Rutan & Stone, 1984, p. 1I8).

LEVELS OF INTERVENTION Depending upon the specific psychodynamic theory espoused, the therapist may focus on any point on these axes at various times (cf. Kauff, 1979). For heuristic purposes, I will attempt to tease out the differences in these approaches. However, it should be underlined that there are no "right" ways to understand dynamic process. Rather, there are numerous "right" ways.

Past-(Here and Now)-Future The psychodynamic therapist is committed to the hypothesis that much of present behavior and perception is predicated on the past. This implies that a careful history of early development is required for each patient. The stereotype of dynamic therapy is that much of the time

Past Future Group as a whole Individuals In group Out of Group Affect Cognition Process Content Understanding Corrective Emotional Experience FIGURE 1 Levels of intervention.

From Rutan, J. S. and Stone, W. N. Psychodynamic Group PsychotherafrY. New York: Macmillan Publishing Co., 1984, p. 118.

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of therapy is spent delving into the history of the patient. In fact, most branches of psychodynamic theory emphasize the here and now, using history only to understand and explain instances when the patient unconsciously repeats the past or misperceives the present based upon historical learning. Nonetheless, within the psychodynamic tradition there is variety in how therapists use the points on this axis. Some clinicians restrict the work in their groups to the here-and-now relationships in the group. Others emphasize the here-and-now interactions but move to individual histories in order to understand the present relationships more completely. Still others use the group forum as a time for comparing and contrasting present character styles and histories of origin in order to help patients learn how their pasts affect the present. Psychodynamic therapists tend to focus very little on the future. The future is usually considered only in terms of the predictable consequences of present action and past patterns.

Case Example A group convenes the week after a stormy session in which a patient, Ms. A., raged at the ineffectiveness of the group and the ineptitude of the leader. She angrily walked out of the meeting five minutes before the group ended, stating that she would not be returning. In the present meeting the other members are present, but Ms. A. is conspicuously absent. The members were agitated and full of feelings. Some were furious at Ms. A. and protective of the group and the leader. Others were angry at Ms. A. but wondered if she had spoken some feelings they shared but feared expressing. Two members expressed relief that Ms. A. was no longer a member, stating that they had never liked her.

Past A dynamic therapist who stressed the past would move quickly to help the patients understand their present reactions by linking them to formative aspects of their history. For example, Mr. B., the leading supporter of the therapist had been the staunch "supporter" for his inept and inadequate father. Ms. C., the patient who was most enraged that the leader had done nothing to stop Ms. A. from leaving the group, had been put up for adoption as a child, and she was clearly terrified and furious that her present "parent" seemed no better at

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keeping families together than her natural parents. Dynamic theory assumes that the lens through which present reality is viewed was formed in history, and one role of the dynamic group therapist is to provide our patients with understanding about that history.

Here-and-Now Another dynamic therapist might prefer to concentrate much more extensively on the current dilemma of the group having lost a member. It is not that such a therapist would not agree that the past was critical in understanding these reactions, but rather that it was even more important to allow the members fully to express and explore their present reactions. For example, Mr. B. would be encouraged to explore and expand his ambivalent feelings about the therapist. On the one hand he clearly feels positively about the therapist, and on the other hand he clearly experiences the therapist as needing his support. Likewise Ms. C. would be given ample opportunity to express and explore her feelings about the therapist who could not keep this family together.

Future The dynamic therapist does not usually emphasize the future other than to predict consequences of present action, especially repetitive patterns that have been identified in the therapy. This is in contrast to existential theorists who attend to the impact of our finitude on current affects and perceptions. For dynamic therapists, present behavior is better understood by exploring history rather than the future.

Group-as-a-Whole- (Interpersonal)- Individuals Within the psychodynamic tradition there is wide divergence of opinion about the place of the group as a healing force. At one end of the continuum there are the followers of Bion (1959), who focused exclusively on the group as a whole. Proponents of this approach assume that the individuals in the group will be changed automatically if the group as a whole processes are identified and interpreted. They also posit that certain reactions occur only in the context of a group, where a particularly powerful form of regression can occur. There are also

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dynamic therapists who highlight the interactions between members of the group. Doubtless influenced by Yalom (1975), these therapists operate on the assumption that all the important character issues will inevitably reveal themselves in the interactions in the group. Therefore, their attention is to the interpersonal interactions between group members. (These theorists obviously stress the here and now on the axis above.) There are also dynamic therapists who concentrate on the individuals who comprise the group. Wolf and Schwartz (1965) emphasize the intrapsychic life of the individual group members. For Wolf and Schwartz, the group is primarily a setting for the analytic work with successive individuals. Group-as-a- Whole. From this tradition, the incident regarding Ms. A. might be understood as a scapegoat phenomenon. That is, it could be interpreted that the group extruded Ms. A. because she contained (and spoke of) feelings that the group as a whole could not bear (such as the wish to kill the leader). This is viewed as a group function unconsciously designed to safeguard the group. Interpersonal. This dynamic perspective would stress the feelings between members and members, and between members and the leader. It would be assumed that to the degree that members could fully express and learn about their feelings for one another and the leader, they could gain insight into the issues that brought them into therapy. The leader, in this scenario, would facilitate exploring the in-group relationships, such as helping Mr. B. and Ms. C. communicate and learn from their reactions to one another. Individuals. For followers of Wolf and Schwartz, the affect stirred by the flight of a member would be an opportunity to analyze individual responses and to offer interpretations linked to individual histories. Thus, the connection between Mr. B.'s relationship to his father and his transference to the leader could be a focus on the following meeting. The focus could just as easily been on Ms. C.'s outrage that the leader could not hold the group together, helping her see the connection between her present reaction and her disastrous early history.

In Group-Out of Group There are wide differences of opinion among psychodynamic therapists about the value of out-of-group material; such material, some therapists reason, is a defense against work on the relationships within the group.

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Some therapists attend exclusively to feelings within the matrix of group relationships. In the most extreme case this would even exclude discussion about Ms. A., who is not in the meeting. These therapists operate on the assumption that all the information about the members that is needed to conduct the therapy will ultimately be available for analysis in the reactions of the members to one another and to the leader. Other therapists value material that comes from outside the group itself. This would include discussion of parents, bosses, loved ones, or any important outside relationship. What is common to most psychodynamic therapists is the emphasis on in-group relationships. Thus, in most dynamic groups the core of the meeting in question would be spent exploring the feelings of the members in response to Ms. A.'s affect and flight.

Affect-Cognition The various schools of psychodynamic theory agree that affect is primary in the therapeutic process. Despite being grounded in an educational philosophy ("The truth shall make you free," John 8:32), this is affective rather than cognitive learning. Thus, the therapist's attention would be on the member's feelings generated by Ms. A.'s affect and action rather than on thoughts about it. There is a place for cognition in dynamic therapy, but cognitive closure should occur after a full expression of affect. While some insight is cognitive, it is presumed by dynamic theory that the deepest insight occurs as an affective "Ah hal" experience.

Process-Content Listening with the "third ear" refers to the dynamic therapist's heightened attention to the process, in addition to the content, of our patients. It is a natural corollary of the hypothesis about the unconscious that dynamic therapists attempt to detect and help our patients recognize meaning below the overt level of communication. Thus, if the group in this example had made no overt reference to the previous meeting or Ms. A. but had instead begun with a rousing discussion of abortions, suicides, and/or important but absent people, the leader would at some point link the current "content" to the unconscious "process" of the group's reacting to the power of Ms. A.'s termination.

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Understanding-Corrective Emotional Experience Perhaps the biggest discrepancy among psychodynamic theories concerns the fundamental assumptions regarding what produces therapeutic growth. Freud was clear in his judgment that understanding (via insight) brought about change. The goal of psychoanalysis was to make the unconscious conscious. That remains the ultimate goal of contemporary dynamic therapists as well, but the vehicle for that process is conceptualized differently. For some dynamic therapists, insight will occur naturally if the patient receives treatment different from what historically caused maladaptive behavior. This is not to be confused with Franz Alexander's (1946) misguided attempts at "corrective emotional experience" later in his career, but rather indicates a benign and understanding therapeutic atmosphere. All therapists attempt to establish such an atmosphere, but some believe that such an atmosphere is sufficient for change. This tradition, begun with the neoanalysts such as Rogers (1951) and Sullivan (1954), finds elaboration in the work of Kohut (1971) and the self psychologists. Insight. For dynamic therapists focusing on insight as the primary change agent, the goal of the example session would be to help the members understand their affective responses to Ms. A.'s termination in light of their history and their character. This would occur primarily through the classical therapeutic responses of confrontation, clarification, and interpretation (Greenson, 1967). Corrective Emotional Experience. For those therapists relying on corrective emotional experience as the principal change agent, the emphasis would be on empathic understanding of the members' personal responses and an acceptance of those reactions whatever they may be. In this scenario there would be less need to place those responses in historical context in order to facilitate change.

WINDOWS INTO THE UNCONSCIOUS Given that a primary task of most dynamic therapists is to help patients gain access to their unconscious world, it is important to understand the points of entry to that out-of-awareness world.

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Transference Freud first mentioned the concept of transference in his "Studies on Hysteria" in 1895 (Freud, 1956). His colleague, Breuer, had been treating Anna Pappenheim (Anna 0.), and Freud became fascinated by this case. When the patient developed a false pregnancy with the delusion that Breuer was the father, Freud began to hypothesize about the phenomenon of transference. This concept is beautifully described by Malcolm (1981). The phenomenon of transference-how we all invest each other according to early blueprints-was Freud's most original and radical discovery. The idea of infant sexuality can be accepted with a good deal more equanimity than the idea that the most precious and inviolate of entities-personal relations-is actually a messy jangle of misapprehensions, at best an uneasy truce between powerful solitary fantasy systems. Even (or especially) romantic love is fundamentally solitary, and has at its core a profound impersonality. The concept of transference at once destroys faith in personal relations and explains why they are tragic: we cannot know each other. We must grope around for each other through a dense thicket of absent others. (p. 6)

Transference, or the distorting of present-day object relationships on the basis of early, formative object relationships, became one of Freud's primary "windows" into the unconscious of his patients. It also became the fundamental premise upon which psychoanalytic theory was based. Analysts were able to deduce much about the nature ofearly relationships of their patients through careful analysis of the attributes with which the patients endowed them. This has been a controversial theorem. How transference develops, for example, has been a matter of conjecture. Classic analysts believed that transference "neurosis" must be carefully nurtured, that it is fundamentally a delicate phenomenon that will not flourish unless the situation is perfect. Even the visible stimulus of the analyst's face was too much "reality" to allow for the projection of unconscious attributes, and the offices of such analysts were (and are) typically bleak and devoid of signs of the personhood of the therapist. Naturally, such a posture would eliminate the effective use of transference in groups, where the option for consensual validation about the therapist would significantly dent the transference distortions of individuals

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Modern psychodynamic thought holds that transference is not nearly so delicate a phenomenon. Indeed, it now appears obvious that people are transferences waiting to happen and that all we must do to encourage it is not to interfere. Even with the consensual validation that groups afford, individuals still hold firm with their transferential distortions of the therapist, the other members in the group, and the group itself. As if things were not complicated enough, transference is not a monolithic phenomenon. There are at least three different types of transference, as defined by Anna Freud (1937): 1. Transference of libidinal impulses, in which wishes attached to infantile objects break out toward the analyst (in the example, Ms. C.'s rage at the "abandoning parent" is transferred to the therapist); 2. Transference of defense, in which former defenses are repeated (repetition compulsion) (in the example, Mr. B.'s defense of protecting the father and avoiding any feelings of disappointment or anger was replayed in the group); 3. Acting out in the transference, in which the transference spills out into the patient's life (an example of this would be if Ms. C. found herself raging at various people in her life without any conscious awareness that this was anger at the therapist spilling out beyond the therapy).

While the first is the classic demonstration of transference, and is the form more obvious in psychoanalysis, the latter two are especially evident in group therapy. From the moment patients walk into the room we have vivid and clear examples of the types of transferences that are employed in stressful situations. For example, entrance into a group provides the opportunity to observe how patients say hello. They do not generate brand new behaviors just in order to join our groups. They bring old, trusted behaviors and transferences with them.

Countertransference Countertransference is the corollary to transference. In its classical definition, it refers to the unconscious and inaccurate response of the therapist to the patient based upon the therapist's own unresolved history. Leo Stone (1961) referred to the "cadaver" model of the analyst.

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According to this stereotypic description, the analyst is a blank screen, certainly showing no feelings and preferably having none. This presumably frees the analyst to observe the patient scientifically, and it frees the patient to "transfer" attributes to the therapist. This unfortunate model of the analyst arose out of benign motivations. The early analysts, living in the Victorian era, were doubtless frightened and worried about the powerful feelings that arose between themselves and their predominantly female patients. The result of this was careful attention to their affective responses, and for the early psychodynamic scholars this meant a primary emphasis on countertransference. Certainly for any therapist the first consideration when experiencing powerful feelings in the therapy is to assess whether countertransference is at work. However, countertransference does not explain all the affect experienced by therapists in their work. The cutting edge of psychodynamic theory has to do with putting the affective response of the therapist to use as a powerful diagnostic tool. For the object relations therapists, for example, countertransference must be carefully distinguished from projective identification (Klein, 1948) or empathic resonance with the patient. Let us assume that a therapist experiences boredom and lack of interest with an individual patient. Once identifying that affect, the therapist must first determine whether this is countertransference. If the therapist is "shutting down" because the patient is triggering unresolved feelings in himself or herself, it is the therapist's responsibility to regain empathic contact since countertransference does not have to do with the patient. If, however, the therapist determines that he or she is not experiencing countertransference, then the task is to determine the source of the affect. If the therapist is containing the unwanted affect projected by the patient (projective identification), the therapist is in a position to help the patient (1) regain disowned affect, (2) understand the impact he or she has on others, and (3) learn new ways of relating that result in nonpathological interactions. If the therapist determines that the "bored" feeling is a nonverbal empathic understanding of the disinterested affect of the patient, there is yet another source of data of significance in the therapy. In group psychotherapy the opportunity for using the affect of the therapist for diagnostic purposes is magnified by the interpersonal field and by the opportunity to compare the therapist's affective responses with those of other members.

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To return to our example, there were many examples of transference at work in this group. Some members were experiencing transferences to Ms. A. For one member Ms. A. represented the sister who had committed suicide in adolescence. Another member has transferred to Ms. A. the competitive feelings she had with her mother. Other members had primary transference reactions to the leader. The member (Ms. C.) who had been put up for adoption, along with all her siblings, was enraged with the leader for being yet another "parent" who could not keep a family together. A male (Mr. B.) who had taken a protective and supportive role to care for his socially and professionally inept father was very protective of the leader, worried that the leader would become as demoralized as his father had been. The leader was filled with affect during the meeting in question. For example, he was anxious in response to the rage of Ms. C., thinking "I wish she would leave." It was important to distinguish between countertransference and projective identification in order properly to handle this important time in the therapy. If the leader is responding to unresolved issues regarding an angry mother, for example, it is probable that he is not capable of hearing or responding to his patient sensitively. If, on the other hand, the therapist is "containing" the projected fear of the patient he is vulnerable to "acting like" the parents who "threw her away" in childhood. In this case the therapist decided the latter was the proper response and used his feelings of wanting to put this patient "up for adoption" to guide his interpretations.

Free Association There is evidence that "free association," the technique popularized by Freud and Breuer, was borrowed from the German and English experimental psychology of the day (Matarazzo, 1965, p. 408). According to this technique, the patient is asked to suspend the usual conventions of speech and simply say whatever comes to mind. The assumption is that these "free" associations are not free at all but rather are guided by unconscious preoccupations. By following the associations carefully the analyst is able to gain insight into the unconscious of his or her patient. In psychodynamic group therapy all the members of the group are requested to speak openly about whatever they are thinking, feeling, experiencing, or remembering during the session. The therapist at-

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tempts to curtail efforts to "understand" one another in favor of simply responding to one another. Thus, in dynamic groups there is not an agenda in the usual sense of the word. Rather, there is faith in the notion that the unconscious of the members will bring to the fore the most important agenda. To return to our example, a more directive therapist might begin the meeting in question by stating, "We need to discuss the stormy leaving of Ms. A. in our last session." A psychodynamic therapist, on the other hand, would assume that the members would begin processing the previous session, no matter what the overt content of discussion might be. Further, the dynamic therapist would operate on the principle that even more important information might be revealed if the members were allowed to deal with the previous meeting in terms of metaphor if that is how they began. What if, for example, there was no overt mention of Ms. A. but the group began with a discussion of the dreadful events occurring around the world? From a dynamic point of view this might represent both an avoidance of the affect regarding the previous meeting and a working on those affects through metaphor. From the dynamic point of view, the group members were demonstrating that they were not yet able to deal directly with the affective power of the previous meeting and therefore it would be an error prematurely to connect the present data to that stimulus. Rather, by following the free associations (group process) the therapist and the members will ultimately gain much information about the unconscious responses of the members to Ms. A.'s departure.

THOUGHTS ABOUT THE FUTURE Psychodynamic theory is so interwoven with our culture that it is surprising that it has been less than a century since Freud began his work. Freud (and therefore psychoanalysis) belongs to a time-honored philosophical tradition that "the truth shall make you free." Freud's genius was in realizing that the "truth" must include unconscious truth, the world of feelings and memories and impulses. Dynamic therapists, therefore, are fundamentally educators. They are convinced that fundamental character can be altered for the good if the impact of history is thoroughly understood, if the unconscious is made conscious.

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Nonetheless, long-term, character-changing psychotherapy is under siege in modern times. Whether DSM-Ill/R and its successors are responsible for this change or merely reflect changes in our culture, today patients are conceptualized as clusters of symptoms rather than as troubled individuals. Today we are led to believe that our patients "have a depression" rather than "are depressed." This notion has become so fashionable that patients often conceive of themselves by their symptoms-they are "adult children of alcoholics," or "eating disordered," or "posttraumatic stress" victims. This basic change in how psychological suffering is understood is compounded by financial factors, where the length and type of therapy is often dictated by third-party payers. On the one hand, this makes long-term psychotherapy a financial imposition of considerable magnitude for many of our individual psychotherapy patients. On the other hand, however, it makes group therapy all the more attractive as a resource for those who wish to avail themselves of the deep "education" that a psychodynamic approach offers. Psychodynamic theory is a flourishing despite these hardships. The contributions of the modern schools of dynamic theory are substantive and abundant. There have been many elaborations, modifications, and enhancements to Freud's original theories of personality. As typically occurs when followers attempt to collate, deepen, and expand the thoughts of an original thinker, dogma and orthodoxy have become the order of the day. Analysts heatedly debate the truth and justice of the classical instinct theory, ego psychology, the neoanalytic position, self psychology, or object relations theory. It is important to remember that all the modern modifications of classical theory agree in emphasizing the importance of relationship in forming personality, in the etiology of psychopathology, and in healing of psychiatric symptoms. They highlight different aspects of the inc terpersonal world and use different concepts to explain it, but they all emphasize it. It is this interpersonal world that is available for observation and therapeutic use in every group session. As our group members evolve in group therapy they are forming important relationships, and in so doing every aspect of their character is present. Not only do they demonstrate their defensive operations and their transferences, they receive feedback and insight from each other as well as from the therapist. Foulkes (1961) referred to groups as "halls

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of mirrors." Perhaps in no other therapeutic situation is so much data available to patients about themselves as in group psychotherapy. REFERENCES Alexander, F. (1946), The principle of corrective emotional experience. In F. Alexander & T. M. French, Psychoanalytic therapy (pp. 66-70). New York: Ronald. Alonso, A. (1989), The psychodynamic approach. In A Lazare (Ed.), Psychiatry: Diagnosis and treatment (2nd ed., pp. 37-58). Baltimore: Williams & Wilkins. Bion, W. R. (1959), Experience in groups. New York: Basic Books. Foulkes, S. H. (1961), Group processes and the individual in therapeutic groups. British Journal of Medical Psychology, 34, 23-31. Freud, A. (1937), The ego and the mechanisms of defense. London: Hogarth Press. Freud, S. (1956), Studies on hysteria. In]. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 12). London: Hogarth Press. (Original work published 1895) Greenson, R. R. (1967), The technique and practice of psychoanalysis. New York: International Universities Press. Kauff, P. F. (1979), Diversity in analytic group psychotherapy. International Journal of Group Psychotherapy, 29, 51-65. Klein, M. (1948). Contributions to psychoanalysis 1921-1945. London: Hogarth Press. Kohut, H. (1971). The analysis of the self. New York: International Universities Press. Malcolm,]. (1981). Psychoanalysis: The impossible profession. New York: Vintage Books. Matarazzo,]. (1965). The interview. In B. B. Wolman (Ed.),Handbookofclinical psychology. New York: McGraw-Hill. Rogers, C. R. (1951). Client-centered therapy. Boston: Houghton Mifflin, Rutan,]. S., & Stone, W. N. (1984), Psychodynamic group psychotherapy. New York: Macmillan. Stone, L. (1961). The psychoanalyticsituation. New York: International Universities Press. Sullivan, H. S. (1954), The interpersonal theory of psychiatry. New York: Norton. Wolf, A, & Schwartz, E. K. (1965). Psychoanalysis in groups. New York: Grune & Stratton. Yalom, I. D. (1975), The theory and practice of group psychotherapy. New York: Basic Books.

j. Scott Rutan, Ph.D. Director, Center for Group Psychotherapy Massachusetts General Hospital 15 Parkman Avenue Suite 805 Boston, MA 02114

Psychodynamic group psychotherapy.

The author provides an overview of critical factors in the working phase of group psychotherapy from the perspective of psychodynamic theory. The disc...
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