Group Analytic Psychotherapy

Working with affective, anxiety and personality disorders

Steinar Lorentzen

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781135137830
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Group analytic theory is internationally recognised as an effective treatment for people suffering from mental distress, struggles with personal development and interpersonal problems. Integrating psychoanalytic and social psychological thinking and providing a group setting for self-discovery and developing social skills, long- and short-term courses in this type of therapy are increasing in popularity.

This manual provides a detailed description of both long- and short-term versions of group analytic therapy, with rich and vivid clinical examples to illustrate theory and techniques. Group Analytic Psychotherapy describes in detail what a participant may expect, differences between short- and long-term therapy and how to behave as a group member, as well as the main issues the clinician has to deal with. Topics covered include:

Group Analytic Theory

Methodology

Clinical Examples

Therapist Adherence and Competence

Providing a basis for understanding the dynamics of groups at work in offering emotional support and a positive atmosphere, Group Analytic Psychotherapy is ideal for clinicians, students and informed patients as well as all psychodynamically oriented professionals in the field. It is an essential manual for those looking to learn the main attributes of short-term intervention.

Part I Long-term group analytic psychotherapy

DOI: 10.4324/9780203796887-1

Chapter 1 Group analytic theory

DOI: 10.4324/9780203796887-2

Defining group analysis

Group analysis was developed by S.H. Foulkes. For a short biography and bibliography, see Pines (1983, pp. xi–xviii). Group analysis is a form of psychodynamic group therapy where treatment of individual patients takes place in the group and is effected by the group, including the leader. The group of people gathered is therefore the actual treatment instrument, and it is the therapist’s task to involve the group in this process. Although Foulkes developed several concepts to describe the structure and process in therapeutic groups, group analysis shares many of the basic assumptions of other psychodynamic or psychoanalytic therapies: a developmental perspective on personality, existence of internal representations of interpersonal relationships, psychological causation, influence of unconscious individual and group processes on behaviour, ubiquity of psychological conflict and the existence of psychic defences.

The objective of the therapy

Group analysis is an investigative therapy which seeks to optimize interaction between group members with a view to raising awareness of the group’s dynamics and the individual member’s intrapsychic conflicts, and eventually to contribute to correcting irrational forms of behaviour and problematic interactional patterns. The use of these insights and new corrective experiences to promote behaviour change within and outside the group can provide a starting point for a more realistic self-image, for changing dysfunctional interpersonal behaviour patterns and for the adoption of new, more functional ones.

View of human nature

Foulkes emphasized that man is primarily a social being, and that individuality arose in the late stage of the industrial revolution (biologically speaking, the individual is the smallest unit, while the group is the basic psychological unit). One of his fundamental principles was that ‘the whole’ (the group) is more elementary than ‘the parts’ (the individuals). He used the term ‘foundation matrix’ to characterize our common cultural background (the facts that we have a body, that we are born and are socialized in a group, that we depend on communication, that we have a language, etc.). He considered this common background to be of vital importance in our being able to understand each other. Much of this background we take for granted, ‘like the air we breathe in and out’, without us being conscious of it.

Mental disorders

Foulkes believed that individual psychic disorders, that is especially neuroses and personality disorders, are related to human relationships. They manifest themselves in the individual’s relationship with a group and often occur or are found only in the patient’s relationship with those who are nearest to him, the primary group. Since mental disorders occur in man’s relationship to his surroundings, Foulkes believed that the best treatment for these disorders is group analysis, as the basis for a deeper understanding and correction of dysfunctional human relationships.

The therapeutic group and the therapy process

The composition of the group is usually determined according to ‘the Noah’s Ark principle’: the members should be drawn from all age groups, both sexes, the anxious—more uninhibited and extroverted—introverted spectrums, and should include at least two members from each of these groups, in order to prevent anyone feeling like an outsider. The idea is that various types of problems and personalities provide space for the softening of defences and new learning. In our research project (SALT-GAP) the therapists do not select patients and compose the groups, but the patients are randomized into groups, which will hopefully result in a roughly equal distribution with respect to sex and age, degree and type of psychopathology. Foulkes raised the question of how a group of deviant individuals could ‘normalize’ a person, and answered it himself by saying that ‘collectively they constitute the norm from which, individually, they deviate (Foulkes, 1977, p. 297). All members are characterized by the foundation matrix, which is a given factor in the group. In addition, the group develops its own history over time. Foulkes used the image of a network, where individuals are located at the point of intersection (‘nodal points’) between the fibres, to describe the group. The network consists of ‘all the individual mental processes, the psychological medium in which they meet, communicate, and interact’ (Foulkes and Anthony, 1984, p. 26). The processes are transpersonal, i.e. they penetrate to the core of every individual. He called this network ‘the dynamic matrix’ or ‘the interactional matrix’, which is a network that is developed and shaped by the individuals in the group. He saw this term as a construct, in the same way that he saw the term ‘traffic’ or ‘mind’, and he found the term useful when it came to characterizing the ‘group-as-a-whole’. By relating to each other, group members recreate the conditions from their own primary network, as they perceive them, consciously or unconsciously. Foulkes saw this as the group’s equivalence to the ‘transference neurosis’, as can most clearly be seen in the analytic situation. In today’s terminology, one would be more inclined to say that members develop multiple transferences onto other members, including the leader. These will be characterized by the attachment pattern to the primary object and more or less processed relational patterns to other members of the family group.

Foulkes saw communication as absolutely essential for the therapeutic process. The essence of the process is ‘working towards an ever more articulate form of communication’. He believed that, while each member of the group would tend to reverberate at every group event which was consistent with the level he was at, this level and the depth of communication intent would change if group members were aware of and able to work through their problems. Foulkes used the phrase ‘ego-training in action’ to describe an important mechanism which would contribute to the change. This concept can be understood as follows: the patient, who will constantly be stimulated to act in the group, postpones this and discloses his problems, reflects and tries to recognize his own feelings instead. The new experience which is provided by the insight gained through analysis and new responses from others in the group will lead to the modification of the member’s previous behaviour and make him open to new learning.

Common and specific group factors

Certain common factors exist in all therapeutic groups: a sense of being supported and accepted, the opportunity to speak and be listened to, to share with others, to have the same emotional experiences as others and to cope with isolation and loneliness.

In addition, Foulkes described several group-specific factors (Foulkes and Anthony, 1984, p. 149).

Socialization through the group

By observing how others in the group, including the leader, relate in interpersonal situations, opportunities arise for imitation and identification. The possibility of directly testing the new interpersonal strategies which the group provides represents a great opportunity for social learning.

The mirroring phenomenon

The group situation has been likened to a hall of mirrors, where an individual is confronted with a variety of his social, psychological and physical characteristics (body image).

The condenser phenomenon

This term has been used to describe a sudden discharge of deep and primitive material or the pooling of associated thoughts (ideas) in the group.

The chain phenomenon

From time to time, the group comes close to free association on account of its own characteristic, free-floating discussion. This often proves to be the case in a well-established group, in the form of a chain reaction, in which each member contributes an important and idiosyncratic link to the chain.

Resonance

Communication in the group bears the hallmarks of both ‘the dynamic matrix’ and ‘the foundation matrix’. Whereas ‘the foundation matrix’ is based on a common biological and cultural background, ‘the dynamic matrix’ represents the ‘artificially created’ but potentially intimate network developed by the members of the therapeutic group. All group members ‘talk’ and ‘understand’ language, but they interpret or misinterpret it in keeping with the resonance inside them, which is created through that which is referred to at any given time.

The therapist

Foulkes downgraded the therapist’s importance and called him the ‘conductor’. He also compared the therapeutic group with a symphony orchestra, where one, first and foremost, experiences mental processes which take place as a united whole. However, it follows from what I have outlined in the next chapter in the ‘Therapist responsibilities’ section that this role, nonetheless, carries a significant responsibility. The therapist makes himself available to the group, in particular as a transference object, and he should allow himself to be led by the group. The leader is on the other side, an instrument of the group, or should be one. In return, he must follow the group’s leadership, and he should not, for example, use the group as an audience. Ideally, he should leave it to the group to capture the meaning and to place the action in the appropriate dynamic setting. When this does not happen, however, he has the ultimate responsibility for doing this.

Chapter 2 Methodology

DOI: 10.4324/9780203796887-3

General information about the group

Each group can be analyzed in terms of structure, process and content (de Maré, 1972).

Structure

The structure consists of the room, the arrangement of chairs, the duration of sessions and the therapy, the timing of sessions, the frequency of sessions, the financial arrangement, as well as any rules for behaviour inside and outside the group. The main rationale for having a structure is to create a frame in which the individual members’ and the group’s idiosyncratic behaviour become visible. The therapist is responsible for maintaining the structure and for understanding and intervening when boundary incidents take place. The structure is also affected by the group composition and by whether the group is open or closed.

Process

The process consists of communication and other interactions which develop in the course of a session, and from session to session — over time. The ‘ideal goal’ is to develop a working group which is characterized by being task-oriented, where all members are involved and where communication is characterized by free group association. This means the members make associations with what is going on at any time, and the group develops an increasingly investigative, personal and open tone over time. The therapist should facilitate this process with his interventions.

Content

The content of a group consists of working towards a deeper understanding of statements and interactions. In this context, ‘deeper’ means the preconscious or unconscious meaning of what is happening, for the individual member, sub-groups of members and/or the group-as-a-whole. The therapist’s task is to assist in clarifying the latent content of statements and interactions. The clarification is mainly given with respect to the here-and-now, but it may also focus on group members‘ history and the social unconscious.

Therapist responsibilities

1. To involve the group members and the group in the therapeutic process.
2. To maintain the group’s structure and to try to understand and intervene in boundary incidents.
3. To facilitate the group process.
4. To interpret and translate.

A key overarching responsibility which must be kept in mind during the performance of the specific tasks mentioned above is that the therapist should seek to develop an analytic culture that the other group members can become part of. His model function is crucial, because he welcomes all communication as valuable; he is non-directive, he clarifies and interprets or translates preconscious/unconscious material, in order to promote the opportunity for members to learn something new about themselves and others. It is also important that he understands his position as a transference figure and that he is willing to comment on the relationships which group members develop to him and to each other, to make them the object of analysis. This analytic approach enables him to respond appropriately to the transference reactions and everything else going on in the same spirit. In the long run, this will promote understanding and tolerance amongst the other group members, which in return will contribute to their further development.

The contract between patient and therapist

Each patient agrees to work in a group with a therapist and six to eight other patients for a predetermined period of time, which in this case is about two years, that is altogether 80 weekly sessions, lasting 90 minutes, which take place at a fixed time. All patients are informed about the group’s basic rules regarding commitment to participation and responsibilities inside and outside the group. Each session is wrapped up by the therapist at a scheduled time. The patient pays a charge for therapy by arrangement with the therapist. Patients are asked to talk freely and openly about any subject which they raise during the session. On his part, the therapist will try to help patients understand and resolve the problems which have brought them into therapy.

Therapist interventions

In order to achieve the objective of the therapy, the patients should be encouraged to be open verbally and through interaction with other group members, including the therapist. That creates the conditions whereby common and group-specific factors can become effective, in addition to more or less patient-specific interventions from other group members, including the therapist.

An overview of the therapist’s interventions is offered by Roberts (2000).

Maintenance of structure

This includes all activity whose aim is to clarify or define a limit, which may include the place, time, membership, task or rules. This can apply to the whole group or an individual member, including the therapist.

Open facilitation (process)

This characterizes an intervention which aims to move the group forward. It is not necessarily based on any particular interpretation or hypothesis put forward by the therapist, nor does it relate to any unconscious level of understanding.

Guided facilitation (process)

This includes all promoting comments which are not ‘open’, but which show that the therapist has a hypothesis as a background for his questions, enquiries and observations.

Interpretation (contents and form)

This consists of a verbal intervention from the therapist which puts words to feelings or meaning that is latent in the group-as-a-whole or in what individual members say or do. In group analysis, where the therapy process consists of an ever-increasing expansion and deepening of communication, the term ‘translation’ is often used instead of ‘interpretation’. ‘Translation’ of behavioural and interactional events is a more tentative approach, working from ‘the surface’, and keeping open other possibilities for the understanding of phenomena, whilst avoiding asserting oneself as an unilateral authoritative specialist on the unconscious mental life of others, which could adversely interfere with the development of a group-analytic culture. However, situations may arise where it is important to take responsibility and to be clear when one feels sure about a particular situation. Autonomy and natural self-assertion is also part of the group-analytic culture.

No immediate response

This intervention reflects the fact that much of the therapist’s behaviour consists of silent observation of the group. Depending on the situation in the group, the therapist will sometimes refrain from saying or doing anything whilst r...

Table of contents

• Cover Page
• Half-Title Page
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Acknowledgements
• Abbreviations
• Introduction
• Part I Long-term group analytic psychotherapy
• Part II Short-term group analytic psychotherapy
• Part III Clinical research
• Appendix
• Bibliography
• Index