Late Stage Group Treatment, Conflict, Repair ... - Classes at U. of L.

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Late Stage Group Treatment, Conflict, Repair ... - Classes at U. of L.

LATE STAGE GROUP TREATMENT

CONFLICT, REPAIR, AND REUNION


IT’SALL ABOUT

CHARACTERLOGICAL CHANGE…

• Working on personality disorders

• Benign manifestation of deep habitual patterns

• Disordered attachments

!

• Transference distortions arising from …


MAIN THERAPEUTIC TASK

• Work on character pathology while also trying to

maintain a balance of “erupting” defensive

structures (e.g., shame and worthlessness) that

dominates most addicted sufferers internal world

!

• Watch client’s feeling of “too good or too bad“


OPTIMAL FRUSTRATION AND

BALANCE

• Thus, clients are afforded the opportunity to

experience enough anxiety and frustration to

promote the emergence of their typical destructive

and maladaptive characterlogical patterns and

coping styles


WORKING ON

CHARACTERLOGICAL PATTERNS

• Help client’s realize that behaviours, reactions, and

interpersonal functioning are a result of unmet

developmental needs for self-object

responsiveness in the here and now


LATE STAGE TREATMENT

STRATEGIES

• Taking a cold, hard, honest look at addicted

sufferers past and their early history of

relationships with their family of origin

!

• Unconsciously group members use projective

identification to coerce others into behaving and

treating them as they have been treated in the

past!


PROJECTIVE IDENTIFICATION

THE EXTERNAL AND INTERNAL

• Two Simultaneous levels of interaction occur during

group member exchanges 


1. External interaction

2. Internal interaction

Each of these influences the other


…THE EXTERNAL

Impacts the internal representation of self and one’s

object relations…


THE INTERNAL

While the internal world of an individual colours,

distorts, and influences others in the group to behave

or act in ways that “fit” the individual’s projected

unconscious expectations…


EACH LEVEL MUST BE WORKED OUT

Group projective identifications are diluted by virtue of #’s,

which reduces anxiety helping in the healing process

!

Group provides for more possibilities for projective

identification to occur

!

Group provides safe space between threats of abandonment or expected

retaliation (transitional object) - but the group must not be allowed to hide

a member’s fears based on their own anxiety (this is tolerated in early

stage of group process)


INTERNAL - EXTERNAL GAME

• We have to keep in mind and remember that the necessity for

projection identification and its healing resides in acknowledging

and understanding that we did not get certain needs met

!

• Moreover that the search/insatiable need, and or denial of needs

is behind the external / internal game

!

• Leaving addicted suffers with a view that the world is unfair and

rejecting (Remember addicted sufferer cannot contain

emotions on their own)


ADDICTED SUFFER MUST SEE…

• That their current interpersonal functioning can never

change the “other or others”

!

• Thus their expectations of others are unrealistic and their

demand on them will never be fulfilled

!

• As such, this must be accepted and surrendered to… The

realization being (no one can give them what they want - they

must do it themselves).


RETURN OF THE REPRESSED - CANNOT FAIL

TO UNDERSTAND RAMIFICATIONS OF

CHILD’S EARLY EXPERIENCES

• First because of a parents or caregivers position / role,

children cannot give up there external objects (need them for

survival)

• Then we have their PCF’s rejections, anger, and persecutory

behaviours…

!

• Thus external reality cannot be changed (too helpless and

dependent) thus frustration and disappointment is retained

and internalized to be mastered and controlled in one’s

internal world


THESE INTROJECTIONS BECOME

PART OF ONE’S PERSONALITY

• Thus if your PCF was demeaning/critical or what

have you - individuals will force others in their

external world to change into a critical, demeaning

object….

• Why? So their external reality fits internal reality!

• How critical or demeaning are you to yourself?

• In your groups… Do you perceive members as critical/

demeaning? Are you unconsciously forcing group mates to fit

into your internal world?


CONFLICT, REPAIR, AND UNION

• Therapist does not pretend to have it all figured out

!

• He/she experiences countertransference (will discuss

it - point out how he/she has misinterpreted

!

• However, the competent group therapist also knows

the importance of facilitating “healing conflict” in

group


THE NECESSITY OF CONFLICT

TOWARD REPAIR AND GROWTH


NECESSITY OF CONFLICT

• All dysfunctional relationships are characterized by

the relative absence of the repair process

!

• Failure to repair leads to structural dampening of

prefrontal limbic system that involves capacity for

affect regulation

!

• However, dyssynchrony will occur in group - it’s

inevitable - we need to welcome it, and equally repair it


Neuroscience Explains Projective Identification and the

Role of the Prefrontal Cortex


REPAIR OF RUPTURES

• Watch for ruptures and begin reparative process

!

• What does repair look like - therapist acknowledges

misattunement, apologizes, and error explored so that feelings

missed or ignored, are recognized

!

Research has recognized that the ability to successfully manage

conflict and maintain close personal relationships is synonymous

with freedom from all serious anxiety, depression, and

psychopathology including addiction.


REPAIR OF RUPTURES

• Also hinges on therapist willingness to look into the negative process and

helping group member to speak to his/her process in group, share feelings

of being misunderstood and both take responsibility for their parts

!

• Also the therapist needs to also understand and review the impact of their

attachment history and how this is impacting the therapeutic milieu

!

• Maybe most important, allow and create a climate where anger and

protest can be experienced with group therapist and between group

members

!

• Therapist works within themselves to embrace protest and hostility without

the need to retaliate, and with experiencing limited amount of fear


LET’S TALK ABOUT VULNERABILITY


LET’S PLAY THE VULNERABILITY GAME


RULES AND PREPARATION FOR

THE GAME

• Individuals from each group this semester are too pool into the same area

!

• Half of Each Group - will “self” select themselves to come to the front of the class

!

• At which time - each person from each group will have to blind select an issue

(provide in cup), read it out loud to the entire class, and complete the instructions

(instructions are not carried out until each person has read out aloud their issue)

!

• After the first round is completed - the projected onto - from each group will then

have a chance to choose from the blind pool of selected issues and the process

then continues

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