Group Descriptions And Inclusion

All of my groups are heterogeneous and psychodynamic. They are made up of private patients, on a continuum from moderate functionality to high functionality, and including diversity in age, gender, and diagnosis. Over the years, each group had developed a somewhat different personality, and I had become quite proud of the technique I

had developed for placing patients in groups. This was a process of "fantasy." I would try to picture how a given patient would affect each of the other members of the group, how each of them would affect the patient, and what effect this patient might have on the functioning of the group as a whole-. This method had worked so well that I had never been disappointed in the result, and the only surprises had been that patients would achieve more, progress more quickly, or reach more meaningful insights than I had expected.

As time went on, some of my groups' patients came from referrals from individual therapists who did not have groups, but felt that their patients could benefit from concurrent group therapy. Most group therapists require at least one screening interview before placing a referral into a group, but we still have to depend, to a certain extent, on the individual therapist's evaluation of the patient's readiness for group therapy.

On one particular occasion, I placed a referred patient into a rather high-functioning psychodynamic group after a single screening interview. Since the patient appeared to have trouble in social relationships, the therapist hoped that a group experience would give this indi vidual some insight into how he was contributing to his problems. In rare instances, I have found that new patients, on entering a group, will begin to provoke the other members of the group. This becomes grist for the mill of group therapy, and with only minimal help from the group therapist, the group can explore the motivations and unconscious forces that drive such behavior. Usually, as a result of the "magic" of group process, everybody gains.

In this particular instance, it took a very different course. The new participant's attacks were particularly vicious, striking at each member's vulnerabilities, stimulating forceful retaliation from the group members. The provocateur's response to the retaliation seemed to be a rapid decompensation. His wild, frantic, and paranoid utterances seemed to be adding to the outrage of the group. I felt I was seeing a psychotic process in the making, and decided to direct the focus of the group away from the psychologically deteriorating new member.

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