COTHERAPY IN PSYCHODYNAMIC GROUP PSYCHOTHERAPY: AN APPROACH TO TRAINING

Victor S. Alpher, Ph.D. Joseph C. Kobos, Ph.D.

Cotherapy in a training relationship with a senior therapist~supervisor and a trainee~junior leader is presented. A structured training year with planned sessions for the junior leader to lead the group alone, as well as intensive supervision, is described. The training relation- ship is seen as evolving into an egalitarian, collegial working rela- tionship. An incidental benefit of this cotherapy approach is that additional opportunities are provided for group members to work through attitudes, feelings, and behaviors associated with attach- ment, interpersonal relationship (autonomy and affiliation), sepa- ration, and loss. Potential drawbacks and applications are also noted.

Cothe rapy has evolved du r ing the ascendance of group t h e r a p y as an acceptable mode of psychological in te rven t ion . This paper focuses on one pa r t i cu l a r ap- proach to cotherapy, in which one senior t he rap i s t funct ions as the superv isor of the cotherapis t . In th is approach, the co therap is t is acknowledged expl ic i ty to be a t r a inee , a l t hough one t r a i n ing goal is for the co the rapy re la t ionsh ip to evolve into an ega l i t a r i an , collegial col laborat ion.

B A C K G R O U N D

Hei l f ron (1969) sugges ted t h a t the co the rapy dyad e m b a r k s on ~an a d v e n t u r e of discovery about t he i r own re la t ionsh ip" (p. 366). T h a t co therapis t s will con t inua l ly assess and eva lua t e the dynamics of t he i r r e la t ionsh ip and the effect on the group m u s t now be considered fundamen ta l .

Ben jamin (1972) provided a de ta i led clinical account of a co the rapy rela- t ionship be tween a psychia t r ic r e s iden t and psychia t r ic nurse. This re la t ion- ship was complicated by the addi t ion of a ~status" var iab le (professional

All correspondence and requests for reprints should be addressed to Victor S. Alpher, Ph.D., Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, 6410 Fannin St., Suite 600, Houston, TX 77030. Joseph C. Kobos, Ph.D., is Associate Professor, Department of Psychiatry, University of Texas Health Science Center at San Antonio. The authors express their appreciation to the many group members and cotherapists whose experiences provided the stimulation and clinical material for the present formulation.

GROUP, Volume 12, Number 3, Fall 1988, Brunner/Mazel, Inc. / 135

136 / GROUP, Volume 12, Number 3, Fall 1988

discipline) to the evolution of an effective cotherapy dyad. Benjamin noted that important evidence for the strengthening of the cotherapy relationship came from the handling of absences of the senior therapist with greater depth of feeling and less rigid defensiveness. In early stages of the relationship, greater ambivalence and denial were observed, while later the realities of separation and loss were acknowledged and worked through in the dyad.

McGee and Schuman (1970a, 1970b) stressed the vitality of the cotherapy dyad and various parameters that may be instituted to refine this therapeutic tool. They noted that anticipated loss of a cotherapist is often the result of institutional and programmatic pressures on training sequences. However, they did not present any specific methods that could obviate the potential detrimental effects of multiple therapists in sequence on group psychotherapy.

Rutan, Alonso and Molin (1984) assessed several possible responses to single group leader absences. They suggested that providing substitute leadership presents many unusual opportunities for exploration of the relationship of the group-as-a-whole and of individual members to the single therapist. Also, the vicissitudes of transference to a novel leader may afford a more complete picture of patients' functioning. However, the occasional substitution neces- sitates a good deal of preparation of both the group and the substitute leader for the experience to be of therapeutic value.

Dick, Lessler and Whiteside (1981) reviewed the history of cotherapy and proposed a four-stage developmental model of the cotherapy relationship. Dur- ing Stage 1, the Formation stage, intrapsychic dynamic issues between co- therapists predominate. After working through the initial transferential issues of Stage 1, cotherapists enter into the Development period, Stage 2. Interper- sonal issues are addressed; here, the goal is the ascendance of a complementary egalitarian relationship. In the complementary relationship, each of the ther- apists' strengths interact to enhance the therapeutic endeavor. In the Stabi- lization phase, Stage 3, mutual trust and a realistic relationship are reached between cotherapists. Finally, cotherapists occasionally enter the Refreshment stage. During this stage, Stage 4, effortless cotherapy evolves. Here cotherapy is unique: creative, complementary, dynamic and spontaneous. Dick et al. viewed Stage 4 as the cotherapy relationship promoting the greatest and most rapid cognitive and affective growth in group members. They suggest that Stages 3 and 4, Stabilization and Refreshment, provide the essential thera- peutic ingredients of group cotherapy.

A cotherapy training approach will be presented here that, in our experience, promotes the evolution of the cotherapy dyad into the advanced stages char- acterized by an ~egalitarian" working relationship reflecting increasing mu- tuality, autonomy, and collegiality. It has been successfully employed for 13 years as part of a clinical psychology internship training program approved by the American Psychological Association at a major health science center in the southwestern United States. The utility of the approach in a systematic training module, cycling on a yearly basis, has appeared in our experience to promote not only the development of the group therapist, but also the focusing of the group process on significant therapeutic issues. This focusing makes use of the opportunity for growth afforded by the senior therapist 's occasional absences. However, because our approach utilizes a cotherapy paradigm, more information is immediately available to both leaders to facilitate therapeutic use of absences.

The dynamic functions of the yearly cycle, and the vicissitudes of group dynamics and group therapist t raining associated with it, are described in detail below. The narrative also attempts to convey some of the ambience of

Cotherapy in Psychodynamic Group Psychotherapy: An Approach to Training / 137

the therapeutic situation, particularly in the training cotherapist's experience and relationship to the group. First, the training approach will be described. Emergent issues in applying this approach to training and to group psycho- therapy will then be discussed.

BASIC PARAMETERS

Our approach to cotherapy is presented as feasible for a psychodynamically oriented group of functioning (gainfully employed) outpatients. Group size is limited to 8-10 in an ongoing group in which members have participated from 6 weeks to 36 months. Once screened for the group, members make a com- mitment to enter for 6 weeks. This allows time for members to process at- tachments, separations and losses within the group membership. A 6-week notice of termination is recommended for similar reasons. The senior thera- pist/supervisor assumes responsibility for critical aspects of maintaining the group: place, time, frequency and fees. (In what follows the supervisor will be referred to as ~senior therapist," and the trainee as either ~cotherapist" or ~trainee.")

The group meets weekly during the year, except when the meeting time (an early weekday evening) coincides with major holidays, a rare occurrence. A 2-week hiatus is planned for the last 2 weeks of August. The cotherapist enters the group the first session in September and departs at the session prior to the 2-week break at the end of the following summer. The senior therapist and cotherapist meet for i hour of supervision per group meeting, split equally into pre- and postsession discussions.

Phase 1: Cotherapist Trainee Observation and Group Transference

During Phase 1, the cotherapist observes the group in process after the August break. This break has provoked some regression, while also facilitating con- solidation of patients' gains. At this point, transference and at tachment to the senior therapist are salient. Typically, during this period, the group-as-a-whole functions in a dependent transference with the ongoing senior therapist (Bion, 1959). 1 Early transferences to the cotherapist have qualities of affiliative pair- ing, as individual group members displace rescue-nurturance and power-af- filiation fantasies onto the cotherapist.

After early transference-related phenomena are worked through in the in- itial period of the yearly cycle, the group's cohesiveness emerges: fight-flight group bonding (Bion, 1959) declines and the formation of a cohesive work group progresses. At this point, the cotherapist trainee has had ample oppor- tunity to learn from the senior supervising therapist through in vivo modeling and through pre- and postgroup supervision discussions. The cotherapist has engaged in interventions progressing from supportive (of the senior therapist 's efforts) in the direction of automony and spontaneity. The degree to which interventions are timely is carefully scrutinized and processed in supervision, as are cotherapist transference and countertransference phenomena.

At this juncture, approximately one-third of the way through the training year, it is announced that at a date 6 weeks hence (early February), the cotherapist will lead the group alone. This is often scheduled to coincide with a yearly competing professional obligation of the senior therapist. As with all absences, the nature of the absent therapist 's outside involvement becomes material for therapeutic work.

138 / GROUP, Volume 12, Number 3, Fall 1988

End of Phase 1: Group Challenge

At the end of the 6-week period, the cotherapist leads the group alone. It is anticipated that at this point the trainee is familiar with individual group members' transferences to one another and to authority figures and is capable of accepting the responsibility of leading the group as well as learning from the experience. Also, the cotherapist has had several months to observe the senior therapist's style and to internalize aspects of group leadership functions for the task ahead. The group, for its part, now prepares to challenge the cotherapist's ability to function as group leader in the absence of the senior therapist.

On leading the group alone, the cotherapist can expect to be challenged by the group; this is a regressive fight-flight phenomenon. The group, of course, has for 6 weeks been preparing for the first absence of the senior therapist since the August break. Memories of individual struggles with separation, abandonment fears, and loss from that experience are evoked, and the group- as-a-whole may question the ability and desire of the cotherapist to function to prevent group fragmentation.

Several experiences during the yearly cycle have confirmed that the group will at tempt to challenge the ability of the cotherapist to maintain the group's cohesiveness at this event. For example, in a recent training year, a borderline patient (and group veteran of nearly 3 years) prepared the group for her as- sumption of the challenging role in the weeks prior to the event. When the cotherapist made a comment regarding the senior therapist 's planned absence, he stated, ~The group continues, and I will be here." This patient added crypt- ically and prophetically, ~I know." During the session led by the cotherapist, this patient became increasingly agitated as two group members paired off in the early part of the meeting. Abruptly, she announced she was thinking about leaving the group (not stating whether referring to the current session only or permanently). Before the group could respond, she abruptly stood up and left the room. However, the next week she returned, not speaking about the event. This appeared to confirm the collusion of the group with this patient to test the cotherapist with a symbolic catastrophe--group disintegration. It fell upon the cotherapist and senior therapist to facilitate working through the acting out of fight-flight. Other aspects of the acting out having to do more directly with the senior therapist 's absence were also addressed (cf. Rutan et al., 1984, for clinical examples and discussion of working through the nominal leader's absence).

Phase 2: Working Through the Catastrophe

During the following weeks, and prior to the next time the group is led by the cotherapist alone, the group assesses its impact on the trainee. Also, the trainee seeks opportunities to engage the group in understanding its behavior vis-a- vis him- or herself. Surprisingly, there is often little overt effect of the symbolic catastrophe, which implies group fragmentation, on the relationship of the group-as-a-whole to the senior therapist. With the example cited above of the woman who abruptly left the group session led by the cotherapist, the incident was not brought up by group members in the next session, which the woman attended. Instead, consultation between the cotherapist and senior therapist was needed to prepare for clarification and interpretation of the group's be- havior toward the two leaders. Engaging in the development of the cotherapist

Cotherapy in Psychodynamic Group Psychotherapy: An Approach to Training / 139

in the professional role comes to be understood and accepted as a mature function of the work group.

In the ongoing outpatient psychodynamic group, the recovery of the group from a regressed state in early September to functioning consistently in a work group manner has taken about 5 months. The trainee is ready to begin de- veloping a more collegial cotherapy relationship with the supervisor, and to engage the group with greater autonomy. This is partly because, after leading the group alone, the cotherapist and the group now share an interpersonal history imbued with affect that becomes part of the group dynamics. The handling of such a transitional event requires a supervisor with considerable experience in group dynamics and supervision of group psychotherapy trainees (Dick et al., 1981).

End of Phase 2: Abandonment

Approximately 31/2 months after the cotherapist has led the group alone, it is announced that the senior therapist will again be absent from a group meeting (this again may involve either a professional or personal commitment). The group and the cotherapist are given less time (about 3 weeks) to prepare for the anticipated event.

At this point, it is expected that the cotherapist is ready to take an even more active and autonomous role in the group process. The group, while re- sponding to the departure of the senior therapist, continues to respond also to the task of "training" the cotherapist. In a recent year, this second planned event met with a number of group members announcing their own planned absences for that session. Many of these absences were cloaked with "healthy" veneer, that is, with ostensibly rational foundations. For example, one member stated that, as a sign of emerging health, he decided to stay out of town on business for an extra day to participate in a sporting event.

In the second session led by the cotherapist, issues of dependency and trust in the trainee are acted out in more functional ways than in the first such session. The cotherapist must therefore learn to comprehend and respond to a different level of group process and expression of psychopathology. The group benefits from the stimulus to experiment with attempting to meet relationship needs and goals with a significant other who is becoming increasingly differ- entiated from the senior therapist. This is an important step in the general- ization and consolidation of gains from group work. The senior therapist facilitates this aspect of the group process as well. The group-as-a-whole is less regressively dependent on the senior therapist in this phase of the training year, and the senior therapist is much more of a "real" object to the group at this time and can guide the training function while integrating it with other aspects of the group's therapeutic work.

Phase 3: Working Through and Rapprochement

The first two experiences in which the cotherapist leads the group alone are facilitated by cohesiveness in the group's reaction to abandonment by the senior therapist. In the final portion of the training year, individual bonding of group members to the cotherapist will be processed. This involves the dif- ficult analysis of transference and countertransference issues. Examples of such recent transference bonding and working through follow.

During this third phase of the year, a member of the group, in an allied profession, attempted to engage in competitive maneuvers with the trainee in

140 / GROUP, Volume 12, Number 3, Fall 1988

relationship to the senior therapist. He asserted that his education put him on an equal footing with the cotherapist. As this relationship was analyzed and worked through, it was revealed that the patient in fact longed for a supportive, brotherly relationship with another male; his most recent such relationship had been interrupted by the violent and untimely death of the friend. Once this wish and his attempt to defend against the pain of relationship had been understood, considerable tension in the relationship with the co- therapist was defused, and he could accept the cotherapist's efforts in the group.

A different transference relationship occurred between two female group members and a male cotherapist. One of the women had identified (erro- neously) the trainee as a particular minority group member, and had, in the early stages of the training year, maintained a private enthusiastic support of him in her attempts to come to accept the intrusion of an ~'assistant therapist" in the group (this member was particularly strongly attached to the primary senior therapist for reasons that are beyond the scope of this discussion). The other woman, in her 40s, unmarried, and strongly identified with an ethnic- religious group, fantasized a special relationship with the young man, who was in fact of similar ethnic background. Late during Phase 1, these two women conferred outside the group meeting, at which point real and distorted aspects of each person's projections onto the cotherapist were revealed. During Phase 3, both women began to disclose and work through their relationship with the cotherapist to reach an understanding of the functions of their original dis- torting defensive operations.

End of Phase 3: Saying Goodbye

By the end of Phase 3, the group-as-a-whole, individual members and the cotherapist trainee have accomplished considerable therapeutic work. The group faces the dissolution of the relationship with the cotherapist when the 2-week August hiatus commences. This provides a special learning opportunity for the group. Although individual group members may come and go during the course of the year (there is an average of 2-3 such changes per year), the departure of the cotherapist is accorded special status as the trainee is likely to move on professionally and often moves to a new geographic location. There is a separation and loss experience that is akin to the young adult separating from parents, which has distinct qualities vis-a-vis other individual members' terminations. In this aspect of the group process, the group has facilitated the development of the trainee, and there should be an occasion for reciprocation as well as appreciation and celebration of mutual relationship despite a per- manent separation.

The group is led for a third time alone by the cotherapist. This occurs in the week or two prior to the final session before the August break, so that the senior therapist will have an opportunity to address the cotherapy relationship before the group in the final session, and for the group to say good-bye to the trainee. At this point, we find the cotherapy relationship frequently function- ing at a level characterized by trust and mutual support similar to the ~egal- itarianism" promulgated by Dick and his colleagues as beneficial for group work (1981, p. 281).

During and before the third and final time the cotherapist works alone with the group, we find that individual members will realistically process the mean- ing of their relationship with the cotherapist. For example, one member re- cently stated a clear understanding of the strength of his defenses both against forming relationships and against loss. Though he was often unable clearly

Cotherapy in Psychodynamic Group Psychotherapy: An Approach to Training / 141

to express his thoughts and feelings in group, he stated during the departure of his third cotherapist, ~'I knew you would leave so I didn't invest in you," while another member became tearful at the pain of this anticipated separa- tion. We find that in this particular variant of the psychotherapy work group, differentiation of individual members from one another, while maintaining the group's cohesiveness, is stimulated by the permanent departure of an important transferential object such as the cotherapist.

DISCUSSION

Many contributors to the cotherapy literature have suggested that cotherapy with a trainee is a complicated endeavor. However, with certain constraints, a cotherapy approach to training is viable. It is obviously not appropriate for a novice therapist trainee (cf. Bernard et al., 1980). The cotherapist should have a strong background in psychopathology and clinical experience working with diverse populations. For some trainees, this may be the first experience of actually collaborating with a senior therapist in cotherapy. While this cre- ates a charged atmosphere in that the trainee is also under scrutiny (i.e., being directly observed through par t ic ipant observation, not being supervised through videotape, audiotape, one-way mirror, or self-report), the common goal of developing an effective cotherapy relationship with an experienced clinician is felt to be unique and rewarding by those who have experienced this yearly cycle. The emergent egalitarian nature of the relationship implies the devel- opment of a collaborative alliance and a sense of a balance between interde- pendence and autonomy in the cotherapy dyad. Thus, the relat ionship approximates a parental relationship, and the ~parental" dynamics function to facilitate the goals of the group at all t imes (Heilfron, 1969).

We acknowledge that absences per se are neither necessary nor sufficient for this type of egalitarianism to occur. However, they do provide opportunities for greater mutuali ty between cotherapists. This mutual i ty draws on the ex- ploration of the nature of the cotherapy relationship that occurs during su- pervision and consultation, as well as on the multiple challenges that occur during group session to the stable and therapy-promoting functioning of the cotherapy unit (Heilfron, 1969; McGee & Schuman, 1970a, 1970b). Thus, while we do not assert that the periodic absences are prerequisites to "egalitarian cotherapy," we nonetheless believe that they provide additional affectively charged moments which afford both individual learning and group psycho- therapy.

Events occurring around the cotherapist's solitary leadership provide sig- nificant opportunities for learning. For the trainee, these are important mo- ments when, out of the supervisor's field, risks are taken in the direction of developing autonomy and mastering the ~'containment" function in group (Delvey, 1982, 1985). The processes of change affecting the cotherapist are more salient to the group members during these ~practicing" (Mahler et al., 1975) moments. After these episodes, there is increased demand on the senior therapist to modify and integrate a changing representation of the cotherapist. It may be these factors that substantially promote the development of a more mature and functionally egalitarian cotherapy relationship (McGee & Schu- man, 1970a, 1970b).

There can be no doubt that the cotherapist's periodic assumption of the mantle of group leadership is stressful and anxiety provoking. Assuming the cotherapist is properly selected, increased levels of affect accelerate the reor- ganization and reintegration of clinical knowledge, empathy, and confidence

142 / GROUP, Volume 12, Number 3, Fall 1988

in the ability to tolerate and metabolize the storms of affect that occasionally pervade the group. For example, in one recent group led by one of the authors (VSA), two continual external stresses threatened to overwhelm the group and interrupt the psychotherapeutic function. One stress involved a realistic eco- nomic threat (the decline in an energy-related industry). One member of the group, whose livelihood was in this field, brought this material to the group, and anxiety and fear mounted precipitously. Fortunately, the cotherapist's integration of the primitive fears provided the material for an empathic, anx- iety-reducing intervention, which brought out expression of the need to con- tinue with the group's ongoing work. A second, related stress involved the tragic death of an acquaintance of a group member, which threatened to move the group into a helpless and hopeless dependency position. Both stresses challenged the cotherapist to intervene autonomously during the senior ther- apist's absence. The manner in which these stresses are addressed introduces an important facet of real parenting into the therapeutic situation (Delvey, 1982, 1985; Heilfron, 1969). Also, it highlights the fact that significant work on issues less directly related to the senior therapist's absence may be accom- plished when the cotherapist is fully informed about the group, its members, and the environmental variables impinging on the group.

We noted above that much of the positive benefit to a training cotherapy relationship depends on ~proper selection" of the cotherapist and, by impli- cation, the supervisor. Considerable maturity of both members of the dyad is desirable. Object relations capacity must be intact, and ~'tolerance of affect" (Krystal, 19.79) is important, given the regressive tendencies of therapy groups. An ideal of maturity can, of course, become a rigid image which can become a parody Of itself (McGlashan & Miller, 1982). Instead, flexibility and will- ingness to engage in a process that demands intimacy and acknowledgement of personal weaknesses and frailties are desirable characterstics for both mem- bers of the cotherapy dyad. The involvement of supervisor and trainee in the treatment proper lends a unique cogency to supervision.

Other variables may substantially affect the natural history of any given dyad. These include the nature of the relationship to the training institution, and professional and extragroup loyalties (e.g., faculty or staff versus trainee group membership). The fee structure and the age of the group may also need to be discussed in supervision, and the recipient of fees identified and ac- knowledged in the group. Obviously therapist gender can substantially affect the sequence and course of transferences (Heilfron, 1969; McGee & Schuman, 1970a, 1970b), as will the addition of other cotherapists to the group situation.

One of the most crucial ~developmental tasks" of learning to conduct group psychotherapy is that of the trainee's separation and individuation from men- tors and teachers. The present format could be compared, for example, with other formats such as two trainees conducting group therapy with external supervision. Often, however, a junior/senior element occurs in the trainee dyad nonetheless (e.g., third year and second year psychiatry residents). The sep- aration and individuation path may take a different course in these situations. The interpersonal dynamics of trainee-trainee versus trainee-faculty dyads and their multiple relationships with the group and group members would raise potential comparisons in areas such as dependency, autonomy, gratifi- cation, loyalty, competition and rivalry. The manner in which various conflicts are resolved probably has the greatest impact on the group psychotherapy itself, rather than the individual content raised.

As noted above, the addition of the cotherapist to the group provides some noteworthy incidental learning opportunities for the group members. While

Cotherapy in Psychodynamic Group Psychotherapy: An Approach to Training / 143

it may be possible for certain members of the group to avoid interacting with the cotherapist for a period of time, the presence of the cotherapist stimulates observable responses to dynamic themes at critical junctures, even from the most resistant group members. Some such responses were discussed above. In dealing with the stages of the yearly cycle of the training cotherapy, a specific agenda to work through feelings and attitudes toward the cotherapist grad- ually evolves. These are valuable, though incidental, therapeutic benefits of exposing the group to the evolving cotherapy relationship.

This approach to training in outpatient group psychotherapy is particularly amenable to integration with any advanced year-long training sequence. Such sequences are common at advanced levels of training in psychiatry, clinical psychology, and social work (Rutan & Alonso, 1980). In addition to training in group therapy, the supervision format provides for the trainee opportunities for critical experiences in professional role development and in understanding the effects of individual psychopathology in a social matrix. For the group, certain critical events inherent in the yearly cycle promote the emergence of group processes that facilitate individual growth and change. For the super- visor, it provides an opportunity to provide a competent professional model and to monitor quality in both the trainee's development and the group treat- ment. Many of the benefits of an advanced cotherapy relationship may be afforded to both leaders. It is hoped that this presentation will encourage others involved in group psychotherapy training to consider adapting and evaluating this approach in the context of their particular training needs and goals.

NOTE

1 Bion (1959) describes four developmental stages of group process in relation to a group leader. Three of these stages involve the group's functioning ~'as if ' in accordance with a "basic as- sumption." The dependent group seeks to evoke direction, structure and nurturance from the group leader. The fight-flight group copes with anxiety by joining together to annihilate or escape the threatening object or situation. In the pairing group, members pair off with the assumption that "we can do this better," including reproducing to generate a ~messiah" or a more acceptable (powerful but caring) leader. Having struggled with the regressive vicissitudes and maladaptive- ness of the dependent, fight-flight, andpairing assumptions, the mature work group finally emerges to tackle the task of encouraging free communication of attitudes, feelings, and thoughts for the benefit of individuals in the group and the group-as-a-whole.

REFERENCES

Benjamin, S. E., Jr. (1972). Cotherapy: A growth experience for therapists. International Journal of Group Psychotherapy, 22, 199-209.

Bernard, H. S., Babineau, R., & Schwartz, A. J. (1980). Supervisor-trainee cotherapy as a method for individual psychotherapy training. Psychiatry, 43, 128-145.

Bion, W. (1959). Experiences in groups. New York: Basic. Delvey, J. (1982). Parenting errors and their correction in group psychotherapy. American Journal

of Psychotherapy, 34, 523-535. Delvey, J. (1985). Beyond the blank screen: The patient's search for an emotional container in the

therapist. Psychotherapy, 22, 583-586. Dick, B., Lessler, K., & Whiteside, J. (1981). A developmental framework for cotherapy. Inter-

national Journal of Group Psychotherapy, 30, 273-285. Heilfron, M. (1969). Cotherapy: The relationship between therapists. International Journal of

Group Psychotherapy, 19, 366-381. Krystal, H. (1979). Aspects of affect theory. B uUetin of the Menninger Clinic, 41, 1-26. Mahler, M., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant: Symbiosis

and individuation. New York: Basic Books. McGee, T. F., & Schuman, B. N. (1970a). The nature of the cotherapy relationship. International

Journal of Group Psychotherapy, 20, 25-36. McGee, T. F., & Schuman, B. N. (1970b). The nature of the cotherapy relationship. Presented at

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the 27th Annual Conference of the American Group Psychotherapy Association, New Orleans, January.

McGlashan, T. H., & Miller, G. H. (1982). The goals of psychoanalysis and psychoanalytic psy- chotherapy. Archives of General Psychiatry, 39, 377-388.

Rutan, J. S., & Alonso, A. (1980). Sequential cotherapy of groups for t raining and clinical care. Group, 4, 40-50.

Rutan, J. S., Alonso, A., & Molin, R. (1984). Handling the absence of group leaders: To meet or not to meet. International Journal of Group Psychotherapy, 34, 273-287.

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