Frustration, anger, and the significance of alter-ego transferences in group psychotherapy

When working with narcissistically vulnerable and angry patients in group psychotherapy one must take into account the entire treatment context. Interaction takes place among the identified patient, the other members, the therapist, and the image of the group as a whole. In members' counter-reactions to the difficult person, group-destructive forces frequently are stimulated. The offending individual may flee, or the group may reach an impasse in which little growth occurs. In this communication, I have focused on alter-ego relationships and transferences as a way of understanding aspects of group formation and destruction. Angry patients may have intense wishes to be like others and to feel part of the human condition. They suffer from feeling alone. Disruption of an alter-ego relationship may result in rage. A self-psychological perspective in concert with knowledge of group dynamics enables the clinician to formulate ways of intervening in problematic group interactions. The therapist's capacity to attend to the vulnerabilities of the self of all persons involved in the group is often severely tested, particularly under circumstances of emotional contagion. Elucidation of twinship and alter-ego transferences may help stabilize difficult patients and enable them to restart their psychological growth.