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Module 1
Group Psychotherapy Foundations
Historic, Contemporary, and Cultural Perspectives
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1 History and Contemporary Developments
Francis J. Kaklauskas and Elizabeth A. Olson
The history of group psychotherapy (Anthony, 1971; Barlow, Fuhriman, & Burlingame, 2004; Scheidlinger, 1994, 2000) bursts with happenstance discoveries, creative and courageous inventiveness, investigative fortitude, caring hearts, and interesting, passionate personalities. Despite being just over one hundred years old, group psychotherapy has branched out into many aspects of our contemporary world. Group dynamics are regularly acknowledged and discussed, from small workplace power struggles to global diplomatic dynamics. While the formal term of “group psychotherapy” only began to gain a footing with the rise of psychotherapy at the middle of the last century, the practice of people getting together to learn, grow, and support one another is timeless. Groups form the very base of our humanity and humanness.
Pre-Therapy Group Influences
- Anthropologists recognize the practices of human group identifications, conflicts, connectedness, and collaboration from our earliest historical roots.
- Many worldwide myths highlight the underpinnings of group psychological factors on human behavior. These stories tell timeless tales of interpersonal alliances, misunderstandings, mistreatments, and all shades of human relatedness.
- Gustave Le Bon’s (1895) “The Crowd” described how one’s thinking and behaviors change in unique ways in varied social situations.
- Charles Triplett (1898) discussed how cyclists perform better when riding in a group or peloton than individually.
- Some cite Sigmund Freud’s Thursday night discussion group of psychoanalysts as the first group psychotherapy or group supervision meeting.
Joseph Pratt
Internist Joseph Pratt inadvertently started group psychotherapy in July of 1905. He began holding educational classes focused on hygiene with some inspirational religious readings for his patients suffering from tuberculosis. He noticed that patients often gathered together after his talks in dyads and small groups. Moreover, he suspected that patients who regularly attended his presentations, not only remained optimistic and courageous despite living with a chronic illness, but also appeared to have fewer symptoms and better recovery.
In Pratt’s talks, the patients were taught about how to work with their attitudes and illness. Yet, after the class, they also got emotional support and connection from other patients. While Pratt initially thought that it was the information he was providing that was the magic in their improved health, his patients believed it was the connection, support, and the increased hope they felt through their conversations with others struggling with similar challenges (Pratt, 1907). Over time, Pratt further expanded the opportunities for his patients and their families to talk to each other during his presentations. The power of group psychotherapy was discovered.
- Pratt is usually considered the creator of group psychotherapy.
- First formal psychotherapy groups for people with tuberculosis started in 1905.
- Created out of necessity to see more patients simultaneously.
- Initially focused on lectures and providing medical information.
- Attendees reported most enjoying and benefitting from talking with one another, and Pratt increasingly utilized their between-member interactions in lieu of lectures.
- In 1921, the psychiatrist E.W. Lazell adopted and extended this group approach at St. Elizabeth’s Hospital in Washington, D.C. for World War I veterans suffering with psychotic symptoms.
Jacob Moreno
Jacob Moreno was a Romanian psychiatrist who was always drawn to theater, the creative arts, and spontaneity. Well before completing his formal medical training, he engaged in spontaneous theater, ranging from forming acting troupes to impromptu performances in the parks of Vienna with children and marginalized individuals.
- Creator of psychodrama – a form of group therapy in which group members engage in spontaneous theater and roleplaying.
- Worked with the underprivileged in the parks in Vienna prior to World War I.
- Coined the term “group psychotherapy” in 1931.
- The following year (1932), the American Psychiatric Association held a conference that accepted this term and this new method of treatment.
- Valued spontaneity, creativity, and mutual sharing.
Psychodrama therapy enlists its group members to role-play a scene from a group member’s (protagonist) historical past, dreams or fantasies, or anticipations of future events. With collaboration and input from the group, the group leader or director sets up the scene and group members enact the characters, psychological parts of the protagonist, and all the other elements of the scene.
Basic psychodrama techniques are:
- Doubling: Someone stands behind and speaks for a member.
- Role reversal: Characters switch roles in the middle of the action.
- The Soliloquy: At the end of a scene the protagonist speaks spontaneously.
While the focus in a psychodrama scene is on one group member, other participants and the audience (group members who did not take a role) can vicariously experience strong feelings and insights into their own lives.
Other Early 20th Century Developments
During this period, ideas about the psychology of groups gained interest in academic writing as reflected in the works of William McDougall (1908, 1920), Sigmund Freud (1921), and others. The practice of group psychotherapy also expanded into more mental health hospitals and clinics (Marsh, 1935).
- Trigant Burrow expanded psychoanalytic ideas into the group therapy format and first used the terms group analysis and here-and-now
- Post-Freudian theorists including Melanie Klein, Alfred Adler, and Carl Jung had increasing interest in interpersonal relationships and collectives.
- Kurt Lewin coined the term group dynamics (1947) in his innovative studies of group process and leadership roles
Samuel Slavson
Samuel Slavson was an engineer, journalist, and teacher who began conducting psychotherapy groups in 1919. He was a proponent of progressive education and the child guidance movement, wrote extensively on group psychotherapy, and founded the American Group Psychotherapy Association in 1942.
- Believed self-expression and self-acceptance increase adjustment and happiness.
- Started with Activity Groups using art supplies with children and adolescents.
- Moved to Interview Group Therapy which encouraged members to talk honestly with one another.
- Group members were prompted to focus on each other’s positives and to have positive interchanges.
Mid Century Developments
Following World War II, group psychotherapy experienced a rapid and dramatic growth in application, theory development, and research as soldiers returned home with both physical and psychological injuries, and families dealt with grief and loss, and the general population struggled with ongoing fear and trauma. The need for psychological services greatly exceeded the systems that existed, and so health care workers increasingly relied on group approaches.
Clinicians and participants found benefit through connecting with others who shared similar experiences, hearing feedback and suggestions from a diverse collection of peers, experiencing one’s vulnerability, and providing support to others. During this period two of the most prominent group practitioners and theoreticians, S. H. Foulkes and Wilfred Bion, developed their lasting seminal ideas about group work.
S. H. Foulkes
Foulkes was a German born psychiatrist who immigrated to England. He studied with many of the leading figures of the psychoanalytic movement including Helene Deutsch and Wilhelm Reich, and was colleagues with many individuals of the Frankfurt Institute of Sociology. He is noted for at times asking the patients in his clinic’s waiting room to free-associate together, and went on to significantly contribute at the Military Neurosis Centre at Northfield Hospital in the areas of group analysis and therapeutic community.
- Prior to World War II, conducted private practice psychoanalytic groups.
- During and after the War, worked at Northfield Hospital to help with the mental health needs of soldiers and families.
- Group-as-a-whole – Group was seen as more than the sum of its parts (members, leader and setting), but also a whole unto itself.
- Each group has a unique pace, anticipation, defensiveness and work style.
- Identified group selection criteria.
- Group members benefited from having multiple transferences towards each other as opposed to just the individual therapist. He focused closely on how members responded to each other, and he asked about these choices or behaviors.
- Preferred the term “conductor” (as in an orchestra) to the term group leader, as he felt the title “leader” reflected negatively within the cultural context of the autocratic and destructive leaders of World War II.
Wilfred Bion
While Foulkes is remembered for his outward warmth, his sometime colleague Wilfred Bion was known for his passion and strong ideas and ideals. Bion studied under John Rickman and Melanie Klein, and made many significant contributions to psychotherapy and group psychotherapy. His book Experiences in Group (1961), a collection of essays based on his leading groups at the Tavistock Clinic in London, is a classic study in group psychotherapy.
- Used an unstructured group approach to study group processes and encouraged members to focus on the group dynamics that unfolded.
- Basic Assumptions (see Chapter 5) interfere with the work of the group.
- Bion ultimately became disillusioned with group work as he returned to focus more on individual treatment, developing a sophisticated theory of personality and an interest in psychotic processes.
Recommended Resources
Anthony, E. J. (1971). The history of group psychotherapy. In H. Kaplan & B. Sadock (Eds.), Comprehensive group psychotherapy, 4–31. Baltimore, MD: Williams and Wilkens.
Barlow, S. H., Fuhriman, A. J., & Burlingame, G. (2004). The history of group counseling and psychotherapy. In J. L. Delucia-Waack, D. A. Gerrity, C. R., Kalodner, & M. T. Riva (Eds.), Handbook of group counseling and psychotherapy, 3–22. Thousand Oaks, CA: Sage.
Bion, W. R. (1961). Experiences in groups and other papers. London: Tavistock.
Foulkes, S. H. (1990). Selected papers of S.H. Foulkes: Psychoanalysis and group analysis. London: Karnac.
Freud, S. (1921). Group psychology and the analysis of the ego. Standard Edition, 18. London: Hogarth.
Freud, S. (1922). Group psychology and the analysis of the ego (1922), Trans. by J. Strachey. New York: Boni and Liveright.
Le Bon, G. (1960). The Crowd: A Study of the Popular Mind. 1895. Reprint, New York: Viking.
Lewin, K. (1947). Group decision and social...
