Silence in group psychotherapy: a powerful communication.

Silence in a psychotherapy group, including leader, member, subgroup, and whole-group silence, is a common phenomenon with many possible forms, uses, and meanings. Five common sources of silence in group psychotherapy are described: situational factors, individual dynamics, member-to-member interactions, group dynamics, and leader-related dynamics. Silence can reflect defenses or indicate conditions favorable to intensified group work. Silence, sometimes mistaken for psychological inactivity, should be viewed as significant communication.

The missed session in psychodynamic group psychotherapy.

Missed sessions in group psychotherapy are often overlooked or not talked about, thus forfeiting an important therapeutic opportunity. Group members miss meetings for many different reasons, be they the result of real-life events or clinically driven occurrences. Missed sessions can have important emotional and metaphorical meanings for the missing member, the other group members, and the leader. Countertransference difficulties may interfere with optimal exploration of the many meanings of missed sessions. Five clinical examples illustrate meanings that may reside in the missed session. A cancellation policy that provides a framework for such exploration is recommended.

Using mind-body techniques in dentistry.

Mind-body medicine is a win-win proposition for dentists and their patients. Patients experience less anxiety and less discomfort during procedures. However, it's important to know the advantages and disadvantages if you are considering offering mind-body services in your practice.

Leadership of mental health consultation groups: a model for group therapists.

Group therapists often lead consultation groups. For effective leadership it is important to distinguish between consultation groups and psychotherapy groups. A consultation group is one in which a leader serves as consultant to the members. Group process variables of task, contract, role of the leader, and effect of the larger system should be understood by the consultant. The process of defining, testing, and maintaining these variables encourages exploration of resistance and parallel process, and is an important aspect of the ongoing learning. Consultation group leaders should understand the importance of serving as group leader but not group therapist.

The ill therapist: therapists' reactions to personal illness and its impact on psychotherapy.

This paper examines the potential countertransference problems therapists face when they become ill. Personal illness creates conscious and unconscious dilemmas for therapists, and the psychotherapy relationship may be strongly affected by the ways in which the dilemmas are managed. Psychotherapy is a relationship based on trust. A therapist's illness does not necessarily damage the trust that has been developed; however, the handling of the illness and interruption can create a major rupture in the relationship. Alternatively, the therapist's illness can create a useful opportunity for therapeutic work. Successful management of countertransference is a crucial ingredient for the latter outcome. Relatively little has been written until recently on countertransference aspects of therapist illness. Available literature has noted such defenses as denial, omnipotent fantasies, and reaction formation against dependency and weakness. Illness has been seen as a problem for "older" therapists, but, in fact, illness can occur at any age. Illness may cause a defensive withdrawal from one's patients and in its most serious instance lead to total empathic failure. Clinical concerns for the ill therapist fall into two categories: how much (if any) information to give patients about the illness and how to work therapeutically with patients' reactions. While there are no clear guidelines, we recommend a flexible, common sense approach with the central focus always on the patient's reactions to information or to changes in the therapy. The foundation for decisions about information and for subsequent processing of reactions must be the therapist's own awareness of countertransference. We recommend consultation with trusted colleagues or supervisors. In addition, we emphasize the ethical responsibility every therapist has to provide for patients in the event of an emergency ahead of time. Finally, we surveyed a small number of experienced therapists who were known to have had personal experience with illness. The results indicated that decisions about giving information were not difficult. However, the countertransference reactions of anxiety, denial, sadness, and avoidance (of patient anger) were often troublesome. We recommend that psychotherapy training include management of therapist illness. We also recommend that supervisors be familiar with the countertransference aspects as they may be called on suddenly to give consultation. Our conclusion is that therapist illness is as big an event for the therapist as it is for the patient, and we hope that a body of literature will be developed on this important topic.