Theoretical Concepts of Narcissistic Personality Disorder. Overview of Narcissistic Disorder in Group Analysis

Narcizam se u novije vrijeme sve češće razmatra u psihijatrijskoj literaturi, prije svega jer se nalazimo u dobu kada je izrazito raširen te se često se vidi kod osoba na vodećim funkcijama tako da za neke postaje model poželjnog ponašanja. Patologija narcizma se počinje intenzivnije proučavati početkom 20. stoljeća te kulminira radovima Kohuta i Kernberga. Prema mnogim istraživanjima prevalencija narcističkog poremećaja ličnosti u općoj populaciji iznosi 1 % što je veliki broj, no s druge strane dijagnoza narcističnog poremećaja u kliničkoj praksi rijetko se postavlja. Dijagnoza je iznimno složena, te je teško povući granicu između normalnog i patološkog narcizma, a dodatne komplikacije izaziva nedovoljan naglasak u stručnoj literaturi na dva tipa ovog poremećaja: vulnerabilni i grandiozni. Liječenje poremećaja iznimno je dugotrajno i zahtjevno prije svega zbog izostanka uvida pacijenta kao i zbog njegove usmjerenosti na međuljudske odnose. Terapijski izbor kojim bi se moglo pomoći ovim osobama da osvijeste svoje stanje te ga kontroliraju kako bi im se omogućilo stvaranje zdravih međuljudskih odnosa je psihoterapija, što individualna, što grupna. U ovom je radu naglašen grupni rad koji bi narcističnim pacijentima empatijom koja se stvara u grupama i kohezijom koja je esencijalna za integraciju narcističnog pacijenta pomoglo izgraditi manjkave intrapersonalne strukture, a dinamikom grupnog rada i povratnom vezom (feedback) pokazati kako svojim ponašanjem utječe na druge.Narcissism has been discussed in the literature with increasing frequency, primarily because we are living in an age when it is widespread and is often seen in people holding leadership positions, so that for some it has become a model of desirable behaviour. Pathological narcissism began to be more intensively studied in the early 20th century, which culminated in the works of Kohut and Kernberg. According to many studies, the prevalence of narcissistic personality disorders in the general population is 1%, which is a large number, but on the other hand its diagnosis in clinical practice is rarely described. Diagnosis is extremely complex, and it is difficult to distinguish the boundary between normal and pathological narcissism, while additional complications result in insufficient emphasis in the professional literature on the two types of this disorder: vulnerable and grandiose. Treatment of the disorder is extremely long-lasting and demanding, primarily because of the patient’s lack of insight and its focus on interpersonal relationships. Psychotherapy, either individual or in a group, is emphasized as a therapeutic choice that could help patients revitalize their condition, control it and enable them to create healthy interpersonal relationships. In this paper, we discuss the group work, that could help narcissistic patients to build upon a lack of intrapersonal structures through group empathy and cohesion that is essential for the integration of a narcissistic patient through the dynamics of group work and based on feedback about how their behaviour affects others

VILLAIN OR PROTECTOR OR WORKING THROUGH DREAMS IN GROUP PSYCHOANALYTIC THERAPY

U psihoterapiji je važno razumjeti značenje snova jer snovi otkrivaju nesvjesno. San ispričan u grupi može ukazivati na nesvjesnu refleksiju grupnih događaja. Terapeut se treba pitati što je ono što sanjač ili grupa ne mogu procesuirati te pokušavaju proradom donesenog sna. S obzirom na to da snovi mogu biti kontejneri individualnih i kolektivnih anksioznosti, ako ih se ne proradi, mogu voditi u acting out. Grupni analitičari smatraju da je vrlo važno doći do latentnih misli sna u grupi ako je i kad je to moguće, posebno onih koje imaju transferni predznak. U ovom radu bit će prikazani primjeri kako je grupa donošenjem snova koji imaju grupni karakter pokušavala proraditi grupni događaj koji je utjecao na evociranje strogih roditeljskih figura. Grupa je kroz snove prorađivala otpore, negativan krak transfera te u konačnici integraciju negativnog i pozitivnog kraka.Understanding the meaning of dreams is of great importance in psychotherapy, because dreams reveal the unconscious. A dream shared with a group can indicate an unconscious reflection of group events. The therapist should inquire into what the person who had the dream or the group itself cannot process, and trying to work through the shared dream. Since dreams could represent containers of individual and collective anxiety, failure to work them through may lead to acting out. Group analysts believe that, if and when this is possible, it is important to reach the latent dream thoughts, particularly those with a transference prefix. In this paper, we will present examples of how a group attempted to work through a group event that affected the evocation of strict parental figures by discussing dreams that have a group character. Through dreams, the group worked through resistance, the negative side of transference, and ultimately, the integration of the negative and positive sides of transference

GROUP AFTER EXCLUSION OF A SUICIDAL MEMBER OR WHAT IS HIDDEN IN THE RUG

Grupna analiza (ili grupna analitička psihoterapija) je tehnika grupne psihoterapije. Uspješno liječenje u grupi za članove grupe povezano je i s terapeutovim pripremnim zadatcima vezanima uz pokretanje grupe, a to se prije svega odnosi na izbor članova te priprema tih istih članova. Razvoj grupe može se sagledati kroz određene faze grupnog razvoja. Svaka sljedeća faza grupnog razvoja oblikovana je i nadograđena na uspješno savladanu prethodnu fazu. Stoga će se rani razvojni neuspjesi pokazati kroz daljnji grupni život i grupnu dinamiku. Svrha ovog članka je prikazati tijek grupnog procesa i zbivanja u grupi vezano uz isključenje suicidalnog člana. Prvi dio prikaza odnosi se na isključenje člana, a drugi koji obuhvaća kasniji period grupe uz još uvijek prisutne posljedice koje se odnose na usporenu detronizaciju voditeljice i usporenu proradu negativnog kraka transfera te razvijanja fenomena žrtvenog jarca. Detronizacija voditelja, prorada agresivnog /negativnog kraka transfera te nalaženje žrtvenog jarca su karakteristike druge faze grupnog razvoja koja je u ovom primjeru bila prolongirana.Group analysis (or group analytic psychotherapy) is a group psychotherapy technique. For group members, successful treatment in a group is also connected with the therapist’s preparatory tasks relating to group development, which primarily refers to the selection of group members and their preparation. The development of a group can be viewed through various stages of group development. Each subsequent stage of group development is shaped and built upon the successfully mastered previous stage. Early developmental failures will, therefore, become visible through further group existence and group dynamics. The purpose of this paper is to present the course of a group process and events in the group in relation to the exclusion of a suicidal member. The first part of the presentation refers to the exclusion of the member, while the second part includes a later group period when consequences referring to the slow dethronement of the conductor and the slow working of the negative part of transference are still present, in addition to the development of the scapegoat phenomenon. The dethronement of the conductor, the working of the aggressive/negative part of transference and finding of a scapegoat are characteristics of the second phase of group development, which in this case was prolonged

Encouraging Resilience and Thus Also Quality of Life in Trauma and Stressor-induced Disorders Through Crisis Interventions

Ubrzani ritam života donosi sve veći stres koji može dovesti do iscrpljenja i sloma prilagodbenih kapaciteta, a kod nekih pojedinaca s vremenom uzrokovati dugotrajne posljedice te psihotraumatizaciju. Novija istraživanja sve veću pozornost usmjeravaju podizanju kvalitete života oboljelih raznim intervencijama koje potiču rezilijenciju. Kriznim intervencijama, psihoterapijskim i farmakoterapijskim metodama u sklopu rada Dnevne bolnice specijalizirane za provođenje preventivnog i terapijskog programa stresom i traumom uzrokovanih poremećaja (DB STUP) potičemo zdrave snage ličnosti odnosno rezilijenciju što omogućava oporavak, odnosno vraćanje na premorbidno funkcioniranje i kvalitetu života. Cilj rada je pokazati kako su intervencije koje primjenjujemo u Dnevnoj bolnici utjecale na kvalitetu života i time povećale rezilijenciju. Prikazat ćemo evaluaciju našega rada tijekom četiriju godina (od 2015. do 2019.). Uzorak čini 129 pacijenata. Primijenjen je upitnik WHOQOL BREF (World Health Organization Quality of Life Brief Version questionnaire) na početku i na kraju programa/hospitalizacije. Istraživanje je pokazalo statistički značajno poboljšanje kvalitete života pri izlasku iz programa/hospitalizacije. Našli smo poboljšanje u svim četirima domenama kvalitete života i to sljedećim redoslijedom: poboljšanje psihičkog zdravlja, fizičkog zdravlja, percepcija utjecaja okoline te društvenih odnosa. U aspektu sociodemografskih čimbenika kao značajan pokazao se isključivo spol – žene koje su izvještavale o značajnijem poboljšanju u aspektu društvenih odnosa, dok su u preostalim domenama spolovi izjednačeni. Naše je istraživanje pokazalo da se intervencijama u kriznim situacijama povećava rezilijencija pa time i kvaliteta života što je neodvojivo povezano.The accelerated rhythm of the modern lifestyle has resulted in growing levels of stress, which can lead to exhaustion and a breakdown of a person’s capacity for adjustment, sometimes even causing lasting effects and psychological trauma. Newer studies have increasingly focused on improving patient quality of life through various interventions that improve resilience. Crisis interventions as well as psychotherapy and pharmacological treatment are used in our Day Hospital, which specializes in the implementation of preventative and treatment programs for trauma and stressor-induced disorders (TSRD) in order to encourage healthy psychological strength, i.e. resilience, enabling recovery and return to premorbid functioning and quality of life. The goal of this study was to show how the interventions we apply in the Day Hospital have influenced the patient quality of life and thus increased their resilience. We will present an evaluation of our work over a period of four years (from 2015 to 2019). Our sample comprises 129 patients. We applied the WHOQOL-BREF (World Health Organization Quality of Life Brief Version) questionnaire at the start and at the end of the patients’ hospital stay or program. The results show a statistically significant improvement in quality of life at the end of the program. We found improvements in all four quality of life domains, in descending order of magnitude: improvement in mental health, physical health, environment, and social relationships. Sex was the only sociodemographic factor that was significant – women reported more significant improvements in the social relationships domain, whereas the results were equal between the sexes in the other domains. Out study demonstrated that crisis interventions improve resilience and therefore also quality of life, as the two are unquestionably related