Group Psychotherapy: The Psychoanalytic Approach

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This classic work attempts to present a comprehensive account for the lay reader of the principles and methods of group psychotherapy.

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1. Group Psychotherapy and Group-Analysis: Basic Considerations (S.H.F.)

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1. INTRODUCTION

Group psychotherapy is now practised in clinics and institutions as well as in private practice all over the world. Beyond this there is a growing realization of its significance for other groups, social life in general, social psychiatry, community therapy, selection procedures and education.

There are many varieties and types of group psychotherapy. For a broad orientation it may be useful to consider these types according to whether their impact is primarily due to:

(a) relief through expression. Catharsis (action methods and activities of all sorts);

(b) restoration through participation and acceptance, best known as encounter groups; or in addition to these

(c) the liberation of creative forces in the individual, the liquidation of old fixations in development by laying bare disturbing conflicts, bringing them to awareness and resolution (group-analysis).

Only this last category, characteristic for the analytic approach, concerns us here. All the pioneers in this field came from psychoanalysis: T. Burrow, S. H. Foulkes, P. Schilder, S. R. Slavson, L. Wender and others. All of them were American, except S. H. Foulkes whose work developed independently in England. Only the latter, while always remaining a Freudian psychoanalyst in the individual field, maintained from the beginning that in this new field the group situation changes the therapeutic process decisively. Accordingly, he created a novel method of approach which he called group-analytic psychotherapy and new theoretical concepts: group-analysis. This view has more recently gained much ground. It is nevertheless fair to say that it is even now insufficiently understood and that psychoanalysts are more reluctant to accept the changes in method and theory involved than are other workers in this field.

 

2. Significant Features of the Group-Analytic Group in Relation to Other Types of Human Groups (S.H.F.)

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1. GROUPS IN GENERAL

In this chapter we shall pass in review a number of groups as they are found in ordinary life. They will be roughly classified according to certain criteria, derived partly from analytic observation of the dynamics in the therapeutic group. In thus presenting a whole scale of typical groups we hope to bring out more precisely the features of psychiatric therapeutic groups in general, and of group-analytic groups in particular. In any human society we may study there will be an infinite variety of groups, and it is not proposed to describe or classify them fully here.

First of all there are such fundamental social groups as the family, the clan, or even an entire nation. In such groups the members are vitally interdependent; as a class they are best called communities. They satisfy basic needs such as food, protection, and sex; human life is never found outside such groups. These fundamental groups, root groups, and especially the family group, are in one sense the true objects of treatment, for the mental health of the individual is dependent on his community. However, we are less concerned with the consideration of these root groups in this book, the intention being to study therapeutic groups whose members are initially strangers.

 

3. Patients and their Background, and the Group-Analytic Process (S.H.F.)

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1. PATIENTS AND THEIR COMPLAINTS

Our patients come from all walks of life. They are of all ages and as often men as women. Clinically, they are mostly so-called psycho-neurotics. Others would be labelled psychotic, depressed, psychopathic, psychosomatic, or suffering from particular aberrations in their sexual life. We have however learned that these labels have a limited value only, and that people who can be cured or considerably improved may belong to any of these categories.

It is on the whole true to say that all patients suitable for psychotherapeutic treatment individually should also be suitable for group treatment. However, patients whose problems mainly and manifestly concern a very intimate aspect of their lives, e.g. overt sexual disturbances such as frigidity in women or impotence in men, or homosexuality, are as a rule better suited in a group which is particularly selected and arranged for them, or for individual treatment.

Undoubtedly, for some conditions and some personalities the individual situation is preferable. What is less well understood and perhaps more surprising: there are many patients for whom the group situation is definitely to be preferred. In the course of this book we shall have occasion to say something more about the reasons for this, and about selection. The finer points of selection and diagnosis, the arrangements, the matching up of suitable groups, are not so much matters for us here as technical problems for the expert. But we shall in the following pages say something of the sort of problems those patients present whom we can encourage to join a therapeutic group.

 

4. Some Technical and Practical Aspects of the Group-Analytic Situation (E.J.A.)

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1. THERAPY AND RESEARCH

Every therapeutic episode can be regarded somewhat loosely as an experiment or essay in research. This concomitance of treatment and research is now a commonplace in medicine and is largely responsible for advances in the field of therapy. For many psychotherapists, however, even this moderate scientific attitude is felt to interpose an emotional distance between the therapist and his patient. Research is interpreted as an active interference with the spontaneous evolution of the therapeutic relationship.

This shows a misunderstanding of the nature of therapeutic research. Such research is a by-product of the spontaneous therapeutic process. The therapist remains relatively passive and detached. There is no overt difference in his behaviour. He is a participant observer. He does, however, observe with an open mind and tries to view his data without a preconceived bias. That is, he is prepared to learn something new from his findings and not only something old. The ‘open mind’ is the prerequisite for research. In treatment, you find what you set out to find. In therapeutic research you may find nothing significant – but that would still be something.

 

5. Clinical Illustrations with Commentary (S.H.F.)

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First, by way of introduction, an excerpt from a letter from a woman who is well motivated for participation in a group-analytic group:

Why I want to join a therapeutic group, and what I expect from it.

All I know at present of what goes on at a therapeutic group session is secondhand and theoretical. When I first came across Dr Foulkes’ introductory book [Introduction to Group-Analytic Psychotherapy] I was fascinated by it to such an extent that I read it through at one sitting. Here, at last, was a ‘natural’ way of working out one's difficulties and problems!

When a little while before I had considered undergoing psychoanalytic treatment I had rationalized my general repugnance to having my true self laid bare by expressing doubts whether psychoanalysis was not too special, too artificial a method for me. I hardly liked the idea of being so ill that I needed the attention – hour after hour, week after week, month after month, and year after year – of a highly skilled therapist as required for full psychoanalysis. It just seemed out of proportion. I had not understood the idea that psychoanalysis aims at really changing a person. All I expected was perhaps the disentangling of a few strands in my early emotional life, and having them neatly rearranged.

 

6. The Natural History of the Therapeutic Group (E.J.A.)

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The psychotherapeutic group is a mirror not only for the patient but also for the analytic theorist, who can look in on this complex scene and note what he will. There are no limits to the possible descriptive subtleties open to him, and he may find himself exhibiting surprisingly different group models from those of his colleagues. Conceptions will alter with preconceptions. Certain aspects of these conceptual models, however, tend to repeat themselves.

The living portrait of the group is most uniformly painted in terms of conflict, which is evident in manifest or latent forms in every group situation. It may be conflict brought in by an individual, or conflict arising autochthonously from the matrix of the group and its developments. There is, for example, ample provocation in the setting itself to set going a life-long defiance. The freedom of the group situation may unleash the monopolist or exhibitionist and leave the rebel with nothing to rebel against save time and space. He may respond with open irritability and hostility, or by an exaggerated show of boredom. His problem is learning to live with his group neighbours in the limited ‘living space’ of the group, and accommodating himself to their ‘elbowing’.

 

7. The Phenomenology of the Group Situation (E.J.A.)

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The data for theorizing on group dynamics are present in all types of groups. Its availability varies from group to group. In some it is cloaked in convention and formalism resistant to any inquiry, whereas in certain mass demonstrations, spontaneous phenomena may be evoked in a profusion that is equally apt to defeat analysis.

In the therapeutic group the uncovering process is not only permissible but pertinent and expected; and in the analytic variety it can be carried out with a minimum of interference and distortion of the material. It should be emphasized that the spontaneous dynamisms observed in the treatment situation exist in all other life groups. Group-analysis does not create them, but it renders them manifest and susceptible to closer investigation. The results of such investigations can, therefore, be applied, with some reservations, to non-clinical groups, and expanded, perhaps, into comprehensive, social theories. It is the group analyst's conviction that he can procure field data not otherwise available to the social scientist. He would, therefore, welcome some reciprocal arrangement whereby, in return for the facts supplied him, the sociologist would feed back theory into the therapeutic situation and so enhance its already rich potentialities.

 

8. Group-Analytic Psychotherapy with Children and Adolescents (E.J.A.)

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1. GENERAL PRINCIPLES

Group therapy with children, like group therapy with adults, can be organized to include a wide range of therapeutic situations, which allows the therapist to prescribe more appropriately to the child's needs. Some types of disturbed children, for example, do better in mixed diagnostic groups, some with groups in which there are mixed sexes, and some in settings where the age range has been stretched a little to include both younger and older children. Again, some children are more responsive when confronted with a group occupation, whereas others will create their own interests and activities or restrict themselves for long periods to purely verbal interchanges. Some of these differences are related to the age and sex of the child, but temperament, personality, and diagnosis also play a considerable part. Having male and female therapists and co-therapists also available serves to expand the spectrum of treatment still further. Although such provisions aim at obtaining the right type of group for the right patient, it is well to remember that selection criteria are, at best, only approximately effective in this respect, and that it may be of more therapeutic worth to allow the individual to adjust himself to the requirements of the group than to find a group that is ideally adjusted to his idiosyncrasies. By concentrating too rigorously on compatible membership, there is a double danger of defeating one of the crucial therapeutic functions of the group which is to resolve disturbing differences or the disturbances associated with differences, and, secondly, of creating a compulsive organization that disregards ends in its pursuit of means. It must be borne in mind that group therapy is still in the fallible stage of learning from its own mistakes and that even if we work towards providing a particular patient with what he needs at a particular time, it is still worth trying him out in a group when age, sex, and diagnostic considerations do not appear altogether promising.

 

9. Group-Analytic Psychodynamics (S.H.F.)

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1. GROUP AND INDIVIDUAL

Group psychotherapy raises many questions. What is the meaning of ‘individuality’ in the group situation? What forces create and disrupt human relationships and govern the integration and disintegration of groups? What are the most important dynamic processes upon which therapeutic operations depend? Social psychologists have not hitherto provided any theories that do justice to group-analytic experiences and bring order into this field of observation.

Work with therapeutic groups, with people under the pressure of suffering and conflict, gives access to facets of personality and of personal interaction which are deeply hidden and inaccessible in other circumstances. The nature of this material and the group-analyst's familiarity with the language of symptoms, with the unconscious meanings of utterances and reactions, allows him to observe and understand phenomena hitherto concealed. This gives him new insights and reveals new aspects of those sociological groups which have already been studied.

 

10. Wider Theoretical Formulations and Applications (S.H.F.)

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1. GROUP AND COMMUNICATION

Group-analysis used as an instrument of treatment, teaching, and research has a bearing on all human activities and experiences. It raises problems about, and may offer solutions of interest to, philosophy, semantics, psychology, psychoanalysis, education, art, religion, and social and cultural movements and organizations. It opens the gates towards a new social psychopathology and a dynamic science of psychotherapy. What follows are theoretical formulations arising from group-analytic observations and speculations as to their significance.

Communication and reality. As the process of communication has been found important, let us begin with this. How does the group help us to know about the world, its reality, and the relationship of this to mental reality, unconscious phantasy, and the possibility of communicating about these? Our immediate guarantee for an object's existence is our perceiving it. Its existence is its being perceived, as Berkeley put it. On the other hand we feel quite rightly that what we perceive is not of our making, that there is something independent, a world of ‘objects’ by virtue of which we can have perceptions at all.

 

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