Academic journal article American Journal of Psychotherapy

Conflict in Group Therapy of Chronic Schizophrenics: Coping with Aggression

Academic journal article American Journal of Psychotherapy

Conflict in Group Therapy of Chronic Schizophrenics: Coping with Aggression

Article excerpt

This paper describes a pivotal group session in which there was a major conflict between two members of a group that has met for many years. The group serves chronically ill outpatients suffering primarily from schizophrenia or schizoaffective illness. The aftershocks of the explosive outburst, the leaders' understanding of the contributing factors, countertransference feelings, and coping mechanisms are described. The literature recommends two pathways concerning the expression of anger and aggression in groups of severely disturbed individuals: restriction of intense negative affect or expression of such affect as a helpful component of a therapeutic process. We reflect on this question in sharing detailed clinical material and conclude that coping with aggression in such groups is dependent not only on the group context, but also on the relative fragility, strength, and tolerance of both members and leaders. A crucial step in dealing with eruptive crises consists of reflecting upon the leaders' conscious and unconscious intervention motives and affects.

INTRODUCTION

The "Thursday Group" serves those outpatients of a Montreal hospital who are low functioning, chronically ill, and suffer primarily from schizophrenia or schizoaffective illness. The group is open-ended and not time-limited. It has met for forty-five minutes each Thursday since 1985. This paper will focus on a pivotal group session in which there was a major conflict between two members that had an explosive effect on the group and its leaders. The group leader experienced a sense of helplessness in the face of a member's tremendous rage. The responses of the leaders and members both within, and for several months following, the pivotal session were dramatically different than those of the previous thirteen years in the life of the group. We will describe the explosive outburst-a kind of group earthquake, the aftershocks, our understanding of contributing factors, countertransference feelings, and coping mechanisms.

HISTORY OF THE THURSDAY GROUP

The group began with two regular attendees and currently has thirteen members and a waiting list for joining. Issues of separation, isolation, and intimacy are often associated with patients' psychological breakdown and rehospitalization. Over the years, we have been able to interpret increased psychotic behavior and "make sense" of escalation of anxiety by linking it with members' fears and current life events. Meeting at the same time and place with the same group leader, and occasionally student observers, has provided a firm boundary within which members have participated regardless of the fragility of their own structures. The group is not outcome- or goal-oriented. It has traditionally been able to serve as a secure container for the sense of struggle of its members allowing individuals to continue their lives with what we feel is the helpful knowledge that others know or have also undergone some of their experiences (1). Furthermore, this group is probably the only weekly socializing occasion for many of the members. The group leader, Dr. S., is the same psychologist who founded the group and has led it since its inception. A cotherapist (S.H.) joined the group in September, 1997, a few months prior to the eruption, and an intern (C.C.) joined in May, 1998.

SELECTED LITERATURE REVIEW

Reports in the literature generally support the use of groups in the treatment of the severely mentally ill (2-11). The literature concerning eruption of aggression in a long-term group of severely disturbed individuals is sparse and rarely provides detailed clinical description. Themes of conflict and aggression are mainly addressed in the context of higherfunctioning groups in which members do not suffer psychotic illness (12-15). According to some authors who do work with groups of severely disturbed individuals (6,16), issues related to primitive rage and expression of anger should be carefully modulated. …

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