Therapeutic Group Analysis

S.H. Foulkes

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429922893
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

'This book is based on twenty-five years of intensive study of patients in psychotherapeutic groups. The attitude is psychoanalytic but the method and technique are new. The background of consideration is the mental matrix of the group as a whole inside which all intra-psychic processes interact. This has a profound significance for psychoanalytical concepts and the many problems connected with them in psychoanalytic practice and theory.

Part I
The Evolution of Group-Analytic Psychotherapy

Historical Perspective

Historical accounts of group psychotherapy are in abundance. Klapman made a beginning, Corsini a thorough study. Among recent books one by Kadis and others (A Practicum of Group Psychotherapy) and one edited by Rosenbaum and Berger contain extensive_surveys, to mention but a few. There is no intention of writing another such account here. Like our history books these presentations are strongly influenced by the writers’ various national and doctrinal affiliations and personal bias, prejudices and involvements.

As this book is about my own work, all I will try to do is to put this in some sort of perspective. I will focus on the situation as it existed at the time of my first publications, that is, roughly, on the first five years of development, out of the twenty-five years here reported. Before doing so I should like to make a few quite subjective and personal observations. I became a medical student knowing that I wanted to be a psychiatrist. I was greatly stimulated by the books of Jaspers, Gruhle and others, but soon found my way to the work of Freud. Since then (1919) I knew that the precise name of what I wanted to be was a psychoanalyst.

I chose to have a thorough training in Medicine, Neurology (with Kurt Goldstein) and of course Psychiatry (Kleist, Wagner-Jauregg, Pötzl). This was valuable experience, the more so as I observed wherever I was and whatever I saw with the eyes of the psychopathologist.

In the mid-’twenties I came across one or two papers by Trigant Burrow which must have made a deep impression on me. They put the idea of group analysis as a form of treatment into my mind. There were other influences in the air at that time: apart from plays like Six Characters in Search of an Author by Pirandello, I remember being greatly impressed by Maxim Gorki’s The Lower Depths (Nachtasyl)—quite recently revived in London. Here was a play without a hero, a leaderless group on the stage, driven by strong, anonymous forces. I pondered about the pathogenic and therapeutic power of the theatre and of everyday life.

Fifteen years elapsed between this first germinal inception and my first actual experience with a group. This took place under quite different circumstances, early in World War II, but in private, civilian practice in Exeter. After the first session held in a waiting room at 23 Dix’s Field I went home to my late wife and said to her ‘a historical event has taken place in psychiatry today, but nobody knows about it’. I remembered Trigant Burrow—nobody else did at the time—but I did not know then that he had never practised group analysis as I understood it and in the light of later closer acquaintance I think somewhat overestimated the range of his work. I did know, though, that he had come to consider psychoneurosis as a faulty biological development of the human species and called his system now ‘phylo-analysis’. Thus I felt free to call what I was doing ‘Group Analysis’, the first to have used this term since Burrow.

Of Wender’s and Schilder’s work in the USA I knew only from hearsay. Social psychology hardly existed, there was no work on small groups and no method of approach to them whatever, to my knowledge. Psycho-analytic contributions to cultural anthropology—with a few exceptions—fell lamentably short, partly through ignorance of the subject, more so through the onesidedness and bias, largely unconscious, of the psychoanalysts. Freud’s work had always been in the centre of my interest. As a psycho-analyst I adhere to the classical line of approach. Otherwise in applying psycho-analytic knowledge to psychotherapy I keep an open mind towards all innovations and all criticism from whatever quarter they may come. My interest in work in the group situation arose from my own observations with psycho-analytic patients, and from my particular interest in theoretical problems. I am convinced that this work is the best method to make the revolutionary discoveries of psycho-analysis effective on a broader front both in therapy and in teaching. Moreover, that the study of mental processes in their interaction inside the group-analytic situation will teach us much that is new and help to solve theoretical, conceptual problems which are self perpetuating in the psycho-analytical situation. Therapeutic group analysis is the foundation upon which a new science of psychotherapy can rest. For myself I have always looked upon psycho-analysis in the light of life as a whole and not upon life from the perspective of the analytical couch.

Now to a more objective account. A word about the great pioneers of individual psychotherapy in modern times, Freud, Jung, Adler, and the significance of their work for group psychotherapy might be indicated. About the importance of psycho-analysis this whole volume bears witness.

Freud’s explicit contributions, e.g. ‘Group Psychology and the Analysis of the Ego’ are not really relevant. He uses the group model in order to illustrate the operation of processes as revealed in the analysis of the individual patient in isolation. Jung, more than Freud even, was greatly concerned with the collective and archetypical unconscious. He and those close to him appear to have disliked the idea of ‘group treatment’ but I have met a number of Jungians amongst the younger generation in London who showed particularly good understanding for a group dynamic analytical approach. Adler, it is true, stressed the community and saw the individual’s relationship to it in perspective. He may well have held occasional group discussions or even therapeutic meetings with a number of mothers at child guidance clinics, as is reported, or on similar occasions. But to proclaim him posthumously as a group psychotherapist is not justified. Nowhere, to my knowledge, did he put the group, the social interactional network into the centre of either his method or theory. Had he done so, Adler could have made a great contribution at the time. As it was, he extolled the individual as the indivisible entity, as a reaction to psychoanalysis, which had taken the individual to pieces in order to look into his inner working mechanics, and correspondingly refuted Freud’s interpretations and method.

Trigant Burrow did put the group into the centre of his orientation. That was and remains his great merit. He built up on Freud and Jung—so far as their work went at the time—but hardly mentions Adler, though Burrow’s emphasis on the disastrous human obsession with the ‘I-persona’ is reminiscent of the latter’s orientation.

Group psychotherapy can be practised with or without an analytic orientation. We are here only concerned with the latter. In order to make clear what had been done before the present method made its appearance the best way is to indicate shortly what different authors actually did in their work with groups.

Trigant Burrow lived with a number of closely connected colleagues and co-operators and they seem to have spent a number of years together, living together in the same campus in a sense analysing each other mutually and partly collectively under his guiding influence. Study of tensions which could be demonstrated in physiological, measurable, objective terms occupied more and more a central position. These are understood as an expression of a phylic aberration of the human species, as a result of which the individual is vitally ill at ease, desperately and defensively concerned with his ego identity. No therapy is possible, only the whole species could overcome its faulty development. I am not sure that this short account conveys sufficiently an orientation which has led to some profound insights and formulations. Enough has been said, however, to make it clear that we are dealing with a totally different approach from the one described in this book.

Louis Wender applied a class method, using his own psychoanalytical experience and skill, interpreting individual psychopathology and stimulating some mutual experiences and exchanges in small sub-groups. In a session which I attended, still in 1949, we were seventeen in the classroom, Wender in the position of the teacher in front.

Paul Schilder never exceeded five patients in a group and did not yet dare to mix sexes. All the patients had been intensively analysed by him individually beforehand over a number of years. Questionnaires were used, case notes presented in turns and interpretatively discussed. He found these groups useful in particular for the analysis of ideologies, on which he wrote interestingly.

S. R. Slavson became known at the time for his work in activity groups with children and adolescents. This was alive and original. His analytic approach to groups, which he cultivated later, was largely theoretical, the absence of the experience of the psychiatrist and psycho-analyst being noticeable. Slavson has considerable merit as an organizer and editor. He adheres strictly to psycho-analytical concepts. These have absolute validity, being merely modified, inevitably, by the group situation. Slavson writes precisely and tends to make dogmatic pronouncements.

Following on Schilder’s and Wender’s publications Alexander Wolf began practising group psychotherapy of a psycho-analytic type in the USA. He published his experiences in 1949 and has since made many valuable contributions. His work has influenced many group psychotherapists in the USA. It is rather a prototype for the application of psycho-analytical principles in a group setting, as it grows from individual treatment, when the analysis of dreams, transference, resistances, etc., appears not substantially affected by the group situation. Like Schilder’s, Wolf’s patients joined the group after more or less intensive individual preparation, as a result of which a ‘special relationship’ with the therapist was established, even explicitly—e.g. patients’ surnames and fees were kept confidential. Groups met three times a week, sometimes with two or three additional ‘alternate’ sessions—without the therapist—with a membership as large as eight to ten. Emphasis appears to be on transference in the family model and on the orthodox aspects of the therapeutic process.

Group constellations and interactions were used much in the sense of the present writer’s ‘mirror reaction’. A peculiar feature was the working through in different phases, e.g. dreams, transference, resistance, etc., under the therapist’s directions. This is difficult to reconcile with a psycho-analytic or a group-analytic attitude as understood here, where the absence of direction and control in so far as patients’ productions are concerned is essential. There is also a good deal of didactic activity on the part of the therapist apparent, although this would perhaps not be recognized as such. I have gone into this method at some length, because it is instructive by way of contrast to the group-analytic approach described in this volume (see specially Part V).

Theoretically Wolf speaks, even now, of the ‘mystique of group dynamics’, unaware that he is working—willy-nilly— with the psychodynamics even in his own type of group. The group-analytic point of view is the opposite: it considers that all psychodynamics are originally multipersonal, at the very least two-personal, refer ultimately to the group (tribe, family, community, species) and are thus primarily group phenomena. The difficulty here is partly semantic, in that the term group dynamics is in the USA associated with the work of K. Lewin and his followers, but more fundamentally due to our upbringing in a psychology which was based on the isolated individual.

Since I have become aware of this I prefer to use the term ‘group processes’ or say explicitly psychodynamics, as used by Freud. The latter insight, namely that psychodynamics are not only interpersonal but transpersonal phenomena goes to the very roots of any approach to group psychology and requires a fundamental turn of mind, for which the undergoing of group-analytic treatment is perhaps the best preparation.

In England Joshua Bierer introduced independently a form of group psychotherapy in a mental hospital. His orientation was on Adlerian lines and had no bearing on group analysis with which it was contemporary. He preferred a more leader centred and more ‘active’ method. Bierer’s main merits lie in his pioneering a therapeutic approach to the community of the hospital, including day hospital and therapeutic clubs and in his great flexibility in the use of ‘situational’ treatment.

Maxwell Jones began with didactic class and discussion methods, but became slowly, after the war, more analytic in his orientation. He devoted himself to social psychiatry and his institutional work in terms of the ‘therapeutic community’—as it was now called following the ‘Northfield’ example—is well known. His attitude differs, however, considerably from that of Bierer.

W. R. Bion had made a mark with his leaderless selection groups. Together with Rickman he confronted a group of neurotic soldiers with their own neurotic behaviour and its consequences. In a later section it is described how these ideas came to fruition and fulfilment in the creation of a therapeutic community, for the first time really conceived as such, at Northfield during World War II. After the war Bion was put in charge of group psychotherapy at the Tavistock Clinic. Like most of his other colleagues there he qualified as a psycho-analyst after the war and was strongly influenced by Melanie Klein. This has a bearing on the type of group psychotherapy at the Tavistock Clinic.

Though this falls after the period here considered a word may be said about its development by way of comparison and contrast to group analysis. The therapist confines himself entirely to interpretations, in particular transference interpretations. These are given preferably in terms of the group. This emphasizes the therapist in relation to the group, which is perceived as if it was one patient. Thus it can be maintained that the analyst functions principally in the same way as in the two-person situation. The group analytic situation appears to have been retained as far as numbers, regular sessions, seating arrangements, etc., go. Whether the situation is as strictly defined analytically I am not so sure, e.g. as regards meetings of patients outside the session.

There was no group psychotherapy in existence on the Continent, but interest began to stir after the war, especially in Holland and France, later in Germany and Switzerland. Apart from direct contacts, the analytical approach in Great Britain reached the Continent largely via America.

In England group psychotherapy has thus been led from the beginning by a number of respectable psychoanalysts and the standard of its practice is relatively high.

Chapter I
Group Analysis

A Study in the Treatment of Groups on Psycho-Analytic Lines

(JOINTLY WITH EVE LEWIS, MA)

One of us (S.H.F.) had for many years given much thought to the inherent possibilities of collective treatment. He was, therefore, particularly glad to have the occasion to put his ideas to a practical test. It has not only fulfilled but far exceeded our expectations. While it is an economy of time for the therapist, group treatment of this type actually intensifies the effect and thus shortens the duration of treatment.

We shall report on four groups, two male and two female. Two (M.1 and W.1) were of private patients and individual treatment was combined with group treatment whereas in the Clinic Groups (M.2 and W.2) group treatment was only supplemented by occasional short personal interviews.

It is clear that the therapeutic aim under these circumstances is a more modest one than is the case where a full analysis is possible. To restore the balance of the patient’s mind and to enable him to resume a satisfactory function in social, family and professional life within a reasonable period was the task for all practical purposes. This was to be achieved, in so far as possible, through a genuine change in mental economy, based therefore on a lasting foundation. This is not a small claim, but group analysis can and does meet it. Under favourable conditions the patient is enabled to work out the stimulus received, to solve his conflicts in a way better adjusted to reality than he has done hitherto and to derive benefit far beyond the immediate improvement. There are many side aspects exceeding the merely therapeutic aim into which we cannot enter here, but we would like to mention the educational value of such treatment. The concrete realization of the part which social conditions play in their troublesome problems, the social front of inner conflicts, so to speak, sets people thinking in a critical way and makes them experience the part they themselves are playing, both actively and passively, as objects as well as instruments of these conditions—an altogether desirable contribution to their education as responsible citizens, in particular of a free and democratic community.

Our observations refer to four different groups of patients, two composed of men, two of women. The numbers attending varied from five to ten people at a time, the average in individual groups being about five in one and nearer eight or ten in another. Some patients formed part of the group from the beginning; others participated for shorter periods and their places were taken by new people. The actual number of cases upon which these observations are based was about fifty. The optimum for a group would seem to be in the neighbourhood of eight, with a bias in favour of a slightly larger rather than a smaller number. A larger group can easily carry a few people who, for some reason or other, are inhibited; a smaller group is more dependent upon all the members being active. In regard to the fact that the sexes were kept separate, it can be stated that there appears to be no objection in principle to having mixed groups. We have, indeed, the impression that some people of each sex would actually benefit from a closer contact with the problems and views of the opposite sex. But so far the experiment has not been made, as the possible difficulties appeared so great that it was felt to be undesirable to add any unnecessary complicating factor. It can, however, now be stated that no difficulties have arisen which could not be dealt with inside the group itself whilst ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• PREFACE
• ACKNOWLEDGMENTS
• Contents
• PART I: THE EVOLUTION OF GROUP-ANALYTIC PSYCHOTHERAPY
• PART 2: PSYCHO-ANALYSIS AND GROUP ANALYSIS
• PART 3: GROUP DYNAMICS AND THE INDIVIDUAL
• PART 4: GROUP ANALYSIS IN OPERATION
• PART 5: A BRIEF GUIDE TO GROUP-ANALYTIC THEORY AND PRACTICE
• APPENDIX
• List of Publications
• Bibliography
• INDEX