Limits and Structure in Child Group Psychotherapy

The number of patients seen by a therapist, say in a day, or rather those who are alive in the therapist's mind, make up a group. Though they may never meet each other they may also be alive in each other's mind. Some days therefore I have an interesting “group” consisting of a boy aged 12 struggling with bi-sexuality, a Bosnian refugee raging about his internal war, a rock musician who finds he can only relate to others from on a stage, a family with an anorexic teenager and a pregnant woman with a history of bulimia. These people relate to each other only through me, as I am the therapist for each of them; however, the therapeutic contact that each has is affected by what I choose to take up, not just with that one but with all, and by the way I respond to them all. Just as the heart of psychoanalytic psychotherapy is the quality of relationship between therapist and patient so is the state of mind of the therapist profoundly influenced by his experience of all his patients. These internal groupings are not limited by time or by any other external constraint such as compatibility of one to another. One of any therapist's patients may be in this way crucially related to someone who was worked with by that therapist, perhaps years before.

When patients are introduced to each other in actuality the therapist cannot predict what transpires. The therapist has no control over the significance each patient may have for another. The balance of power shifts dramatically. Thus we tend to speak of a “member” of a group rather than a “patient”. So if we play within the rules of external reality we must be more circumspect about whom we introduce to each other. There are no rules about group psychotherapy which will necessarily predict which combinations will be therapeutic or not. Experience shows that there are patterns of likely eventualities rather than rules, and there is a body of theory that conveys much of this experience. Group Analytic theory provide