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Introduction to Group Analytic Psychotherapy

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Group Analysis, the approach pioneered by Foulkes, is a form of psychotherapy in small groups and also a method of studying groups and the behavior of human individuals in their social aspects. Apart from a number of practical advantages, it has features of specific value. It is a method of choice for the investigation of many problems and for the treatment of many disturbances.

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PART I. GENERAL INTRODUCTION

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PART I
GENERAL INTRODUCTION

Life is a complex whole. It can only artificially be separated into parts, analysed. Such isolation becomes necessary when we want to know what a particular set of forces contribute to the total phenomenon or, to put it more precisely, how the whole is affected by the absence or altered function of any one part.

This is of immediate importance in dealing with disturbances, as, for instance, in the field of Medicine, with so-called diseases. Disease has been defined as life under changed conditions.

The healthy organism functions as a whole and can be described as a system in a dynamic equilibrium. Dynamic means that it is never in a state of rest, has constantly to adjust actively to the ever changing circumstances, milieu, conditions in which it lives.

Such adaptation, however, does not take place mechanically, following physical or chemical principles merely. There is always a creative element present, even in the simplest forms of adaptation.

The organism acts as if it knew its aim and had a choice as to the means to achieve this aim. It chooses those means which suit best all the prevailing conditions, inside itself or outside itself. If we want to say that we are aware of this and need to take into account all these factors in order to describe and understand what happened, we speak of the “ total situation.”

 

THERAPISTS AND PATIENTS

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It remains to describe the conditions tinder which Psychotherapy takes place under civilian circumstances. It should be mentioned that the first series of observations took place during the war, 1940/42, in a County town. Patients came from many outlying districts and had no social contacts with each other outside the Group meetings which took place regularly once a week. More recent observations are taking place in London since the end of the war.

The general conditions of “ Outpatient Clinic “ patients need not be described. It is perhaps noteworthy that at the present time in London—in my case at St. Bartholomew’s Hospital— there is a long waiting list. It is not unusual for patients to have been half to one year on the waiting list before they are called up for treatment. On being first sent by their Doctor they are given a long interview by the Director and a careful “ social history “ is taken by the Psychiatric Social Worker. A provisional diagnosis is made and they are selected for a particular form of treatment, like electro-narcosis, Hypno- or Narco-Analysis, analytical Psychotherapy, etc., and allocated to one of the treating specialists on whose waiting list they go. Meanwhile they are usually given some medicine, e.g., Bromide and Luminal. Out of those on the waiting list I formed my Group. There was no particular selection, except ruling out those obviously not, or less, suitable. In this case I decided to begin with a women’s Group. Outpatients’ Groups are more difficult to form and treat than inpatients, and women appear to be more difficult to integrate into a Group than men. Mixed Groups have their own problems, but there is also much to recommend them. My private Group at present is a mixed one.

 

VARIOUS PRINCIPLES

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Selection according to Personality Types

Similarity of problems and syndromes has undoubtedly its advantages, but dissimilarity has its own merits too. In the more open type of group, I prefer the latter and selection becomes then more a question of a favourable mixture in the composition of a group. Criteria then shift to the type of personality, for instance, introverted and extra verted, shut-in, seclusive, shy, or forthcoming, good or bad verbalisers, over-conscientious and irresponsible types and so on. I prefer variety, including extremes, in which the one manifestly displays, personifies, what is suppressed in the other’s potential. I presume, that the greater the span, the higher the therapeutic potential, as long as the Group is able to master that span without disintegrating. Obviously, the Conductor’s potential plays a decisive part in this.

In such a case, the emphasis of selection is on the compo sition of the Group in hand, the state of integration it has reached, and whether the inclusion of a particular individual is good or bad for that Group rather than for the individual in question. This type of selection puts the interests of the Group first, is “ group-centred.” The Therapist asks himself, what type of person is desirable to be added, or excluded, to help this Group as a whole ? He looks out for the individual from the point of view of his Group. According to a deep law in interpersonal relationships this Group is then also a good medium for the individual in question.

 

PART IV. THE CONDUCTOR’S CONTRIBUTION THE CONDUCTOR’S CONTRIBUTION

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PART IV
TOE CONDUCTOR’S CONTRHIBUTIION

Some Definitions first.—In a group composed of patients and meeting for the purpose of treatment, the Therapist is normally in the position of its Leader. The term “ Leader “ has, however, become overloaded with meaning and particularly with fascist connotations. I will, for our purposes, therefore replace it by the less pretentious term of Conductor. The terms “ leader “ and “ leading “ will be used to express active and manifest exertion of influence upon the group, based upon the Therapist’s exceptional position within it. For the more indirect, although deliberate, steering of the group, we will reserve the term “ directing.” Directing can be active, too, but is most of the time in the nature of a catalytic action.

Thus a Conductor may or may not lead the group. The guiding principle for him is always the therapeutic function. In the best interests of this function he has sometimes to assume the role of a leader. Most of the time, according to our opinion, his therapeutic function is the better served the more he refrains from leading and, indeed, it is essential that he should not identify the task of conducting the group with that of leading it. At the same time, however, the Conductor must, in his function of Therapist, at any moment be in a position of assuming leadership of his group, as long as anyone in this group is in need of treatment. As soon as the treatment process has come to an end this is different. The Conductor then ceases to be a leader, but he has also no further function as a Therapist withifl this group. As these statements might appear confusing, I will sum up quite simply: Whereas the Group Analyst remains the Conductor of the group throughout, and therefore also its Leader, he only exceptionally assumes actual leadership of the group.

 

PART V. SURVEY

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PART V
SURVEY

This group-analytic situation as here described has features which are without precedent in the patient’s life. It is not unusual for it to produce a reaction of bewilderment and shock in the beginning, as for instance expressed in prolonged silence. In such a situation the group cannot avoid accepting responsibility and must rely more and more upon its own resources instead of turning to a leader or other authority for guidance.

These features are also not realised in any other form of Group Therapy,- even if oriented towards a psychoanalytic approach, as for instance Wender’s and Schilder’s. Moreno’s stress on spontaneity points in the same direction, but he is not psychoanalytically oriented at all, and considers catharsis and acting out as the essentials of psychotherapy. I insist, on the contrary, on the essential value of verbal formulation and articulate communication for the final conclusion of the therapeutic process. This is also essential for the ultimate formulation of our experiences in scientifically accessible terms. What one has fully experienced and understood one can also express in words. Only what one can express in words can be fully detached from the self, a detachment which is the ideal of therapy, in so far as pathogenic influences and past traumatic experiences are concerned. This is true for individual—and group—analysis alike. W. R. Bion’s approach, so far as I know it, is essentially related or possibly identical, as far as the group analytic situation goes. However, in my view, the Leader and his basic authority, as invested in the group Conductor, are absolutely essential for the group-analytic situation to arise, to be maintained, and for it to serve therapeutic ends. The Group Analyst continuously leads the group, directs the group, although from behind the scenes, as it were, on which he appears sparingly, but often at decisive moments. That, in the last resort, he uses this authority, in order to wean the group from such Authority, is another matter. He should eventually become superfluous, but this is, at the same time, the ideal end of all treatment. I also believe, that the Content, the subject matter discussed, and its analysis, is as important as the interpersonal relationships which develop, and become subject to analysis in their turn.

 

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