Contributions of Self Psychology to Group Psychotherapy

Selected Papers

Walter N. Stone

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367106515
• eBook ISBN: 9780429912252
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Stone's central interests include the development of the self, empathy, narcissism, shame, envy, rage and the group-self. He is concerned with several aspects of clinical technique and is especially sensitive to our co-creation of so-called "difficult patients". His understanding of dreams as both personal and group products which manifest visual narratives will be of particular interest to students of the social and collective unconscious. Stone's work with narcissistic and borderline patients developed in parallel with his work with the chronically mentally ill, who are often institutionalised. He demonstrates that group therapy for such patients is not only a matter of containment and holding in the service of administrative control, but also involves interpretative work based on an understanding of the primary need for a good enough self-object.

Section I
Theory

CHAPTER ONE
Contributions of the psychology of the self to group process and group therapy

Walter N. Stone and Roy M. Whitman

Recent contributions by Kohut and his co-workers to the psychology of the self (Kohut, 1966, 1968, 1970, 1971; Ornstein, 1974; Gedo and Goldberg, 1973) and the vicissitudes of narcissism (Kohut, 1972) have direct relevance to the understanding of certain aspects of relationships of group members with one another and the leader as well as group formation, (group) cohesion, and (group) fragmentation. In this paper we propose to integrate the implications of narcissistic transferences as they emerge in group process laboratories and group therapy. We do not mean to negate other developmental and interactional considerations of the individual and group but are adding narcissism as a hitherto not clearly recognized central area.

Developmental models of therapy groups patterned after Freud’s initial contribution (1921) and elaborated particularly by Bion (1960), and Bennis and Shepard (1956) emphasize the “object-love” relationships with the leader and subsequent “object-love” relationships with co-members. Their understanding of group behaviour was based on the model of transference neurosis. The relationships between the members of the group and in particular with the leader were considered object directed transferences involving libidinal and aggressive drives. Understanding the nature of the relationship with the help of the structural model, it is assumed that the group leader is experienced as a separate “object” who is loved or hated, or who, by his behaviour, or indeed by his mere presence mobilizes defenses against such strong feelings. The model for this approach to group behaviour is the oedipal model in which the leader (father) is seen as a person stimulating an intense, positive, erotic or, conversely, intense negative, hostile transference. As additional implication of this model is that the group members are seen as siblings who also relate along the lines of object-love. The opportunity to engage in multiple object-love or object-hate relationships, both vertically and laterally, has been an oft-stated advantage of group therapy over individual therapy.

Along the lines of a separate (but not independent) development of narcissism, Kohut (1971) has made some extremely cogent reconstructions of early intrapsychic structure. Mental life (Gedo and Goldberg, 1973) begins with a phase of uncoordinated, separate nuclei of function from which the whole cohesive self emerges.

Though from the vantage point of an outside observer, an object relationship develops, it is hypothetically experienced by the patient as a one person system in which the “other” is experienced as a part of the self, a so-called “self-object.”

The group, and in particular the group leader, may therefore, be seen as separate entities but they and he may be experienced as part of the patient’s psychic structure, and indeed, a necessary part.

Prior to a stage of “object constancy,” objects are not loved for their attributes but, rather, their need-fulfilling functions, hence self-objects. Kohut’s observations not only permit the clarification of self-objects from libidinal objects but also are also pertinent to another crucial issue, the development of the self.

The sense of self, especially one that may become cohesive or fragmented, is related to the sense of a stable identity (Lichtenstein, 1961). This self is not equivalent to identity as a halfway term between psychology and sociology, but has an intrapsychic form related to the ego but not coexistent with it since it exists at a level of abstraction closer to actual clinical experience. We thus have a self which consolidates from individual ego nuclei (Glover, 1932) and which may coalesce but also fragment. After the formation of the superego, the tripartite model of ego, superego, and id becomes the illuminating conceptual approach, but preoedipal issues of nuclei, self and self-objects become useful conceptual tools in both individual and group psychology.

In group psychology, when this model is used, the leader and/or the group is seen as a “self-object” which maintains the cohesion of the individual by confirming the archaic grandiose self or by offering itself as an idealized vehicle for archaic fantasies of greatness. Therefore, on the level of the group-as-group, we see that each individual, and especially the leader, becomes not only a love object, but also a necessary part of the self of each individual.

Several authors have previously suggested that groups can serve both as a libidinal and a narcissistic object but have not separated these two developmental lines. In this regard, the concept of group-as-mother (Whitman and Stock, 1958) can be seen in two ways: the mother as a libidinal object and the mother prior to the separation of self and object, i.e., a narcissistic self-object (Whitman, 1973). The developing interest in this area was recently reviewed and summarized by Scheidlinger (1974), who linked the concept of the group-as-mother with the deeper emotional meanings of the group. Scheidlinger suggests that a split occurs, with positive affects directed to the group-as-a-whole and negative affects to the leader and other group members as stimulators of threatening, fearful feelings. But Scheidlinger was operating within the frame of reference of the mother as a separate object rather than an even earlier developmental framework in which there is no self-mother differentiation into separate entities.

Gibbard and Hartman (1973), in their description of Utopian fantasies, seem to be referring to a transitional phase in which “group members attempt to institute a state of affairs which is perfect or ideal in some or all respects … The Utopian fantasy is most likely to appear when the positive and appealing aspects of the group-as-mother (the warmth, security, protectiveness, etc.) seem to be attainable and the negative aspects (the engulfment, malevolence, obliteration of boundaries, etc.) appear to be well defended against.” These authors, however, have not differentiated the preoedipal mother as a separate object from Kohut’s formulation in which the mother functions as a self-object and is an integral part of the individual, existing totally for his gratification.

Earlier, Slater (1966) hinted at a developmental approach by theorizing that the initial unconscious perception of the group is an undifferentiated mass from which the leader is gradually differentiated. The dependence upon the powerful leader is necessary to avoid engulfment by the more threatening undifferentiated mass. The leader’s power in this phase is comforting and reassuring. Only later: “revolt becomes imminent, in order for the members to stave off their fear of being overwhelmed by their helpless dependence on the leader” [p. 190]. This is essentially an approach to the differentiation of self and object but implies what Kohut has so cogently criticized, that object-love relations are not necessarily derived from narcissistic relationships in the course of development. We recognize that the leader emerges as a separate object, or he may remain a self-object, and in that sense is not strictly differentiated from the group as a separate independent entity. Therefore, we employ Kohut’s hypothesis that narcissism has it own lines of continuing development to understand both individual and group life.

Crucial to the fruitful use of the concept of narcissism and self is the concept of objects as self-objects, i.e., parts of the self whose only function is to supply missing or needed parts of the self. Both the leader and the group can be usefully conceptualized this way, and this understanding leads to a second major observation; two basic forms of transference may exist for the individual: object-narcissism or an idealizing transference (“my group or leader is the greatest”) or subject-narcissism, thus keeping the original perfection of a grandiose self-concept.

We shall now give examples from groups of the function of self-object relationships as they appear in: (1) exhibitionistic, grandiose reactions; (2) twinship and merger reactions; and (3) idealizing transferences. We shall then examine these concepts as they shed light on (4) narcissistic considerations in some special character problems, and (5) implications for the therapist’s behaviour.

Exhibitionistic, grandiose needs with wish for mirroring

Infantile exhibitionism and grandiosity are important parts of self-esteem development. The early forms gradually are transformed into adult ego functions related to pride and enjoyment of individual accomplishment. Developmental arrests may lead to the persistent search for someone to reflect the over-inflated and unmodulated grandiosity. In the transference the other is not experienced as a separate object but, instead, as a self-object whose function is to mirror the grandiosity. Gratification of these archaic wishes, however, may be so over-stimulating that even though such a state is ardently hoped for, the internal discomfort may become intolerable. Thus, the wished for praise of one’s accomplishments or of one’s “self” can lead to withdrawal in order to reduce internal tension.

A thirty-one year old single woman, Katherine, was in combined therapy (both with the group leader) and was particularly sensitive to over-stimulation of her affects. She found herself especially anxious in a group session in which the major theme was discussion of sexual feelings. In the subsequent individual session this patient revealed she had a fantasy of startling the group by announcing that she and the therapist were secretly dating. She felt a great anxiety associated with that fantasy and found herself withdrawing markedly from the group after having it. Her wish to show off, to be seen as special, was clearly demonstrated in this fantasy. Other aspects of paring with the leader and of emerging positive oedipal transferences seemed relevant but less significant than the idea of the “bombshell” that she would exhibit to the group. This patient previously presented a dream in which she was naked, standing on a balcony in front of a large symphony orchestra some hundred yards away. She had been anxious in the dream, but the manifest content indicated her wish to show off and exhibit herself before a large, admiring audience. The dating fantasy within the group thus represents some progress in that she had become more accepting of her exhibitionistic fantasies.

A second example occurred in which a 37-year-old woman, Jackie, was in simultaneous individual and group therapy (with different therapists). In her individual therapy she reported an incident in which she had become the central figure in a series of group interactions. Frequent references by the group as well as her own fantasies led to the idea that the spotlight was on her. She basked in this spotlight and enjoyed being the centre of attention in the group. She experienced a heightened feeling of self-esteem when the group, and particularly the leader, became an admiring “other” concentrating solely on her. The scrutiny and envy of other group members increased her inner excitement, which then became intolerable, and she said: “I see a dark corner of the room where I would like to go which seems comfortable and snuggle.” She retreated to a corner of the room away from the group.

One possible explanation of this sequence was the patient’s avoidance of the envy of others as separate competing objects. The possibility suggested by the concept of narcissism we are present is that she had to hide because of over stimulation of her grandiose exhibitionism. These possibilities highlight the two chief alternative understandings of such behaviour, but we feel that the narcissistic over stimulation was most central and that it was this, which caused her to take the defensive extreme of retiring into a dark corner.

We would like to present a third example from the literature: Glatzer (1962) describes a patient who was particularly intolerant of praise and transformed recognition into self-depreciation. She noted that a major therapeutic task was to confront the patient with his patterned response. Glatzer’s interpretative emphasis was on the masochistic elements of the patient’s response rather than what we would now suggest was the patient’s defense against the grandiose self being over stimulated. The three possibilities for the interpretation of this phenomenon are: (1) the classical one of superego guilt linked to obvious success; (2) guilt about omnipotent fantasies being realized; and (3) shame about the mobilization of primitive exhibitionist grandiose wishes. It is our thesis that the emergence of exhibitionistic grandiose fantasies must be understood in order to respond empathically to the patient.

Twinship and merger fantasies (Subtypes of mirror transferences)

More archaic forms of the grandiose self can be seen in the twinship and merger fantasies. In the twinship fantasies the other person is experienced as an alter ego, a twin exactly like the patient. A theoretical note needs to be made in this connection. The original description of pairing phenomenon in groups by Bion (1960) describes one particular form of a two-person relationship occurring with a group. Rioch (1970) in her summary of this concept states: “The basic assumption is that when two people get together it is for sexual purposes. When this basic assumption is operative, the other group members are not bored [by the pair] … but the group, through the pair, is living in the hope of the creation of a new leader or a new thought or something which will bring about a new life, will solve the old problems and bring Utopia or heaven, or something of that sort.” This model again refers to the pair being experienced as separate individuals joined together for a specific (although unconscious) purpose. Twinship, which also involves intense interaction between two people, is characterized by patients attempting to emphasize the identical nature of the other. The other person is essentially part of the self.

Merger fantasies, an even earlier developmental stage of grandiosity, arise often in the beginning phase in groups, but may be present throughout the life of the group and may only be exposed after a period of therapy. Slater’s (1956) description of early group phenomenon refers to this process: “In the absence … of clear evidence of conscious attachment and differentiations, and in the presence of an imperative inner desire for unity and belonging, the fear strikes then that perhaps [the members] may forget this fact and ‘lose’ themselves.” In the merger transferences this state is actually wished for although greatly feared.

A twinship transference was illustrated by Norma and Wanda during a period of adjustment following the addition of several new members to a group. Wanda, a new patient, started with several casual and superficial remarks and was interrupted by Norma, who exclaimed, “She sounds exactly like me,” overtly referring to the tone of Wanda’s voice and her expressions. Later, as Wanda was telling the group about her shoplifting, she said, “I could do something about my shoplifting if I really want to, but I don’t think I really want to.” Norma, who had never shoplifted, said with exuberance and pleasure, “That’s so much like me,” referring to the thought of being able to control unacceptable behaviour, and later in the same meeting she shrieked, “That’s me … that’s me,” in response to Wanda’s description of her lack of sexual satisfaction. The need to be identical was clear on all three occasions. While it is possible that such a response was simply this person’s way of controlling anxiety by trying to establish mutuality, continuation of such statements should alert the therapist to the possibility of a twinship transference.

Merger fantasies or defenses against the loss of self are frequently observed and can be clues to unrecognized narcissistic problems. IN a therapy group of hospitalized patients, just prior to the end of the session, one recompensating schizophrenic patient said he wanted to curl up and go to sleep in the therapist’s lap. Again there are two possible interpretations: one, an anaclitic dependent relationship with the preoedipal mother, or the second, a merger with the pre-object mother. Slater (1966) provides an additional example of fusion of the individual with the group. It was neatly expressed when a member referred to a previous attack on him by other group members with the phrase “we attacked me.”

Defenses against merger and loss of self had impeded the progress of an outpatient group. Jan dealt with these problems, which she labelled as “being too influenced,” by talking about her need to leave the city and try living on her own. In her real life she was a functioning schoolteacher who had lived alone many years. When confronted by the group members with her fears of “involvement,” Jan complained that she didn’t understand, and the following week revealed fantasies of quietly leaving and going to South America where she would have time to think and find herself. During the same meeting Pat described a situation, which she didn’t know how to handle. She said that if her husband remarked that she might enjoy a forthcoming party, she felt trapped because, if she did enjoy it, the enjoyment wouldn’t be hers but his. Such themes, which reverberated through the group, dealt not only with concern over influence by another but reflected the deepening sense of belonging and concomitant fear of losing the self. If the fear of merger predominates, the solution may be actual flight to avoid feelings of loss of self.

Idealizing transferences

Projection of primitive grandiosity onto others who then will be all-protecting is the basic mechanism of the idealizing transference. Marked idealization, whether it be of the leader or of the group-as-a-whole, is often observed during the course of group treatment. Particular stages of group development may mobilize these transferences, and “getting stuck” at such a nodal point may indicate narcissistic idealizing transferences. In Bennis and Shepard’s (1956) classic paper on developmental sequences in groups, the first stage of dependency upon the leader may be re-examined in the light of the leader not as a separate object but, rather, as an idealized self-object. In this sequence, after rebellion against the leader, the group may enter a phase in which everyone agrees about everything and a group atmosphere of harmony temporarily exists. Such a stage when prolonged for the group or an individual suggests the possibility of the group-as-a-whole functioning as an idealized parental imago and stabilizing a state of narcissistic equilibrium between the group and its members.

A straightforward example of immediate idealization occurred in a Tavistock training group during an early phase when the group was actively hoping to elicit more responses from the leader; one participant, with superb mimicry and humour, managed to “break up” the group, including the leader. In response, one of the participants, who was familiar with the technique, became enraged because the leader had dropped out of role and th...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• FOREWORD
• PREFACE
• ACKNOWLEDGEMENTS
• INTRODUCTION
• SECTION I: THEORY
• SECTION II: CLINICAL APPLICATIONS
• SECTION III: SEVERE DISORDERS
• REFERENCES
• INDEX