Psychoanalytic group therapy

1. Introduction

Version followed: Paul Schilder's Bellevue Hospital outpatient analytic groups (New York, c. 1934–1940), as described in "The analysis of ideologies as a psychotherapeutic method, especially in group treatment" (Am J Psychiatry, 1936), "Results and problems of group psychotherapy in severe neuroses" (Mental Hygiene, 1939), "Introductory remarks on groups" (J Soc Psychol, 1940) and Psychotherapy (1938; revised edition ed. Lauretta Bender, 1951). Louis Wender's parallel Hillside Hospital method (from 1929; J Nerv Ment Dis 1936) is covered as a separately labelled variant.

Source warning. This is a historical method, not a manualised therapy. No treatment manual exists. Schilder's group papers and the book are not drawn on here (PEP-Web, Springer, the 1951 Internet Archive scan). What follows uses secondary accounts (AGPA history page, Pinney 1978 abstract, Gil Escudero & Rodríguez-Zafra 2022, encyclopaedia entries) plus bibliographic knowledge of the primary papers. Unconfirmed procedural details are tagged [uncertain]. Clinical step-by-step guidance is largely [synthesis] built around the elements the sources attribute to Schilder. [source: AGPA history; Pinney 1978; Wikipedia Schilder; archive.org record]

What it is. It is a small-group adaptation of psychoanalytic therapy for severely neurotic and mildly psychotic outpatients. Patients are prepared individually. They write about their lives and attitudes, then discuss this material in a small group. The therapist interprets resistance, transference and dreams in the group, as in individual analysis. A distinctive focus is the patients' "ideologies": their conscious, organised attitudes towards their body, sex, aggression, possession, cooperation, death, work and the self. [source: AGPA history; Pinney 1978; Wikipedia Schilder]

How change happens. Schilder treated an ideology as a conscious structure that is partly shaped by drives and early relationships and partly taken from the social world. Analysing it shows the patient where it comes from and what it does for them. The group adds a social correction. Patients find that thoughts they kept secret are shared by others, and the sources describe the individual as overcoming his isolation through interpersonal exchange (Schilder 1936, as cited in Gil Escudero & Rodríguez-Zafra 2022). Interpretation that connects a present emotional reaction with its origin, inside a group that revives family patterns (therapist as father, members as siblings), lets patients revise both the drive conflict and the attitude built on it. Schilder's wider work stressed a "constructive" aim: helping the patient build a more workable set of attitudes, beyond uncovering. [source: Gil Escudero & Rodríguez-Zafra 2022; constructive emphasis from Schilder 1942 Goals and Desires of Man, [uncertain]]

2. Framework

There are no formal numbered phases in the sources. The sequence below reconstructs the order of the elements attributed to Schilder. [source: AGPA history; Pinney 1978; Wikipedia Schilder; ordering and transition criteria are [synthesis]]

Phase A: Selection and individual preparation

Goals: diagnose, take a psychoanalytically oriented history, start a working relationship with the therapist, and judge whether the patient can use a group.
Population: Bellevue outpatients with severe neuroses (obsessional, anxiety, depressive and character neuroses) and some mildly psychotic patients. [source: Wikipedia Schilder; Psychology Wiki] Diagnostic mix per group is [uncertain].
Format: one or more individual interviews. The number of interviews is [uncertain].
Move on when: the patient has an outline understanding of their main conflicts, tolerates talking about intimate topics with the therapist, and agrees to group work. [synthesis]

Phase B: Written self-exploration

Goals: produce material on the patient's life history and attitudes ("ideologies") that can be discussed.
Format: the patient writes an autobiographical account and/or answers written questions on attitudes to body, sex, aggression, death, work, possession and cooperation, between sessions. Whether this was done before entry, during the group or both is [uncertain]. The version hint and secondary literature describe questionnaires. The AGPA page confirms only the topics. [source: AGPA history; questionnaire format [uncertain]]
Move on when: written material exists that the patient is willing to have read and discussed. [synthesis]

Phase C: Analytic group work (main phase)

Goals: discuss the written material and spontaneous productions, interpret resistances, transferences and dreams, and analyse and reconstruct ideologies.
Format: a small group led by Schilder or an analytically trained physician. Commonly reported sizes are about 2–7 patients, with sessions of about one hour once or twice weekly, lasting several months. Individual sessions continued alongside the group as needed. All figures are [uncertain] (from secondary memory).
Move on when: symptoms and attitudes are revised, the patient reports less isolation, and transference reactions in the group are recognised and worked through. [synthesis]

Phase D: Ending

No ending procedure is documented. [uncertain] Suggested approach: give notice several sessions ahead, review each patient's earlier and current attitudes using their own written material, and offer individual follow-up. [synthesis]

Wender variant (Hillside Hospital, in-patients). Groups of 6–8 patients of the same sex met 2–3 times a week for one hour, over about 4–5 months, with individual therapy running alongside. Patients needed intact intellect and some capacity for affect. Sessions began with the therapist's informal talks on Freudian concepts. Next, an anonymous case was presented and discussed. Patients then talked about their own problems. Wender later used family-like and multi-generational outpatient groups at Beth Israel. [source: Wikipedia Wender; AGPA history]

3. Guiding principles

[source: Pinney 1978; AGPA history; Gil Escudero & Rodríguez-Zafra 2022; Wikipedia Schilder/Wender. One-line practical meanings are [synthesis].]

The individual is the unit of analysis. Treat each member's conflicts. The group is the setting and the means of treatment, not the patient.
Psychoanalysis carried into the group. Use the same core tools as in individual analysis: interpretation of resistance, transference and dreams.
Interpretation is the essential task. Your main contribution is well-timed interpretation, not advice or managing the group.
Link emotion to origin. Interpretations work best when they connect a feeling arising now with its source in history or fantasy.
Ideologies are clinical material. Explore beliefs about body, sex, aggression, death, work, property and cooperation as seriously as symptoms. They carry both drive content and social borrowings.
The body image is social. Schilder's body-image theory holds that the body image forms in relation to others. Discussing the body in a group is therefore a direct way to work on it. [source: AGPA history names body image as a focus; the link to his 1935 book is [synthesis]]
The group revives the family. Expect and use father transference to the therapist and sibling transference between members.
Breaking isolation is curative. Help patients see that shameful or bizarre private thoughts are shared. This is a goal in itself.
Individual preparation and concurrent individual work. Do not place patients in the group cold. Keep individual access available.
Constructive, not only reductive. After analysing an attitude, help the patient formulate a more workable one. [uncertain: from Schilder's wider writings]
Wender: intellectual understanding as an entry point. Brief teaching of psychodynamic ideas lowers anxiety and gives a shared vocabulary before personal disclosure. [source: AGPA history]

4. Intervention inventory

The sources attribute elements 4.1–4.10 to Schilder and 4.11–4.14 to Wender. Steps and wording are [synthesis] unless cited. Schilder's own wording was not available, so all example language is illustrative.

4.1 Selection and individual preparatory interview (Schilder)

Purpose / when: Before group entry. Use it to assess suitability, take an analytic history, and build the alliance with the therapist that the group will rely on. [source: Wikipedia Schilder (small groups of selected outpatients); details of preparation [uncertain]]
Steps: (1) Do a standard psychiatric and risk assessment. (2) Take a history focused on family relations, sexuality, bodily experience and the onset of symptoms. (3) Identify one or two central conflicts and name them to the patient in plain terms. (4) Explain the group: who attends, confidentiality, and that intimate topics are discussed. (5) Decide on group entry. Defer entry if the patient is actively psychotic, acutely suicidal, or unable to tolerate others' disclosures. [synthesis]
Example language (illustrative): "In the group you will hear others speak about things you may have thought only you felt. We will look together at why these ideas matter so much to each of you."
Watch for: Fearful secrecy or a wish to keep "special" status with the therapist. Both predict sibling-rivalry transference in the group, so note them for later interpretation. Working sign: the patient can state, in their own words, a problem they are willing to bring.

4.2 Written autobiography (Schilder)

Purpose / when: Early in treatment, so that life-history material can be discussed and the patient starts reflecting on it. [source: version hint and secondary tradition, [uncertain]]
Steps: (1) Ask for a written life history: family, childhood, school, sexual development, illnesses and body experiences, work, the present illness. (2) Read it before the next session and note gaps, contradictions and charged passages. (3) With the patient's consent, choose passages for group discussion (see 4.4). [synthesis]
Example language (illustrative): "Write your life story as honestly as you can, including what seems unimportant or embarrassing. Leave out nothing because it seems shameful."
Watch for: Omissions (often sexual or aggressive material), a flat chronological style that avoids feeling, or over-production. Treat each as resistance (4.7). Working sign: later drafts or spoken additions fill earlier gaps.

4.3 Ideology questionnaire (Schilder)

Purpose / when: To bring the patient's conscious attitudes into focus on the topics Schilder treated as central: body and body image, sex, aggression, possession and "expulsion" (giving or getting rid of things), cooperation, self, death and work. Use it at entry and repeat it later to track change. [source: AGPA history names body image, ideologies, self, possession, expulsion, aggression, cooperation; death, work and the questionnaire format are from the version hint, [uncertain]]
Steps: (1) Write open questions, one or two per domain, in your own words. Schilder's actual items were not available. Do not present yours as his. (2) Give them as written homework. (3) Ask for frank, unpolished answers. (4) Read the answers for (a) the stated attitude, (b) its emotional charge, (c) its apparent sources (family, religion, class, culture) and (d) its link to symptoms. [synthesis]
Example items (illustrative, not Schilder's): "How do you feel about your body, and which parts do you like or dislike?" "What do you believe happens at death, and how often do you think of it?" "What do you do with anger?" "What does owning things mean to you?" "How do you feel about working with others?"
Watch for: Socially correct answers that do not match the symptoms (for example, "I have no anger" from a patient with obsessional harm thoughts). That gap is the material to work on. Working sign: answers grow more personal and ambivalent over time.

4.4 Group reading and discussion of written material (Schilder)

Purpose / when: The main working format. It turns private material into shared material and invites comparison and association. [source: version hint; AGPA ("ideologies" discussed in group); mechanics [uncertain]]
Steps: (1) With prior consent, have the patient, or you, read a passage or answer aloud. (2) Ask the others for reactions and similar experiences. (3) Let discussion run. Note who identifies, who attacks and who withdraws. (4) Gather common themes. (5) Interpret (4.5–4.7). (6) Return to the author, ask how it felt to be heard, and close the item. [synthesis] Whether Schilder read material anonymously is [uncertain]. Consider reading anonymously first with very shame-prone groups. [synthesis]
Example language (illustrative): "Mr. A has written that he feels his body is weak and dirty. Has anyone else had thoughts like this?" Afterwards: "Several of you have the same secret idea. Let us look at where it came from for each of you."
Watch for: The reader becoming the group's scapegoat or "patient". Keep turning it back to everyone. Working sign: members volunteer their own parallel material without prompting.

4.5 Interpretation linking present emotion to origin (Schilder)

Purpose / when: The essential therapeutic act. Use it when an emotional reaction appears in the session (shame, anger, excitement, sudden silence). [source: Gil Escudero & Rodríguez-Zafra 2022, summarising the founders]
Steps: (1) Name the observable reaction. (2) Ask for associations. (3) Offer a hypothesis linking the reaction to an earlier relationship, a drive conflict or the patient's written history. (4) Ask the patient and the group to test it. (5) Leave it if rejected and note the rejection as possible resistance. [synthesis]
Example language (illustrative): "When B spoke of his father you went red and changed the subject. In your life story your father ridiculed your body. Could the same feeling have come up just now?"
Watch for: Intellectual agreement without affect, which may be a sign the interpretation is too early. Working signs: a shift in affect, new memories, or symptom change reported in later sessions.

4.6 Transference interpretation in the group (Schilder)

Purpose / when: When reactions to the therapist or to other members repeat family patterns: rivalry for the therapist's attention, deference or defiance towards the therapist, or ganging up. Pinney's abstract notes that Schilder "interpreted the resistance, transferences, and dreams" in group sessions. [source: Pinney 1978; father/sibling framing from Gil Escudero & Rodríguez-Zafra 2022]
Steps: (1) Note a repeated pattern across two or more sessions. (2) Describe it neutrally to the person or the group. (3) Link it to the family constellation from the history. (4) Invite others to say how they experience the same situation. (5) Interpret your own place in it, for example as a father figure. [synthesis]
Example language (illustrative): "Each time I speak to C, you interrupt. In your story the younger brother got all the attention. Perhaps here too it feels as if there is not enough of me to go around."
Watch for: Members using a transference interpretation to attack one another. Keep interpretations from you, not from members acting as "co-therapists". Working sign: the patient spots the pattern before you do.

4.7 Resistance interpretation (Schilder)

Purpose / when: When the group or a member avoids material through silence, joking, chit-chat, missed homework, lateness, intellectualising, or agreeing to keep topics off-limits. [source: Pinney 1978]
Steps: (1) Name the avoidance. (2) Guess at the feared content, often sexual, aggressive or death-related. (3) Link it to the topic just before the avoidance began. (4) Invite associations. [synthesis]
Example language (illustrative): "Since D read his answer about death, we have talked only about the weather. Perhaps that topic frightened all of us more than we can say."
Watch for: Shaming. Frame resistance as protection, not failure. Working sign: the group returns to the avoided topic.

4.8 Dream analysis in the group (Schilder)

Purpose / when: When a patient brings a dream, or to deepen work that has stalled. [source: AGPA history; Pinney 1978]
Steps: (1) Have the dreamer tell the dream. (2) Ask the dreamer for associations to each element. (3) Ask members for associations and reactions, marked as theirs, not as the dreamer's meaning. (4) Interpret, linking to the dreamer's history, current ideologies and the group (for example, the therapist or members appearing in the dream). (5) Ask the dreamer what fits. [synthesis] Whether Schilder used members' associations to another's dream is [uncertain].
Example language (illustrative): "You dreamed of a crowded room where a doctor examined you while others watched. That is close to how this group may feel. What comes to mind about being examined?"
Watch for: Group "wild analysis" of the dreamer. Working signs: dreams begin to show the group or the therapist, and patients bring dreams spontaneously.

4.9 Analysis and reconstruction of ideologies (Schilder)

Purpose / when: The method's distinctive core. Use it when a stated attitude ("the body is disgusting", "anger is sinful", "death means punishment", "possessions make me safe") supports symptoms or isolation. [source: Schilder 1936 title and AGPA list of domains; the "constructive" phase is [uncertain]]
Steps: (1) State the attitude in the patient's words, from the questionnaire or session. (2) Trace its sources: parents, religion, class, peer culture, and drive conflicts such as guilt over aggression or anxiety about bodily integrity. (3) Compare it with other members' attitudes on the same theme so the patient sees alternatives and that the attitude is not inevitable. (4) Explore what the attitude protects against. (5) Invite the patient to state a revised attitude they can actually hold, and test it in later sessions and in life. [synthesis]
Example language (illustrative): "You wrote that a decent person never thinks about sex. Where did you first learn that? … E has a different view. What happens inside you when you hear it?" Later: "How would you put your view now, in your own words?"
Watch for: The therapist imposing their own values. Reconstruction must come from the patient. Working signs: questionnaire answers rewritten in a more flexible, owned form, alongside symptom easing.

4.10 Concurrent individual sessions (Schilder; also Wender)

Purpose / when: For material too private to bring to the group, crises, intense transference, or preparing a patient to bring something to the group. [source: Wikipedia Wender (individual sessions alongside group); Schilder's practice [uncertain]]
Steps: (1) Keep individual times available. (2) Agree with the patient how individual material may later be brought into the group. (3) Encourage, but do not force, bringing it into the group. [synthesis]
Example language (illustrative): "We can work on this here first. When you feel ready, it may help you to say some of it in the group, because others may share it."
Watch for: Individual sessions used to avoid the group or to gain a privileged position. Interpret this if it happens.

4.11 Didactic introductory talks (Wender)

Purpose / when: At the start of a session or series, to lower anxiety and give a shared vocabulary (unconscious, repression, conflict, the family's influence). [source: AGPA history; Wender 1936]
Steps: (1) Give a 10–15 minute informal talk on one concept. (2) Use everyday examples. (3) Invite questions. (4) Move to the case (4.12) or to personal material. [synthesis on timing]
Example language (illustrative): "Today let us talk about how feelings we pushed away as children can come back as symptoms."
Watch for: The lecture becoming a way for the group to stay intellectual. Shorten it as the group matures. Working sign: patients use the concepts to describe themselves.

4.12 Anonymous case presentation (Wender)

Purpose / when: As a bridge from theory to self-disclosure. Discussing a disguised case is safer than discussing oneself. [source: AGPA history]
Steps: (1) Present a fully disguised or composite case that illustrates the concept. (2) Ask the group what they think happened and why. (3) Ask who recognises something of themselves. (4) Turn to members' own material. [synthesis]
Example language (illustrative): "A man of thirty began washing his hands for hours after his father's death. What do you make of that?"
Watch for: Breaches of confidentiality. Never use a recognisable case. Working sign: members say "that's like me" and go on.

4.13 Fostering patient-to-patient openness and the "substitute family" (Wender)

Purpose / when: Wender found patients opened up more to each other than to the therapist. He treated the hospital and group as a substitute family and encouraged friendships between members. [source: Wikipedia Wender; AGPA history]
Steps: (1) Direct questions to members rather than answering yourself. (2) Name similarities between members. (3) Allow, and later explore, attachments and rivalries between members as family repetitions. [synthesis] Note: Wender allowed contact outside the group. Most modern group protocols restrict this, so decide your own rule explicitly. [synthesis]
Example language (illustrative): "F, you've been through something similar. What helped you?"
Watch for: Subgroups, and secrets kept from the group. Working sign: members help each other without being asked.

4.14 Family and multi-generational groups (Wender, later work)

Purpose / when: Wender believed the group's main advantage was its resemblance to the family. In outpatient groups at Beth Israel he included two or three generations of the same family. [source: AGPA history] No procedure was found in the sources. [uncertain] Treat this as a historical note. Anyone attempting it should follow modern family-therapy training. [synthesis]

5. Handling problems

The sources give no troubleshooting guidance beyond the general instruction to interpret resistance and transference. Everything below is [synthesis] unless tagged. Otto Fenichel's contemporary doubt about whether "purely psychoanalytic" effects occur in groups (reported in Wikipedia Schilder) is a reminder to watch for suggestion and group pressure as hidden change agents.

Stuck or repetitive group. Bring in fresh written material: assign a new ideology domain, such as death or work, that has not yet been covered. Alternatively, interpret the stalemate as a shared resistance (4.7). If it persists, check the group's composition. One dominant or very disturbed member can freeze others; consider extra individual work for them.
Silence or refusal to read written work. Do not force reading. Offer to read it anonymously, or read it in individual session first (4.10). Interpret the fear of exposure as possibly linked to early shaming. Return to the issue later.
Non-completion of questionnaires or autobiography. Explore what made it hard: shame, fear of judgement, or literacy or language problems. Allow spoken answers instead. Treat repeated non-completion as resistance to interpret, not a rule breach to punish. [synthesis] For literacy limits, an oral version keeps the method. [synthesis]
Overwhelm or regression (especially in mildly psychotic members). Schilder treated some mildly psychotic patients [source: Wikipedia Schilder], so this risk is real. Slow the pace, move from deep interpretation to clarification and support, and avoid interpreting primitive material in front of the group. Arrange an urgent individual review. If disorganisation, suicidal ideation or self-harm appears, carry out a standard structured risk assessment and follow local crisis protocols. Pause group attendance if needed.
Scapegoating or a member attacked after disclosure. Stop the attack. Interpret the group's shared projection ("perhaps we are attacking in E what we fear in ourselves"; illustrative). Link the moment to sibling transference (4.6). Check on the attacked member afterwards.
Rupture with the therapist (anger, disappointment, feeling misunderstood). Acknowledge your part first. Then explore the father-transference elements without using interpretation to deflect valid criticism. Repair is part of the work.
Rivalry for the therapist / requests for privileged contact. Interpret openly in the group. Keep individual-session access even-handed.
Erotic transference or sexualised group talk. Discussing sexual ideology is part of the method, but discussion must not become acting out. Interpret, keep strict boundaries, and do not allow sexual contact between members, or between members and therapist. This is an absolute ethical limit.
Therapist imposing values during ideology reconstruction. This is a risk specific to 4.9, since ideologies about sex, religion, death and work are value-laden. Check whether the revised attitude came from the patient. Respect cultural and religious frameworks. Target rigid or symptom-driving uses of a belief, not the belief itself.
Intellectualising (a particular risk in the Wender variant). Cut the didactic portion, ask for the feeling behind each idea, and interpret intellectualising as a defence.
Outside contact and subgroups. Wender encouraged outside friendships [source: Wikipedia Wender]. Modern practice usually asks that outside contact be reported in the group. Set your rule at entry and interpret secret alliances.
Confidentiality breaches. Restate the agreement. Discuss the breach in the group. Remove a member after repeated breaches.
Dropout. Contact the member individually, explore their reasons, and bring the dropout to the group as material on abandonment and loss.
Mismatch between historical and modern practice. Questionnaires on sex and death, open sexual discussion, and outside friendships were used in a 1930s hospital context. Today, obtain informed consent for written disclosures, store written material securely, and agree who may read it.

Sources

Sources

Further reading (primary works, not drawn on)

Schilder, P. (1936). The analysis of ideologies as a psychotherapeutic method, especially in group treatment. American Journal of Psychiatry, 93, 601–617.
Schilder, P. (1938). Psychotherapy. New York: Norton. Revised edition, ed. L. Bender, 1951.
Schilder, P. (1939). Results and problems of group psychotherapy in severe neuroses. Mental Hygiene, 23, 87–98.
Schilder, P. (1940). Introductory remarks on groups. Journal of Social Psychology, 12, 83–100.
Schilder, P. (1935). The Image and Appearance of the Human Body. London: Kegan Paul.
Schilder, P. (1942). Goals and Desires of Man. New York: Columbia University Press.
Wender, L. (1936). The dynamics of group psychotherapy and its application. Journal of Nervous and Mental Disease, 84, 54–60.
Wender, L. (1940). Group psychotherapy: a study of its application. Psychiatric Quarterly, 14, 708–718.

Volume and page numbers for the primary papers come from bibliographic memory and are [uncertain].

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