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with women-only groups at the portman. the groups have weekly sessions of an hour
and a half. patients know each other only by first names, to protect confidentiality. the
group therapist sees patients individually a few times before they join the group, but not
afterwards. each patient is
assigned a case manager who can see him individually to discuss particular issues.
part of the tradition at the portman is to have some specialized groups: for example for
paedophiles, or patients with gender identity problems.
adolescent or child patients are only seen individually. the experience at the Clinic
indicates that in the context of an out-patient service young patients are harder to manage,
they are more prone to acting out and do not respect the limits imposed by the group
therapist, for example, not to have any social contact outside the group.
Confidentiality
the Clinic keeps a fundamental independence from the organs of the law: that
is, no information is given to the courts or the police in order to protect the possibility of
offering a confidential treatment to the patient. Nevertheless, the explicit and basic attitude
with which we work is of not colluding with the delinquent behaviour. some cases do not
involve the law, such as sado-masochistic practices between consenting adults.
this is a controversial question and is the source of many intense discussions. it is an
issue that is continually kept in mind and thought about at the portman. the main focus
of our work centres on the unconscious of the patient, what interests us the most is his
internal world. the external changes in the patient´s behaviour cannot be effected in a
successful and permanent fashion unless there has been an internal change in the patient´s
psyche.
there are many risks in confusing the role of therapist with that of authority: it is
essential for the patient that the therapist can sustain and defend his role as herapist,
that he should not become the “victim” of the patient through manipulation nor give in
to the pressure imposed by the authorities to disclose information about his patient. the
patient can easily feel that the therapist is “ like all the others”: just another inquisitor
whose sole interest is to interrogate him about his offence or perversion, and who
does not really care about the individual, his state of mind, his suffering or his personal
history. this type of scenario in the mind of the patient can lead him to censor and direct
his discourse to control the sessions or avoid disappointing the therapist. But he only
succeeds in deceiving himself as well as others, and ultimately cheats himself of effective
treatment.
in this context, the work with children and adolescents poses particular problems
and specific challenges: the child and adolescent psychotherapist has both the legal and
professional duty to give priority to the welfare of the young person. there are countless
problematic situations. For example, what happens when the patient is a child who has
abused or continues to abuse another child? Who must be protected? What happens
during treatment if an adolescent patient discloses that he is committing this type of
offence? there are no easy answers. Within the Clinic there are divergent attitudes. John
Woods, a colleague, has written about his work with adolescent abusers. in his book:
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