ABSTRACT
Individual therapy for persistently and severely mentally ill persons has evolved from treatment based primarily on drive theory to more flexible adaptive approaches based on more recent models privileging "relationships". Clinical examples merely illustrate the complex interactions and the nature of the discourse that occurs in groups with chronically mentally ill persons. This chapter illustrates applications of self-psychological formulation focusing on patients' strivings as an effort to enhance the relationship between the group and therapist and increase a sense of trust and safety. The flexibly bound model is developed for outpatient group treatment of persons with persistent mental illness, primarily those diagnosed with schizophrenia, has evolved over the past three decades. The chapter also illustrates the value of shifting from a position of focusing on patients' repeating old patterns to one of trying to address strivings and new modes of interacting.
