ABSTRACT
This paper is concerned with the problems incurred when patients with the same pathology are grouped together for the purposes of treatment. I aim to describe how, in the case of designated drug and alcohol groups, highly narcissistic individuals attempt to only engage in group therapy at a ‘false-self’ level, which if unchecked, can result in a therapy group where no one is properly the patient. I begin with a case example in which I particularly wish to emphasise the therapist's experience of strong feelings of being repulsed and excluded, which link to the patients' anxieties about the therapist. A group member's image of a ‘Magpie's eye’ gave this anxiety a concretised form for the group and in so doing demonstrated the particular value of the pictorial images in processing this material. I then discuss the theoretical issues this raises, beginning with how narcissistic pathology manifests in patients unifying, by over-identifying with each other's perceived similarities, against the therapist. This results in the therapeutic resource of individual differences within the group being seen as a threat. I suggest that art therapy is particularly useful in this setting because the use of image-making facilitates an engagement by proxy of those individual differences, otherwise resisted in the group relationships.
