Group analysts seldom write about the risk of harming their patients. Yet it is now widely recognized that all psychotherapies come with a small risk of harm and this risk has remained since it was first identified in the 1970s. In the wider group psychotherapy literature, risk of harm has been linked to the poor management of conflict and scapegoating, the misuse of interpretation, narcissistic leadership and unsuitability or lack of preparation of patients. Group analytic writers have examined each of these areas to varying degrees but not from the perspective of harm to the patient. This article highlights this ‘blind spot’ within the profession and signals the need for action.
BurlingameGMStraussBJoyceA, et al (2006) Core Battery-Revised. An assessment tool kit for promoting optimal group selection, process, and outcome. New York: American Group Psychotherapy Association.
13.
CastonguayLJamesFMichaelJ, et al (2010) Training implications of harmful effects of psychological treatments. American Psychologist65(1): 34–49.
14.
ChristensenKRValbakKWeekeA (1991) Premature termination in analytic group therapy: Dropout frequencies and pretherapy predictors. Nordisk Psykiatrisk Tidsskrift45(5): 377–382.
15.
CrawfordMJThanaLFarquharsonL, et al (2016) Patient experience of negative effects of psychological treatment: results of a national survey. British Journal of Psychiatry208(3): 260–265.
16.
Crits-ChristophP (1992) The efficacy of brief dynamic psychotherapy: a meta-analysis. American Journal of Psychiatry149(2): 151–158.
17.
CzechD (2015) The group and its discontents: Contempt. Qualifying Course Dissertation, Institute of Group Analysis, London, UK.
18.
DickBM (1975) A ten-year study of out-patients in analytic group therapy. British Journal of Psychiatry127(4): 365–375.
19.
FoulkesSH (1964) Therapeutic Group Analysis. London: Allen and Unwin.
20.
FoulkesSH (1968) On interpretation in group analysis. In: FoulkesE (ed) Selected Papers of S. H. Foulkes. Psychoanalysis and Group Analysis. London: Karnac, 1990, pp. 187–194.
21.
FoulkesSH (1971) Three lectures by FoulkesS.H. Available at: https://youtu.be/SdHYai0WZAQ (accessed on 30 March 2019).
22.
FoulkesSH (1975a) The leader in the group. In: FoulkesE (ed) Selected Papers of S.H. Foulkes. Psychoanalysis and Group Analysis. London: Karnac, 1990, pp. 285–296.
23.
FoulkesSH (1975b) Group Analytic Psychotherapy. Method and Principles. London: Karnac.
24.
FreudS (1993) Further recommendations in the technique of psychoanalysis: On beginning the treatment: The questions of the first communications: The dynamics of the cure. In: EllamSJ (ed. and trans.) Freud’s Technique Papers: A Contemporary Perspective. Northvale, NJ: Jason Aronson, pp. 165–191. (Original work published 1913).
25.
GarlandC (2010) The groups manual. In: GarlandC (ed.) The Groups Book. Psychoanalytic Group Therapy: Principles and Practice. London: Karnac, pp. 25–41.
26.
HarpazN (1994) Failures in group psychotherapy: the therapist variable. International Journal of Group Psychotherapy44(1): 3–19.
27.
HorwitzL (2000) Narcissistic leadership in psychotherapy groups. International Journal of Group Psychotherapy50(2): 219–235.
28.
KaplanR (1982) The dynamics of injury in encounter groups: Power, splitting, and the mismanagement of resistance. International Journal of Group Psychotherapy32(2): 163–187.
29.
KarterudS (2015) Mentalization-Based Group Therapy (MBT-G): A Theoretical, Clinical, and Research Manual. New York: Oxford University Press.
30.
KennardDRobertsJWinterD (1993) A Workbook of Group Analytic Interventions. London: Routledge.
31.
KeownPWardADavisonS (2007) Psychoanalytic group therapy in an NHS psychotherapy department: From the post-war period to the new millennium. Group Analysis40(1): 109–124.
32.
KirmanJH (1995) Working with anger in groups: A modern analytic approach. International Journal of Group Psychotherapy45(3): 303–329.
33.
LiebermanMYalomIMilesM (1973) Encounter Groups: First Facts. New York: Basic Books.
34.
LorentzenS (2003) Long term analytic group therapy with outpatients: evaluation of process and change. PhD Thesis: University of Oslo, Norway.
35.
LorentzenS (2014) Group Analytic Psychotherapy: Working with Affective, Anxiety and Personality Disorders. London: Routledge.
36.
LorentzenSRuudTFjeldstadA, et al (2013) Comparison of short- and long-term dynamic group psychotherapy: randomized clinical trial. British Journal of Psychiatry203(4): 280–87.
37.
MaratosA (2019) First, do no harm: How do group analysts understand the management of risk? Qualifying Course Dissertation, Institute of Group Analysis, London, UK.
38.
NitsunM (1996) The Anti-Group: Destructive Forces in the Group and Their Creative Potential. London: Routledge.
39.
NitsunM (2009) Authority and revolt: The challenges of group leadership. Group Analysis42(4): 325–334.
40.
O’BeneyRSalmALavenderT (2019) An exploration of members’ experiences of group therapy: an interpretive phenomenological analysis. Group Analysis52(1): 82–99.
41.
ParryGCrawfordMDugganC (2016) Iatrogenic harm from psychological therapies—time to move on. British Journal of Psychiatry208(3): 210–212.
42.
PinesM (1994) Borderline phenomena in analytic groups. In: SchermerVPinesM (eds) Ring of Fire, Primitive Affects and Object Relations in Group Psychotherapy. London: Routledge, pp. 128–148.
43.
PiperWEAzimHFAJoyceAS, et al (1991) Transference interpretations, therapeutic alliance, and outcome in short-term individual therapy. Archives of General Psychiatry48(10): 946–953.
44.
PiperWEOgrodniczukJSJoyceAS, et al (1999) Prediction of dropping out in time-limited, interpretive individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training36(2): 114–122.
45.
RobackC (2000) Adverse outcomes in group psychotherapy: Risk factors, prevention, and research directions. Journal of Psychotherapy Practice and Research9(3): 113–122.
46.
RobertsJ (1991) Destructive phases in groups. In: RobertsJPinesM (eds) The Practice of Group Analysis. London: Routledge, pp. 128–135.
47.
RogersC (2004) Psychotherapy and Counselling: A Professional Business. London: Whurr.
48.
SchlapoberskyJR (2016) From the Couch to the Circle: Group Analytic Psychotherapy in Practice. London: Routledge.
49.
SpotnitzH (1985) Discovering new truths: how to channel destructivity. Modern Psychoanalysis10(1): 5–12.
50.
StoneW (1991) Treatment of the chronically mentally Ill: An opportunity for the group therapist. International Journal of Group Psychotherapy41(1): 11–22.
51.
TschuschkeVAnbehTKienckeP (2007) Evaluation of long-term analytic outpatient group therapies. Group Analysis40(1): 140–159.
