Bereavement and heightened existential awareness.

"Ask not for whom the bells toll; they toll for thee." John Donne's admonition, though written 350 years ago, endures with astonishing freshness; it speaks to something self-evident, to a truth that is well known to many who have experienced bereavement--that the death of a significant other has the potential to hurl the survivor into a confrontation with his/her own death. A confrontation with death--should we seek it? There is evidence in the clinical literature that in terminally ill patients such a confrontation may lead to pronounced positive psychological changes. Research (Yalom 1980) has documented that terminally ill patients may undergo a series of positive personal changes; they communicate more openly with family and close friends, they experience fewer fears, they rearrange their life priorities, they are less preoccupied with the trivialities of life, they live life more immediately rather than postpone experience and pleasure into the future. Does spousal bereavement in our culture confront individuals with their own personal death? Does it cause some widow/widowers to regard their existence in a different manner? If so, might it be possible that those bereaved individuals who examine their life deeply may have a different course of bereavement than those who do not look within? Might it even be possible that bereavement, for some individuals, results in psychological shifts analogous to the positive changes reported by terminally ill patients? These are the basic questions of our research inquiry. We designed a project which would allow us to determine, in a nonclinical sample of bereaved spouses, differences in the degree of existential awareness and the consequences of such awareness on the course of bereavement. We also attempted to determine which subjects were more likely to develop heightened existential awareness. The participants studied were part of an intervention project on bereavement in which we studied a sample of widows and widowers in the first few months of bereavement and then offered them an opportunity to participate in an eight-meeting support group. Reports of the clinical issues emerging in our short-term bereavement groups and of the efficacy of these groups were published elsewhere (Yalom and Vinogradov 1988; Lieberman and Yalom 1991).

Approaches to chemical dependency: chemical dependency and interactive group therapy--a synthesis.

Though the focus on interpersonal interaction is a powerful therapeutic factor in group therapy, traditional chemical dependency therapy groups generally fail to employ the interactional group orientation. An interactional approach can be effectively applied to alcoholics if the following guidelines are observed: (1) recovery is always accorded priority, (2) the patient accepts identification as an alcoholic, (3) anxiety is carefully modulated, (4) the proper distinction is made between what the alcoholic is and is not responsible for, (5) the therapist is thoroughly familiar with Alcoholics Anonymous language, steps, and traditions. It is important that therapists not permit misperceptions of A.A. to be used as therapy resistance and that they be able to harness the wisdom of A.A. for psychotherapeutic ends. Group therapists must also be prepared to deal with common themes arising in the treatment of the alcoholic patient: idealization, devaluation, externalization, defiance, grandiosity, conning, and avoidance.

Alcoholics in interactional group therapy: an outcome study.

Three interactional therapy groups of alcoholic patients (N = 20) were formed, and treatment outcome after eight months and again after 12 months of therapy was compared with the outcome of 17 neurotic patients in comparable therapy. Outcome assessment was obtained from three sources: patient, therapist, and independent judge, using both nomothetic and ideographic measures. The results indicated that although more alcoholic than neurotic patients terminated therapy within the first six sessions, a higher percentage of alcoholic patients remained in therapy for 12 months. At the end of 12 months, both samples had improved along a wide variety of variables, and there were no significant differences between the alcoholic and neurotic population in degree of improvement.

Group therapy with the terminally ill.

The authors describe their four-year experience with a therapy group for patients with metastatic carcinoma. Patients in the group are helped by helping one another, by moving out of a morbid self-absorption, and by finding that they have much of value to share and to teach. The most important aspect of the group experience is the "presence" it offers; patients find support and the opportunity to express their needs and fears openly. The authors believe that group therapy is a valuable modality for the treatment of terminally ill patients and that much can be learned from such groups for the everyday therapy of the living.

The impact of a weekend group experience on individual therapy.

Thirty-three patients in long-term individual therapy were referred to one of three weekend groups: two experimental (affect-arousing, gestalt therapy) groups and one control (meditation-Tai Chi) group. The impact of the weekend group experience (WGE) on individual therapy was examined six and 12 weeks later. At six weeks the patients in the experimental groups showed, on some measures, a significantly greater improvement in their individual therapy than did controls. By 12 weeks, there were no demonstrable differences. The WGE was not without risk: even though the group leaders were highly trained, responsible clinicians, two patients suffered considerable psychological damage. The control (meditation-Tai Chi) group offered a relatively innocuous experience; there was no risk, but few members found the specific procedures useful in their lives. Intense affect arousal in the WGE was not related to positive change in subsequent individual therapy. Those expressing the greatest affect in either experimental group were no more likely to have had a measurable positive impact on their subsequent individual therapy than patients expressing little or no measurable affect.

Interational group therapy with alcoholics.

The techniques used and problems encountered in interactional group therapy with alcoholics are descussed.