How Many Group-Psychotherapiststs
Does it Take to Change a Light Bulb?
by Marc G. Schramm, Psy.D., C.G.P.
In inaugurating this column on group psychotherapy, I thought I would propose a question rather than answer one. I don't have a witty response of my own, but hope that many of you do, which I will share in this space next time.
My tentative plan for this department is to provide a question and answer forum, giving myself the option to do either, sometimes in a meandering fashion. In this initial outing, I thought we might look at an issue widely recognized by group therapists as of the highest importance.
In a survey of experienced group therapists, Robert Dies (1992) asked them to "review a list of 44 topics that practitioners should understand in conducting their groups during the working phase of group treatment," and select the most important. Tying for tenth in the clinicians' ratings were boundary management, cohesiveness, and timing of interpretation. Here-and-now activation finished fifth, and resistance fourth. Transference was #2. And in first place, endorsed by 72% of the clinicians surveyed, was countertransference. (It should be noted that there were significant differences based on orientation, BTW.)
Had I been surveyed, my own choices would have been quite similar to the overall results. In particular, I put much emphasis on the importance of countertransference. As in individual therapy, there is countertransference to the patient, but also to the group as a whole, as well as to subgroups.
It is impossible in the brief space available here to do justice to the concept of countertransference, but I would like to emphasize one issue: defining countertransference. The survey noted above did not address this matter, which largely breaks down as one of countertransference as primarily an impediment, vs. countertransference as an often valuable resource. This largely corresponds to "classical" vs. "totalist" conceptions of countertransference. The first is sometimes defined as the therapist's reaction to the patient's transference. The second considers all responses of the therapist as part of the countertransference, to the point where its utilization may become virtually indistinguishable from the therapist's "use of self."
Neither concept is more "correct" than the other, both concepts having their usefulness; I personally favor the latter, especially as enriched by theorists such as Racker (1968). I've found that using the classical approach tends to make clinicians more defensive in looking at themselves. A totalist approach seems to make self-exploration easier, since what one finds when casting a wider net is as often positive as negative. Unfortunately, I don't recall having seen a comprehensive definition of countertransference from the totalist perspective. Thus I propose the following (written for a workshop I presented).
Countertransference: The interaction of the intrapsychic and the interpersonal in the context of psychotherapy, whereby a therapist projects him or herself by means of their cognitive, affective, and behavioral experiences of, and responses to, anything pertaining to therapy, especially--but not limited to--the patient.
I will not at this time attempt to apply this definition to group psychotherapy specifically. But this perspective will inform almost everything else I am likely to write in this journal. In the end, the group therapist is the most crucial element in group psychotherapy. As E. James Anthony (1968) put it, "every therapist gets the group he [or she] deserves."
Anthony, E. (1968). Reflections on twenty-five years of group psychotherapy. International Journal of Group Psychotherapy, 18:277-301.
Casement, P. (1991). Learning From The Patient. New York:Guilford
Dies, R. (1992). Models of group psychotherapy: Sifting through confusion. International Journal of Group Psychotherapy, 42, 1-17.
Kleinman, A. (1988). How do professional values influence the work of psychiatrists? In: Rethinking Psychiatry (Ch. 5). New York:The Free Press.
Racker, H. (1968). Transference and Countertransference. New York:IUP
Ross, W. & Brissenden, A. (1961). Some observations on the emotional position of the group therapist. Psychiatric Quarterly, 35, 516-522.
Scwartz, E. & Wolf, A. (1964). On countertransference in group psychotherapy. The Journal of Psychology, 57, 131-142.
Vannicelli, M. (1991). Dilemmas and countertransference considerations in group psychotherapy with adult children of alcoholics. International Journal of Group Psychotherapy, 41, 295-312.
Marc G. Schramm, Psy.D., is a Founding Certificant
of the National Registry of Certified Group Psychotherapists, a clinical member
of the American Group Psychotherapy Association, and President of the Tri-State
Group Psychotherapy Society. He is currently Cincinnati-Dayton Regional Director
for Counseling Consultants, Inc. Call Dr. Schramm at 513-984-9222