Introduction to Group-Analytic Psychotherapy

Studies in the Social Integration of Individuals and Groups

S.H. Foulkes

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367325169
• eBook ISBN: 9780429915161
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Group Analysis, the approach pioneered by Foulkes, is a form of psychotherapy in small groups and also a method of studying groups and the behaviour of individuals in their social aspects. Apart from a number of practical advantages, it has features of specific value. It is the method of choice for the investigation of many problems and for the treatment of many disturbances.

Part I
General Introduction

The individual as a whole in a total situation

Life is a complex whole. It can only artificially be separated into parts, analysed. Such isolation becomes necessary when we want to know what a particular set of forces contribute to the total phenomenon or, to put it more precisely, how the whole is affected by the absence or altered function of any one part.

This is of immediate importance in dealing with disturbances, as, for instance, in the field of Medicine, with so-called diseases. Disease has been defined as life under changed conditions.

The healthy organism functions as a whole and can be described as a system in a dynamic equilibrium. Dynamic means that it is never in a state of rest, has constantly to adjust actively to the ever changing circumstances, milieu, conditions in which it lives.

Such adaptation, however, does not take place mechanically, following physical or chemical principles merely. There is always a creative element present, even in the simplest forms of adaptation.

The organism acts as if it knew its aim and had a choice as to the means to achieve this aim. It chooses those means which suit best all the prevailing conditions, inside itself or outside itself. If we want to say that we are aware of this and need to take into account all these factors in order to describe and understand what happened, we speak of the "total situation."

On the highest levels creative activity seems to be an inevitable ingredient, the hall mark of healthy life. Dynamic equilibrium therefore means: the active and creative maintenance of a good balance. From the point of view of the person such a state is described as being well, healthy, feeling happy, contented.

Disturbed function is due to disturbance in the equilibrium of the total situation. But we cannot and we need not take all factors in the total situation into account all the time. Some factors are more responsible than the rest for a disturbance and we must get them into focus.

Everything depends on whether we find the best perspective, the most adequate point of view, in approaching a disturbance. This includes that we concentrate on the right sector, make the right cut out of the whole. Sometimes one sees more under a microscope, another time more with the naked eye. If we know the problem already, this is easy enough. But if we don't know, we cannot find out before we find the correct approach, we cannot get the right answers before we ask the right questions. But worst of all, if we don't know but we believe that we do. Then we are hopelessly fixed to an inadequate approach, and land in a maze of pseudo-problems and pseudo-solutions, defended by a host of theories. In such a case it is best to stand back and look afresh with the naked eye on the totality of the situation, with a mind as keen to observe and as free from prejudice as we can possibly muster.

Let us have an example: suppose a man suffers from lack of vitamin X. What do we find? A highly complex picture of disturbances, in the beginning stages probably only discernible on the mental plane, and on the other side the absence of a minute single ingredient of food. If the condition is known to us and if we know our stuff, we should be able to diagnose this condition from the nature of the patient's complaints and the mental disturbance alone. No examination of the patient alone, however, no matter how thorough, how subtle, could lead us to discover the specific factor—and here one could almost say the " cause "—as long as vitamins were unknown. What abstractions were necessary and adequate for the solution of this problem?

• (a) We separated the person from the surrounding world, made a split between " inside " and " outside."
• (b) The isolating scientific method, so characteristic of the 19th century, without which the vitamins could never have been discovered.
• (c) We separated the physical from the mental.
• (d) We applied to the problem the categories of cause and effect.

Thus we find: an outside, material factor (the absence of vitamin X) causes an inside psychological disturbance.

This fits in perfectly with the classical scheme of scientific medicine:

Examination—Diagnosis—Treatment.

Treatment here obviously consists in the replacement of the missing vitamin and is, therefore, causal, not symptomatic, and—if all goes well—curative. Symptomatic treatment would have been if the doctor had prescribed tablets to alleviate the patient's headaches. Such a treatment would have been inadequate and in the presence of better knowledge, wrong.

Our abstractions in the face of this problem were adequate and correct. This is the type of disturbance where the classical scientific abstractions have their heyday. The trouble starts when they are applied in principle to every " disease," where they are inadequate and out of place and where quite different sets of abstractions, quite a different point of view, become necessary.

The whole development of Medicine, and similar of other Disciplines, in the last half century, in a nutshell, is the gradual realisation of the fact, that this scheme is not sufficient in the great majority of disturbances and that—to do them justice— one must take the whole personality and its life situation, past and present, into account. This can only be done in terms of Psychology. The vantage point for the observation of the person as a whole is his own mind.

Let us see what kind of " case " sets people thinking on these lines, still taking an example, schematic and oversimplified, very much from the extreme end of a scale, still near enough a sphere, where the classical categories could operate.

A man has a duodenal ulcer. A clear cut and well-known disease, or at least syndrome. The pains and complaints are typical, it can be deduced from physical examination and to crown it all its signs can be clearly seen under the X-ray. Here it is. The diagnosis is clear. But what is the cause? A certain anatomical configuration of the stomach. Yes; there are a greater number of people with this configuration amongst Ulcer patients than is the statistical average. But—by no means all of them ever develop an ulcer and most of the people who do have no such configuration. It can't be the cause; may be a contributory cause. Hyperacidity? Same argument and, besides, why the hyperacidity? Other causes— Hypermotility, irregular meals and—Psychology creeps in— worries, anxieties, mental strain, overwork, etc. A set of causes, co-operating, seem to fit into a new scheme: constitution, predisposition and accidental unfavourable external influences. But Psychology is an uncomfortable newcomer; once allowed entrance it uses its elbows, rudely asking question? hot at all fitting to the medical upbringing. And the worst is still to come, we have not yet talked about Psychoanalysis. What, it asks for instance, about these worries and anxietiess? You call them " external," but I can show you that they are very much " internal," I can show you that this person would not have worried at all over his, say, financial impasse if it had not been for his whole character. I can show you that this character itself is the result of his early experiences, can show you in detail that the worries he told you about are only a screen, a red herring, covering up deeply buried passionate longings and fears, buried maybe since his earliest years. However, he himself believes in these present-day worries and is quite unconscious of the war which is going on inside his own mind, even though I can show the most precise and detailed links between them and his unconscious mind, and also how and why it has to disguise itself almost beyond recognition. Moreover, I can almost—not quite—trace the links between these unconscious struggles and the stomach itself. I am nearer the stomach anyhow from " inside " than you, even with your X-ray and microscope.

Now stop, says the Doctor, this goes too far. Are you telling me that you can find out what is in a person's mind, which even he himself does not know? This is nonsense, phantasy, speculation! Precisely, says the Analyst, but the nonsense and phantasy are in the patient's mind, and very highly charged and very real too, and not in mine. Thanks to Professor Freud's discoveries, I have a Method of access to the unconscious mind, so that the patient himself can find it all out with my help, and there is a great deal of knowledge now to make it intelligible. However, it is a very lengthy business and a long story and we can't go into all that now. But I can tell you something else—you think of constitution as organic, but studies by trained observers show, in this case most systematically in Chicago, that persons who develop ulcers belong to a particular, well-defined personality type. Anyhow, seen from this angle, the ulcer itself is only a sideshow, an incident, so to speak, in a long chain of events. If I ask you, for instance: Why did this patient develop an ulcer just now? you could not give an answer, but the odds are that if I analysed him I could. By the way, what about treatment and cure? In a good number of people this condition will not heal under the usual dietary regime, and the reason is that the underlying conflict has not been resolved. Do you propose that every gastric ulcer, or every patient for that matter, should be analysed? No, I don't, but we can't go into all that now.

This was at least reassuring to the Doctor that his colleague has not altogether abandoned reason and common sense. But he wondered; he had often noticed that some people with the " same condition " made a good recovery and others went from bad to worse under the " same treatment " or even died. It had never occurred to him that " psychological " reasons could be responsible for this—there might be something in this Analyst's ideas, however incredible they sound. Should artists and writers know better than men of science? It came back to him that he had read Thomas Mann's " Zauberberg " and the " Buddenbrooks." He had represented the crisis in young Hanno Buddenbrooks' scarlet fever—when he died— as a deep inner decision between will to live and will to die . ., there might be something in it ....

We will leave this imaginary discourse between the Physical and the Mind Doctor, but must remark that this was an unusually good Doctor, not typical for the way the average responds.

What has all this to do with Group Analysis? It will soon become evident.

The Problem.It will have become clear that our classical scheme is not applicable any more to the same degree.

In the case of an infection the cause is well defined, a bacillus. Without this and the organism's characteristic response to it, the condition could not develop in its particular form. But this tells us very little as to the real meaning of the event for the patient's life and its bearing upon the future.

At first sight an accident seems to be only a matter of a motor car and a patient's bones—a concern of the surgeon. But it has been shown that to be run over can be far from accidental. There is a whole scale: from the person who may commit deliberate suicide in this way, to the far greater number of those to whom it happens while they are quite unaware of the dark powers inside themselves, which drive them into some such catastrophe, from deep, desperate, insoluble conflict; and finally those, who know peculiar, frightening, fleeting impulses to throw themselves under an oncoming train, which puzzle and bewilder them. Some persons never have an accident, others whole series of them, a great many during their lifetime. The latter have been shown to belong to a recognisable type of personality.* They are " accident-prone " and become involved in a very much greater number of " accidents " than the statistical average. They have no conscious intention whatever for doing so. Don't we all know this and express it in so many superstitions?

Wise physicians always knew this. You must always treat the patient and not the disease, they say. But the advent of modern scientific medicine has made this more and more difficult to maintain. The more one learned about the details, the more one lost sight of the whole. Now, under the impact of modern scientific Psychiatry, it. is being rediscovered. In some ways, the old pre-scientific idea that people are sick because they have fallen victims to evil spirits and ghosts, have become obsessed, invaded by them, was nearer the truth. So-called primitive people, not yet capable of rationally disciplined thinking, blame the transgression of taboos or the anger and revenge of restless ancestors for such occurrences.

What a dilemma! Is this the end of scientific medicine? Or is the pendulum just swinging? Neither. This is where Psycho-Analysis steps into the breach. It has shown that while it is not possible to ignore the truth in these primitive beliefs, nor the extent and power of the mind, it is possible to admit them without abandoning the ground of science and its principles. Psycho-Analysis has furnished the key which opened up this sphere to scientific investigation and, through this investigation, made it known and intelligible. It has done so in the first instance in such disturbances, which are either frankly psychological or for those physical symptoms the physician finds nothing to account for on purely physical grounds, the so-called Psycho-Neuroses.

Psycho-Analysis the key.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. We are witnessing the beginning of this process. Here these contributions must be condensed to a few statements. The total personality and total situation in their interaction could not be approached from the vantage point of Psychology as long as one was dependent upon introspection on the one hand and experiment on the other. There was no psychology which took everyday life and its meaning for the individual on emotional and instinctive levels into account, at least scientifically. Only the great philosophers and in particular true artists had been able to make their contributions. Psychology as a natural science, based on Biology, did not exist before Freud. Psycho-Analysis opened this territory up by developing three major tools:

• (1) A method of investigation called free association. The Analysand is instructed to relate everything in his mind, as it occurs, resisting the urge to make a choice.
• (2) A mode of understanding the full, unconscious, meaning of conscious thoughts, motives, actions, and the relationship between the two spheres of mind. It made clear that, why, and how the most powerful motivations of human behaviour had often to be concealed from the person's own awareness, had to be excluded from consciousness, repressed. More than that—they had to be subjected to a barrage of transformations, distortions, such as symbolisations, sublimations, substitutions, displacements, perversions, condensations and other defensive mechanisms, before they were admitted to self-consciousness. The grammar of all this, a kind of deciphering code, is contained in Freud's " Interpretation of Dreams."
• (3) Psycho-Analysis created a new situation, the analytic situation, between the Analyst and the Analysand. The essence of this situation lies in the fact that it is a transference situation. The Analysand tends to revive all those earlier relationships to other persons, which are still active in his mind, because they have not come to a satisfactory conclusion. While doing this he imbues the Analyst with all the features of his mind's images, allocates to him the roles of the most important persons of his earlier life, down to infancy. His most passionate love and hate, acutest anxiety, panic, despairing remorse and guilt come into play. If the Analyst allows it to happen, that is! If the Analyst would take the patient's reactions up as a real person in the present reality only, a Doctor in a consulting room, he would force the Analysand to return on his part to the present, and to abandon this transference. The Analyst does not want to interfere with this transference process, however. He knows that by way of repetition his patient thus experiences and communicates his most vital and most unconscious conflicts. In fact, there is no other way of expressing these conflicts. They are not only forgotten, but could never be directly recalled to memory, because they had never been experienced in articulate language. The Analyst therefore allows the patient to manoeuvre him exactly as the patient's own unconscious mind dictates. This is where the possibility of Self Analysis ends and the social situation, the other person, becomes indispensable. If the Analyst were himself conflict-ridden or anxiety-laden as to his own primitive instinctual reactions, he would be forced to keep away from this sphere and put up a resistance on his own, albeit unconsciously, against the patient's transference reactions. In the technical language of today this implies that the Analyst himself should have undergone a thorough analysis in his own person. Transference thus becomes the corner-stone of psycho-analytic procedure. It can be experienced and explored fully only in the analytic situation. Psycho-Analysis, as a therapeutic procedure, does not consist of a repetition of transference alone. The Analyst does both: he allows his patient to regress as far as he will, to make out of him what he likes, but also recalls him to the present day level, represents present, mature reality for him. The art of the Analyst, his good technique as it is called, consists in fulfilling both these parts in the right proportion and at the right moment. Thus he enables the Analysand to link up his past with his present life, to bring his conflicts up-to-date, so to speak, and achieve a better integration.

Without these three tools, which we have outlined, free association, the knowledge of the unconscious and the analysis of the transference situation, no Analyst can work. The last mentioned, however, has gained more and more in importance. It must be mentioned that in its pure form it can only be experienced in a highly intimate social situation—an intimacy unprecendented and unparalleled—between two people. It should also be noted that this situation can be established only under exceptional circumstances, because the preconditions on the part of both the Analyst and the patient are dependent on highly selective factors. In addition, it is a time-consuming process, necessitating daily sessions for a number of years.

With these tools Psycho-Analysis has, as we said before, made it possible to open up the total personality and the total situation for operation. Indeed, it revealed that the present personality and the present situation, even in their totality, are inseparable from the past—that of the individual and the race—and the future. It has stressed the unexpected importance of sexual life, its newly discovered pre-existence in the life of the infant, and the crucial significance of the Oedipus Conflict. It has established beyond doubt the formative nature of early childhood experiences not only for later life and its conflicts, but for the genesis of the person's ego and character itself. Through its concept of conflict as of paramount pathogenic importance, conflict, that is, between innate impulsive instinct and restricting authority and limiting reality, it has allowed for the basic nature of man as a social animal. Moreover, 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.

Explicity, however, Psycho-Analysis has not as yet allot...

Table of contents

• Cover
• Half Title
• Dedication
• Title
• Copyright
• FOREWORD
• PREFACE
• ACKNOWLEDGMENTS
• Contents
• PART I GENERAL INTRODUCTION
• PART II THE BACKGROUND
• PART III THE GROUP-ANALYTIC SITUATION
• PART IV THE CONDUCTOR'S CONTRIBUTION
• PART V SURVEY
• BIBLIOGRAPHY
• INDEX