Enhancing the Dyad: The Benefits of Combining Group Therapy with Psychoanalytic Treatment

ABSTRACT

In this article, I consider the benefits of adding group therapy to psychoanalytic treatment. I describe the evolution of combined treatment, advantages of the group modality, and some of the reasons for therapists’ resistance to it. Through clinical example, I describe developmental blocks that became clear during a patient’s analysis, countertransference responses I became aware of during the analysis, and my assessment of the potential risks and benefits of adding group therapy. I then describe how some of the patient’s developmental blocks were engaged after the addition of group therapy, particularly highlighting the to-and-fro between modalities during working-through. Subsequent discussion addresses the indications for the addition of group therapy, specific therapeutic elements gained through combined treatment, and technical challenges confronting the combined therapist.

Notes

¹ My analytic chair is typically at a 45-degree angle to the couch, which allows me to see much, but not all, of the patient’s facial expressions from my chair. The patient cannot see me unless she looks back intentionally to do so. For more on the impact of the analyst’s chair placement, please see Sletvold (2014), and Emde (2009).

² The technical management of the patient’s privacy—that is, how the analyst handles information divulged in the individual setting before the patient is ready to bring it to the group, and how he deals with this material when it becomes a point of resistance—is covered elsewhere (Brabender et al., 2004). I will also not elaborate here on the fact that an analyst/group therapist must similarly protect the privacy of an individual patient by not sharing certain data with his cotherapist prematurely. In my experience, this kind of issue becomes a routine point for dyadic discussion for most patients in combined treatment, and as the combined treatment progresses, the patient’s inclination to keep psychological data away from the group and cotherapist tends to dissipate.

Additional information

Notes on contributors

Andrew I. Smolar

Andrew I. Smolar, M.D., is Training and Supervising Analyst and Current President, Psychoanalytic Center of Philadelphia; and Associate Clinical Professor of Psychiatry, Temple University.