Group Psychotherapy

The Psychoanalytic Approach

E.J. Anthony

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429914379
• Edition: 2
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This classic work attempts to present a comprehensive account for the lay reader of the principles and methods of group psychotherapy.

Chapter 1

Group Psychotherapy and Group-Analysis: Basic Considerations

1. INTRODUCTION

Group psychotherapy is now practised in clinics and institutions as well as in private practice all over the world. Beyond this there is a growing realization of its significance for other groups, social life in general, social psychiatry, community therapy, selection procedures and education.

There are many varieties and types of group psychotherapy. For a broad orientation it may be useful to consider these types according to whether their impact is primarily due to:

(a) relief through expression. Catharsis (action methods and activities of all sorts);

(b) restoration throughparticipation and acceptance, best known as encounter groups; or in addition to these

(c) the liberation of creative forces in the individual, the liquidation of old fixations in development by laying bare disturbing conflicts, bringing them to awareness and resolution (group-analysis).

Only this last category, characteristic for the analytic approach, concerns us here. All the pioneers in this field came from psychoanalysis: T. Burrow, S. H. Foulkes, P. Schilder, S. R. Slavson, L. Wender and others. All of them were American, except S. H. Foulkes whose work developed independently in England. Only the latter, while always remaining a Freudian psychoanalyst in the individual field, maintained from the beginning that in this new field the group situation changes the therapeutic process decisively. Accordingly, he created a novel method of approach which he called group-analytic psychotherapy and new theoretical concepts: group-analysis. This view has more recently gained much ground. It is nevertheless fair to say that it is even now insufficiently understood and that psychoanalysts are more reluctant to accept the changes in method and theory involved than are other workers in this field.

The reader will find at the end of this book (p. 271) a selection of books from the vast literature which now exists on this subject. Some of the most important books we have included give a general survey and an integrated view from the early beginnings to the present time. Books which have a special merit for those interested in historical developments are also included. For the most part the reading list gives different analytical approaches with representatives from the different schools as they will presently be reviewed. Books which put more emphasis on research are also included. We also mention some of the more important journals in this field.

2. THE PSYCHO-ANALYTIC APPROACH

Let us now turn to the psychoanalytic approach to psychotherapy. We consider psychoanalysis as a therapeutic method taking place between two people, the analyst and his patient, and consider group-analysis as a form of psychotherapy and not as a form of psychoanalysis. We use the terms ‘group-analysis’ and ‘group-analytic situation’ as the equivalents, in a group situation, of ‘psychoanalysis’ and ‘psychoanalytic situation’. If we wish to make explicit that we talk of group-analysis as a form of treatment, we use the term ‘group-analytic psychotherapy’. This indicates that this method is analytic but primarily based on the group. It should however be understood that the analysis of the individual remains a primary concern. The individual is being treated in the context of the group with the active participation of the group. For a detailed description of this method, the reader is referred to S. H. Foulkes: Therapeutic Group Analysis (Allen & Unwin, 1964). A new comprehensive book on the method by the same author will soon appear.

Like other work which is considered in this book, we take as our starting point the practice and theory of psychoanalysis. The present writers stand firmly on the grounds of classical psychoanalysis whilst many other workers appear to have been trained within schools which, for short, one might call neo-Freudian. All these neo-analytic schools are not so much distinguished by what they have added to or developed from Freud’s work, but by what they have left out or distorted. The foundation on which their approach to groups has been built up thus differs considerably. Nevertheless the same workers often refer to their practice as ‘psychoanalysis’ in groups. In truth they often violate psychoanalytic concepts whether in the individual or the group setting and consequently fail to do justice to the significant features of the group situation. The present writers consider that psychoanalytical concepts, clinical and theoretical, are firmly rooted to begin with in the one- and later in the two-personal situation. There is no intrinsic reason why psychoanalysis should not in futureextend its dimension and claim that group-analysis is psychoanalysis in the multi-personal situation. If and when this should be stated it would become clear, however, that the whole of psychoanalytic theory and practice would have to be changed, and far removed from the mind and intention of its originator. For the time being, we think as psychoanalysts that this discipline has an important function to fulfil on its own grounds. We do no wish to inaugurate yet another neo-analytic school of thought.

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

3. THE MAIN TRENDS

The first point we have to keep in mind when we consider the meaning and delineation which several authors give to an analytic approach is that their concept as to what is psychoanalysis differs significantly. Having this in mind, the main trends discernible at this point in time may be stated as follows (as they are stated briefly and summarily it will be appreciated that this account is over-simplified):

(a) If the psychotherapist is individually trained and experienced in psychoanalysis he will, and must, use psychoanalytical concepts to guide his practical actions. He will note that the group situation modifies all processes and introduces some new factors. The theory, which remains that of psychoanalysis, has to take note of these modifications. What we are dealing with is analytic group psychotherapy as represented most clearly in the work of S. R. Slavson. We agree with him in so far as psychoanalysis is concerned. We think that he takes psychoanalytical concepts too much as absolute truths, instead of relatively correct in their own setting, as perhaps all truth is. The morerelevant differencebetween this view and the group-analytic position, however, concerns the valuation of the group situation and its influence on practice and theory.

(b) Psychoanalysis in the group is possible. The emphasis is on the individual in the group. Group dynamics do exist, but have no bearing on the ongoing treatment, group or no group. This view is held by A. Wolf who has been one of its pioneers and has considerably influenced the practice of ‘psychoanalytic’ group therapy in the U.S.A. In their book, Psychoanalysis in Groups, A. Wolf and E. K. Schwartz present a comprehensive and valuable account of their experiences, method and theories as practised at the Postgraduate Center for Mental Health in New York. Workers adhering to this view use to good effect thepossibilities inherent in the stimulation and potentialities of a multipersonal interactive setting, and they feel, with us, that therapy is more effective and intensive in this setting than is the treatment of the isolated individual. To some extent their experience precludes them from understanding our views, as they work in a different situation in which they cannot well test and correct our premises. Their groups are large, up to ten members. Wolf and Schwartz prepare their patients by individual analysis, who may return to individual sessions if they become too anxious, though this is rarely necessary for prolonged periods. They have also worked with ‘alternate sessions’ taking place without the therapist’s presence. There is no question that good psychotherapy can be done in this way, but the present writer, who independently had occasionally used similar procedures, found possible gains to be heavily outweighed by the advantages of analysing all conflicts in one single, clearly defined, therapeutic situation at one and the same period of time. Otherwise one works in a transference situation which is unnecessarily complicated. Schwartz and Wolf seem to make no allowances for this or the consequences concerning the theory of group dynamics. By this term we mean the psychodynamics in the group situation, which build up into an interconnected, transactional network.

(c) A third view which also originated in England, in particular at the Tavistock Clinic, is that the psychoanalyst follows exactly the same principles in the group as he does in the individual situation. The difference is that the whole group is now considered as if it were one patient. Thus a one-to-one relationship is restored, corresponding to the situation in individual psychoanalysis. The analyst confines himself to the interpretation of the transference situation as it presents itself in the ongoing session. This, in the ‘here and now’, is the centre of the procedure. Though these workers base their approach purely on psychoanalysis they have, like the present writers, refrained from calling it group psychoanalysis. This approach to groups was introduced by W. R. Bion (see Selected Reading list). The type of psychoanalysis on which it is based is strongly influenced by the theories of M. Klein and W. R. Fairbairn, in particular the so-called ‘inner object’ theory. This is really valid only on narcissistic, psychotic levels of mentality and Bion has indeed paid particular attention to these levels in his interpretations. Later followers, H. Ezriel amongst others, concern themselves exclusively with transference interpretation, reminiscent of James Strachey’s conviction that these alone are effective, ‘mutative’. For a critique of this work see S. Scheidlinger, Group Process in Group Psychotherapy I and II,* and also I. D. Yalom (see Selected Reading). Recently a concise account of this school of thought, edited by H. Walton, has appeared (see Selected Reading). This approach might be said to represent (psycho-) analysis of the group as a whole by the therapist. The main difference between this and the group-analytic position appears to lie in the much greater variety of interpretations used by us, and in a different view as to their dynamic significance. The active participation of the group itself is in our view much more important for psychotherapy in the group. At the same time, the function of the group as a whole has in our view a more primary significance for the understanding of all part processes concerning its members, and not the other way round (‘trans-personal processes’).

(d) The ‘group-dynamic theory’ originated by K. Lewin has influenced group psychotherapy in various ways. A certain cross-fertilization also took place between the Tavistock Institute of Human Relations in London and some American institutions influenced by him. Though this theory has no common ground with psychoanalysis, it seemed at first compatible with an analytic approach, as exemplified at the time by the work of G. R. Bach and C. Rogers.

This type of ‘encounter’ group clearly falls into our category (b): restoration through participation and acceptance (see p. 15). In recent years the term ‘encounter’ group has been extended to group activities with an emphasis on action. These may take their inspiration partly from Moreno’s ‘psychodrama’, but go far beyond this as in communal bathing and other pursuits at Esalen, California. These are popular, sensational entertainments and do not claim to be psychotherapy. They appear to make an impression on the participants, sometimes to the good, sometimes to the bad. At best they may be regarded as helping the anomie of the isolated human individual estranged as he is from his community in the western culture. The openly anti-analytic bias of these methods has helped in bringing the analytical schools of group psychotherapy closer together.

We do not find that ‘group dynamics’ enter much into the small therapeutic group, and in this respect agree with Wolf and others. If occasionally we use terms which are also used in K. Lewin’s work, they have a different connotation or dimension, though they need not necessarily clash with his usage. For our orientation to the hospital ‘therapeutic community’ at Northfield, we found that our own group-analytic views married well with concepts used in ‘field theory’, and that the latter helped us in our orientation. Here belongs for instance the concept of a social ‘field’. Further, there is a common background as regards Gestalt psychology.

The present writer learned to appreciate the holist view of the human organism and all its consequences from his teacher K. Goldstein, and through his studies with Adhémar Gelb became convinced of the dictum that the whole is prior and more elementary than its parts. He considers the figure-ground relationship is of principal significance. As applied to group-analysis this is, however, extended in depth and applied to complex processes of interaction between the more obvious manifestations and their more silent or concealed background. Without the elucidation of this background they cannot be fully understood or even observed. Taking a very simple example: if a person leaves the group, this must be understood from that person’s point of view as well as that of the rest of the group, and is in fact a result of their interaction.

The term ‘group dynamics’ has sometimes been used by us for ‘group psychodynamics’ in the sense of Freud’s unconscious dynamics. In order to avoid confusion we later adopted instead the term ‘group processes’. As we shall presently make clear, to us intra-psychic does not convey, as to G. Bach, ‘intradermic’, and we look upon the dynamic processes in the group not from the outside, but from inside, as intra-psychic dynamics in their interaction.

4. THE GROUP-ANALYTIC VIEW

The group-analytic view itself is in the centre of this whole book and need not be set out here specifically. Some of it has been made clear in the preceding discussion of other approaches. A comprehensive and integrated presentation of this work in the preceding twenty-five years appeared in 1964.*

In spite of many and important differences there seems to be enough agreement between group-analysts – including ourselves – to set them apart from other non-analytic group psychotherapists, and for them to be considered as speaking the same language. Agreement largely exists with respect to the analytic attitude of the therapist, the guiding principles of his interventions, his concern with the dynamic unconscious, and the interpretation of resistances, defence reactions, transference, etc.

The importance of human experience, of the encounter, is also common ground among group-analysts, and probably all group psychotherapists. This element has been recently stressed by ‘existential analysts’ in individual as well as in group psychotherapy.

The most important issue between the different forms of analytic group psychotherapy is the varying significance attached to the group situation itself. It is in this respect that group analysis as understood by us takes a different position, both in practice and theory, by placing the group and the group situation decidedly in the centre.

The treatment of a patient within a group setting is so far removed from the psychoanalytic set-up – one could almost say it is its opposite – that in the writers’ opinion it is misleading to call it psychoanalysis. In so far as the therapist is a psychoanalyst he will still be a psychoanalyst; one cannot be a psychoanalyst in the morning when sitting behind a couch and something else when sitting in a group in the afternoon. The patient too remains the same person, and what is true for him from a psychoanalytical point of view must still be true for him when he sits in a circle, as has been said long ago.* Such treatment is therefore psychotherapy of a psychoanalytical orientation.

It is, however, group psychotherapy. Psychoanalysis is principally biological and genetic in its approach. It views complex behaviour as motivated in the last resort by elementary instinctual drives which are firmly rooted in somatic needs. The ego is fundamentally a body-ego, says Freud. Only the therapeutic function of psychoanalysis brought social, interpersonal dynamics into orbit with the discovery of transference in the two-personal situation.

These interpersonal psychodynamics have a greater bearing on the therapeutic processes. Group psychotherapy which intensifies and amplifies the social, interactional aspects of psychodynamics is thus the situation of choice for the study of therapeutic and pathogenic processes as they operate in the immediate present, the here and now of the therapeutic situation.

The group situation is not a psychoanalytical situation manquée; it introduces powerful and completely new parameters of its own. These will be set forth throughout this book. Thus all experiences and theories in the wide field of the group psychotherapies, however far removed from an analytic approach, have common ground with our app...