Feeling Worse Before Feeling Better: A Case of Increased Disorganized Mental States Following Group Psychotherapy

ABSTRACT

Is group therapy effective if it results in members revealing greater unresolved/disorganized mental states related to childhood trauma? That is, do patients have to more fully experience partially disavowed trauma before they get better? We found a small proportion of patients whose pre-treatment Adult Attachment Interview (AAI) transcripts were not coded as Unresolved/Disorganized at the start of group treatment, but were coded as such at the end. In one case report, we examined pre- and six months post–AAI transcripts and group therapy interactions to document the emergence of an unresolved/disorganized mental state. Despite the increase in disorganization, the patient showed some symptom improvement and improved reflective functioning. The 16-week psychodynamic group therapy allowed the patient to reflect on her traumatic experiences and their impact on her life. However, this also resulted in a disorganizing effect on her mental state. Longer-term therapy may be necessary to improve interpersonal functioning and affect regulation in patients who experienced early trauma.

Acknowledgments

Participants in the clinical trial described in this article provided informed consent to allow the data and video recordings to be used for research purposes. The case presentation and description of the group, therapist, and participants were de-identified and disguised so that neither the group nor the individual participants can be identified.

Additional information

Notes on contributors

Giorgio A. Tasca

Giorgio A. Tasca is an Associate Professor in the School of Psychology at the University of Ottawa, Canada. Hilary Maxwell is a Graduate Student in the School of Psychology at University of Ottawa, Canada. Megan Faye is a Graduate Student at Loyola University Maryland in Baltimore. Louise Balfour is an Associate Professor in the School of Psychology at the University of Ottawa, Canada.

Hilary Maxwell

Giorgio A. Tasca is an Associate Professor in the School of Psychology at the University of Ottawa, Canada. Hilary Maxwell is a Graduate Student in the School of Psychology at University of Ottawa, Canada. Megan Faye is a Graduate Student at Loyola University Maryland in Baltimore. Louise Balfour is an Associate Professor in the School of Psychology at the University of Ottawa, Canada.

Megan Faye

Giorgio A. Tasca is an Associate Professor in the School of Psychology at the University of Ottawa, Canada. Hilary Maxwell is a Graduate Student in the School of Psychology at University of Ottawa, Canada. Megan Faye is a Graduate Student at Loyola University Maryland in Baltimore. Louise Balfour is an Associate Professor in the School of Psychology at the University of Ottawa, Canada.

Louise Balfour

Giorgio A. Tasca is an Associate Professor in the School of Psychology at the University of Ottawa, Canada. Hilary Maxwell is a Graduate Student in the School of Psychology at University of Ottawa, Canada. Megan Faye is a Graduate Student at Loyola University Maryland in Baltimore. Louise Balfour is an Associate Professor in the School of Psychology at the University of Ottawa, Canada.