Current interest in shame is examined in its relationship to psychotherapy supervision. Clinician/trainees are vulnerable to exposure and humiliation in the course of their training. This article examines the sources of shame in supervision and offers some suggestions for reducing the shame that might compromise the professional well-being of neophyte clinicians and their supervisors.As the pendulum swings around to more concern about affects in psychoanalytic theories, we have come to see shame and guilt as important byproducts of the uncovering analytic process. Psychoanalytic writers define shame and guilt in a variety of paradigms consistent with their theoretical emphasis. Shame is distinguished from guilt in the psychoanalytic literature by Piers & Singer (1953), who defined guilt as the painful result of a transgression of a superego boundary, and therefore a willful act; shame, on the other hand, is a defect in the self that prevents the person from living up to the ego-ideal. Whereas guilt leads to castration anxiety, shame leads to abandonment and hiding. Furthermore, whereas a person usually feels guilty or not guilty, shame can be experienced along a whole spectrum of discomfort, ranging from awkwardness and embarrassment all the way to corrosive humiliation and fear of disintegration.Freud (1912/1963) and other drive theorists place shame as emerging from the exhibitionistic wishes and fears of the individual. Later in development, anal impulses around the loss of control generate shame. Still later, guilt emerges around the wishes to overwhelm the competitor in the oedipal triangle.
The author provides an overview of critical factors in the working phase of group psychotherapy from the perspective of psychodynamic theory. The discussion is organized around a clinical vignette to illustrate various types of intervention such as past, here and now, future; individual, interpersonal, group as a whole; in group--out of group; affect-cognition; and understanding--corrective emotional experience. The critical "windows into the unconscious," transference, counter-transference, and free association, are also discussed in terms of the clinical example. The author concludes his article with a few thoughts about the future of psychodynamic theory in relationship to group treatments.
The authors describe a range of critical issues that are common within homogeneously composed groups for patients suffering from Acquired Immunodeficiency Syndrome (AIDS) and AIDS Related Complex (ARC). They examine the need for these patients to understand their physical symptomatology, to reconsider life's priorities, and to confront their ethical and moral dilemmas. The authors also highlight special effects, unique group atmosphere and process, and the nature of the group contract that is essential for these patients.
Group therapy is emerging as a favored treatment for eating disorders. Open-ended psychodynamic group therapy is an effective treatment for the underlying conflicts in eating-disordered patients, yet these groups are difficult to form. The authors suggest a specific sequence using time-limited psychoeducational groups initially for symptom control, then offering an open-ended group for patients who are ready to address deeper issues in a group therapy setting.The incidence of anorexia and bulimia nervosa continues to rise. Investigators estimate that 5-10% of adolescent girls and young women are affected by eating disorders (Pope et al., 1984). Despite the great attention and interest these disorders have received from researchers, clinicians, and the media, a destructive preoccupation with thinness persists in young women. Several promising treatment modalities have emerged, but no single treatment has been shown to be universally effective. Among the treatments that have been reported to be useful alone or in combination are pharmacotherapy, family therapy, nutritional therapy, individual psychotherapy (psychodynamic, cognitive-behavioral, behavioral) and group psychotherapy. There are five major models of outpatient group therapy for eating-disordered patients: psychodynamic psychotherapy groups, cognitive-behavioral groups, psychoeducational groups, self-help groups, and combinations.Group therapy is emerging as a favored treatment for patients with bulimia nervosa (Herzog, 1988). Furthermore, there are many types of group therapy available for eating-disordered patients. Effective decisions about which type of group to recommend for patients are difficult because many different forms are touted to be effective. Time-limited psychoeducational groups and cognitive-behavioral groups have received wide acclaim for results in decreasing bulimic symptoms, while open-ended psychodynamically oriented groups are reported to repair the gaps in ego structure necessary for long-lasting recovery
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