Medicine as metaphor and medium in group psychotherapy with psychiatric patients

Interpretive work in milieu groups

Interpretive work in milieu psychotherapy groups aims to bring concealed and hidden material to the fore so that it can be discussed openly. A host of clinically important issues thrive in the milieu, about which the patients are fully aware, but are unable to discuss. Two types of interventions are described whose goal is to overcome resistance to discussion; they are clarifying interpretations and making a parallel statement. Clarifying statements help patients understand their experience in the milieu; they are interpretive when they bring avoided material into the open. In those instances where resistance to discussion is great, the subject first appears in metaphor, is worked with, and then emerges in a displaced form. Working indirectly with metaphor and displaced material can serve to overcome transference resistance. The therapist then need only ask a direct question or make a statement in order for the avoided material to emerge. The combination of working with displaced material followed by a question or statement that is framed in terms of that theme has an interpretative function.

Previewing: a developmental principle that promotes the therapeutic use of metaphor

When one is treating mother-infant dyads psychotherapeutically, the infant's inchoate language skills render the traditional use of metaphor ineffective. This paper discusses how a developmental principle, labeled previewing, may function like a metaphor and be used to address the therapeutic needs of the dyad. Previewing and metaphor also may complement each other in the treatment of adults in individual therapy. Previewing--like metaphors--may provide a means of addressing interpersonal issues, may function as a shared language that promotes intersubjectivity, and may help the patient deal with conflict in a non-threatening manner that may circumvent defensive operations.

Antidepressants in group psychotherapy

This article alerts us to consider depression as a relatively frequent cause of impasse in the course of group psychotherapy. The authors recommend the combined use of antidepressant medication along with group psychotherapy when such depression is confirmed independently outside the group. Common obstacles and pitfalls preventing successful combined treatment are reviewed; the depressive logjam is differentiated from common resistance; and profiles of responders versus nonresponders are described. A rationale of the combined treatment, its results, and implications for group therapists are all delineated.