Group Psychotherapy of the Psychoses: Concepts, Interventions, and Contexts

Clinicians who work in psychiatric settings are routinely faced with a host of challenges when providing psychotherapeutic services to persons whose psychiatric disorders can include chronic and acute presentations of major psychotic, affective, and personality disorders. Although much has been written about the positive and negative aspects of providing individual psychotherapy for this patient population, little has been written about the efficacy of group psychotherapy. This apparent neglect has been attributed to the belief that patients with psychoses cannot benefit from group treatment or that when group sessions are used, they are highly structured and psychoeducationally oriented, with minimal emphasis given to process or interpersonal dynamics—in essence, not "real" psychotherapy groups.

The editors of Group Psychotherapy of the Psychoses, Victor L. Schermer and Malcolm Pines, have taken on the task of addressing this topic as well as the challenge of arguing that group psychotherapy can be an effective treatment for patients with psychoses. The book comprises a collection of papers written primarily from a psychoanalytic and psychodynamic perspective that address the theory and contextual issues of group psychotherapy of inpatients and outpatients with psychotic disorders. Several of the contributors have broadened the category of psychoses to include schizoaffective, bipolar, and borderline personality disorders.

As a psychologist who works with patients with major psychiatric disorders, I was particularly interested in learning how others in the field have conceptualized this type of intervention and how they dealt with the practical aspects of running these groups. What I found instead, however, was a great deal of background and theory with less emphasis than I had hoped for on the practical side of running groups. Nevertheless, much useful information is spread throughout the various chapters, although not always easily accessible, as it is embedded in the technical discourse of the psychoanalytic literature and often not well summarized. Some chapters include transcripts and summaries from group sessions. This material could perhaps have been processed more fully either from a theoretical or practical perspective.

Among the more interesting topics covered in the book are supervision issues, in a chapter by Eugene Della Badia; expressive group psychotherapy, by Tetsuro Takahashi, Glenn Lipson, and Lane Chazdon; and assessment and pharmacotherapy issues, by Alan M. Gruenberg and Reed D. Goldstein. One particularly concise, informative, and useful chapter is Nick Kanas' "Group Therapy With Schizophrenic and Bipolar Patients." Kanas summarizes several clinical issues, including appropriate boundary and goal setting, and emphasizes that group psychotherapy is most efficacious when it is integrated with educational, psychodynamic, and interpersonal theories and techniques and when it is conducted in tandem with pharmacotherapy.

Overall, this book offers a great deal of useful information, although because of the contributors' style of writing, it is not always easy to locate. Group Psychotherapy of the Psychoses is not for everyone who provides psychotherapy to this patient population, but the interested and diligent reader may find much that is relevant and applicable. The authors make a very good case for the use of group psychotherapy in the treatment of psychotic disorders—a refreshing and encouraging point of view in an age when medication and behavioral management priorities tend to eclipse the intra- and interpersonal world of the psychiatric patient.