(BQ) Part 2 book “The Wiley-Blackwell handbook of group psychotherapy” has contents: Group therapy with children, a spiritually informed approach to group psychotherapy, group psychotherapy as my career path, my development as a group therapist,… and other contents.
21 Group Therapy For Females Molested In Girlhood Shoshana Ben-Noam Introduction Clinical Illustration Moira1 was sexually abused by her father since the age of For the first several weeks, he playfully tickled her and she giggled Then, the tickling changed to gentle fondling between her legs She didn’t understand the sensations in her body and was afraid to move Gradually, the caressing became rough and she felt sore Her father told her she was his special little girl and she better keep their special time secret to avoid trouble She was confused and scared The abuse stopped at the age of 11 when her parents were divorced Moira didn’t understand her sexual arousal and the father’s actions She was confused by her father shifting from playful, seductive behavior to rough fondling She was also constantly petrified he would return to inflict more pain Even worse, she was afraid he would abandon her if she didn’t keep the secret “The horror [was] not in the sexual act, but in the exploitation and the corruption of parental love” (Herman, 2000: p.4) Characteristics of Child Sexual Abuse Child sexual abuse is the misuse of a child by an adult for the sexual needs and gratification of the perpetrator To be legally determined abuse, the sexual act has to be No real names are used in the chapter The Wiley-Blackwell Handbook of Group Psychotherapy, First Edition Edited by Jeffrey L Kleinberg © 2012 John Wiley & Sons, Ltd Published 2012 by John Wiley & Sons, Ltd 410 Groups for Adults between a child under the age of 18 (Doll, et al., 2004; Finkelhor, 2008) and an adult who has power over them (Gartner, 1999; Herman, 2000) This power leads to the child’s compliance out of fear of rejection, punishment and abandonment, particularly in incestuous relationships The sexual abuser may be a member of the child’s nuclear or extended family, or a non-family member as a teacher, coach or clergy It is often that the abuser is known to the victim (Finkelhor, 1994) and the child trusts him/her This trust, in conjunction with seductive behavior, initially leads the child to cooperate with the sexually abusive acts These involve fondling of genitals through clothing or directly, oralgenital contact, attempted intercourse or intercourse It also includes exhibitionism and pornography These sexual acts destroy the child’s trust in the perpetrator and very likely in other individuals The mistrust engendered by the abuse, along with the child’s real or feared threats by the abuser, often prevents the child from disclosing the molestation Cultural Impact on Disclosure Disclosure of sexual abuse has undergone a cultural revolution in the last few decades It has received unprecedented social exposure as a result of the Women’s Movement in the 1960s and 1970s, and the active promotion of the disclosure of abuse by the Children’s Protection Movement In addition, the media gave center stage to celebrities such as Oprah Winfrey, Roseanne Arnold and McKenzie Phillips who came forward with their own stories of sexual abuse in their families (e.g Gorman and Dolan, 1991) Furthermore, during this same time period more books were published on personal accounts of sexually victimized girls (e.g., Freeman, 2005; Braddock Bromley, 2007) The impact of this publicity may have encouraged an increased number of sexually abused women in girlhood to come forward with their stories or seek treatment However, as yet, no statistics are readily available to document it In contrast to the extensive publicity of girls’ molestation, the sexual abuse of boys has been minimized (Courtois, 2010) This changed when the sexual victimization of young boys by Catholic priests was highlighted in the press (e.g., Cooperman, 2005; Slack, 2005; Donadio, 2010) and when other instances were revealed by former scouts of the Boy Scouts of America (Boyle, 1994) However, the fact that incest of boys often goes unreported may be in part attributed to the cultural notion that boys are not traditionally the victims in their families The aftereffects of child sexual abuse vary considerably between men and women (Gold et al., 1999) This chapter will address the ramifications and treatment of women only Factors Affecting Female Survivors of Childhood Sexual Abuse To better understand the consequences of women’s childhood sexual victimization, we need to consider the circumstances in which the abuse occurred These include the following factors: Group Therapy For Females Molested In Girlhood 411 Age of onset and developmental stage Some studies documented the age of onset as 8–12 years old, while others suggested a younger age (Courtois, 2010) The younger the age of onset of repeated parentdaughter incest, the more likely it will be dissociated to enable the girl to establish an attachment with the abusive parent Whereas the older latency girl maybe more aware of the abuse and therefore more distressed while it happens In both infancy and latency developmental stages, sexual abuse disrupts the girl’s psychological and cognitive development in areas such as learning, emotional regulation and social isolation She is consciously or unconsciously preoccupied with the abuse and has difficulties dealing with its affective impact Duration and frequency of abuse Prolonged, repeated abuse is more harmful than a brief period or single occurrence of abuse since it further exacerbates the loss of trust and betrayal Types of sexual acts Sexual abuse involving penetration and/or violence are more harmful than other types of acts as they cause intense pain, horror and serious traumatizing effects However, on the continuum of noncontact to manual or genital contact, it is not clear which acts are the most damaging to the victim since the context of the abuse must be considered Girl’s relationship to the abuser The closer the relationship between the perpetrator and the child, the greater the psychological damage Parent-child incest is associated with the most serious aftereffects because of the betrayal and loss of trust Also, sexual abuse within the family is more likely to affect emotional and cognitive disturbances than abuse outside the family Nondisclosure/disclosure by sexually abused girls Children’s nondisclosure at the time of the abuse is often due to the fear of the abuser’s threats; fear of being blamed or not believed; or, at a very young age, not understanding they were abused Nondisclosure, then, usually prevents intervention, prolongs the abuse and often has negative consequences (to be discussed later in the chapter) Disclosure is most likely to occur when the perpetrator is a nonfamily member, and the least likely to occur when the abuser is within the nuclear family, since incest threatens the parent-daughter, or siblings’ bond Once the victim discloses the sexual abuse to her mother, another family member, or a trusted adult, a protective and supportive response may stop the abuse and reduce damage When the response entails blaming or shaming of the child, more traumatic manifestations might emerge at a later age 412 Groups for Adults Secure/insecure attachments A secure mother-child (or caregiver) attachment may mitigate negative consequences of sexual abuse The victimized girl has the mother’s “safe base” to return to and be protected by, thereby decreasing the possibility of trauma In contrast, insecure attachments with the parent/caregiver often induce the girl to “become fearfully attached or anxiously obedient” (van der Kolk, 1987a: p 32) Thus, she is more susceptible to sexual abuse inside and outside the family In summary, prolonged, repeated sexual abuse with an early age of onset, coupled with insecure attachments, are linked to negative consequences such as cognitive and emotional disturbances as well as interpersonal difficulties with peers during childhood These are likely to set the stage for further symptomatology during adolescence and adulthood, especially “when the trauma has been neither acknowledged nor treated” (Krugman, 1987: p 128) and the world awaiting the innocent victim has been tainted with violation Functional Definitions of Trauma, PTSD and Complex PTSD for Sexually Victimized Women in Childhood Trauma Psychological trauma renders the abused girl helpless by overwhelming force (Herman, 1992a: p 33) She is horrified, experiences loss of control and intense fear of annihilation She also feels trapped in an inescapable situation, especially in fatherdaughter incest It is the fear of punishment or abandonment that keeps her compliant The traumatized girl often manifests symptoms of Post-Traumatic Stress Disorder such as startle reactions, flashbacks and avoidance behavior Post-traumatic stress disorder (PTSD) “In PTSD the past (of childhood sexual abuse) is relived with an immediate sensory and emotional intensity that makes victims feel as if the event were occurring all over again” (van der Kolk, et al., 1996: p 8) The onset may occur immediately after the abuse, months or even years later The three main clusters of PTSD symptoms are “hyperarousal” (Herman, 1992a: p 35; Van der Kolk, 1987a: p 3) “intrusive reexperiencing” (van der Kolk, 1987a: p 3) and “avoidance” (Figley, 1985: p 263) The hyperarousal cluster Includes sleeping difficulties, irritability, and easy startle This cluster, often applicable to women sexually abused in girlhood, may be understood as a constant arousal of the autonomic nervous system in anticipation of returned danger This ongoing elevated state of arousal may cause difficulties for traumatized women in modulating anger and anxiety, particularly in situations associated with the traumatic event For example, a woman molested by her father may be easily startled when incidentally touched by a man or easily irritated when having a minor disagreement with a male co-worker Group Therapy For Females Molested In Girlhood 413 The reexperiencing cluster Includes flashbacks, nightmares, and intrusive recollections of the traumatic event along with the emotional intensity of the event itself Flashbacks or nightmares may occur when a woman, sexually molested in childhood, enters significant, emotionally charged phases or events in her life, such as a wedding or entering college The traumatic experience is then consciously or unconsciously relived In addition, insignificant reminders such as the smell of a pipe or the décor of a specific room may trigger a woman’s memories of the abuse The avoidance cluster Includes numbing, a feeling of being detached from the world, emotionally constricted interpersonal relationships, and dissociation The latter defends the sexually abused woman against the horrifying childhood trauma by keeping it “walled off.” However, the dissociated material filters into consciousness through intrusive thoughts or disturbances in areas such as intimate relationships and/or compromised interests in occupational, cultural and community activities These three PTSD clusters, according to Herman (1992a), apply to the aftereffects of single traumatizing occurrences She proposed the concept of Complex PostTraumatic Stress Disorder to depict the symptomatology of victims with prolonged, repeated trauma Complex post-traumatic stress disorder (complex PTSD) Expansion on the PTSD categorization to include adaptations to early prolonged interpersonal trauma where the victim feels imprisoned and controlled by the perpetrator (Herman, 1992b), as exemplified in parent-daughter incest or ongoing, nonfamilial-child sexual abuse The complex PTSD profile includes early prolonged disturbances in the areas of affect and sexual behavior regulation, states of awareness, somatic manifestations, perception, interpersonal relationships, and belief systems (Herman, 1992a, 1992b; van der Kolk, 1996; Wallenberg Pachaly, 2000; Briere and Spinazzola, 2009) Difficulties in affect and sexual behavior regulation Are manifested primarily in the inability to modulate anxiety, aggression and sexual behavior Women molested in girlhood often experience ongoing anxiety such as panic and phobias; chronic depression or alternations between repression and extreme eruption of rage; and, either manifest loss of interest in sexuality or inappropriate/risky sexual behavior These are conscious and unconscious adaptations to the emotional impact of the original trauma States of awareness Characteristic of coping with childhood abuse are amnesia and dissociation These defend the sexually abused girl against the horrifying and disorganizing trauma Physical and somatic symptoms Are directed toward the sexually violated body, thereby avoiding the feelings connected with the trauma Feelings, such as selfhatred and self-blame, are manifested in physical illnesses and neglect of medical care/ procedures 414 Groups for Adults Changes in perception Are noted in ongoing guilt, shame and self-accusing, as well as idealizing of the abuser These misperceptions protect the victim from experiencing the rage, pain and betrayal induced by the trauma Chronic relationship difficulties Are common following prolonged sexual abuse in childhood The woman has difficulties trusting or being intimate with others She is also prone to being revictimized or victimizing others, thus repeating the trauma Belief systems Are altered as a result of the betrayal of the perpetrator Hope is altered to hopelessness, and the belief in the goodness of others is changed to the loss of faith in others The complex PTSD symptoms and/or adaptations are often the presenting concerns for which women, sexually victimized in childhood, seek therapy Presenting problems for treatment Women rarely enter therapy stating they are seeking help for traumatic antecedents associated with childhood sexual abuse There might be several reasons for this: being unaware of the dissociated or suppressed memory of the victimization, disguising the abuse because of previous painful responses to the disclosure, mistrusting others, or being afraid of losing control or being rejected Additionally, they may not connect the molestation to the problems for which they are seeking help However, when women molested in girlhood seek treatment, it is usually for PTSD and/or complex PTSD symptoms The presenting problems often include clinical depression, intense anxiety, impulsive behavior, somatization, distrust, chronic interpersonal difficulties, and negative self-perceptions such as low self-esteem, guilt and shame The following example illustrates some of these problems Clinical Illustration Lisa entered my office for the first time, apologizing for being five minutes late She also apologized for not knowing how to explain why she came to see me, adding: “I always apologize.” She was 26 years old, and married to an emotionally abusive man She complained of frequent anxiety, even when performing simple tasks; having difficulties concentrating on her job; and becoming petrified when arguing with a co-worker or with her husband, stating: “my body trembles, my heart pounds and my palms get sweaty I don’t know why I get so anxious.” Lisa’s guilt, intense anxiety and troubled relationships may be associated with early attachment disturbances and/or maltreatment at a young age or adolescence These hypotheses had to be explored in subsequent sessions Additional presenting problems that may be associated with women’s girlhood sexual abuse meet the diagnostic criteria for substance abuse and eating disorders Group Therapy For Females Molested In Girlhood 415 (such as bulimia or anorexia) (Levenkron and Levenkron, 2007), Borderline Personality Disorder, that is, fear of abandonment, severe interpersonal difficulties, self-destructive behavior such as self-mutilation (Rodriguez-Srednicki and Twaite, 2006), and Dissociative Identity Disorder, that is, presence of more than one dissociated personality state (Herman, 1992a) The association between these diagnostic disorders and childhood sexual abuse has been supported by extensive empirical research Yet, the association has to be established in treatment since other underlying disturbances/occurrences may also be present Furthermore, female survivors of childhood molestation may present for crisis intervention or therapy following intense aftereffects of life events that symbolize the childhood trauma The outburst of PTSD symptoms and/or trauma memories may be triggered by transitional events such as getting married, divorce, death of a family member, or loss of a job (Courtois, 2010) Individual therapy is usually a beneficial first step in stabilizing the flood of intense memories and symptoms affected by a crisis situation It can address the symptomatic manifestations and/or unfold the association between women’s presenting problems and sexual abuse in girlhood Individual Therapy for Females Molested in Girlhood In individual therapy in private practice, mental health clinics, or inpatient units, initially the therapist needs to focus on the woman’s concerns in the present, including, regulating feelings such as rage and anxiety (adding medication if patient is highly symptomatic), working on sobriety and detoxification (if necessary, adding an alcohol or drug program), and relinquishing or reducing/minimizing an eating disorder or self-mutilating behavior This process may take a long time since sexually abused women in childhood may have difficulties letting go of the complex PTSD symptoms and self-destructive behaviors they have adapted to in order not to experience feelings such as pain, shame and guilt To begin the process of relinquishing symptomatic/self-destructive behavior, the therapist needs to create a therapeutic relationship in which the woman feels safe This begins with focusing on patient’s concerns, validating the individual’s strengths, and addressing the therapist-patient contract in reference to fees and time boundaries In addition, clarifying that the patient can choose the material to be discussed is quite empowering This may begin to counteract the feelings of disempowerment and clearly establish that the purpose of the relationship is neither exploitive nor sexual (Rodriguez-Srednicki and Twaite, 2006) Additionally, by listening empathically to the patient and offering undivided attention, the therapist may further strengthen the woman’s trust in the therapeutic relationship As the trust develops, the woman may begin to let go of symptomatic/ self-harmful behavior, and volunteer the childhood sexual abuse story, or access some memories of the abuse This is usually a very long and painful process during which the therapist needs to be attuned to the woman’s pace and ability to tolerate the induced feelings Gradually, the molested female may learn about the association between the presenting problems and the trauma history She may come to realize 416 Groups for Adults the harmful impact of the girlhood abuse and start to understand the intrapsychic and interpersonal difficulties in the present Clinical Illustration Several months after entering treatment, Lisa (addressed in the previous section) disclosed that her mother’s live-in boyfriend molested her between the ages of and The abuse stopped when the mother “kicked the boyfriend out of the house.” Lisa was petrified to disclose the abuse since he threatened to kill her mother if she did As Lisa began to talk about the molestation, her symptoms worsened She became more anxious and insomniac Medication was added to the individual treatment However, with time, as our therapeutic alliance strengthened, her anxiety began to regulate and the sleep pattern improved She also gained some insight into the connection between her childhood abuse and current difficulties Her medication was gradually reduced To offer Lisa the opportunity to further explore her interpersonal difficulties and symptomatic manifestations, group therapy was added to her therapeutic regimen Why Group Therapy for Sexually Victimized Survivors? For several decades, group therapy has been a beneficial adjunct to individual therapy for women sexually victimized in girlhood It offers an atmosphere of safety, respect and relational consistency that is conducive to counteracting the isolation, shame and secrecy characteristic of abused individuals In a supportive, non-exploitive and nonjudgmental group, members gradually share their painful, horrific stories of sexual abuse and learn to attend to each others’ stories in an empathic, accepting manner In this process, dissociated memories slowly emerge, starting to replace the traumatizing experience with a narrative to be brought to the group discussion Additionally, the victimized women learn to better understand their symptoms, and the connection between their symptoms/maladaptive behaviors and the childhood sexual abuse Consequently, they are able to better manage and modulate affective and somatic reactions in the present As the therapeutic alliance with the group leader and members evolves, trust slowly develops and repeatedly tested Once the group becomes more cohesive, interpersonal dilemmas are addressed and explored in the “here-and-now,” utilizing the group therapist and members’ feedback Furthermore, the victimized women learn from each other how to communicate assertively rather than aggressively and impulsively, and, how to listen to each other rather than being self-absorbed and demanding They begin to develop an individuated voice, a sense of personal empowerment and self-worth Group Therapy For Females Molested In Girlhood 417 In the process of hearing and being heard in the group, women molested in girlhood begin to regain their power, enhance their sense of self, and bond with the group therapist and other members As interpersonal connections strengthen, group members may mourn together the loss of life experiences resulting from constricting aftereffects of the interpersonal trauma This grieving process can be liberating, and open the possibility for new life experiences Hope may be instilled (Yalom with Leszcz, 2005; Kleinberg, 2007), beginning to replace the grim and constricted outlook on life A safe sense of belonging emerges within the group Research on Group Therapy with Women Molested in Childhood Group therapy has been used to treat women sexually victimized in girlhood (Lundquist, et al., 2006) in inpatient and outpatient settings However, it “has not been extensively evaluated in rigorous randomized clinical trial…research, and the scientific evidence of its efficacy is limited but growing” (Committee on Treatment of Posttraumatic Stress Disorder, 2007 as reported in Ford, Fallot and Harris, 2009) The outcomes of different approaches to group treatment with females sexually abused in childhood (Wolfsdorf and Zlotnick, 2001; Lundquist, et al., 2006) have been reported These include psychodynamic, supportive, and trauma memory disclosure modalities Results have also demonstrated enhanced functioning two years after the treatment was completed (Ford, et al., 2009) A randomized clinical trial, comparing present focused and trauma focused (Lubin and Johnson, 2008) groups of childhood molested females with a wait-list of women with similar histories, resulted in self-reported reduced symptomatology in both group modalities (Classen, et al., 2001) Most group interventions for female survivors of childhood sexual abuse offer supportive or process oriented approaches, addressing patients’ affect, perceptions of self/others and new behavior possibilities The group therapist’s choice of a modality is often impacted by her/his conceptual framework of group treatment My Theoretical Framework of Group Therapy My theoretical framework for working with this population in a group setting includes the interpersonal approach, some conceptual formulations from the intrapsychic perspective, attachment theory, and, interpersonal neurobiology Interpersonal theory My initial training in group therapy focused primarily on the interpersonal perspective The basic premise of this approach is that growth occurs through the group interactions in the here-and-now (Yalom with Leszcz, 2005) I find this approach effective in working with sexually abused women in girlhood These women often manifest affective and behavioral disturbances, such as dysregulated anger or impulsive behavior They may not be aware of the extent of these disturbances and the negative impact on others Group members and the group leader 418 Groups for Adults can offer authentic, nonjudgmental feedback about how a member is perceived, “bear witness” to the painful childhood molestation story, and help the member explore and gain insight about the connection between her maladaptive behavior and the girlhood sexual abuse When this therapeutic work is done repeatedly in a supportive, empathic atmosphere, it can improve the patient’s relationships with the other group members and lessen/diminish her symptoms with time The role of the therapist in this context is to create a safe atmosphere in which the interactions between the members can be explored in an open and honest manner In addition, the therapist role models how to offer feedback, encourages members to help each other grow, and demystifies the anticipation of traumatic consequences within the group This facilitates authentic sharing of the molestation stories and genuine interchanges between members Intrapsychic perspective: transferential issues The intrapsychic approach to group therapy utilizes the conceptual formulations of the psychodynamic and psychoanalytic theories In my group work with females molested in childhood, I consider the intrapsychic transference phenomenon especially useful since the group offers opportunities to examine and work through parental, sibling and group-as-a-whole transferences Spiegel (1986) addressed the mistrustful transferences of abused individuals as traumatic transferences, for example, the molested patient projects the unconscious expectation of being exploited by the group therapist or group member for their own needs These negative transferences are enactments of the original danger that induced, for example, betrayal, nonprotection or abandonment The nature of the projected transferences is usually affected by the severity and duration of the childhood molestation and the protection or lack of it the girl experienced at the time The more severe the abuse and the more isolated the little girl felt, the more difficult is the working through process of the transferences Furthermore, the projected transferences depend on the group’s composition For example, in an all-women group with a female group therapist, a woman who has been abused by a male and has not been protected by her mother may project rage toward a helpless, passive member or a perceived nonresponsive group therapist Another transferential phenomenon maybe the patient’s notion that the group-as-awhole is a group of damaged women I find that working through these negative transferences can be a long and difficult process which may enhance the victimized women’s self-esteem and lead to more trusting and authentic relationships in the group and beyond Attachment theory Attachment styles developed at an early age tend to continue into adulthood According to Bolen (2002), childhood sexual abuse seems to be associated with insecure patterns of attachment such as anxious/ambivalent or avoidant attachments The anxious/ambivalent attachment may stem from inconsistent responses to the child (at times starting before the abuse), such as exploitive incestuous demands from a father on one hand, and the same parent’s overly nurturing manifestations 790 Subject Index countertransference (cont’d) theoretic purity 250, 253, 255, 258, 261, 266 trauma and disaster 499, 508, 511 youth offenders 647, 649, 653 couples group psychotherapy 2, 272, 276, 431–53 clinical illustrations 433–4, 436–7, 441–2, 444, 446, 448 existential base 432–3, 435 creativity 66, 200, 708, 739, 745, 764 caregivers 581 children and mass trauma 623, 629, 633 couples 433 maturational needs 226 psychosis 567 trauma and disaster 502, 508 crisis 441 culture 7, 223–4, 226, 665–6, 667–79, 716 adolescents 610–13, 619 caregivers 580 children 589, 598 children and mass trauma 628, 632, 634, 637 intersubjectivity–relational groups 71–2 large groups 457, 458–9, 462, 463, 467, 469 sexual abuse 410 sexual diversity 402 spiritually informed approach 682–4, 687, 689, 691, 695–6, 701 supervision in Guatemala 521–2, 526, 529–30, 543, 544 trauma and disaster 502, 503, 507 youth offenders 647, 648–9, 653, 659 curative fantasy 723–4 cybernetic feedback 70 cyboxin 346, 377 dance therapy 625, 627 death of group member 31, 75–7 death of therapist 30–1 defenses 66, 485, 548, 740 large groups 459–60 modification 122, 123–30, 131–4 supervision in Guatemala 519, 536 trauma and disaster 505, 508 youth offenders 652–5, 657–8, 661, 662 dependency 171 depression 99, 324, 336, 557, 620 adolescents 611, 619, 620 caregivers 573, 578 cognitive–behavioural therapy 89, 91–7, 99–101, 104–7, 109–10 couples 433 difficult patients 313 functional group model 159 high functioning adults 750–1, 753–4 interpersonal model 37, 45–6, 51 maturational needs 227 mirror reactions 207–8 psychoanalysis 15–16 resonance 188, 193 spiritually informed approach 685, 693, 694, 697 substance abuse 365, 366, 413 support and process oriented groups 275–6, 278, 283, 294–5 systems centered therapy 128, 131 trauma and disaster 503, 505, 508, 510 depth psychology 66, 450 derailments 68–9, 84 Derrida, Jacques 401 development stage 140, 149–54, 155, 159 developmental approach 382, 390, 392–3, 394 romantic relationships 390–2 diagnoses and treatment populations 61, 62–3 dialectical behavior therapy 63, 267, 278 dialogic mirror reaction 206 Dickinson, Emily 172 didactic–education function of supervision 232 diet and nutrition 101, 102, 104–5 difference bridger 670, 671 differentiation stage of group 614 difficult patients 271–2, 299–319 case studies 308–17 support and process oriented groups 291–3 disaster 499–512 mediating factors 501–3 role of leader 505–6 technique 506–7 disclosure 411, 422, 491 see also self-disclosure discrete intervention 11, 249–67 Subject Index discrimination and integration of differences 114–15, 117–18, 135 displacement 670 disruptive behavior disorder 650 dissociation 321, 324, 754 sexual abuse 411, 413, 414, 415 trauma and disaster 500, 503, 508 youth offenders 652, 653 distance group experiences 6–7 distortion 23–6 diversity 15–17, 468, 665–6, 667–79 adolescents 619 large groups 468, 472, 475 psychosis 553 divorce 439, 448, 450, 619, 684–5, 753 children 598 support groups 276–7, 282–3, 287–8, 291, 293–4 domestic violence 386, 387, 648 Donne, John 467 doubt of others 36 dreams 22, 240, 272–3, 479–95, 724 children and mass trauma 627–8 development as group therapist 735, 737 difficult patients 307, 310–12 interpretation 250, 251 large groups 459 psychosis 551–2, 557–8 driving forces 121, 122–3 dropouts 2, 95, 100, 258 support and process oriented groups 283, 285, 293–4 drug abuse 345–77, 388 Duque, Vilma 525 Durkin, Helen and Jim 114 dynamic-analytic psychotherapy 64, 708, 712 early recovery groups 349 Early Stage General Psychotherapy Group 678–9 earthquakes 588, 623–39 Eastern Group Psychotherapy Society (EGPS) 735 eating disorders 386, 757–61 sexual abuse 414–15, 423 spiritually informed approach 685, 690, 693, 694 Echo myth 203–4 791 education and youth offenders 647, 649 effectance motivation 139 embeddedness 325 embodied 331–2, 333 embodiment 403–4, 408 emotional attachment 272 emotional contagion 603–4 emotional co-participation 178–9 emotional intelligence 52, 453, 766 emotional vitality 263–4 emotional reinforcement 271, 275, 277 empathic immersion 254, 260–1 empathy 10, 11, 67–8, 98, 328, 722–4, 755 caregivers 572, 573, 578–9 children 591 difficult patients 315–16 diversity 669, 679 functional group model 161 interpersonal model 35, 47, 50, 52, 54 intersubjective–relational groups 60, 63–8, 73, 80, 83–4 maturational needs 226 mirror reactions 205, 209 process oriented groups 279 psychosis 561, 565 relational group therapy 178 resonance 188, 189, 190, 193, 194 sexual abuse 416, 418, 419, 422, 427 substance abuse 354, 355, 368 supervision in Guatemala 543 support groups 277, 280 trauma and disaster 511 empowerment 28, 470, 472, 475 sexual abuse 415, 416, 417, 425 enactments 170, 261, 330–1 couples 447, 452 high functioning adults 754, 756, 761–2, 766–7 primitive defenses 324, 327, 330–1, 333 support and process oriented groups 285 theoretic purity 253, 259–60, 261, 262, 265 energy organizing 119, 122–3 engagement 132, 177, 263, 549, 718 interpersonal model 35, 43, 47, 48, 51, 55 intersubjective–relational groups 62, 64 maturational needs 217, 223, 225 792 Subject Index erotic imagination 397, 403, 404, 407, 408 espoused theory 231–2, 233, 245, 247 ethics 449, 588, 605 ethnicity 665–6, 667–79 exclusion 95, 189, 518, 669, 694–5 spiritually informed approach 694, 695 sexual abuse 422–3 sexual diversity 402, 407 exercise 101, 105–6 existential factors 171, 590, 683, 761 couples 432–3, 435 large groups 463, 467 expanding emotional range 219–21 expectancy, hope and placebo factors 98 expectations of large groups 474–5 experience 66–7, 68–9, 71 experimenting in large groups 475 exploring 123, 128–9 expression 66–7, 68–9, 71 expressive arts therapies 590 extra-group contact 19, 47, 256, 257–8 adolescents 617–18 couples 445, 448 substance abuse 358 support groups 283–4, 289 extra-therapeutic factors 98 Ezriel, Henry 737, 739 facilitators see therapists fantasies 459 fear 36, 573, 738 trauma and disaster 500, 503, 511 Federal Emergency Management Agency (FEMA) 677–8 feedback 763 adolescents 617, 619 children 591, 599, 602 couples 442, 444, 449 diversity 674 functional group model 140, 144–7, 152–4, 158–9, 161 group facilitator development 234–5 interpersonal model 33–4, 36, 38–44, 46–7, 49–51, 53, 55 large groups 465 relational group therapy 170, 178, 182 sexual abuse 416, 418, 420, 422, 427 sexual diversity 407 spiritually informed approach 682 supervision un Guatemala 527 support and process-oriented groups 280, 292–3 theoretical purity 252, 258 feeling as a group therapist fees 19–20, 415, 424, 595, 720 financial commitment 2, 6, 15, 449 Fidler, Jay 114 Field Theory 251 fight subphase 121, 123, 128, 171 flight subphase 121, 123, 124–7, 128, 131, 171 Flowerman, Samuel 736, 737 focal conflict theory 714 focusing 475 food and children’s groups 597 forgiveness groups 689, 692 formation stage 140, 144–9, 150, 159 formative approach 489–91, 494 forming 280, 601 Foulkes, Sigmund H 203, 208, 210, 251, 260, 764 development of therapist 736, 737, 739 sexual diversity 400, 404 supervision in Guatemala 522–5, 524–5, 529, 531–2 four-ear model 533–4 free association 14, 17, 250, 251 group facilitator development 235, 237–8, 240, 243 Feud, Anna 60 Freud, Sigmund 209, 228, 256, 289, 721, 733 difficult patients 299, 302, 310, 315 intersubjective–relational groups 60 relational group therapy 170, 171, 183 sexual diversity 399–400 supervision in Guatemala 522, 524–5, 528–31 functional group model 10, 139–66 common questions 161–2 leader role 162 member roles 163–5 functional group protocol 140, 141–4 functional subgroup 10, 113, 114–19, 130, 133–5 theory of living human systems 119–23 Subject Index Gamblers Anonymous 277 Ganzarian, Ramon 745–6 gender 272, 381–94 adolescents 611 clinical illustrations 384, 385–6, 387 dreams 495 psychoanalysis 15, 16 sexual diversity 400 specific problems 386–7 trauma and disaster 502 youth offenders 647, 649, 650 general system theories 715, 746, 754, 756, 763 generativity 766 genuineness 98 geriatric depression 33 German Technical Cooperation (GTC) 519–21, 526 gestalt therapy 100, 131, 250, 321, 530, 715 goal-directing 119, 122–3 goal orientation 130 goals 1, 20, 95, 444, 505 going around the group 20 Golani, Dr Ilan 199 Goodwill Industries 89–90 grandparents 142, 741–2 group agreements 257, 423 support and process-oriented groups 282–5, 286, 289, 294 group analysis 200, 252, 522–5, 533–5, 547–67, 719 large groups 459, 462 supervision in Guatemala 522–7, 530, 533–41 group-as-a-whole 251, 252, 262–3, 328, 715, 724 children 592, 593 couples 436 difficult patients 300 high functioning adults 746, 755, 756, 761–2 large groups 459, 461, 473 group as witness 397, 405, 407, 408 group assessment 140, 141–2 group building and maintenance role 164 group centered action 140 functional group model 139, 140, 143, 146–50, 152–5, 159–60 793 Group Cohesion Scale 100 group development 149–54, 275, 278–81 stages 140, 144–60, 236–41, 280–1, 601–2, 614 group dynamics 139, 250, 251–2 group member development 265–6 group morality 404, 407, 408 group narratives 140 closure stage 154–60 development stage 149–54 formation stage 144–9 group process 14, 15, 17, 20, 22, 23 Group Psychological First Aid 509 Group Psychotherapy Foundation 725 group task roles 163–4 group tensions 165–6 group work stage 238 Guatemala 273, 517–44 clinical illustrations 521, 524, 529, 532 guided self change 371 guilt and responsibility for others 36 guilt of success 36 Gutheil, Dr Emil 735 hallucinations 549, 550, 558–9 Harvard Health Plan 91–2 Hayes, Steven 96 Heirink, Richie 735 helplessness 500, 504, 511 here-and-now 46–9, 326–7, 335 adolescents 618, 619, 621 couples 444, 446, 451 difficult patients 305, 316, 318 group facilitator development 231, 235, 237, 241, 245 interpersonal model 44, 45, 46–9, 52, 55 large groups 458 psychosis 549, 554, 555, 565–6 sexual abuse 416, 417, 421 sexual diversity 406–7 spiritually informed approach 681, 682 support and process-oriented groups 278, 283, 289 theoretical purity 249, 252, 253, 263 trauma and disaster 505, 508, 510 hermeneutic spiral 66, 70 794 Subject Index heterogeneous groups 387, 439, 669 gender 381–94 sexual abuse 419, 410, 421–2, 428 spiritually informed approach 686–7, 690, 697 substance abuse 348–50, 363–70, 372 hierarchy 119–20 defense modification 123–30, 131, 132 Hitler, Adolf 530 holding 237, 592, 599 holism 689 homework 95, 100, 343, 506, 660 adolescents 617, 620 homogeneous groups 420–1, 439–40, 509 gender 381–94 sexual abuse 418, 419, 420–1, 428 specific problems 382, 386–7, 394 spiritually informed approach 688, 690, 695, 703 substance abuse 348, 349, 350, 360–3 homosexuality 397–408 clinical illustration 406–7 hope 98, 581–2 see also instillation of hope Hopper, Earl 719 Horkheimer, Max 525, 531 horror 500 hostility 25, 69, 191, 304 interpersonal model 37–8, 39, 50, 55 psychoanalysis 21, 22, 24, 25 relational therapy 171, 176, 182 human conflict 170–2 human resources group 342 humanistic psychotherapy 321 humor 307 Hurricane Katrina 500 hurricanes 6, 500, 574 hyperarousal 412, 500, 508, 511, 573 I statements 70, 73–4, 84, 755 ideas v reality 343 identification 610, 612 imitative behavior 463, 466, 590 immediacy 300, 315 impact messages 39–40, 41 imparting information 463, 464, 590 implicit/unconscious meanings 67, 83 incest 410–13, 418–19, 425–7, 572 boys 410, 572 high functioning adults 746, 748–9 inclusion 95, 422, 557, 720 adolescents 610, 614, 617 incongruity 500 individual roles 164–5 individuation 432, 433 infant observation 34, 35 influence 482 informative approach 484–9, 491 informed consent 689–91, 693 infrastructure 591 initial contact and consultation 20–2, 442–3 initial relatedness stage 614 insecure–ambivalent attachment 322–3 insecure attachment 412, 419, 427 insecure–avoidant attachment 322 insecure–disorganised attachment 322, 323 insight 2–4, 9–10, 29, 250, 707–8, 711, 724 cognitive behavioral therapy 101–2, 109 couples 448 diversity 669, 671 dreams 485 functional group model 140, 161 group facilitator development 234, 235, 239, 241, 742 high functioning adults 750 interpersonal model 33, 35, 36, 49, 54 intersubjective–relational groups 61, 63, 66–7, 72 large groups 465 psychosis 549, 552, 554 relational group therapy 170, 172, 174, 178–9, 182 sexual abuse 416, 418 spiritually informed groups 683, 687, 688 supervision in Guatemala 521, 523–4 support and process-oriented groups 272–3, 276, 279, 281 theoretical purity 250, 262 trauma and disaster 506 instillation of hope 279, 590, 599, 631, 683 larger groups 463, 464 insulation barrier 300, 318 integrative developmental model 696 Subject Index intergenerational frame 434 intergroup romance 382, 390–2 internal working models (IWMs) 322 International Association of Group Psychotherapy 724 International Association for Group Psychotherapy and Group Processes 135 International Journal of Group Psychotherapy 250–1 internet 6, 401 interpersonal approach 2, 10, 33–55, 715 adolescents 609, 610, 612–15, 617, 620 children 599–600, 602 clinical illustrations 37–8, 40–1, 43–8, 50–3 cognitive behavioral therapy 92, 93–4 couples 435, 437, 451 diversity 667, 669, 673 dreams 480, 482–3, 485, 487–8, 491–2, 494–5 group therapist development 740 large groups 472, 475 primitive defenses 321, 333 process oriented groups 276, 278–9, 293 psychosis 561 sexual abuse 417, 419, 421, 422, 428 spiritually informed approach 681–2, 686–8, 691, 696–7, 702 substance abuse 345 theoretic purity 249, 252–3, 261, 263, 266 youth offenders 658 interpersonal circumplex 39 interpersonal effectiveness 217–18, 224, 229 interpersonal feedback 33 interpersonal interaction 33 interpersonal learning 33, 44, 52–3, 463, 465, 631 children 590, 591 process oriented groups 271, 275, 278, 283, 293–4 interpersonal neurobiology 419 interpretation 262–3 intersubjective–relational groups 10, 59–85, 459, 721, 726 dreams 480, 482, 484, 492 illustrative vignette 72–83 795 maturational needs 228 primitive defenses 321, 331, 333 principles 64–72 relational therapy 170, 172, 175, 181, 183 theoretical purity 260, 261 interviewing children 629, 635 intimacy 300, 305, 318, 433 intimacy stage 121, 123, 129–30, 614, 615 introjections 554, 560 intrusion 500, 510, 511 intrapersonal approach 472 intrapsychic approach 9–10, 60, 249, 473, 715–16 children 602 difficult patients 307 diversity 673 primitive defenses 333 psychosis 561 relational group therapy 170, 174 sexual abuse 416, 418 supervision in Guatemala 525, 530, 531 support and process oriented groups 278–9, 283, 293, 294 youth offenders 658 isolation 467, 503, 506–7, 512 caregivers 571, 572, 579 isomorphy 120, 122, 435–6 joining 190, 218, 441 difficult patients 303, 304, 313, 317 functioning subgroups 113, 114, 119, 120, 129 Jungian psychology 485, 490 Juvenile justice system 647–8 Kadis, Asya 736, 737 Kaiser Permanente 90–2 Karterud, Sigmund 719, 724 Keller, Fred 732 Kierkegaard, Soren 170 Klein, Melanie 60, 719 Relation group therapy 170, 171 Kleinberg, Otto 733 knowledge of multiple theories Kohut, Heinz 721–4 Krier Juvenile Correctional Treatment Center 646–9 796 Subject Index ladder of children’s participation 625–6, 638 language 469–70, 473 large groups 272, 457–76 clinical illustration 460 leaders 472–4 therapeutic factors 462–71, 475 therapeutic value 461–2 lateness 445–6 Law of Optimum Distance 611 learning disabilities 590, 649 learning from others factors 98 leaving a group 259–60, 283 Leff, Jerome 736, 740 Lehman 710 leveraging differences 668, 670, 673–5, 677, 679 Levine, Maurice 709, 710 Lewinian Group Dynamics 733 Lewinson, Peter 93 life choices 433 Life Enrichment Counseling Approach 336–7 limit-setting 616 lithium 276 long term stage of trauma 503, 510, 511 Lorenz, Konrad 200 MacKenzie, Roy 91 maintenance 96, 164, 659, 662 major affective disorder 650 maladaptive transaction cycle (MTC) 36–7, 41–2, 49 Malan, David 737 malignant mirroring 208–9 managed care 346 manic-depressive illness 276 Marcuse, Herbert 525, 531 Marlatt, G Alan 110 Marsh, Cody 221 maturational needs 10, 217–29, 260, 266 clinical illustrations 218, 221–3, 224–6 difficult patients 317, 318 modern analytic approach 255–6 Mead, Margaret 710, 735 mediation 541–4 Medicare and Medicaid 720 men in groups 384–6 Menninger Clinic 710, 745–6, 763 Men’s Movement 383, 393 mental health factor 649–54 mental health hospitals 89 mentalization 60, 69, 84, 171 primitive defenses 323, 325, 327, 328 metacognition 323, 325, 327 metaphors 306, 711 mindfulness therapy 59, 93, 96–7 mirror neurons 60, 188, 211, 228, 755, 767 mirroring 10, 197–214, 233, 243, 722, 724 clinical illustrations 201–2, 205–8, 212, 213–14 difficult patients 303, 304 dreams 488, 492 high functioning adults 748, 754, 755, 762 intersubjective–relational groups 67, 68, 70 patterns 204–9 psychosis 547, 557, 560 resonance 188, 192 misconstrual 35, 36 misconstrual–misconstruction sequence 35, 38, 42 model and technique factors 98 modeling 617, 620 moderation management 371, 376 moderation training 370–3 substance abuse 347–50, 365, 369–73, 376 modern analytic therapy 249–50, 255–6, 258, 260–2, 264–6 difficult patients 300–1, 302, 308, 318–19 primitive defenses 321 monopolizer 591, 592 mood and anxiety disorders 276 mood disorder track 95 mood disorders 2, 451 mother groups 592, 633 motivational systems theory 60 moving on stage 614 multidisciplinary treatment team (MTT) 645–63 dynamic challenges 656–8 role of facilitator 656, 658–62 structure and process 654–8 Subject Index multiple self states 324–5 multiple transference 23–4, 523–4, 533, 740 Murphy, Gardner 733 music therapy 746 naltrexone 346, 357, 366, 370, 376 narcissism 265–6, 291, 731, 746 career in group psychotherapy 722, 724 difficult patients 299–302, 310, 313, 315–16, 318 diversity 668, 674 functional group model 148 intersubjective–relational groups 62, 65, 70 maturational needs 217, 226 mirror reactions 209 relational group therapy 176 resonance 191 self psychology 254, 266 sexual abuse 423 youth offenders 651, 662 narcissistic defense 301, 302, 316 Narcissus myth 203–4 Narcotics Anonymous 351, 357, 361, 365, 374, 376 narrative stage 238–9, 240 National Institute for Mental Health 90 National Registry of Certified Group Psychotherapists 294 natural disasters 2, 6, 573 earthquakes 588, 623–39 hurricanes 6, 500, 574 needs hierarchy 139 negotiating function 660–1, 662 nervous avoiders 670 neurobiology 419, 453 neuroscience 748–9, 754–5, 756, 762, 767 neutrality 21, 23–4 new members 18–19, 26–7, 43, 286–7, 700 cognitive behavioral therapy 95, 96, 100–2 non-disclosure 411 non-verbal communication 20–2, 24, 752, 760, 767 couples 447, 448, 453 interpersonal model 35, 39, 45 797 non-psychodynamic therapy 267 norming 280, 601 “not me” experiences 34 numbing 573, 578 obesity 15 object feelings 219–20 object oriented questions 302, 304–5, 313–14 object relations theory 59, 251–2, 486, 746–7, 749, 755, 762 objectivity 21, 23, 60 Oedipal complex 66, 179, 183, 400, 486 operative principles of supervision model 236 oppositional defiant disorder 650 oppression 668, 670, 673, 679 orientation 95 Ormont, Louis R 217, 220 Ornstein, Ana 721, 723 Ornstein, Paul 721 outcome measures 99–100 out-of-group contact see extra-group contact outpatients and psychosis 549–50, 553, 554–5, 556–7, 564, 566–7 Overeaters Anonymous 277 oversight 232 Padesky, Christine 93 pairing 171, 530 panic disorders 15, 95, 102, 104–5, 109 pan-theoretical approach 250 paradoxical interventions 617 parallel processes 240 paranoia 734 paraverbal communication 35, 39, 45 parental loss 15, 74, 79, 590–1 Parents Anonymous 277 participants 505 participation 631–2, 634, 636–8 pelicans 198, 199–200 performing 280, 601 personal growth 271, 275, 280 personality disorders 2, 207, 278, 711 personality integration 217, 221, 223 pharmacotherapy 548–9, 550, 553–4, 566–7, 710, 717–20 phenomenological field 64 Phillips, McKenzie 410 798 Subject Index photography 629, 634, 639 Pines, Malcolm 719, 737 Planned Parenthood 726 play 263–4, 628, 630, 632–3 pleasant activities 93, 96, 103, 103–4 pluralism 468–9, 472, 474, 475, 694, 695 polite inquirers 670, 671 positive diversity processing 667 positive psychology 447, 453 positive regard 92, 98 post-acute stage of trauma 502–3, 510 Postgraduate Center for Mental Health 734–43 Group Therapy Department 735–42 post-traumatic stress disorder (PTSD) 62, 652, 749 caregivers 571, 573, 577 disaster 501, 503, 508, 510, 511 evacuated children 461 sexual abuse 412–13, 414, 415, 423 power and control stage 614 power struggle in large groups 467, 469–71, 472–5 Powles, Bill 714 practical knowledge 231 pre-affiliation stage 601–2, 614 pre-contemplation 96 predictable problems 445–6 prejudice 398, 400–2, 405, 407 pre-oedipal disorder 265, 300, 301–2, 304 preparation and pre-group interviews 17, 96, 256–8, 716 adolescents 610, 613–14, 618 couples 440–1 sexual abuse 423 substance abuse 357–8, 362, 365, 368 trauma and disaster 507 Present Centered Supportive Group 510 pretraining 440 priests and sexual abuse 410 primitive defenses 272, 321–33 case study 324, 326, 329, 331–2 Principles for Positive Diversity Processing (PPDP) 668, 670–5, 679 probation 647–8 problem-solving 108 process commentary 163 process-oriented approach 271, 275–98 clinical illustrations 278, 287, 288, 292 example 284–5 sexual abuse 417 procrastination 93, 106, 108 programs organizer 362–3 program proselytizer 361–2, 366, 685 projections 593, 670, 712 psychosis 548, 552, 554, 557, 560, 561 youth offenders 651, 657–8, 661, 662 Projective Identification-in-the-Dream 485, 487 psychiatric assessment 443 psychoanalytic approach 9–10, 13–32, 250–1, 399, 533–5 career path 709, 710, 713, 720, 721 couples 446–7, 452 dreams 479, 482, 485, 486 group therapist development 734–7, 739, 742 high functioning adults 745, 754, 756 intersubjective–relational groups 59–60, 61, 62, 64 large groups 459, 462 sexual abuse 418 sexuality 399, 400–1, 406 supervision in Guatemala 522–5, 530, 533–5 theoretical purity 249, 250–1, 252, 256, 262 see also modern analytic therapy Psychoanalytic Training Program 734 psychobiological mirrors 200, 210–12 psychodrama 471 psychodynamic approach 6, 276, 278, 294, 650–1, 720–1 couples 432, 434, 447–8, 453 difficult patients 300 group therapist development 739, 740, 742, 743 large groups 457–9, 464, 471, 474 primitive defenses 321 psychosis 547–67 sexual abuse 417, 418, 420 spiritually informed approach 681, 682 structured techniques 340–1, 344 substance abuse 272, 345–77 theoretical purity 250, 262, 263, 265–7 Subject Index trauma and disaster 504, 511 youth offenders 645–63 psycho-educational groups 463, 464, 579, 590 adolescents 612, 619, 620 spiritually informed approach 688, 692 systems-centered therapy 131, 135 trauma and disaster 505, 507, 509–11 Psychological First Aid (PFA) 509 psychological testing 443 psychological work factors 98 psychological mindedness 15 psychopharmacotherapy 548–9, 550, 553–4, 566–7 psychosis 16, 63, 273, 547–67, 572 role of leader 561–6 youth offenders 650, 651 psychosocial group therapy 631–2, 637–8 psychosomatic symptomology 301 purposeful action 140 functional group model 139–40, 143, 146–8, 150–2, 154–60 pushback 673–4, 677 qualifications of therapist 61 qualitative descriptions of leisure 340, 343–4 race 665–6, 667–79 RAP framework 668–9, 673 rape 386, 387 see also sexual abuse “Rashomon” effect 28 readiness group 349 recapitulation of family 464–5 children 590, 591, 598 large groups 463, 464–5, 468 recorder/observer 711, 712–13 re-experiencing 413, 500–1, 508, 573–4 reflection 302, 436–7, 719–20 group facilitator development 233–4, 236–41, 243–7 stage 236, 239–41 reflective action model 234–5 reflective examination 233, 234, 236 regression 28–9, 522, 611, 652 psychosis 549, 553–4, 557, 560–3, 566–7 799 rejectionism 694, 695 relapse 93–4, 96–7, 101, 109–11 relapse prevention groups 348 relational approach 10, 59–85, 169–83, 253, 447 career in group psychotherapy 715, 721, 726 children 589, 599 couples 445, 446, 447, 452 high functioning adults 754, 755, 756 illustrative vignette 72–83 large groups 462 primitive defenses 321, 331, 333 principles 64–72 theoretic purity 250, 253–6, 259–65 youth offenders 658 relationship building 90, 93–4, 99 relaxation 101, 102 religion 7, 714, 731–2 diversity 665, 669, 677–8 spiritually informed approach 681–703 REM sleep 106 repetitive behavior 21, 29–30 representation of society 467–9, 472 required skills of therapist 4, research 132–5, 307–8 substance abuse 370–1 resilience 634, 636, 637 resistance 26–8, 244, 251–2, 289–90, 364, 534 difficult patients 300–2, 304 maturational needs 217, 219–20, 224, 226–9 modern analytic approach 255–6, 262 psychoanalytic approach 9, 14, 15–16, 19–20, 22, 25–30, 533–5 sexual abuse 420 single or mixed gender groups 392 substance abuse 350, 362, 364 supervision in Guatemala 519, 521, 533–6 support and process oriented groups 279, 289–90 theoretic purity 251–2, 257–60, 263, 265 trauma and disaster 505 resolving authority issues stage 614 800 Subject Index resonance 10, 213, 187–95 clinical illustration 188–91 dreams 488, 492, 494, 495 psychosis 560 subjective experience 193 therapeutic value 191–3 respect 98, 282, 612–13, 627 response plan 101, 110–11 restoring structure and routine 627, 632–3 restraining forces 122–3, 128 risk issues 609, 617 Rogers, Carl 98 role lock phase 121, 123, 128–9 role of leader 162, 326–8, 505–6, 512, 561–6 MTT 656, 658–62 role of members in children’s groups 591–2 role play 358–9 Rorschach 733 Ross, W Donald 709, 710 Russian dolls 524–5 Rutan, Scott 719–20 safety 101, 111, 194, 671–2 adolescents 620 children 593–4, 599, 602–4 children and mass trauma 623, 627 diversity 668–9, 670, 671–2, 673, 679 mirror reactions 198, 210 sexual abuse 415–16, 420–3, 428 sexual diversity 398 single or mixed gender groups 393 substance abuse 348, 354 supervision in Guatemala 532 support and process oriented groups 281–3, 291–2 trauma and disaster 501, 503, 505–7, 509, 512 youth offenders 652 Salisbury, John 256 San Francisco Psychotherapy Research Group 35 scapegoating 68, 173, 521, 670, 747, 764–5 adolescents 615 children 591, 595–6, 602–3 functional subgroups 117–18, 135 support and process oriented groups 289, 293 schizophrenia 89, 217, 276, 710, 711 caregivers 572 difficult patients 300, 301 psychodynamics 547–9, 565 screening and selection of group members 1, 4, 422, 594–5, 714 adolescents 588 children 590, 54–5, 604 cognitive behavioral therapy 95–6, 100 couples 438–9 intersubjective–relational approach 63–4 maturational needs 218 primitive defenses 326 psychosis 553 relational therapy 180 sexual abuse 422–3 spiritually informed approach 686–7, 691, 695 structured techniques 335 support and process-oriented therapy 275, 279, 285–7 trauma and disaster 506–7 secondary post-traumatic stress disorder (SPTSD) 511 secondary traumatic stress (STS) 573, 576–7 secondary traumatization 520, 573, 653 secure attachment 322, 325, 328, 333 sexual abuse 412, 419, 427 security 19 selection of group members see screening and selection of group members self-disclosure 70, 77, 261–2 adolescents 616, 619 children 599, 600 couples 443–4 functional group model 161 intersubjective–relational groups 70–1, 73–4, 80, 83–4 mirror reaction 213–14 relational group therapy 173–5, 176–8 resonance 188, 190, 192–4 spiritually informed approach 690, 695 substance abuse 350, 363, 374 self-doubt 36 self-empowerment 28 self-evaluation of enjoyment 338, 342–3 Subject Index self-exploration 13–14, 18–20, 23, 27 self-feelings 219–20 self-generated list of leisure activities 337–8, 339–42 self-harming 329, 415, 423 self-initiated action 139, 140, 143, 146, 148, 150–5, 158–60 selfobjects 254, 721, 722, 724 self-psychology 254, 707, 721–4, 727, 747–8 dreams 490 high functioning adults 747–8, 749, 756 intersubjective–relational approach 59–60, 64–5, 67 theoretic purity 250, 254, 256, 260, 262–3, 266 self-reflective capacity self-revelation factors 97 self-verification theory 34 sense of self 34–5 separation stage 614 session evaluations 140, 146–7, 152–3, 158–9 setting 1–2, 4, 6, 337, 436, 764 adolescents 610, 611, 613 cognitive behavioral therapy 90, 94–5, 106 couples 436–8, 445–8 functional group model 140, 154, 161–2 gender 382–4, 386–9 interpersonal model 33, 42 intersubjective–relational groups 61, 63–4 psychoanalysis 13, 17, 27, 29–31 sexual abuse 417, 420, 423 spiritually informed approach 688–91 support and process oriented groups 276, 278, 283, 285 systems centered therapy 131–2, 135 sexual abuse 15, 53, 329, 409–28, 572 boys 410 children’s groups 590, 591, 593, 600–1 clinical illustrations 409, 414, 416, 424–6 cognitive behavioral therapy 90, 97 high functioning adults 746, 748–9, 767 process oriented groups 272, 276 youth offenders 648 sexual activity 342, 611 sexual compulsivity 386, 387, 389–90 801 sexual diversity 397–408 as experimental 401–2 as natural 401 as perversion 399, 400–1, 404 clinical illustrations 406–7 sexual orientation 15, 272, 397–408, 432, 712 adolescents 618, 619 gender 382, 387 spiritually informed approach 684–7, 694, 697, 700–2 Shakespeare, William 108–9 shame 65, 67, 154, 290, 613, 575, 674 caregivers 57, 575 maturational needs 219 resonance 188, 190–2, 195, 202, 206, 212 sexual abuse 414, 415, 416, 423 sexual diversity 397, 404 substance abuse 372,374, 375 trauma and disaster 503, 507, 512 Sharett, Moshe 731 shellshock 522 sibling rivalry 175–6, 179, 183, 251, 524 difficult patients 305, 311–12 silence 20, 712, 760 children 591, 592 difficult patients 301, 304, 305, 315 dreams 490 group facilitator development 241–3, 244 mirror reactions 201–3, 213 relational group therapy 172, 174, 176, 182 support and process oriented groups 280, 289 Sisyphus problem 123 skills training 348 Skinner, B F 732 Skola, Atura The Family (film) 209–10 Slavon, Samuel 250–1, 590, 715, 736, 739 sleep hygiene 101, 106–7 social dynamic groups 531 social microcosm 33, 38, 42, 44–6, 49, 52, 55 social networks 107–8, 110 social psychologists 733–4 social unconscious 458–61, 468, 470, 473 802 Subject Index social skills 10, 91 adolescents 609–10, 612 socializing techniques 463, 465, 468, 590, 591 Socialshteimung 200 sociopathy 62 somatization disorder 276 special medical needs 649 special needs 587 see also learning disabilities specificity 33 spiritually informed approach 681–703 clinical illustrations 697–701, 702 spontaneity 20 spontaneous action 139, 140, 143, 146–8, 150, 152–5, 158–60 Spotnitz, Dr Hyman 217 stages of group development 140, 149–60, 236–41, 601–2, 614 intimacy 121, 123, 129–30, 614–15 states of mind 219–20 Stekel, Wilhelm 735 Stewart, Bob 715 storming 280, 601 stress 2, 93, 105, 107 structure of therapy 596–8 subjectivity 254, 260, 323, 328 mirror reactions 198, 201, 206, 214 relational group therapy 170, 172, 182, 183 resonance 192, 193 substance abuse 67, 110, 272, 345–77, 618–19, 753 adolescents 609, 613, 618–19 children 592, 602 couples 451 recovery1related defenses 361–3 sexual abuse 414, 422 single or mixed gender groups 388 spiritually informed approach 685 trauma and disaster 510 youth offenders 647, 649, 650, 652 sugar 104, 105 suicidal ideation 69, 75, 291–2, 324, 331–2 adolescents 618 caregivers 581 cognitive behavioral therapy 95, 99, 104 difficult patients 299 psychosis 549–50 sexual abuse 423 spiritually informed approach 684–5 substance abuse 366 summary stage 241, 245 supervision 62, 94, 294, 296, 333, 335, 527–9 career in group psychotherapy 711–12, 715 caregivers 580 children 589, 627, 639 clinical illustrations 241–3, 521, 524, 529, 532 couples 450–1 difficult patients 307–8 group therapist development 232–47, 264, 739, 740 Guatemala 517–44 sexual abuse 423–4, 428 spiritually informed approach 681, 683, 696–7 substance abuse 272, 377 team 537–9 support groups 27, 271, 275, 276–98, 713 clinical illustrations 276, 282, 287, 290 couples 434 development of group therapist 743 example 284, 291, 295 psychosis 548 sexual abuse 417–18 trauma and disaster 502, 504, 509, 511 supportive factors 97 supportive function 232 symmetry 632–3 systems centered therapy (SCT) 10, 113–36 methods 130–1 research 132–5 TLHS 119–23 Systems Centered Training and Research Institute 132, 135 system-correcting 119, 122–3 system development 121, 123–30, 131 talkers and non-talkers 173–6, 177, 178–9 tattoos 649 Tavistock groups 464, 472, 682, 737, 763, 765 team supervision 537–9 tension 272 termination of group 30–1 Subject Index children 602 couples 442 difficult patients 317–18 sexual abuse 421 spiritually informed approach 700, 702–3 substance abuse 357 support and process oriented groups 280, 287–9, 294 terrorism 2, see also World Trade Center attack testing of limits stage 614, 616 T-group movement 714 theme oriented group discussion 340–1 theoretical constructs 34–42 theory of living human systems (TLHS) 114, 119–23 theoretic knowledge 231 theoretic purity 249–67 clinical illustration 257 theory in use 231–2, 233, 245, 247 therapeutic alliance 257, 285–6, 560–1 adolescents 613, 615 difficult patients 301 maturational needs 224 primitive defenses 333 psychosis 549, 560–1, 563 sexual abuse 415, 416, 427 therapeutic factors 97–9, 504–5 therapeutic meta-communication 38, 44, 50, 53–5 therapists 3, 66–70, 227–9, 231–47, 264–5 qualifications 61 transparency 53–4 vicarious trauma 273 therapy relationship factors 98 there-and-then 241, 245, 283, 681 Thomas, Dylan (154) 175 torture 273 training 94, 294, 296 career path 709–29 development as therapist 731–44 difficult patients 301, 305, 318 transactional analysis 715 transference 9, 22–6, 68, 599–601, 615–16 adolescents 614, 615–16 career in group psychotherapy 712, 716, 723–4 children 599–601 couples 439, 440 803 difficult patients 301, 302, 309, 318 diversity 669 dreams 485 functional group model 153, 165 group analysis 523–4 group therapist development 735, 740, 742 high functioning adults 746, 750–2, 762, 766 interpersonal model 35, 36, 37 intersubjective–relational groups 60–1, 66, 68, 71 maturational needs 221, 222–3 modern analytic approach 255, 264 multiple 23–4, 523–4, 533, 740 primitive defenses 325, 333 process oriented groups 279, 289 psychoanalysis 9, 19, 20, 22–6, 28 psychosis 548–9, 553–5, 560–3, 567 relational group therapy 169, 177, 179, 180, 181 sexual abuse 418, 421, 423, 427 spiritually informed approach 682, 683, 686, 695 supervision in Guatemala 522–4, 532–3 theoretic purity 251–2, 253, 255, 261–3, 264 trauma and disaster 505–6 youth offenders 661, 662 transmuting internalization 254 transparency 261–2 trauma 2, 6, 273, 421, 422, 499–512, 620–1 adolescents 609, 619, 620–1 care of leader 511–12 caregivers 571–2, 573–80 children 587, 588, 590, 623–39 defined 412 diversity 672 Guatemala 518, 520 guidelines 507–8 high functioning adults 746–9, 752, 754, 756 intersubjective–relational groups 59, 62, 63 large groups 460–1 mediating factors 501–3 primitive defenses 321 process oriented groups 276 804 Subject Index trauma (cont’d) role of leader 505–6, 512 sexual abuse 409–20, 421–8 vicarious 273, 427, 428 youth offenders 653, 654, 656–7 trauma-focus group therapy 510 treatment constructs 42–55 treatment planning 1, 2–7 triggers 96, 103, 110, 111 Tri-State Group Psychotherapy Society (TSGPS) 710, 714–15, 725 trust 18, 92, 101, 259, 762 adolescents 615 caregivers 572 children and mass trauma 627 diversity 671, 672 functional group model 149, 163 MTT 656 psychosis 551, 552, 560 sexual abuse 410, 411, 415 supervision in Guatemala 519, 521–2, 535, 543 support and process oriented groups 280 trauma and disaster 506, 507, 508 Trust for Group Analysis 737 truth 170, 171–2, 179, 182–3 tsunami 636 tuning in stage 236 twinship 722, 723, 724 unconscious 533–4 uncovering oppressive patterns 668, 670, 673, 679 understanding 66–7, 68–9, 71 unisex or mixed gender groups 381–94 clinical illustrations 384, 385–6 specific problems 382, 386–7, 394 universality 235, 463, 466, 590, 591, 631 diversity 676 unthought known 323–4, 328 values and beliefs 231, 685 spiritually informed approach 685, 689, 692, 696, 698–9, 701 vampires 207 vectoring 130, 133 verbalization 21 vicarious trauma and traumatization 273, 427, 428, 635 ABCs 580–1 caregivers 573–4, 576, 577, 580–1 disaster 499, 508, 511 youth offenders 653 waiting list groups 718–19 waiting room 712, 716 war 517–22, 571, 572–3, 576, 733 weekly organizer 108 Weitzman, Chaim 731 what and how 236, 245 Whitman, Roy 709, 723, 726 Wilde, Oscar 28 Winfrey, Oprah 410 wise men of Helm 198, 199 Wolberg, Lewis 734, 738 Wolf, Alexander 736, 737 women in groups 383–4 women’s groups 418–19, 420–1, 428 Women’s Movement 383, 393, 410 Women’s Wellness Group 675–6 Woodworth, Robert S 733 work stage 121, 123, 130, 236, 602 working on self stage 614 working through 29–30 World Trade Center 31, 71, 84, 677–8 caregivers 574, 578 trauma and disaster 501, 503, 504 Youcha, Isaac “Zeke” 239–40 Young, Jeff 93 Young Women’s Christian Association (YWCA) 763 youth offenders 589, 645–63 demographics 648–54 ... small -group The Wiley-Blackwell Handbook of Group Psychotherapy, First Edition Edited by Jeffrey L Kleinberg © 20 12 John Wiley & Sons, Ltd Published 20 12 by John Wiley & Sons, Ltd 4 32 Groups... family has the properties of a small group Both are greater than the sum of their parts, and the subsystems of each can be fully understood only through a knowledge of the working of the whole... learn that they are not as badly off as their peers in the group or as they had thought Such diversity offers group members concrete proof of the scope of marital function and dysfunction The wide