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Group psychotherapy is especially indicated when the patient's character defenses constitute a source of resistance in individual psychotherapy. These defenses may or may not be evident in the one to one situation. The therapist may know they are there, but their manifestation and ego syntonicity may make them particularly difficult to get at. In a group situation, they will stand out with greater salience, and the individual, when confronted with his defensive maneuvers, will be less able to deny them and less free to act them out in treatment.
An example of this would be compliance as a characteristic way of warding off anger or criticism, originally that of the parent and now, transferentially, that of the therapist. The compliance may be manifested as “good patient” behavior, and indeed be so well carried off that therapeutic work appears to be progressing when, in fact, it is not. The therapeutic alliance is with the conforming child, and no real inner change takes place.
At this point it is necessary to make a distinction which is often overlooked in the selection of patients for group. This is the distinction between character defenses and character structure. It is because they are often equated, that patients are sometimes erroneously referred for group psychotherapy.
A character defense is a behavior (overt or covert) which may have a number of aims—to ward off anger or disapproval, to win