1. LATE STAGE GROUP TREATMENT CONFLICT, REPAIR, AND REUNION

2. IT’SALL ABOUT CHARACTERLOGICAL CHANGE… Working on personality disorders Working on personality disorders Benign manifestation of deep habitual patterns Benign manifestation of deep habitual patterns Disordered attachments Disordered attachments Transference distortions arising from … Transference distortions arising from …

3. MAIN THERAPEUTIC TASK Work on character pathology while also trying to maintain a balance of “erupting” defensive structures (e.g., shame and worthlessness) that dominates most addicted sufferers internal world Work on character pathology while also trying to maintain a balance of “erupting” defensive structures (e.g., shame and worthlessness) that dominates most addicted sufferers internal world Watch client’s feeling of “too good or too bad“ Watch client’s feeling of “too good or too bad“

4. WORKING ON CHARACTERLOGICAL PATTERNS Help client’s realize that behaviours, reactions, and interpersonal functioning are a result of unmet developmental needs for self-object responsiveness in the here and now Help client’s realize that behaviours, reactions, and interpersonal functioning are a result of unmet developmental needs for self-object responsiveness in the here and now

5. OPTIMAL FRUSTRATION AND BALANCE Thus, clients are afforded the opportunity to experience enough anxiety and frustration to promote the emergence of their typical destructive and maladaptive characterlogical patterns and coping styles Thus, clients are afforded the opportunity to experience enough anxiety and frustration to promote the emergence of their typical destructive and maladaptive characterlogical patterns and coping styles

6. LATE STAGE TREATMENT STRATEGIES Taking a cold, hard, honest look at addicted sufferers past and their early history of relationships with their family of origin Taking a cold, hard, honest look at addicted sufferers past and their early history of relationships with their family of origin Unconsciously group members use projective identification to coerce others into behaving and treating them as they have been treated in the past! Unconsciously group members use projective identification to coerce others into behaving and treating them as they have been treated in the past!

7. PROJECTIVE IDENTIFICATION THE EXTERNAL AND INTERNAL Two levels of interaction occur during group member exchanges Two levels of interaction occur during group member exchanges 1.External interaction 2.Internal interaction Simultaneous Each of these influences the other

8. …THE EXTERNAL Impacts the internal representation of self and one’s object relations…

9. While the internal world of an individual colours, distorts, and influences others in the group to behave or act in ways that “fit” the individual’s projected unconscious expectations…

10. EACH LEVEL MUST BE WORKED OUT Group projective identifications are diluted by virtue of #’s, which reduces anxiety helping in the healing process Group projective identifications are diluted by virtue of #’s, which reduces anxiety helping in the healing process Group provides for more possibilities for projective identification to occur Group provides for more possibilities for projective identification to occur Group provides safe space between threats of abandonment or expected retaliation (transitional object) - but the group must not be allowed to hide a member’s fears based on their own anxiety (this is tolerated in early stage of group process) Group provides safe space between threats of abandonment or expected retaliation (transitional object) - but the group must not be allowed to hide a member’s fears based on their own anxiety (this is tolerated in early stage of group process)

11. INTERNAL - EXTERNAL GAME We have to keep in mind and remember that the necessity for projection identification and its healing resides in acknowledging and understanding that we did not get certain needs met We have to keep in mind and remember that the necessity for projection identification and its healing resides in acknowledging and understanding that we did not get certain needs met Moreover that the search/insatiable need, and or denial of needs is behind the external / internal game Moreover that the search/insatiable need, and or denial of needs is behind the external / internal game Leaving addicted suffers with a view that the world is unfair and rejecting (Remember addicted sufferer cannot contain emotions on their own) Leaving addicted suffers with a view that the world is unfair and rejecting (Remember addicted sufferer cannot contain emotions on their own)

12. ADDICTED SUFFER MUST SEE… That their current interpersonal functioning can never change the “other or others” That their current interpersonal functioning can never change the “other or others” Thus their expectations of others are unrealistic and their demand on them will never be fulfilled Thus their expectations of others are unrealistic and their demand on them will never be fulfilled As such, this must be accepted and surrendered to… The realization being (no one can give them what they want - they must do it themselves). As such, this must be accepted and surrendered to… The realization being (no one can give them what they want - they must do it themselves).

13. RETURN OF THE REPRESSED - CANNOT FAIL TO UNDERSTAND RAMIFICATIONS OF CHILD’S EARLY EXPERIENCES First because of a parents or caregivers position / role, children cannot give up there external objects (need them for survival) First because of a parents or caregivers position / role, children cannot give up there external objects (need them for survival) Then we have their PCF’s rejections, anger, and persecutory behaviours… Then we have their PCF’s rejections, anger, and persecutory behaviours… Thus external reality cannot be changed (too helpless and dependent) thus frustration and disappointment is retained and internalized to be mastered and controlled in one’s internal world Thus external reality cannot be changed (too helpless and dependent) thus frustration and disappointment is retained and internalized to be mastered and controlled in one’s internal world

14. THESE INTROJECTIONS BECOME PART OF ONE’S PERSONALITY Thus if your PCF was demeaning/critical or what have you - individuals will force others in their external world to change into a critical, demeaning object…. Thus if your PCF was demeaning/critical or what have you - individuals will force others in their external world to change into a critical, demeaning object…. Why? So their external reality fits internal reality! Why? So their external reality fits internal reality! How critical or demeaning are you to yourself? How critical or demeaning are you to yourself? In your groups… Do you perceive members as critical/demeaning? Are you unconsciously forcing group mates to fit into your internal world? In your groups… Do you perceive members as critical/demeaning? Are you unconsciously forcing group mates to fit into your internal world?

15. CONFLICT, REPAIR, AND UNION Therapist does not pretend to have it all figured out Therapist does not pretend to have it all figured out He/she experiences countertransference (will discuss it - point out how he/she has misinterpreted He/she experiences countertransference (will discuss it - point out how he/she has misinterpreted However, the competent group therapist also knows the importance of facilitating “healing conflict” in group However, the competent group therapist also knows the importance of facilitating “healing conflict” in group

16. THE NECESSITY OF CONFLICT TOWARD REPAIR AND GROWTH

17. NECESSITY OF CONFLICT All dysfunctional relationships are characterized by the relative absence of the repair process All dysfunctional relationships are characterized by the relative absence of the repair process Failure to repair leads to structural dampening of prefrontal limbic system that involves capacity for affect regulation Failure to repair leads to structural dampening of prefrontal limbic system that involves capacity for affect regulation However, dyssynchrony will occur in group - it’s inevitable - we need to welcome it, and equally repair it However, dyssynchrony will occur in group - it’s inevitable - we need to welcome it, and equally repair it

18. REPAIR OF RUPTURES Watch for ruptures and begin reparative process Watch for ruptures and begin reparative process What does repair look like - therapist acknowledges misattunement, apologizes, and error explored so that feelings missed or ignored, are recognized What does repair look like - therapist acknowledges misattunement, apologizes, and error explored so that feelings missed or ignored, are recognized Research has recognized that the ability to successfully manage conflict and maintain close personal relationships is synonymous with freedom from all serious anxiety, depression, and psychopathology including addiction.

19. Neuroscience Explains Projective Identification and the Role of the Prefrontal Cortex

20. REPAIR OF RUPTURES Also hinges on therapist willingness to look into the negative process and helping group member to speak to his/her process in group, share feelings of being misunderstood and both take responsibility for their parts Also hinges on therapist willingness to look into the negative process and helping group member to speak to his/her process in group, share feelings of being misunderstood and both take responsibility for their parts Also the therapist needs to also understand and review the impact of their attachment history and how this is impacting the therapeutic milieu Also the therapist needs to also understand and review the impact of their attachment history and how this is impacting the therapeutic milieu Maybe most important, allow and create a climate where anger and protest can be experienced with group therapist and between group members Maybe most important, allow and create a climate where anger and protest can be experienced with group therapist and between group members Therapist works within themselves to embrace protest and hostility without the need to retaliate, and with experiencing limited amount of fear Therapist works within themselves to embrace protest and hostility without the need to retaliate, and with experiencing limited amount of fear

21. LET’S TALK ABOUT VULNERABILITY

22. LET’S PLAY THE VULNERABILITY GAME

23. RULES AND PREPARATION FOR THE GAME Individuals from each group this semester are too pool into the same area Individuals from each group this semester are too pool into the same area Half of Each Group - will “self” select themselves to come to the front of the class Half of Each Group - will “self” select themselves to come to the front of the class At which time - each person from each group will have to blindly select an issue (provide in cup), read it out loud to the entire class, and complete the instructions (instructions are not carried out until each person has read out aloud their issue) At which time - each person from each group will have to blindly select an issue (provide in cup), read it out loud to the entire class, and complete the instructions (instructions are not carried out until each person has read out aloud their issue) After the first round is completed - the projected onto - from each group will then have a chance to choose from the blind pool of selected issues and the process then continues After the first round is completed - the projected onto - from each group will then have a chance to choose from the blind pool of selected issues and the process then continues