Foundations of Group Analysis for the Twenty-First Century

Foundations

Jason Maratos

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429913907
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

The Institute of Group Analysis (IGA) celebrates forty years from its foundation with the publication of two new volumes tracing the foundations and applications of Group Analysis. The first volume ('Foundations') aims to publicise the foundations of group analysis (with the earliest papers of Foulkes) as well as the most influential theoretical contributions by pillars of modern group analysis, such as Pines, Brown, and Hopper. The reader will be able to see the development of Group Analysis, form an opinion about the trajectory that it follows, and judge which way the tradition of openness and creative integration of diverse theoretical contributions will lead in the twenty-first century. The second volume ('Applications') focuses on the numerous fields of work that use group analytic principles. Workers in the field of forensic psychotherapy would now consider it a great omission if they did not use some form of group analytic intervention, as would professionals dealing with those who manifest personality disorders, or those who work with different age groups, such as adolescents.

PART I

HISTORICAL FOUNDATIONS

CHAPTER ONE

Principles and practice of group therapy*

S. H. Foulkes

Instead of sitting alone with one individual patient, the therapist may call a number of them together and talk to them. In a military hospital, for instance, there are many things which he may wish to convey to all his patients together, or to a whole ward. In such a situation he would talk differently than when talking to a patient alone. At the same time, if encouraged, they will talk back and also to each other.

One of the first things the therapist will notice is the general atmosphere. His patients may appear obediently or curiously expectant, bored and apathetic, good humoured or tense with anxiety, adversity and hostility. The conductor will become aware of their predominant attitude towards himself. He will sense, for instance, whether and in what way his presence influences the picture. This may be due to the sort of person he is, what he may or may not do, what he has to say and how he says or does it. He will be observed by the group, scrutinized and summed up, quickly and precisely, as by common consent, yet by intangible ways of perception and communication.

Meanwhile his own observation of the group becomes more detailed also. The patients are not a uniform body. Sometimes they are in good agreement, sometimes sharply split and clashing over an issue only to march in perfect unison a few minutes later. They may be with him, or against him. Many of them stand out from the main body, and gradually all of them acquire individual characteristics. Some are absent altogether and others keep out of range choosing their seats behind the therapist. Some sit aside in isolation; some are at ease while others are tense and preoccupied. Some are attentive while others talk, and here and there is a man persistently unconcerned about what is going on, while another is restless and fidgety. A man, sitting in a corner, suddenly, as if awaking from sleep or out of a dream, makes a sarcastic remark or voices violent opposition, or shoots-off at a tangent; another, who had not spoken yet and remained undefined, unexpectedly sums up a whole discussion humorously, follows this up by one or two constructive proposals and alters the whole situation.

The group functions

The psychiatrist listens and mentally registers. His “patients” have become alive, acting in a reality which he can share with them, under his own eyes. He need no longer rely on their own accounts and descriptions, based on self-observation and introspection, with all their fallacies, but can see for himself how they behave, feel and react, where they fail or are hampered by their disturbances. If he is in a position to check this against other observations, he can convince himself of the significance and reliability of this display. He is then fully justified in attaching importance even to the smallest detail observed. Frequently a patient shows up quite new-facets, which the psychiatrist can follow-up with further observation and inquiry.

Thus a first contact is established. It is a mutual contact. The therapist need not be afraid of this searching test, unless he could be credited with bad intentions. All he need be is honest. Pretence and acting would not go far. Nor is there need for them for the group psychotherapist is not concerned with making a good impression, with being liked or disliked. By this first mutual contact a community of feeling has been experienced by the patients among themselves, as well as in relation to the therapist, and in addition embracing the whole little community, therapist and patients together. The importance of this cannot be overrated. While in itself a potent therapeutic agent, in particular against a background of the usual pre-existing apprehensions and misapprehensions, it is the indispensable matrix for other therapeutic steps. If the therapist is open and sensitive to this contact, meets his men more often and regularly in this way, he can learn to play on them at will, as on an organ, and could on this basis alone lead them almost anywhere, if that were his task.

The art of leadership

This, however, is not his task in a psychiatric hospital where the patients’ difficulties are essentially of such a nature as to prevent them from standing on their own feet and grappling with their own problems. If the psychotherapist resists the temptation to be made a leader, he will be rewarded by their growing independence, spontaneity and responsibility and personal insight into their social attitudes. It happens in exact proportion to the psychiatrist’s art of making himself superfluous. He can, however, resign only from something which he is strong enough to possess, and if there are doubts as to his capacity for leadership, he had better accept this function offered to him until such time as he is quite certain and secure in it. He must not hesitate to lead when the situation demands it.

The ward is the patient’s temporary home and surround, his refuge from that strange and bewildering turmoil, the hospital. Here he meets his pals with whom he is to share the ups and downs of his present life and, more or less intimately, the experiences of the past and the worries at home, his and theirs. These are the people with whom he will talk on lonely walks and after “lights out” at night. The spirit which permeates the ward, and which the psychiatrist must foster, is thus of the utmost therapeutic significance. The ward has another function: that of a bridge between the patient and the hospital. It occupies a definite place and has an active, responsible and powerful part to play in the hospital. As a member of the ward, the patient shares in this, he begins to realize that the hospital is his, is what he makes out of it, that he is the hospital.

The psychotherapeutic group

More is needed, however. The patient needs insight i.e. insight into his own inner condition and life, insight into his present feelings, behaviour and reaction. Therein lie the limitations of a large meeting (30–80 men): The patient’s reactions, cannot be brought to light, voiced, described, realized or brought home to him by others. For this a more intimate setting is essential. Seven or eight people at a time have proved a good number. They meet regularly about once to three times a week, for a set period of 1–1½ hours, in the presence of the psychiatrist, in order to discuss anything they wish. Strong interpersonal relationships develop and features of an organismic structure become more and more evident. This type of meeting we call a psychotherapeutic group. The psychiatrist leaves the lead to the group, acting mainly as a catalyst and observer. The individual participant produces himself or his ideas for the group, acting also as receiver and audience when he takes an active interest in the others’ problems.

If the conductor sees to it that each member participates as fully as possible in these various functions and does not neglect to watch and treat the group persistently as a whole as well, it will soon become a self-treating, self-propelling and progressive body. He will be better able then to observe and steer the group unobtrusively—more towards this problem or that, towards one patient or another’s needs, and generally towards psychological levels which he deems desirable or for which he feels fit. In such a group the individual is thrown into high relief and the greater the psychiatrist’s experience and skill, the less will he find it necessary to relegate so-called personal problems to supplementary individual interviews.

Selection factors

No particular selection of patients is necessary for this type of group, but all sorts of selective principles can be interestingly and usefully applied. All that is desirable is to avoid too striking a disparity in such factors as intelligence, age, past Army experience and prospective disposal. It is equally undesirable to put individuals into a group who from certain factors are bound to be sharply separated from the group’s other members. Where possible, a common general background is desirable. Such a group can be left “open”: that is, as older patients leave the hospital newcomers take their place in the group. It is desirable that there should always be a representative number, say two-thirds, present who have been together for at least four weeks, if continuity is to be maintained. Alternatively, once established, it can be conducted as a “closed” group, keeping its composition unchanged until disbanded. This has many advantages, especially if the same group undertakes a group project together as well, and if the time of stay in hospital is altogether short. The stronger bonds thus established outweigh the possible disadvantage of inbreeding, and weaning especially as in spirit and orientation every group should be “open.”

Many of the socializing and therapeutic factors become operative in the same way in the groups which have been extensively developed at this hospital to carry out group projects. Indeed they form their essence. But unless a skilled observer can be always present with the “Selected Activity” group and report to the psychiatrist concerned, these forces operate blindly and there is not the same opportunity, as there is in the therapeutic session, to make the patients aware of what is going on.

The therapeutic session is, in a sense, a “Selected Activity” as well: that of learning to talk, express and listen to opinions, discuss matters of interest and so forth—an important social activity. The relationship and mutual penetration of these two fields of observation, artificially separated as psychotherapy and social therapy, is a fascinating study as well as of great practical importance. It could be said that a group has boundaries like a membrane of variable permeability. If the hospital milieu is opposed to the spirit prevailing in the group, if the osmotic pressure is high, these boundaries harden and become more selective; if the spirit inside and outside is in harmony, they may almost or completely disappear. This is another most important and more specific link between the hospital and the patient, and the more the hospital as a whole becomes a therapeutic field, the more can it become the main function of the psychotherapeutic group to activate and prepare the patient for the impact of the hospital community upon him and in turn to work out with him the stimuli thus received. This puts the emphasis of treatment not upon past history but upon the immediate present—a desirable shift where time is short—and one of the most important aspects of this approach.

Group dynamics

As far as the individual is concerned in group-therapy he finds himself in others and others in himself, by similarity and contrast, thereby regenerating to some extent his ego and its boundaries. At the same time the group is a potent modifier of the superego and a modifier of the id, symbolizing, as it does, the community, and in the last resort being unconsciously understood by the group in its archaic significance. Group dynamics are not within the compass of this paper. They are manifold and seem to work with great precision. There is no doubt that they can be used as therapeutic vectors of great potency. Much of this is still empirical and intuitive, but one cannot escape the impression of a quasi-mathematical precision, best perhaps to be expressed in terms of Field Theory.

It has been possible within this framework to assign a number of psychiatrists and practitioners, without selection and for the most part without much preparation, to groups, or rather, assign the groups to them, without doing any harm, to say the least of it. There is general agreement that it does them, as well as their patients, a lot of good. With increased knowledge, the framework becomes more and more precisely adapted to the purpose. It leaves the individual conductor free to choose a style and range of group psychotherapy appropriate to his experience, skill, and the degree of rigidity in his own make-up, etc. His approach will in any ease be reflected in the group, and as he is himself thrown into the group as well, this acts as a mutually self-regulating procedure. This has helped matters a great deal, since our task at Northfield Military Psychiatric Hospital is to devise methods as simple as possible so as to be applicable, as broadly as possible. A note of warning may be permitted here: not to-connect “Group Therapy” and such with a notion of mass production. It is not a sausage machine! Within a different framework and with more ambitious aims, it is an instrument so delicate and yet so powerful, that its skilled handling demands more from the therapist than the most difficult individual analysis.

One of the ways in which the individual psychiatrist’s position tells, is expressed in what he feels he can handle in a group or individual session respectively (and here again he will choose the right proportion for himself). Individual sessions are partly supplementary, partly antagonistic to the group, at least as long as the approach is not “wholistic” in the therapist’s mind.

The writer’s practice at Northfield, from considerations both of experiment and expediency, has been increasingly towards putting the group into the centre, even in the individual interview where necessary, and shifting the emphasis from the smaller group of the consulting room towards the ward and the hospital as a whole, and in the last resort—from all levels—towards the community. This was possible since the hospital as a whole became more and more a therapeutic field and since he knew that, while digging a tunnel from one end, he would be met halfway by workers from the other end—in other words, that the general hospital activities were directed with the same basic idea and identical intentions.

Note

* This chapter was previously published as: Foulkes, S. H. (1946). Principles and practice of group therapy. Bulletin of the Menninger Clinic, 10: 85–89.

CHAPTER TWO

Introduction to group-analytic psychotherapy*

S. H. Foulkes

General introduction

The Group Analytic Situation. All these considerations have an immediate bearing on Group Treatment and Group-Analysis in particular. For the Group Analyst, too, there are intrinsic reasons apart from practical ones, why Group Analysis has to be carried out under controlled conditions. At Northfield I could practise and observe Group-Approach in unorganised and spontaneous life situations, life, that is, of soldier-patients in a military hospital; free, semi-organised groups under all sorts of conditions, brought together by their chance participation in a particular form of occupation or activity, or by having been selected for a particular function or project, or organised themselves spontaneously for such, say a Netball or Football team. I could see this side by side with the working of group analytic, or I should rather say group analytically oriented sessions.

Some samples will be presented in later chapters to illustrate the mutual interactions and delimitations of these various approaches within the different situations. This was possible under the conditions of a hospital community, with “inpatients,” and with the Psychiatrist living in as well. Under ordinary conditions, when both the patient and the Doctor pursue their own private lives and meet only for the purpose of treatment, this is not possible. Now, to use an analogy; a photographer, to catch certain aspects of his client, might like to take a picture of him in his own home or garden. He will, nevertheless, on the whole prefer to have studio conditions for more ambitious attempts at a portrait. In the same way, the Group Analyst could not undertake to work to the full in the midst of the turmoil of life, but needs the more controlled conditions of the studio, his consulting room or similar room. The Psychoanalyst must remain undefined as a person, in order to enable the patient to project upon him, as on a screen, the unconscious images of his innermost self, to relive with him the vicissitudes of his long forgotten emotional relationships with his paternal figures and other persons of his past life.

The patient thus establishes a relationship of the utmost intensity and intimacy with a strange person. The participant in group analysis also meets with strangers, with whom he can mutually experience those relationships in particular, which are fraught with difficulties in life. In an unmodified life group situation he would prefer to avoid these difficulties, perhaps without even knowing that he does, or let his projections operate without check or correction, or defend himself by all manner of means against the experience of these difficulties. Under the conditions of the group-analytic situation he must face them, but he can also express his thoughts and feelings much more freely than would be possible under ordinary conditions and thus recognise these difficulties and correct them. He can find himself in others, and others in himself, and in this way free himself from old prejudices, as it were, and develop a more mature, creatively adaptable character. This is only one of the ways by which Group Analysis takes effect. For this to be possible, the group-analytic situation must have its own particular features, its own special rules of behaviour, its own code of what is permissible or not. This is very different from life under ordinary conditions. We will have to say more about this in detail presently. One can call such a situation “artificial” if one likes. In fact it stands halfway in artificiality between the analytic situation and spontaneous life situations, or perhaps somewhat nearer the latter. But one should not connect a modicum of reproach with this notion of artificiality or else one might equally well blame the surgeon for operating under the artificial conditions of the operating theatre. It is a situation of life under special conditions; some people are troubled by something beyond their control, they are called patients, and they consult another person, the physician or doctor because they believe or have been told, or profess to believe, that he can help them, “cure” them. If the doctor believes that too, or professes to believe it the roles are cast, the play can begin and nothing much happens. If he does not profess that, however, something very essential does happen—but we come to that later.

Meanwhile the Group Analyst wants to create a situation which is best suited to deal with the problem in which he and the group find themselves, that is all. There is nothing further “artificial” about it. If he is wise he follows the Gr...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• ACKNOWLEDGEMENTS
• PERMISSIONS
• ABOUT THE EDITOR AND CONTRIBUTORS
• SERIES FOREWORD
• INTRODUCTION
• PART I: HISTORICAL FOUNDATIONS
• PART II: GROUP-ANALYTIC THEORY
• PART III: PSYCHO-ANALYSIS AND GROUP-ANALYSIS
• PART IV: GROUP-ANALYSIS AND SOCIETY
• PART V: CHALLENGES TO THE THEORY/EXTENSIONS
• INDEX