Group Therapy

A group analytic approach

Nick Barwick, Martin Weegmann

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781138889712
• eBook ISBN: 9781317384700
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Group Therapy: A Group-Analytic Approach is a comprehensive introduction to contemporary group analytic theory and practice - the prevailing form of group therapy in Europe. Highly accessible yet meticulously referenced, theoretically rich, yet clinically vivid, it is an invaluable resource for all interested in group therapy, providing access to the very heart of working therapeutically with(in) groups.

Part I
Mainly theory

Chapter 1
The development of group analysis

The principle of interconnectedness

Nick Barwick

Although Group Analysis (also known as Group-Analytic Psychotherapy) was conceived out of creative, interdisciplinary intercourse – in particular, between psychoanalysis, gestalt psychology, neurology and sociology – it was destruction, chaos and despair that were midwives to its birth. Flooded by the traumatised casualties of The Second World War, hard-pressed military psychiatrists turned to a group model as the pragmatic, if not quite last, resort. What emerged were ‘The Northfield Experiments’ – experiments in group psychotherapy held at the Northfield Military Hospital, Birmingham. The first of these (led by John Rickman and Wilfred Bion) failed to establish a workable model;¹ the second (led by Harold Bridger, Tom Main and S. H. Foulkes), learning in part from the previous cohort’s mistakes, fared better (Harrison, 2000).

Many of these pioneering psychoanalytically-trained psychiatrists, whether successful or not in those early group ventures, went on to make significant contributions to the development of group-work in civilian contexts. Bion, for example, returning to the Tavistock Clinic, developed his ‘basic assumption theory’, prompted a therapeutic approach to groups that became known as the ‘Tavistock model’ and, in helping to establish The Tavistock Institute of Human Relations, began a tradition of psychoanalytically-oriented organisational con sultancy that continued to develop long after his own relatively brief interest in groups waned. Bridger, another founder member of The Tavistock Institute and, later, The Institute of Human Relations at Lucerne, also became highly influential in developing a psychoanalytic approach to working with organisations, while Main, following his appointment as Medical Director at the Cassel Hospital, began to conceptualise the therapeutic community – an approach that has been immensely significant in the field of inpatient and later, day-centre therapeutic care, providing a key method of working with patients with moderate to severe personality disorders. Foulkes meanwhile, perhaps rather quietly in comparison, returned to private practice before taking up posts first at St Bartholomew’s and then, as Consultant in Psychotherapy, at The Maudsley, London. There he continued his group experiments, meeting regularly with a circle of interested colleagues to discuss their findings, and all the while developing and disseminating his own particular, distinctive model of group psychotherapy: Group Analysis.

Psychoanalysis and group analysis

Foulkes trained as a psychoanalyst in Vienna in 1923. Unequivocal about psychoanalysis’s centrality in his thinking, Foulkes (1948) makes his allegiance clear:

The contributions which Psycho-Analysis has made have inaugurated an epoch in the understanding of the human mind. It will take another half century until the momentum of its impact has reached its climax.

(p. 7)

As a consequence, what Foulkes refers to as three fundamental psychoanalytic ‘tools’ – ‘a method of investigation called free association’, ‘the knowledge of the unconscious’ and ‘the analysis of the transference situation’ (pp. 7–9) – he claims as being of equal import in group as dyadic work.

Even so, Foulkes, in conceptualising group analysis, challenged psychoanalytic orthodoxy on two major counts. First, in contrast to Freud (1921/1991), he believed it was possible to ‘do therapy’ in groups; that, under the right therapeutic conditions, a group had a natural capacity to nurture its members and to encourage reflective capacity and the development of thought. Second, he believed that a group was a natural medium in which to facilitate such development because it was within a group – the family embedded as it is within the wider group of community and culture – that ‘individuals’ are formed. This socio-historical perspective went counter to the dominant psychoanalytic model of the time which, based on a biological perspective, construed the psyche as being formed not by social context, but by innate sexual and aggressive drives, albeit modified by their encounter with the realities of the external world.

Though challenging psychoanalytic attitudes of the time, as Weegmann (2016) notes, Foulkes did so diplomatically, managing to be both the radical and ‘the gradualist who charmed and retained his audience’ (Pines, 2013: xxii) – his orthodox, psychoanalytic audience. Thus Foulkes (1948) dutifully notes how:

… the mental topography evolved by Psycho-Analysis, assigning certain functions of mind to an ‘Id’, ‘Ego’ and ‘Super Ego’ has done justice, theoretically, to the fact that the ‘outer’ world becomes internalised, that man’s inner dynamic world is a microcosmic reflection of the whole world, at least his whole world. It has, in fact, allowed man’s social nature to be represented in man’s innermost structure.

(p. 10)

Referring to Freud, father of psychoanalysis, is a common rhetorical device in psychoanalytic writing. In this way, debts are paid and added gravitas accrued. Drawing on Freud (1930), Vella (1999) suggests another, unconscious motive: an attempt to allay ‘ambivalence and guilt over the murder of the primal father’ – a murder Vella associates ‘with the injuries our contemporary theories inflict upon ideas which Freud held precious… Guilty theorists therefore seek to atone for their heresy with a rich crop of deferential references to the master’ (p. 8).²

Being both loyalist and dissenter,³ Foulkes fits well this guilt-ridden, murderer’s profile. Indeed, in the very next sentence comes the first soft hammer-blow:

… Psycho-Analysis has not yet allotted to this social side of man the same basic importance as it has to his instinctual aspect.

(Foulkes, 1948: 10)

Politely indicating limitations in orthodox psychoanalytic thinking – where primacy is given to drive theory – Foulkes offers for inclusion, a second, though not secondary, perspective: a social construction of human psychology.

Such a construction, today, would put Foulkes in good company. Contemporary psychoanalytic thinking has moved away from the predominantly nativist perspective, embracing instead a more interactional model of psychological development. At the time, however, Foulkes’s proposal, in its foregrounding of an emergent social paradigm, challenged Freudian thinking, as did the very notion of conducting credible therapy in groups.

Freud on groups

Summarising the characteristics of group mentality, Freud identifies:

… weakness of intellectual ability… lack of emotional restraint… incapacity for moderation and delay… inclination to exceed every limit in the expression of emotion and to work it off completely in the form of action… an unmistakable picture of a regression of mental activity to an earlier stage such as we are not surprised to find among savages and children.

(1921/1991: 148)

This characterisation draws heavily upon the work of Le Bon (1895), whom he quotes at length:

… by the mere fact that he forms part of an organised group, a man descends several rungs in the ladder of civilisation. Isolated, he may be a cultivated individual; in a crowd, he is a barbarian – that is a creature acting by instinct.

(Le Bon cited in Freud 1921/1991: 103–104)

In so doing, he affirms a very Nietzschian maxim:

Madness is something rare in individuals – but in groups, parties, peoples, ages, it is the rule.

(1886/1973: no 156 p. 85)

Le Bon, a social psychologist steeped in reactionary politics, had been deeply disturbed by the mayhem surrounding the Paris Commune of 1871. Although, to contemporary sensibilities, it is the violent curtailment, by government forces, of this experiment in social democratic republicanism that is most shocking,⁴ for Le Bon, it was the experiment itself that served to confirm his scepticism about democratic politics and his suspicion that the more power gained by the ‘common man’, the more marked would be society’s regressive descent into barbarism. Consequently, conflating terms such as ‘group’, ‘mass’, ‘crowd’ and ‘mob’, Le Bon dismisses the group’s capacity to act as ‘a medium for civilised discourse’ (Behr & Hearst, 2005: 18).⁵

Although further ironies (in terms of Freud’s allegiance to Le Bon) lie in the fact that both Hitler and Mussolini drew upon his work – Mussolini apparently keeping a copy of Le Bon’s La Psychologie des Foules by his bed – Le Bon’s depiction of the masses under the influence of uncontrollable, primitive forces fits well Freud’s own theorising:

when individuals come together in a group all their individual inhibitions fall away and all the cruel, brutal and destructive instincts, which lie dormant in individuals as relics of a primitive epoch, are stirred up to find free gratification.

(1921: 106)

This is a bleak view of groups; one ‘shaped by [Freud’s]… preoccupation with the leader as the central figure at the apex of a power hierarchy and the ever-present danger of a breakdown into mob-ridden destructive behaviour’ (Behr, 2004: 336).⁶ Outside the happy coincidence of finding itself under the hypnotic influence of an enlightened leader, Freud construes groups as lacking capacity for thought or altruism. They may construct systems that appear civilised, but these are not the product of thinking but of psychological defence. For example, hostile sibling rivalry may be transformed, by means of identification and reaction-formation: the hated object becoming the loved. Group cohesion may be further enhanced ‘by directing hostilities towards others; hence, ‘the Englishman casts aspersion upon the Scot, the Spaniard despises the Portuguese’ (Freud, 1921/1991: 131) – what Freud refers to as ‘the narcissism of minor differences’ (1930/1991: 305). As for social justice, this is simply how we manage envy and jealousy: ‘we deny ourselves many things so that others may have to do without them as well’ (1921/1991: 152). For Freud, most damning of all:

… groups have never thirsted for truth. They demand illusions and cannot do without them

(p. 80)

All this proffers reason enough for apprehension in any psychoanalyst with a mind to develop a group approach. And if this alone were not enough, there is always the salutary case of Trigant Burrow.

The salutary case of Trigant Burrow

Trigant Burrow (1975–1950), psychiatrist, psychoanalyst, co-founder of The American Psychoanalytic Association and, in the United States, founder of ‘phyloanalysis’ (originally called ‘group analysis’), is a figure, until recently, widely unacknowledged if not actively ignored.

In 1921, an analysand of Burrow’s, Clarence Shields, claimed that if they were to swop roles, Burrow would surely reveal himself as riddled with neuroses as Shields himself. Burrow, taking up this challenge, discovered the truth in it. Indeed, concluding that some of these neuroses were rooted in the inequities of power in the therapeutic relationship, he argued that the individualistic application of psycho-analysis was inseparable from authoritarianism. Consequently, he sought to extend (some say replace) the asymmetrical model of analytic work with a project of mutual analysis, first within the dyad, and then, over time, as he experimented with gradually increasing numbers of participants, within a group context. This psycho-social experiment led him to construct a ‘highly original conception of the social nature of human beings’ (Hinshelwood, 2004: 327).

Burrow argued that Western culture had taken a ‘wrong turn’. In progressing towards greater individualism, a hyper-individualised consciousness had evolved which had ‘sever[ed] the natural bond between elements of the societal body’ (1927a: 45), causing people to become alienated, forgetting the essential nature of their relatedness. For Burrow, psychoanalysis needed to restore the balance between self-consciousness and social-relational or group-consciousness; a balance he termed ‘cotention’. Such a view, and the experiments with the group situation – ‘a medium for addressing the societal forces that create our separative, alienated sense of ‘I’ (Gilden, 2013: xxviii) – won Burrow few favours among the psychoanalytic establishment, most notably, Freud. For example, in response to Burrow’s enthusiastic, approval-seeking reports on his group-analytic project, Freud writes:

… my expectations are not at all favourable to you… The mass⁷ situation will either result immediately in a leader and those led by him, that is, it will become similar to the family situation but entailing great difficulties in the function of expression and unnecessary complications of jealousy and competition, or it will bring into effect the ‘brother horde’ where everybody has the same right and where, I believe, analytical influence is impossible.

(Freud, 1926, cited in Campos, 1992: 6)

Chiding Burrow for his ‘speculative analogies’, Freud completes the intellectual castration:

I do not believe that we should be grateful to you for the fact that you want to extend our therapeutic task to improving the world

(ibid.)

Explicit references in the psychoanalytic literature to Burrow’s work are relatively rare; this, despite the fact that, as Pertegato (1999) suggests, he has clearly been ‘widely read’. Given the contempt Freud expressed for both the man and what have been referred to as his ‘extravagant claims’ (Scheidlinger, 1992), such omission is, perhaps, hardly surprising. Given Burrow’s ignominious pro fessional fate – this eminent, respected co-founder and one-time president of the American Psychoanalytic Association had, by 1932, been expelled from its ranks – any hesitancy a group-sympathetic psychoanalyst might have had in fully acknowledging him, might surprise even less.

Other influences on Foulkes’s development of group analysis

Considering the fate of Burrow, considering the psychoanalytic orthodoxy’s attitude to group therapy, considering Foulkes’s own nature – according to Pines, a ‘modest and approachable man’ – what is perhaps striking is that Foulkes should feel able and willing to challenge psychoanalytic orthodoxy at all. For this he certainly did, with increasing clarity and confidence, noting that, for psychoanalysis to ‘extend its dimension’ to include group analysis, ‘the whole of psychoanalytic theory and practice would have to be changed, and far removed from the mind and intention of its originator’:

In the meantime, we firmly reject the idea that experiences in group psychotherapy should be limited by present-day psycho-analytical concepts. Group-analysis is free to develop within the larger framework of psychotherapy. Its effects inside this have been described as a...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Foreword
• Acknowledgements
• A note on pronouns
• Prologue
• PART I Mainly theory
• PART II Mainly practice
• Epilogue
• References
• Author index
• Subject index