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This book contains eleven selected papers on difficult topics group therapists encounter in their work. Based on the author's forty years in the field, these papers include the topics of shame, courage, hostility, combined individual and group therapy, money, indirect communication, difficult patients, silence, and the missed session. Written from a psychodynamic orientation with a relational emphasis, they pay special attention to countertransference. An autobiographical introduction to each paper discusses what experiences have led the author to write on each topic. These introductions honor the role that personal experience has played in the evolution of Dr Gan's therapeutic presence.

This paper, written from a relational perspective, examines the final minutes of an individual psychotherapy session, and is organized around the topics of boundary negotiation, unwitting self-disclosures, visual challenges, and countertransference. Attending to session-ending material is important because the separation involved lends heightened emotional intensity to the often-significant material that appears in the final minutes. This material often serves as a bridge to the psychotherapeutic work to be taken up in subsequent sessions. Session-ending dynamics call upon the therapist to prioritize empathy, validation, and support for the patient suffering from early deprivation; identify and heal narcissistic injury in the patient wishing to be special; judiciously alter the frame when doing so will benefit the patient and not constitute a boundary violation; avoid re-traumatization; admit mistakes; confront blatant denial; advance agency; address uncomfortable topics; set appropriate limits; and deal authentically with uncomfortable countertransference. Numerous clinical examples serve to illustrate these clinical phenomena.

This article discusses an important leadership function: calling attention to phenomena in group therapy that are NOT observed or observed but not commented on by group members. The article includes group scenarios that often generate member omission, ways to mitigate shame that can result from uncovering members' blind spots, and misuses of this leadership function. Numerous clinical examples are provided. Concepts borrowed from attachment theory and interpersonal neurobiology help explain how the group's internalization of this leader function may help the group become a more potent therapeutic environment. The limited contribution of neurological findings to clinical decision-making is discussed.

Although what transpires in group therapy is not gossip per se-except perhaps when absent or former members are discussed-listening to group interaction through an understanding of the dynamics of gossip can contribute to a greater appreciation of group dynamics and group leadership as well as enlarge therapeutic space. After examining the interpersonal dynamics of gossip, this paper discusses six ways in which an understanding of these dynamics can inform group leadership and shed light on group psychotherapy. Central features of gossip that appear in group interactions are explored: These include projection, displacement, self-esteem regulation, clarification of motivation, unself-consciousness, social comparison and bonding avoidance of psychic pain, and making the ego-syntonic dystonic. The lively use of imagination in the mature phase of group therapy is conceived of as the time when the darker side of human nature-imagined gossip harnessed for therapeutic purposes-can be welcomed in and processed in a kind, playful, and compassionate manner. Adapted from the source document.

Although what transpires in group therapy is not gossip per se-except perhaps when absent or former members are discussed-listening to group interaction through an understanding of the dynamics of gossip can contribute to a greater appreciation of group dynamics and group leadership as well as enlarge therapeutic space. After examining the interpersonal dynamics of gossip, this paper discusses six ways in which an understanding of these dynamics can inform group leadership and shed light on group psychotherapy. Central features of gossip that appear in group interactions are explored: These include projection, displacement, self-esteem regulation, clarification of motivation, unself-consciousness, social comparison and bonding, avoidance of psychic pain, and making the ego-syntonic dystonic. The lively use of imagination in the mature phase of group therapy is conceived of as the time when the darker side of human nature-imagined gossip harnessed for therapeutic purposes-can be welcomed in and processed in a kind, playful, and compassionate manner.

Unwitting self-disclosures (USDs), unconscious yet observable parts of personality, are often behavioral relics of past suffering and, as such, constitute valuable though frequently underutilized clinical information. While ego-syntonic aspects of personality can be commented on with impunity, dealing therapeutically with patients' USDs-manifestations of their blind spots-requires sensitivity, empathy, and timing. Providing many clinical examples of patient and therapist USDs from individual and group psychotherapy, this report discusses the origins, possible meanings, and the countertransference and empathic challenges encountered in the handling of these blind spots. The importance of establishing a narcissistic alliance and of employing the methods of the existential school of psychotherapy in processing USDs is described. Self-aware therapists can minimize the clinical impasse that may result when therapist-patient blind spots overlap.

\" \"The therapist should monitor the nature of the emotional bonds and commitment of the members and help the group attain a dialectic balance between needs for relatedness and communion on the one hand, and needs for autonomy and differentiation on the other.\\n Pandering to insurance companies, which our practitioners already have good reason to distrust, will only serve to tarnish the Guidelines. When I was in medical school, there were certain undeniable truths: excess stomach acid causes ulcers, the body's underproduction of insulin is the only cause of diabetes, and patients suffering myocardial infarctions should remain at bed rest for several weeks.

Most group therapists rely on clinical interviews to screen prospective group members' suitability for long-term, open-ended, psychodynamically oriented group therapy. Faulty selection is detrimental to everyone involved and can even lead to the demise of the group. In order to avoid, or at least significantly limit, premature terminations or problematic mismatches between a patient and the rest of the group, pre-group screening needs to examine reality factors, resistance, ambivalence, and their interplay. Therapists need to be aware of countertransferential pressures that affect the screening process. The careful exploration of six specific areas during the clinical interview process increases the likelihood of optimal patient selection and participation. A selective literature review and clinical examples are provided.