The structural and strategic format of Interpersonal Group Psychotherapy is similar to traditional forms of psychodynamic group psychotherapy, but it also differs in several important ways. The design of the IGP method responds to an integration of diagnostic and etiologic factors specific to the borderline disorder. The aim of this chapter is to illustrate the process of change within the context of group interactions and to describe the phases of the treatment. (31 pp.)
Download Author: Monroe-Blum, Heather
Phases of Group Process
For the IGP therapists, the most important task is to recognize and manage their subjective reactions to the treatment dialogue. When this is adequately managed, treatment progresses; when it is ignored or badly managed, treatment derailments and eventual failure are the result. (43 pp.)
Intersubjectivity and the Management of Group Derailments
Therapeutic derailment occurs when a therapist action or inaction results from a failure to understand the contextual features of patient-therapist transactions. Given the ubiquitous occurrence of complex and confusing transactions in all forms of psychotherapy, especially with borderline patients, IGP’s aim is to focus on understanding the precipitants, manifestations, and management of therapeutic derailments. (34 pp.)
Training of Therapists
The training program for the IGP therapists shares the aims of other efficacy treatment programs. Effective training programs are essential for clinical research whose task is to demonstrate posttreatment outcome effectiveness. Sorting out the differences between training and treatment effects is particularly important when the patient population, BPD patients, is known to be difficult to engage in any treatment program. (32 pp.)
Interpersonal Group Psychotherapy: An Illustration
An analysis of an entire group process is presented to illustrate the major group themes, their contextual meanings, and the therapists’ responses. In addition, the responses of several patients selected from three diagnostic subgroups of the borderline disorder are used to illustrate differences in their respective contributions to the process. (51 pp.)
Treatment Outcome
The treatment trial in which IGP was compared with individual psychodynamic psychotherapy showed that borderline patients benefit from both forms of treatment. (26 pp.)
Interpersonal Group Psychotherapy for Borderline Personality Disorder
How do you work with a patient who has intensely conflicted, unstable relationships with others and who seems to move from one full-blown crisis to the next? Therapists who treat such patients–usually diagnosed with borderline personality disorder–have found their efforts hampered not only by the nature of the disorder but also by problems in its classification and the lack of empirical data supporting particular treatment strategies. Now, in this innovative book, clinicians have an effective, standardized model of therapy that will limit the patient’s ability to derail the therapist’s efforts.
Built on the solid foundation of a six-year treatment comparison trial, the interpersonal group psychotherapy model fully detailed here focuses on the current relationships in the patient’s life. The research study showed that individual psychodynamic psychotherapy, which emphasizes the developmental genesis of the borderline disorder, leads down a much longer and more costly road–but with outcomes equivalent to the group model. By zeroing in on the affective significance of the patient’s lifelong search for more gratifying and secure relationships, the therapist can address a key feature of the disorder found in all its subtypes.
With group therapy, the therapist is able to dilute the powerful transference reactions commonly found in individual therapy with borderline patients. In interpersonal group therapy, the patient is also able to form new, positive identifications with others.
This guide, generously illustrated with extensive clinical examples, has been designed to be used in a broad range of treatment settings and employed by an extensive array of mental health professionals: psychiatrists, psychologists, social workers, and nurses. (324 pp.)
Reviews
“Once again the authors have brought their years of experience to hear on a subject that continues to bedevil clinicians. This groundbreaking, lucidly written book is a superb introduction to an innovative treatment approach. It is at once a scholarly synthesis of theory and research and a practical guide to managing therapeutic impasses. It will provide both trainees and seasoned practitioners with fresh insights and new perspectives.
–Arlene F. Frank PhD
Nashua Brookside Hospital
“A practical and well-designed model for treating borderline personality disorder that should be useful in a diversity of settings. This is an important contribution to an area of great therapeutic need and public health importance.
–Allen Frances MD
Duke University Medical Center
“I am impressed not only by the effectiveness of this new form of treatment but also by the diligence, dedication, and drive of the authors, who get top ratings for how well they apply their sophisticated and special contribution to research to everyday clinical practice.”
–Lester Luborsky PhD
University of Pennsylvania
“This is exactly the kind of book the therapy field needs–rich in clinical detail yet firmly grounded in theory and research. In addition to describing (rather than selling) their group treatment approach very clearly and explaining its well-developed object-relations rationale, the authors make clear their commitment to evaluating efficacy with rigorous research. Take note: Marziali and Munroe-Blum are scientist-practitioners par excellence.”
–Varda Shoham PhD
University of Arizona
Diagnosis of Borderline Personality Disorder
Borderline personality disorder eludes meaningful definition. Diagnostic questions abound. Is it a personality disorder? Does it comprise a group of syndromes? Is it a level of severity of psychopathology? Over the past fifty years clinicians and clinical investigators have addressed these questions. However, there remains little consensus on which sets of criteria are specific to describing patients with BPD and whether the classification is useful in clarifying prevention and treatment strategies. (39 pp.)
Etiology
Although most acknowledge the possible influence of genetic, constitutional, neurobehavioral, and early developmental factors, clinicians disagree on which of these features is more important in determining the presence of borderline pathology in adults. Historically, the best formulated and most persuasive postulates regarding the etiology of the borderline syndrome have come from psychodynamic models of personality development that infer from the adult patients’ reconstructions of past experiences possible intra- and interpsychic models of separation-individuation and identity formation. It is likely that many etiologic hypotheses obtain and that there are multiple causes to the onset of BPD. (55 pp.)
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