Psychotic Decompensation During Group Psychotherapy: Early Recognition and Treatment

This article describes how psychotic decompensation can develop in group psychotherapy. In the early stages of decompensation fusion-anxiety (expressed by self-imposed isolation) is replaced by fusion-need (expressed by boundless interaction). When fusion-anxiety is dominant, there is a splitting between libidinous and aggressive object relations. The group-as-a-whole is then experienced positively, while aggression is directed towards individual group members. In later stages of decompensation, the splitting lies within the group itself: some group members are experienced positively, while others are strongly criticized. Psychotic symptomatology is often denied by the group members. In such cases, the therapist should intervene actively, giving the group structure and direction; he or she should not wait for correction to come out of the group itself.