TOPIC. A course in leading psychodynamic psychotherapy groups for assaultive men.
PURPOSE. To teach multidisciplinary staff members to lead these groups, using both didactic and experiential learning.
SOURCE. The author's own experience.
CONCLUSIONS. Multidisciplinary staff members learned about the process of leading psychotherapy groups for assaultive men by attending lectures and observing the author lead a group over a 6-month period. The author's openness about her own thoughts, feelings, fantasies, and countertransference allowed students to explore their own reactions and to empathize with the patients, observing that they were not so different from them.
Key words: Assaultive men, multidisciplinary teaching, psychodynamic group psychotherapy
A training program for staff to lead groups for assaultive men was developed based upon clinical research I conducted (Lanza, 1992-1994). The research examined the impact of group therapy on assaultive men. In an experimental design, the rate of assault for men in the therapy group declined while those who were control subjects continued to assault at the same rate. At follow-up, group therapy members showed decreased expression of anger, increased effort to control anger, and decline in aggressive behavior. Control subjects demonstrated no change in level of angry feelings, increased anger at follow-up, and no change in aggressive behavior. A model for conducting a psychodynamic psychotherapy group for assaultive men was developed that describes process and content aspects as well as leader interventions in each group phase. In line with the research, a course was developed and offered to multidisciplinary staff to teach them to conduct a psychodynamic psychotherapy group for assaultive men.
This training program represents a change in thinking about the treatment of assaultive, violent, or abusive men. First, assaultive men usually are provided cognitive behavioral or psychoeducation group therapy rather than psychodynamic group psychotherapy. Second, in group psychotherapy supervision, supervisors comment on internal reactions reported by the supervisee but do not often share their own reactions and the use of these reactions as a barometer for what is taking place in the group. I shared my internal reactions with students during post-group session to demonstrate the use of one's reactions as a therapeutic instrument.
The following objectives were developed for the course. Students will:
1. Describe the purpose of the group, stages of group development, and a contract for the therapist and patients.
2. Practice the role of interviewing a prospective group member.
3. Observe the group and articulate conscious and unconscious themes from the intrapsychic, interpersonal, and "group as a whole" perspective.
4. Participate in post-group session and describe parallel process between the psychotherapy group and the student group.
Preparing for the Course
Announcements about the course were made in person by me and through memoranda. The course was open to staff from five other area VA hospitals and a local Air Force base; 66.7 continuing education units were awarded for the course. Patient referrals also were requested for the group.
Table 1 outlines the course content. The contract for course participants (Table 2) parallels the contract for patient participants in the therapy group.
Table 1. Course Content
* Overview * Course objectives and content outline
* Contract with course participants
* Review of * Advantages of group therapy over
psychotherapy individual therapy
concepts * Addressing institutional resistance before
beginning a group
* Stages of group development
* Curative mechanisms
* Process vs. content and major group
* Patient selection
* Group composition
* Patient preparation for entering the group
* Group contract
* Role of the leader
* Review of * Literature review of therapeutic
theory for approaches for dealing with aggressive
psychodynamic feelings in group therapy
psychotherapy * Men's issues in group psychotherapy
group with * Men's characterological defenses in a
assaultive men group setting
* Stages of group development for men
and the expression of aggression
* Recommendations for conducting group
psychotherapy for assaultive patients
* Patient selection
* Countertransference and projective
* Group-as-a-whole approach
* Aggression Observation Scale for
* Observe interview of prospective group members
* Observe once weekly a 1-hour psychodynamic
psychotherapy group for assaultive men
* Participate in a 1-hour post-group session per week to
discuss process and content themes as well as leader
Table 2. …