Academic journal article American Journal of Psychotherapy

Individual and Group Therapies as Constructive Continuous Experiences

Academic journal article American Journal of Psychotherapy

Individual and Group Therapies as Constructive Continuous Experiences

Article excerpt

A situation involving continuity between individual and group therapy is problematic. Fortunately, it is dealt with in a recent comprehensive and erudite book by Charles Ashbach and Victor L. Schermer(1) entitled Object Relations, The Self, and the Group. They approach the subject focussing on three distinct areas:

1. The continuity of individual psychic operations within the larger sphere of intrapsychic and extrapsychic group phenomena,

2. The dynamic interaction between individual and group intra-and extrapsychic operations. (Even when there is continuity between the two, the relationship is not a static one. Therefore, the interaction between the two operations can be conceptualized.)

3. The complementary relationship between the individual and the group, between individual inner life and group reality.

In this paper, a clinical example will be provided to illuminate a paradigmatic situation in which a patient who could not tolerate the intimacy of individual therapy was able to work toward a satisfactory resolution of her pathological formations within group therapy.

Three concepts from Winnicott(2-6) will help the reader locate the conceptual tradition from which the writers would illuminate the problem of continuity between the two types of psychotherapy: holding, regression to dependence, and primary maternal preoccupation.

Little(7) has given an inside view of how Winnicott worked with her as his patient. Some critical passages from her account spell out what he meant by three factors.

"Holding" of which "management was always a part, means taking full responsibility, supplying whatever ego strength a patient could not find in himself, and withdrawing it gradually as the participant could take over on his own. In other words, providing "facilitating environment" [Winnicott(5)] where it was safe to "be" (p. 45).

Little stressed that, for Winnicott, holding meant literally restraining or controlling. In her view, Winnicott was compassionate, consistently firm, and even sometimes ruthless in order to ensure the safety of his patients. With respect to the ruthlessness that sometimes accompanied Winnicott's attempts to hold the peace and to create a background of safety for his patients, we learn the following from Little. When Winnicott feared that his patient might kill herself while he was away, he would arrange for hospitalization, or he would go as far as taking charge of his patient's car keys until the end of the session . After appropriating the keys, he would allow the patient to rest quietly alone in an adjacent room until the patient could be safe. Little goes on...

Short of bodily intervention he could "forbid" actions. This was powerfully effective, for although it might be disobeyed, it could not be unnoticed, because it had been said and also because in the context of a delusional transference...it became automatically the patient's own prohibition, and then joined up with some element of sanity. It worked on both conscious and unconscious levels (p.45).

A second concept, "regression to dependence" must follow our necessarily brief account of "holding." From Little's account, this..."is a means by which areas where psychotic anxieties predominate can be explored, early experiences uncovered, and underlying delusional ideas recognized and resolved, via the transference/countertransference partnership of analyst and analysand in both positive and negative phases" (p. 83).

Recognizing that the implementation of this technique is not simple, she shed more light on its requirements. It requires an analyst who sees regression to dependence as a process of healing that originates in the true self of the analysand, and has the courage to attempt the reversal of the original failure by adopting a method of treatment that includes management, technique, intuition, and verbal interpretation without repeating the original annihilation.

The mother's capacity for regression, like the "evenly suspended attention" of the analyst(8) is proximal to that which Winnicott(5) called "the primary maternal preoccupation. …

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