book review

Complex Dilemmas in Group Therapy: Pathways to Resolution

• review by Irena Domachowska

A therapist working within the framework of psychodynamic psychotherapy has to concentrate not only on the patient’s story, but also needs to be aware of the ongoing transference and countertransference dynamic, projective identifications and other defense mechanisms. It makes the therapy process quite challenging for the psychotherapist. All these challenges multiply in a group setting, where the therapist has to be aware of the interactions between the clients and him or herself, but also between the clients. Not all standard psychotherapy trainings include address issues specific to group therapy and it is commonly assumed that experience in individual therapy would suffice to successfully lead a group. Young therapists are often placed in a role of a trainer or co-trainer without enough preparation. It is therefore not surprising that they experience doubts about complex group situations and seek advice from other, more experienced therapists.

The book Complex Dilemmas in Group Therapy: Pathways to Resolution edited by L. Motherwell and J. J. Shay is a collection of clinical problems encountered by group therapists. The problems are answered and explained by experienced practitioners in the field. The chapters are organized around few key concepts: boundary issues, difficult patients, defenses, therapists reactions, substance abuse issues and leadership challenges. To provide theoretical underpinnings for the discussed problems, the theoretical concepts are introduced and explained at the beginning of each chapter. The theories guiding interventions as well as the historical development of certain concepts are shortly reviewed and summarized. Unfortunately, I found the theoretical introductions quite difficult to read, as they were often written in an abstract and dry language. In general, I found them too condensed for someone looking for more theoretical approach, but too theoretical for practitioners.

The theoretical issues are followed by incidences of concrete group dilemmas, presented in form of letters. The fictitious letters are based on real letters sent by practitioners to the “Consultation, Please” column in the American Group Psychotherapy Association’s newsletter. Therefore, even though the problems described in the book are manufactured in order to fit better within each category, they feel very “real”, which makes it easy to relate to the therapist in this situation. Each letter/problem is independently answered by two senior group therapists, usually working within different theoretical approaches (e.g., psychoanalytic and object relations theory). For example, one of the chapters evolves about a dilemma involving a female therapist and a group of patients, in which anger and serial scapegoating lead to a gradual disintegration of the group. An analytically oriented senior clinician interprets the female therapist’s feelings of insecurity and powerlessness as elements of projective identifications that her patients experience in the group. As a way of coping with their own insecurities, the patients blame others in an attempt to dominate them. As a possible remedy, the senior clinician suggests to thoroughly discuss with patients their expectations and group norms before they join the group. The second clinician, working in the object relations theory framework, suggests evoking patients’ curiosity about other group members, as a mean to contain the aggressive projections. Other issues covered in this chapter are i.e. reactions of group members to the therapist’s pregnancy and group boundaries issues. The provided answer never offer a simple solution to the problem, but rather offer multi-facetted interpretations and suggestions.

In general, I would recommend this book to psychodynamic psychotherapists who already have some work experience with groups and would like to compare their experiences with other therapists and read advice from more experienced colleagues.