Introduction to Group Therapy
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Introduction to Group Therapy

A Practical Guide, Third Edition

Scott Simon Fehr

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eBook - ePub

Introduction to Group Therapy

A Practical Guide, Third Edition

Scott Simon Fehr

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About This Book

The main objective of Introduction to Group Therapy is to give the reader a solid understanding of group therapy while simultaneously creating scholars in the group therapy paradigm. This unique book combines theory and practice in a reader-friendly format, presenting practical suggestions to guide both students and novice group therapists through the nuts and bolts of running a group. This third edition continues the clinically relevant and highly readable work of the previous editions, demonstrating the therapeutic power group therapy has in conflict resolution and personality change. A proven resource for introductory and advanced coursework, the book promotes group therapy at the grassroots level – students – where it has the most opportunity to be put into effect.

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Publisher
Routledge
Year
2018
ISBN
9781351007467
The circle is the earth upon which we walk. It is the sun from which the elements of life began on this planet. It is the solar system, the planets, and the stars.
In the beginning, a historical overview of group psychotherapy would probably be somewhat remiss without a preliminary discussion of the concept of the circle, round, or sphere, as it physically represents the process of group psychotherapy. It is a most curious global phenomenon that clans, tribes, societies, and civilizations, no matter how primitive or advanced, have continuously used the circle as a symbol in their cultures.
The circle or sphere is an entity that is self-contained; it has no beginning or end, and represents, theoretically, a perfect state in which the opposites are in mutual harmony before a contradiction begins to occur. It is the only symbol in which all points have parity and equivalency. It is the Uroboros, a symbol from ancient Babylon, embodying the world, represented by a snake holding its own tail in its mouth, forming a circle. This symbol can be found in the ceremonial artwork of the Navajo Indians in America and in the different tribes and castes in Africa, India, and Mexico. It is used in the alchemical writings of wizards, magicians, and in the wheel of reincarnation. The circle is observed in the Book of Revelation and it appears consistently in the form of a mandala for meditation and unification with a supreme being. By focusing upon the mandala, one travels in search for harmony with the universe.
The circle often represents the womb or the origins from which life springs forth. It is the yin and yang of Chinese philosophy and the gold ring of being united in marriage. Children all over the world, no matter how primitive, humble, or affluent, begin their primary drawings by trying to duplicate a circle, and then, as they mature, they move beyond this symbolism to more detailed representations of their internal and external experiences. The circle is the earth upon which we walk. It is the sun from which the elements of life began on this planet. It is the solar system, the planets, and the stars.
The circle can be a bit fanciful, as seen in the more picturesque concept of a group as depicted in the mythical story of King Arthur and the Knights of the Round Table. Although Merlin, King Arthur’s famous magician, was often present to provide dream interpretation, it is not certain that these men were discussing unconscious processes. Perhaps they were fulfilling the requirements of a form of both the circle and group therapy. They sat in the round, each knight having parity to discuss the events of the day not only among themselves but with a leader. Quite probably their meetings were not only goal or task oriented but also included their interpersonal relationships with possible dream interpretation.
But what does all this mean and how does it relate to group psychotherapy? The circle has a historical and perhaps intrinsic attraction for Homo sapiens. In times of great importance, the circle, or being a physical part of a circle, offers a degree of emotional comfort, familiarity, strength, and protection. Thus it would seem that group psychotherapy, by the nature of the physical round or circle in which individuals sit, consciously or unconsciously enhances an environment for people seeking to return to a meditative and protected state in which affiliation provides a sense of belonging, acceptance of individual differences, equality, and the possibility of being healed.
The actual origin of the history of group psychotherapy remains a shrouded mystery. It can be assumed from our knowledge of cultural anthropology that group therapy has been informally in existence since the beginning of hominid time, whenever three or more individuals came together and looked to their companions and leader to discuss their problems.
Indaba, a Zulu term meaning “gathering together in a meeting with a chief or leader,” may have covered such diverse topics as where to hunt and gather or issues facing the individual, clan, or society. These indabas not only had goal-directed behaviors but appeared to offer a degree of healing for both the individual and the tribe.
Unfortunately, time and space does not allow the acknowledgment of every pioneer and student of group psychotherapy who has contributed to the formal, ongoing development of this tremendously important modality for psychotherapy. Referencing and detailing every contribution would call for a book of its own. The individuals to be discussed repeatedly appear in the literature and are always acknowledged when a historical investigation is begun. It is not my intention to slight any other individual who added knowledge to this field.
In the formal sense, group psychotherapy is a fledgling in the field of psychology and psychotherapy, as the majority of monographs appear after World War II. Also, empirical findings concerning the efficacy of group psychotherapy greatly lag behind its actual practice. During World War II, group psychotherapy’s development became known because there was a shortage of mental health providers available to administer necessary psychological interventions for many cases of war neuroses. As with many discoveries in science, group was thrust into prominence because of need.
The following sections describe the contributions of a number of practitioners to the early history of group therapy.
Gustav LeBon’s topic of study was the group mind. His research focused exclusively on large groups of people. He felt that in a group an individual behaved in quite a different fashion than in isolation. Behaviors that were not expected emerged quite readily. He referred to these large groups as a heterogeneous entity, which comprised different individuals transformed into a homogeneous entity of like minds and behaviors. LeBon postulated that in a group an individual exhibited certain characteristics which previously did not manifest themselves. He explained this transformation by suggesting that three events catalyzed the change. (1) Because of the numerical size of the group, an individual developed feelings of invincibility and relinquished personal accountability in favor of the group assuming responsibility. (2) The herd or school mentality developed, in which an individual readily gave up his or her own interest to the interest of the group. LeBon labeled this as contagion. (3) The individual, almost as if hypnotized, obeyed all suggestions without conscious thought of the consequences of the group’s behaviors. It appeared that the individual was no longer conscious of his or her acts and any suggestion by the leader was readily seized and undertaken. The concept of individual will no longer existed and the people relinquished their personal identities. LeBon felt that whenever people entered a group they reduced their socialized development. In isolation they may have been civilized individuals, but in a group or crowd they could quite possibly turn into barbarians who act upon instinct alone.
Joseph Pratt may be considered not only the originator of the concept of group therapy, but also the founder of a procedure related to the essence of “recovery” as a group dynamic with a homogeneous population. He focused on patients diagnosed with consumption, more commonly known as tuberculosis.
To students of classical literature and opera, this disease and its impact on European society during the nineteenth century is well described in Alexandre Dumas’s book Camille, written in 1848, which became the source for Giuseppe Verdi’s 1853 opera La Traviata. Pratt’s patient population was not only consumptive but was also economically distressed. He felt that poverty increased the patients’ problems. He chose to help these patients through an educational model in which all who agreed to be part of his study had to adhere to strict rules of behavior. These rules consisted of a change in lifestyle, as Pratt was very concerned with hygiene, food, and fresh air as a possible foundation for the cure of this insidious disease. He limited his groups to between fifteen and twenty-five members. According to Pratt’s prescription, they would meet once a week and record the number of hours of daily outdoor activity and weight gain. Patients who distinguished themselves in their efforts and gains were reinforced by the intrinsic nature of their accomplishment and became a model of hope for the other individuals in the group. An unforeseen benefit also occurred: inclusion in the group had an emotionally positive effect on the patients.
Pratt’s early work can be seen as quite contemporary. Today in the field of medicine, many groups are medically homogeneous and provide care for the members involved.
Sigmund Freud, the father of psychoanalysis and one of the immortal minds of civilization, contributed to our knowledge of group therapy. Although group psychotherapy was not an area of investigation for Freud, he did work on conceptualizing what occurs to and within individuals when they are in a group. His book Group Psychology and the Analysis of the Ego is primarily the study of large groups. It is quite possible that his interest in this area developed from the escalating nationalism in Europe at the time of its writing. Because of his Jewish heritage, Freud, similar to so many other intelligentsia of his faith and time, was sensitive to the increasing anti-Semitism. Freud recognized and credited LeBon’s work in relation to the individual and group, but he felt that the group mind could be more clearly understood through the principles of psychoanalysis. He suggested that individuals in a group relinquished themselves in favor of the group leader’s goals and ideals, as the group members’ attachment to the leader was a function of desexualized libido. Although the individual members of a group were linked to the leader through this desexualized libido, the leader carried no emotional attachment to any of the group members unless they could serve the leader’s needs. Freud felt that this narcissism on the part of the group leader was functionally necessary. The leader represented for the members an individual who achieved mastery, independence, and self-confidence and became the ego ideal and the embodiment of all those characteristics that they themselves could not attain. Freud, similar to LeBon, felt that in a group an individual’s inhibitions melted away and all the destructive instincts that remained below the surface were allowed free expression, and gratification as personal responsibility was no longer in operation. In some respects, the group functioned as a single entity that lacked a superego to inhibit the expression of primitive id behaviors.
Trigant Burrows’ concept of mental disorder was related to the individual’s interaction with society. He believed that a profound conflict existed between how individuals felt about themselves and the assumed social personality they created in order to feel comfortable within their communities. Burrows perceived that individuals existed in a state of “I-ness” but felt this was not a viable entity for analysis. True analysis of the individual was more effective in relation to the group in which the individual belonged. If the group or society could be changed, the individual “I-ness” could also be positively affected. Burrows did not believe in the concept of isolation as it related to the individual. He considered all interaction to have both a manifest and latent content that needed to be further explored. He felt that group analysis was a corrective environment. In order to understand themselves, individuals could ultimately express what they really thought and felt without fear and inhibition of social restrictions. In effect, Burrows was speaking about a dependency problem. The individual depended upon the perceptions of others as the motivation for creating and maintaining the image personality that the person had come to realize as “I.” Unfortunately, this image was often at odds with the real personality, causing conflict. In group analysis, individuals came to realize that they were not alone in their thoughts and feelings and were privy to these manifestations in others.
Burrows’ observations are quite timely and easily observed in clients today. Many people who come to psychotherapy or counseling repetitively speak about their need to be seen in a particular way by their society, community, and group. Because of this need, they have become estranged from their real selves and have sacrificed internal harmony in order to be seen in such a way that their needs may be gratified.
Louis Wender introduced an eclectic form of therapy into group. Although trained in psychoanalysis, he felt that strict psychoanalysis did not lend itself well to the group arena. His patient population included individuals hospitalized for various psychiatric disturbances. Wender observed that the act of hospitalization caused greater disturbances in the already conflicted individual, but because of the nature of the hospital setting, a closed system, he saw a family structure begin to emerge among the patients in this environment. He felt that individuals were drawn to others similar to themselves and that group membership created a potential for personal growth and change. If this were the case, a group format would prove to be an effective tool in helping this hospitalized population.
Wender appears to be one of the first individuals to promote what we today might call a “group agreement,” although Pratt (1907) might be considered to have developed the first “group contract.” Patients included in Wender’s group had to adhere to certain rules of conduct such as confidentiality. No new members would be admitted into a group that was already in session. Contrary to strict psychoanalysis, Wender’s groups began their sessions with a lecture format in which the group therapist discussed analytic concepts with the patients as a springboard for dialogue. These discussions, which appeared on the surface to cause little anxiety, had the effect of promoting identification among the group members through their personal disclosures. He felt that the nature of the group format helped individuals to re-create early family experiences with their concomitant transferences on the group members. In this case, the therapist and group members would respond differently than the original family did. Disclosures would not be judged and the patient would have a different experience of these disclosures, which effectively created and motivated the development of a new functionally and qualitatively different internalized, healthier ego ideal.
Interestingly, Merton Gill (1982) also postulated this type of experience for the patient in individual psychotherapy. Wender’s observations and beliefs in the effectiveness of the environment, the closed system of the hospital, and the group generating a structure that re-creates the family is far-reaching and quite contemporary although presented over sixty years ago.
Jacob Moreno, MD, was a most interesting man who became quite influential in the practice of group psychotherapy. Initially, he formulated his theories from an original observation of Aristotle who perceived that when an audience watched a performance of a play the spectators often felt an identification with the scenario of the actors. As a result of this identification, the spectators had an emotional release or catharsis during the theatrical performance. Moreno concluded that if this passive catharsis could occur, perhaps an active catharsis might be attained if the spectator became the actor in the drama of his or her own life. This proved to be well validated and the foundations of psychodrama were laid.
Moreno worked to formalize his theory by introducing a different perception of the concept of spontaneity. Although he did not speak primarily of physics, his view of spontaneity was in some sense similar to the Newtonian theorem that “for every action there is an equal and opposite reaction.” In this particular case, spontaneity indicated a degree of energy necessary to deal effectively with changes in one’s life. If this spontaneity did not equal the amount of change that was occurring, the individual could begin to experience a sense of disequilibrium. Moreno felt that the disequilibrium experienced by one individual would begin to spread out toward other people in his or her life, very much as concentric circles move outward when a stone is thrown into a pond of still water. To correct this disequilibrium, it was necessary to devise a technique that would effectively bring about a catharsis for the individual. This technique was to focus on the drama of one’s life.
Moreno felt that the Freudian approach to psychotherapy focused solely on the individual, thus limiting itself to the past, and did not take into consideration the great importance of the present and the future. Scoffing at psychoanalysis, he thought that psychoanalysts chose to try to go back into the womb and beyond as their sole focus in searching for the elusive trauma. He referred to this as the recherche du temps perdu, or “searching for the lost time” (Moreno, 1...

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