Peer supervision groups (PSGs) are attractive to psychotherapists for many reasons, including ongoing consultation and support, networking, and combating professional isolation. These leaderless groups offer opportunities for interpersonal learning from peers, and the parallel process within PSGs can be an important consultative tool. Unfortunately, many PSGs fail. PSGs benefit from careful attention to contract, task, gatekeeping, and group process, including resistances and dynamics of competition, and shame.

This paper examines the potential countertransference problems therapists face when they become ill. Personal illness creates conscious and unconscious dilemmas for therapists, and the psychotherapy relationship may be strongly affected by the ways in which the dilemmas are managed. Psychotherapy is a relationship based on trust. A therapist's illness does not necessarily damage the trust that has been developed; however, the handling of the illness and interruption can create a major rupture in the relationship. Alternatively, the therapist's illness can create a useful opportunity for therapeutic work. Successful management of countertransference is a crucial ingredient for the latter outcome. Relatively little has been written until recently on countertransference aspects of therapist illness. Available literature has noted such defenses as denial, omnipotent fantasies, and reaction formation against dependency and weakness. Illness has been seen as a problem for "older" therapists, but, in fact, illness can occur at any age. Illness may cause a defensive withdrawal from one's patients and in its most serious instance lead to total empathic failure. Clinical concerns for the ill therapist fall into two categories: how much (if any) information to give patients about the illness and how to work therapeutically with patients' reactions. While there are no clear guidelines, we recommend a flexible, common sense approach with the central focus always on the patient's reactions to information or to changes in the therapy. The foundation for decisions about information and for subsequent processing of reactions must be the therapist's own awareness of countertransference. We recommend consultation with trusted colleagues or supervisors. In addition, we emphasize the ethical responsibility every therapist has to provide for patients in the event of an emergency ahead of time. Finally, we surveyed a small number of experienced therapists who were known to have had personal experience with illness. The results indicated that decisions about giving information were not difficult. However, the countertransference reactions of anxiety, denial, sadness, and avoidance (of patient anger) were often troublesome. We recommend that psychotherapy training include management of therapist illness. We also recommend that supervisors be familiar with the countertransference aspects as they may be called on suddenly to give consultation. Our conclusion is that therapist illness is as big an event for the therapist as it is for the patient, and we hope that a body of literature will be developed on this important topic.

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Leaderless groups are found in a variety of settintgs, from self-help organizations to peer-supervision groups. Relatively little has been written about leaderless group dynamics, and most of the literature that does exist is pessimistic about long-term viability. The author offers evidence that long-term leaderless groups can function very effectively if certain tasks typically performed by the leader are assumed by the group. Leadership functions connected wit/h the contract, such as structure, gatekeeping, group norms, and adherence to task are crucial for long-term leaderless group survival. This article describes ways in which contract-related leadership functions can be handled by a leaderless group and gives examples from a leaderless womenr s group that is in its 1 7th year of continuous e-xistence.

During a routine couples psychotherapy, the wife became ill with terminal cancer. The couple continued their treatment through her illness, and the therapist helped the couple say good-bye to each other. The therapist decided to selfdisclose more than usual in service of greater connection with these clients. This article describes the therapist's feelings during the course of treatment and the steps she took to remain emotionally present for the couple. Suggestions for therapists who treat seriously ill patients are offered.