Groups for the chronic mental patient and the legacy of failure

Group treatment of the chronically mentally ill has often been a fruitless and exasperating experience. The intense emotional responses of group leaders in working with this chronic population reinforces a spiral of repetitive failures. An attempt to intervene in this chronic spiral will be presented by the author's experience in leading a training group of mental health workers who, in turn, lead groups of chronic patients. In particular, the effects of projective identification on various holding environments will be examined by using the methodology of object relations. Understanding and utilizing countertransference responses of the training leader illuminate the unconscious aims of chronic patients to perpetuate their internal and interpersonal lives by their effect on the group leaders who work with them and on each other. This understanding can lead to interventions that have more constructive outcomes.