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(2008). Toward the Establishment of Evidence–Based Practices in Group Psychotherapy. International Journal of Group Psychotherapy: Vol. 58, No. 4, pp. 441-454.

(1992). Experiences in Groups. International Journal of Group Psychotherapy: Vol. 42, No. 2, pp. 301-305.

Most writings about terminating psychotherapy begin with a comment about the relative dearth of previous publications on this subject. This paucity of discussion is evident particularly in comparison with the mountainous piles of communications on most other psychotherapeutic topics. There is some truth to the statement that termination has not been as well studied as have been the psychotherapeutic issues and variables that precede it during the course of treatment. The repeated mention of this imbalance also may express a more profound emotional truth that has nothing to do with numbers of articles or chapters but that touches on the conflictual feelings and ideas that are evoked in patients and therapists by this subject. Few topics in psychotherapy stir up so much doubt and debate, and equally few have such poorly defined empirical parameters and clinical benchmarks. How do we know when most or all of the work has been done? Is what is left important enough to justify more time and expense? Is the idea of ending the therapy a way for either or both parties in the dyad to avoid some important issue? Or, conversely, is the continuation of psychotherapy an avoidance of painful feelings of loss, separation, and anxiety? These and other such questions arise in the minds of patients and therapists alike when termination is (or sometimes isn't) addressed. Termination in Psychotherapy: A Psychodynamic Model of Processes and Outcomes goes a long way in filling in the gaps in the existing literature, particularly with regard to psychodynamically oriented psychotherapy, which is the approach that the authors emphasize. It works as an intellectual manual for the practicing psychotherapist, which will guide her or him down the slippery slope of the termination process. The book also will be effective in reducing the anxiety of those practitioners, as its comprehensive review of the literature and its clear, easily used model for understanding and working though termination can be adapted readily by most psychodynamic practitioners. The specific model of termination can be considered and adapted by therapists who work within theoretical orientations other than specifically psychodynamic. The authors have included a very useful chapter that focuses on the differences in the termination process in cognitive– behavioral therapy, interpersonal therapy, supportive therapy, and experiential therapy. The model that is developed in this volume also will serve as the framework for effective and important future research. The book is organized around a goal-oriented, conceptual framework for planning for and working through termination, which is effectively linked to central and necessary clinical techniques. It offers a set of practical guidelines for evaluating progress in therapy and in using movement toward consensual goals as triggers for consideration of the possibility of termination. These guidelines include clearly defined, termination-specific

Throughout the development of object relations theory and self psychology, the importance of attachments, availability, absences, limitations, and endings have been factors that have informed theory and practice. This article examines the multiple meanings and impacts of terminations in group psychotherapy at the intrapsychic, interpersonal, and group-as-a-whole levels, from the perspective of contemporary object relations theory and self psychology. Emphasis is placed on the initiation of a mourning process, with the dynamics of guilt, shame, and aggression toward objects who are separate or inaccessible, and the experience of a shortcoming or absence, associated with a loss of self-object oneness, soothing, and idealization from the narcissistic sector of the personality. Therapeutic opportunities afforded by terminations and the importance of resolving countertransference reactions are highlighted.

Mental health professionals are increasingly aware of the special difficulties encountered by therapists working with HIV-positive and AIDS patients. In this report, countertransference issues experienced by therapists leading a psychotherapy group for heterosexual, drug-using HIV-positive and AIDS patients in an inner city hospital are explored. Countertransference is discussed under the headings of helplessness, death anxiety, and anger.

Treating the chronically mentally ill involves not only working with patients suffering from schizophrenia and other prolonged or recurrent psychotic illnesses, it also means providing treatment for patients with severe personality disorders. Many of these patients are also active substance abusers. This article examines the therapeutic and management issues raised for outpatient clinicians who work with these patients. Consideration is devoted to the special problems in treating the dual diagnosis patient, issues of patient and therapist safety, limit setting, splitting dynamics, and countertransference reactions. A set of recommendations is offered for conducting outpatient group therapy, specifying what is needed from both the clinicians and the facility in which this type of treatment is provided.

(1981). The Patient-Staff Community Meeting: A Tea Party with the Mad Hatter. International Journal of Group Psychotherapy: Vol. 31, No. 2, pp. 205-222.

A review of the available literature concerning the psychosocial consequences of hemophilia for identified patients and their family members is presented. Recommendations are made for the formulation of a psychosocial assessment stragegy which utilizes a family systems perspective, is research-oriented and experimentally rigorous, and collects data about a broad range of individual and family functioning. A combination of psychological instruments, including both self-report and observational data, are specified for use as a comprehensive assessment battery. In addition, a variety of behavioral indices of adjustment are outlined, which provide an unobtrusive and more immediate set of measures of day-to-day functioning with regard to the management of hemophilia.

(1980). Treating shyness and other relationship difficulties in psychiatric outpatients. Communication Education: Vol. 29, No. 3, pp. 250-255.

A brief review is presented of the available literature concerning the efficacy of psychotherapeutic and patient education interventions for hemophilia patients and their families. A session-by-session outline of a family group, educational, intervention strategy is presented, along with a rationale for the content of each session. This strategy utilizes a family systems perspective, is research oriented and experimentally rigorous, maintains a structured, educational focus, and is time-limited. An evaluation plan is recommended to assess the effectiveness of the intervention strategy. Suggestions are given for applying this modular design for use with other chronic disease groups. In addition, the potential for developing a patient education monograph from the material presented in the intervention sessions is described.

The view advanced here differs from traditional psychoanalytic notions. Distinctions are drawn between creativity and psychopathology. Different capacities and processes are postulated for each by virtue of a three-factor model which considers: (1) levels of primary and secondary process thinking, (2) the role of the preconscious, and (3) the nature of the synthetic ego operations. Furthermore, this view diverges from the traditional conceptions of primary and secondary processes which are based upon a hydraulic model wherein a reciprocal relationship between the two processes has been postulated. The present model is more consistent with the views advanced in psychoanalytic ego psychology. Emphasis is placed here not only on the significance of the role of the preconscious and the active posture of the ego during the creative process, but more specifically upon the crucial role of synthetic ego operations, that is, the integrating and organizing capacity itself. An attempt is made to draw attention to the fact that the creative process involves a synthesis of both developmentally primitive and developmentally advanced levels of psychological functioning throughout the entire process, and that the latter phases of the creative process are not merely equivalent to conventional work.

Forty schizophrenic and 40 non-schizophrenic male psychiatric inpatients, matched for age, intelligence, and social competence, were administered equivalent form nonsense syllable discrimination tasks under each of four conditions: an initial baseline information feedback condition, two response contingent reinforcement conditions, and a final baseline information feedback condition. Subjects of both diagnostic groups were further divided into eight groups of ten patients each. Half the groups received praise and half received censure during the response contingent conditions. In counterbalanced order, the reinforcing agent was the experimenter in one condition and a recorded voice of one of the parents in the other. Half received the mother's and half received the father's voice. Schizophrenics responded faster under experimenter than under parent reinforcement. Poor premorbid schizophrenics, making more errors than goods, responded faster under experimenter as opposed to parent reinforcement. Among non-schizophrenics, education, social competence, and I.Q. were all negatively correlated with response latency and number of errors. Among schizophrenics, the higher the I.Q., the fewer the errors and the shorter the response latency, except when such subjects were reinforced by their parents. Then no significant relationship existed. Marital status, however, was significantly related to performance, with unmarried status positively correlated with slower response to parents. All subjects responded more quickly and accurately in the final than in the first baseline condition regardless of diagnosis or interpolated reinforcement experiences. Data were interpreted as providing limited support for the social censure hypothesis of Garmezy and his colleagues, but as consistent with recent formulations concerning the schizophrenic patient in relation to his family.

As part of a large scale, comprehensive study of the psychosocial functioning of hemophilic patients and their families, 12 pilot families were assessed using objective measures of psychiatric symptomatology and general knowledge of hemophilia. Although the small number of subjects in this pilot study precludes any detailed statistical analyses, some preliminary findings are presented concerning the level of psychological distress reported by patients and their family members and the subjects' level of general knowledge about hemophilia. Of most interest was the presence of significant negative correlations between knowledge of hemophilia and extent of self-reported psychological distress for mothers and patients under 15 yr of age. Maintenance of this relationship with a larger sample would have important implications for patient and family education.

This paper assesses the impact of large-group processes and dynamics upon the patient-staff community meeting in hospital treatment. It focuses upon the therapeutic values and limitations of the large-group format by examining, from an integrated general systems and object relations perspective, how size, structure, patient population, staff training, and leadership variables reciprocally affect the process and content of the community meeting. The special problems associated with selecting an appropriate format for the meeting and the intense pull of regressive group forces upon the large-group leader are discussed.

Despite a continuing core of opposition to psychotherapy groups, 18 group therapy has gained general acceptance among professionals at all levels. Though not all therapists utilize the group format themselves, it is an accepted tool in the professional's armamentarium. A recent development in the evolution of new procedures to deal with the increasing demand for psychiatric/psychological services has been the emergence of short-term, time-limited therapeutic interventions. In the past several years there has been a burgeoning literature concerning such approaches to the therapeutic situation. 16,3 This paper represents an effort to review the literature on short-term, time-limited group psychotherapy. An attempt will be made to integrate several suggestions and guidelines for conducting such groups.

With the aid of a computerized system for content analysis, WORDS, the complete Schreber Memoirs was subjected to various multivariate reduction techniques in order to investigate the major content themes of this document. The findings included the prevalence of somatic concerns throughout the Memoirs, clear references to persecutory ideas and to Schreber's assumption of a redemptive role, complex encapsulated concerns about Schreber's relationship with God, a lack of any close relationship between sexuality and sexual transformation either to themes of castration or procreation, and the fact that neither sun, God, nor Flechsig was significantly associated with clusters concerning gender, sexuality, or castration. These findings are discussed in relation to psychodynamic interpretations furnished by prior investigators who employed different research methods.