Conflict in Group Therapy of Chronic Schizophrenics: Coping with Aggression

This paper describes a pivotal group session in which there was a major conflict between two members of a group that has met for many years. The group serves chronically ill outpatients suffering primarily from schizophrenia or schizoaffective illness. The aftershocks of the explosive outburst, the leaders' understanding of the contributing factors, countertransference feelings, and coping mechanisms are described. The literature recommends two pathways concerning the expression of anger and aggression in groups of severely disturbed individuals: restriction of intense negative affect or expression of such affect as a helpful component of a therapeutic process. We reflect on this question in sharing detailed clinical material and conclude that coping with aggression in such groups is dependent not only on the group context, but also on the relative fragility, strength, and tolerance of both members and leaders. A crucial step in dealing with eruptive crises consists of reflecting upon the leaders conscious and unconscious intervention motives and affects.