title: [Serious personality disorder and the analytic group].
abstract: The author describes in this paper how an analytic group deals with members with serious personality disorders. The extent of the seriousness of personality disorder may manifest either in pathological organization or by the presence of psychotic or autistic features. The vignettes presented are from the initial phase of, and a period two years after, an analytic group. One vignette illustrates a middle-aged woman suffering from chronic depression with autistic features. The basic principles of conducting and understanding an analytic group from the perspective of object relations theory involve several points, the first of which is the understanding of group dynamics through basic object relational concepts, such as projective identification and unconscious fantasy, which will often be concretely enacted in the group. The second point is that the group therapist should maintain a "triangular" perspective, consisting of (1) the group as a whole, (2) individual patients, and (3) the therapist. Third, the analytic group will function best if the therapist can facilitate it in a "rotating triangle" manner, consisting of (1) actors and (2) reactors "on stage," and (3) observers in "audience," all of which should be rotating and shifting in turn. With this understanding and using these techniques, the therapist needs to monitor and address the concretely enacted destructive unconscious fantasies in the group as a whole, which are characteristic to a group composed of clients with severe personality disorders. At the same time, the author argues, patients with pathological organization and psychotic or autistic features would tend to use the group as an autistic-object or a non-human exoskeleton, to which they may cling to so strongly that the group would require an intervention and containment on both physical and sensual levels; this would often be performed by members with psychotic personality features, rather than the therapist.
authors.affiliation: Asada Hospital.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Asada
mesh_terms: D005260:Female; D006126:Group Processes; D006801:Humans; D008297:Male; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy*; D011615:Psychotherapy, Group