Robert H. Klein and Harold S. Bernard
The co-therapy dyad conveys in graphic form one of the fundamental dynamics of group relations: the relationship between the couple and the group, whether it be Romeo and Juliet in the context of their feuding families, Oedipus and Jocasta in Thebes, the couple in the pairing basic assumption, the mother-infant dyad, the analyst/analysand partnership, or lovers differentiating from the masses. In what follows, Klein and Bernard view the co-therapist pair as a subsystem of both the therapy group and the institutional/societal context.
Klein and Bernard join the ongoing debate on the usefulness of co-therapy with borderlines by offering a combined systems and developmental model to understand what happens between co-therapists and borderline/narcissistic patients in group. They utilize the 'totalistic' model of countertransference, in which the therapists' feelings and reactions are 'grist for the mill' a source of information about themselves, their relationship, the patients and the group-as-a-whole.
The authors' meticulous attention to countertransference demonstrates how reactions which are often 'invisible' when the 'singleton' therapist works alone in the group become 'visible' in the intimate 'I-thou' cauldron of co-therapy. Such exposure of therapists to one another has the potential to evoke either shame and anxiety or insight and mastery.
In this chapter we will explore the use of co-therapy as a way to treat borderline and narcissistic patients in groups. We shall begin by selectively reviewing the literature on both co-therapy and the generic treatment of borderline and narcissistic patients. A theoretical schema that incorporates both systems theory and developmental theory will then be presented; it is this schema that will inform our perspective throughout the chapter. We shall subsequently discuss countertransference issues in some detail