Strong therapeutic alliances are the cornerstone of combined individual and group psychotherapy and are constantly being built and strengthened. Alliances are typically stronger here than in other modes of psychotherapy because of a conscious and deliberate focus on the relationship by the co-therapists who work together in each group session. While one therapist may sometimes be experienced as threatening or engulfing, the other can help the patient sort out such reactions and examine their origins and validity.
Initially, patients are seen only in individual sessions while a relationship is built with their therapist, and the nature and severity of their difficulties in forming a solid therapeutic alliance are evaluated. Once a workable alliance is established, the patient is ready to join an ongoing psychotherapy group composed of eight to ten patients and meeting for 90 minutes twice a week. Weekly individual sessions and the increased contact with a co-therapist and fellow patients in the group allow for deep emotional involvement.
Periodic extended group sessions, varying in length from several hours to 28-hour marathon sessions, help patients more fully integrate previously attained gains and further experiment with new modes of being. The extended time reduces the need for resistances and allows patients to reach levels of increased affective involvement.
Commitment to serious therapy is a two-way affair, both therapists and patients making conscious choices to work with each other over the long term. The patient pays the therapist for his or her time, yet the latter must decide which patients to work with and has to agree to emotionally invest in each patient for the duration of therapy. Patients in turn commit to taking full responsibility for the thoughtful conduct of their lives and their well-being. Since patients frequently sense that the therapeutic milieu of combined individual and group psychotherapy provides them with a “home” where they are heard and understood, they are not usually likely to give this up easily. In this safe setting they gradually find the freedom to replace problematic character patterns with healthier living.
Obviously, in such an intense model, an unusually strong emotional relationship is likely to develop between patient and therapist. Among other things, this facilitates a working-through of the difference between infantile emotional dependency and real adult dependence upon another, in this case, the therapist.