10 Pages

Axis II Had Me Spinning

Dear Consultant: The more group therapy I do, the more I realize that my understanding of defenses from my individual psychotherapy practice has only limited applicability to my group work. Like many of my colleagues, I began as a group therapist in a clinic setting and then took my group private when I left the clinic. In the clinic however, and even after, I had no real training in group therapy, with the operative assumption in the clinic being that my individual therapy experience would suffice. From my individual work, largely with healthier patients, I am familiar with such higher-level defenses as repression, sublimation, and projection. In my group work, however, especially with the more primitive patients I now treat, many from Axis II, cluster B (the “dramatic-erratic” personality disorder cluster), I often feel in over my head. The intense conflict between members and the fluidity of what members experience at any one time have been puzzling to me. It’s a lot different from having an individual patient in the office whose affects are predictable from week to week.