Group Analytic Therapy a Meeting of Minds Harold Behr
Contents
Chapter 1 The social and cultural basis of group analysis 2
Chapter 2 A century of group therapy 4
Chapter 3 Planning an analytic group 5
Chapter 4 Dynamic administration 7
Chapter 5 The assessment interview 7
Chapter 6 The symptom in its group context 7
Chapter 7 The start of a new group 9
Chapter 8 A newcomer to the group 10
Chapter 9 The group in action 10
Chapter 10 Life events in the group 12
Chapter 11 Bringing therapy to an end 12
Chapter 12 Therapeutic pitfalls 13
Chapter 13 Challenging scenarios 14
Chapter 14 The group analyst in trouble 16
Chapter 15 The Large group 16
Chapter 16 All in the same boat: the value of homogenous groups 17
Chapter 17 Groups for children and adolescents 17
Chapter 18 Family therapy: a group analytic perspective 19
Chapter 19 The application of group analysis to non clinical settings 20
Chapter 20 The supervision of group therapy 21
Chapter 21 The group analyst as a professional 22
Chapter 22 The changing landscape of group analysis 22
Chapter 1
The social and cultural basis of group analysis
Sciences of the mind were isolated, philosophy, medicine and
natural sciences in 19th century. Freud challenges that we are
supremely rational but argues we are motivated, by irrationality, unknown, and
erotic forces.
Darwin reduced human life to lower animals, Freud to
infantile sexuality./
First world war saw ending of great empires, e.g. ottoman,
and the rise of monolith ideologies, communism and fascism.
Frankfurt school
Integrate different disciplines, anti-fascism, Adorno, Fromm,
Foulkes influenced by Frankfurt school, holism and
gestalt. Goldstein and Wertheimer.
Goldstein=holistic view of neural functioning, as his work
with injured soldiers showed there wasn’t a one-to-one relationship between
body and function, so damage to CNS doesn’t always lead to stopping of function,
as a bypass would be created .
Foulkes sees the group like this, that it is a network of
communications and if there is obstacle, it can be worked around.
Gestalt= a whole organism that is greater than the sum of
its parts.
The group is the gestalt, and the members are the parts of
that.
Foulkes: psychoanalysis, application to group, change of
theory from mind as goal driven from instinctive drives to a dynamic system of
object relations a system in perpetual flux.
Wind of change
Bion Container\contained
Fairburn libido as object seeking
Winnicott mother child unit
Bowlby attachment theory
Kohut psychology of self
Lacan subject and self
Psychoanalysis as dyadic vs group, different concepts are
needed.
The role of culture in group analysis
Elias=sociologist, people are interdependent with people
that they have never met.
Group analyst therapist is the conductor
Communication as main agent of change, relegation of
individual in favour of the inter relationship between individuals
Group: people joined by united attribute\outlook\purpose.
Groups meeting reinforced identity. Groups which rarely meet, have the judgements
of others contributing to its identity]
Foulkes: artificial dichotomies,
individual\society, inside\outside, inner is created by the outer and contrary
wise.
Aim of therapy, to increase communication between these
dichotomies.
A therapeutic group represents society.
Individuals bring their own disturbances, within the
microcosm of society
Isolation is the basis of disturbance and communication its
antidote
Foulkes: Neurosis is where we become at odds with our group
and isolated from ourselves and others.
Neurosis as highly individualistic (but we live in an individualistic
society, neo liberal)
Symptoms as disturbance not being able to communicate in
words, so represented in symptoms
Individual as the base biological unit, group as the base
psychological unit, and society as the container for them both.
Chapter 2 A century of group therapy
Pratt: 1910: inspirational classes for TB patients,
interplay mind\body\spirt: people do well in groups, waiting for treatment.
Same problems, different skills.
Lazell: 1920: Psycho ed groups
Cody Marsh: 1930 WW1 from internal to external, broken by
the crowd and healed by the crowd
Louise Wender: group psychoanalysis: bpd. Therapist as
parent, group as siblings.
Paul Schilder: base of body image therapy
Burrow: social basis of consciousness
Pauline revelation, holy spirit reveals to St Paul about
Jesus’ gospel. Mutual analysis. Network of relations into group, friends,
colleagues, family etc.
Freuds aversion to groups.
Interested in psychology of groups, but not a medium for
psychoanalysis.
Encorsed le Bon, who saw groups as dangerous entities
capable of bringing out mans childish and bestial instincts.
Kurt Lewin: Groups more effective run on democratic lines,
as opposed to laissez faire or authoritarian.
Moreno: dramatherapy: social therapy, gestalt, family
therapy and the encounter movement.
Bion and Foulkes: small group analysis. Bion a Kleinian analysis,
supremely detached view of the world. View the group as a whole, rather than
individuals in it. Bion: unconscious of
group=basic assumptions=> must be addressed by leader if group is to
function.
Leader as mother to nurture, Warrior to fight or flight,
Pairing to rescue group from hopeless
situation.
Northfields experiments: post WW2, soldier\patients
dependent on authority=passive with MH, so increase responsibility in setting
up groups for clients,
US vs Europe. ~US: analyst as central figure
Ezriel: object relations theory: individuals part objects
jostling for position until they reached a stable position one which provokes
the least anxiety.
Argelander: group is gestalt, with ego, superego and id.
Whitaker, group goes through a series of conflict of ucs
wishes which produces a certain amount of fear.
Schindler, groups adversary, roles within the group Alpha to
Omega
Foulkes It’s not a dyadic model of group therapy, rather
it’s a communication network
Chapter 3 Planning an analytic group
Plan a group within the remit of the organisation which it
is within. This is to say take into
account the system in which the group operates.
7 or 8 adults in the group,
Types of groups
Open\closed
Closed group, all join\leave at the same time
Open people come and go when they want
Slow Open
duration of therapy is years rather than weeks\months.
Addresses problems that accumulate over time.
Conductor needs to manage entries and exits. He reached his
aim what about me? New baby envy? Leaving as loss
Open groups
People come for a couple of sessions. Each session is an
event in its own right
Closed groups
Time limited, shared beginning and ending. Strong sense of
group identification although fragility if people leave. Useful for more
homogenous participants.
Short term groups
Incident based, focus on commonality of members not
difference, e.g. traumatic event
Block therapy
Few sessions gap, few sessions. More sessions more
attachment
Co Therapy
2 therapists, dispersal of the transference
The room
Situated in the building, in the company, in the area etc.
Theres an onion of meaning and function.
Group composition
As wider range of presentation and demographic factors is
ideal. Ideal number 8, minimum 3 in
attendance.
Chapter 4 Dynamic administration
Paying for group as providing an adult interaction, where
non fee-paying groups can stay angry and demanding for longer. The conductor
seen as omnipotent, all giving, and all withholding
Dynamic administration: liaising with others outside the
group, professionals, relatives, managing, communications between group members
outside the group and the conductor.
Chapter 5 The assessment interview
The inscrutable therapist, who doesn’t make ripples on the
pool of transference!
The client who structures the interview !
I would see the tears as a defence against what lies below
the tears
Assessing both the problems and the non-problems
Assessing symptoms and social history
Timing of entry to group, is the group ready, is it in a
depressive state?
Contraindicators for group: can’t identify with others, i.e.
too narcissistic
Chapter 6 The symptom in its group context
People used to talk about their problems with a tale of
suffering, and use those words, but now they talk in an impersonal medical way.
Establishing symptom and non symptom, how a client tells
their tale.
The function of the symptom is to draw attention to a
problem in the organism as a whole. The
organism can be a relationship or a group, or a network
Anxiety as sharpening the focus on something ? But it leads
to muddled and ineffective thinking. Anxiety comes from the Greek word
strangulation. Anxiety cuts off, chokes
other thoughts and just leaves this thought, so it stops self reflection
Confident façade belaying repressed anxiety?
When lack of anxiety accompanies psychopathic behaviour then
there most likely is large repressed anxiety\trauma\abuse.
Phobias, panic attacks and obsessional thoughts
An irruption of the unconscious, symbolic, distance from
inter personal relationships and a power, over others ?
Intrusive thoughts, as intrusions by someone. Anger at
symptoms, anger to someone. Symptoms as acting out of relationships?
Depression
Carrying a heavy burden, which leads to a vulnerable
helplessness. Thinking of depressed, a self image which is both grandiose, and
self blaming
In group, reframe as an interpersonal difficulty, affect it
has on others. `
Rage as underlying depression
Exaggerated sense of guilt and omnipotent responsibility as
unrealistic and self defeating.
Depression, as passive, evokes frustration and annoyance,
which can lead to a withdrawal of attention on the depressed person
Some group members to counteract their fear of destructive
omnipotence can move into compulsive caring, they can fear the depressive
outlook affecting the whole group.
The depressed person can sink into narcissistic self
absorption, which can frustrate the group, as the depressed person, withdraws
from the group and is indifferent.
Paranoia
As in the minds capacity to expel aspects of self which
cannot be borne at the time, and have to be located else where: projection and
projective identification.
Trauma
From the Greek word to pierce
Borderline
Sensitive to criticism, or rejection, proness to rage,
repeated bids for controller attention
Defences are denial, projective identification and splitting
(black vs white)
Psychosomatic
Resisting putting meaning to their somatic state.
Chapter 7 The start of a new group
Joining a group, first day at school\work etc. A beginning
moment.
People playing the socially acceptable version of their
story at least once, until silence descends and something different happens.
One member: big disclosure\problem, leads others to not be
able to talk about their smaller problems?
Putting the individual each individual into the centre
without excluding others, finding the common ground, not identical problems but
linking ones
Reasons people leave the group, superiority, group
unsympathetic, , the enormity of others problems
Conductor as role model as to how to navigate this strange
social situation.
Conductor as analysed for their characteristics, ethnicity,
sexuality, class etc, so that they can be the object of different transference.
At the start the conductor may be seen as omniscient and
omnipotent, then gradually the group takes over the analytic function.
Chapter 8 A newcomer to the group
Member leaving group, another entering. Warm\difficult
leaving, attachment to conductor if had one: one. A group performing well, on
the edge of dissolution, all the factors to take into account.
Enough time to grieve, separation, loss, from departure, a
never ending process.
Established group process of affiliative, analytic, and
challenging. Different from the standard social repertoire.
Chapter 9 The group in action
The group carries therapeutic authority the conductor
therapeutic profession. The group is the active agency for producing that most
precious of things the individual.
The conductor should intervene when someone\the group is
near to an insight but isn’t quite there. Like a midwife, maieutic!! Likewise
if the group isn’t therapeutic they should being them back.
Interpretation as a process of translation? Making the
unconscious conscious.
Conductor needs to speak to the group at the same level that
it is communicating at.
Moving from a symptom to an underlying conflict.
Language, from monologue through dialogue to discourse
Unconscious to unconscious communication between group
members.
Trust the group, but don’t abandon group members, don’t
ignore scape goated members.
Balancing over emotional and under emotional over reflective
and under.
Balancing challenge and calm.
Between reflection and turbulence
Current events in the group and groups past.
Whats happening currently in peoples lives, historically in
peoples lives.
When one dimension takes a lot of focus, it could be because
there are some aspects that re being denied of haven’t been worked through?
Focus on one group member avoiding looking at self?
Manic flight of light heartedness, depressive state to get
omnipotent conductor to fix me.
Figure and ground in group, the subgroups, men, late comers
etc.
High focus on one person, groups fascination, with an
omnipotent wish to heal
Culture of humour, speech, emotional expression, intonation,
both from different cultures and the same culture!
Attend to a denial or an exaggeration of cultural
differences. We have both commonality and difference.
An optimally constituted group mirrors the society from
which its members are recruited.
Containment and confrontation
When confrontation arises, emotions increase and reflection
decreases.
Confrontation which can bring out important issues, and
malign confrontation which escalates, is personal, violent, vindicative? And
will lead to withdrawal from the group.
Dreams happen in non social context, so how to bring into
the group?
Group dream as an individual dream that there is a link to
the group
Aristotle: metaphor is a mixture of the lucid and the
strange. We use them when we are trying to express something that lies between
the part and the whole.
Foulkes uses the metaphor of group as matrix or network
Similarity of metaphor with humour where juxtaposition of
images\ideas which are at once similar and different.
Laughter as the release of tension or the expression of the
forbidden
Technique as internalised theory + your personality
Chapter 10 Life events in the group
Relationship and family breakdown can all too often become a
voyeuristic spectacle
Event happens=>emotional response, what are the previous
similar events that contribute to the emotional response.
Figure\ground, sometimes the individual is figural,
sometimes the group
Chapter 11 Bringing therapy to an end
Aim of group is to return the person to the world ready
undeterred to face the rough and tumble of everyday life.
Ending in a biological sense, is the demarcated process of
the change from one state to another.
Janus faced we look bac to the past and forward to the
future, mourning and celebration.
Ending sessions offer much material but no time to work
through them.
A person might fear
ending, so manufacture a row, being the pretext to leaving.
Some people who bring energy and colour to a group, might
have the group persuade them to stay.
3 months to work through an ending
Leaving as an avoidance
Every exit\entry from a group creates loss and disturbance
Defences against ending
Quietly, Row (defends against abandonment), Joking\lightness
Stress of leaving can often provoke the initial presenting symptom
Separations as impermanent, endings as permanent. Fantasy of
reunion offers protection against loss.
Not identifying with the group helps to protect against
loss.
Chapter 12 Therapeutic pitfalls
Conductor blank screen: good for transference, can be
withholding if not previously experienced as reliable, caring and holding
Conductor overly zealous, can provoke defence and
withdrawal. Guided there by a group who
want an omniscient father figure.
The group is the therapeutic agent.
Chit chat as precursor to therapeutic engagement or an
avoidance.
Silence post interpretation: reflection, bemused due to
interrupted process,
Interpretation as definitive and now we should move on.
Who is the client the individual or the group, where does
the attention sit.
All interventions at a group level, individuals will feel
unheld.
Here and now vs there and then .
Excessive focus on either may be defensive. Here and now
more interest to the conductor, there and then to the clients.
Chapter 13 Challenging scenarios
Dropping out: was there an unconscious challenge, which may
be wanted to be faced (how?) I leave as anger at having been left. I leave as
avoiding conflict
Signals of leaving include leaving connection in
communication.
Group rejecting the client to force a leaving.
Someone leaves failure in the therapist, guilt in the group
Slippages\absence etc: no conductor engagement=group fears disintegration,
excessive conductors fear of losing the group
A dropping out a covert way to leave which needs to happen
Scapegoat, as the carrier of the all the badness in the
group and then attempting to get rid of that carrier, is part of the human
condition. Likely to be the one that threatens the fantasised integrity of the
group. Empathy and identification reduce scapegoating.
Scapegoating more like where there has been trauma that has
threatened the integrity of the group
The threat is to social cohesion. The scapegoat is the one
perceived as a threat to that, then attributed to them are all the threats to
social cohesion both from the social unconscious and personal unconscious.
Whilst their behaviour will play a part its is
more this projection that does the work in big groups, whereas small
groups its more the behaviour of the individual.
Collusion and its relation to scapegoating. If difference
isn’t tolerated, then theres a fragile nexus, its just this that connects us,
so that can threaten it.
Empath with the scapegoat, noticing the process in the
scapegoating, underlying, blame\resentment (?).
The Monopoliser, prevents group activity, motivated by erm,
high levels of ax, dimly aware of, then growing resentment of the group or not
feeling heard\understood
Insight follows change rather than causing it
Monopolizing and attention seeking. Former taking control,
latter getting attention on self?
Aggressive exchanges as open communication or sadistic,
destructive.
Perpetrators of verbal abuse excuse insults in the name of
honesty and are oblivious to the impact
of aggression on others.
Disguised aggression, mockery, sarcasm and ridicule.
Group members playing therapist, helpful or avoidant of
personal involvement.
Isolation as the antithesis of communication, you can help
someone who is isolated to bring them into conflict with their own
isolation. Isolated through early
trauma, or conflict ridden latter states.
Stucknes, nothing much happens, avoiding fantasised powerful
feelings.
Mirroring seeing oneself as others see you.
Malignant mirroring, 2 people each see the hated attribute
in the other.
Chapter 14 The group analyst in trouble
Fantasy of therapist omnipotence.
Group has to keep the therapist healthy, a bad dad is better
than no dad. This can be through ignoring a problem.
Stalking the person being stalked is seen as essential for
the survival and well being of the stalker
Stalker as possessive and controlling.
From grandiose protestations of love to hostile persecution.
Breuer handed over
AnnoO to Freud as he has fallen in love with her
The group when it represents the family mobilises the incest
taboo.
Threat of client\therapist, client\client relationship: stalking,
love
Threat of client\therapist accusations of harm or failure to
help
Accusations of the harmful effects of therapy are often
stimulated by family members who feel left out.
Chapter 15 The Large group
Larger groups can activate more primitive collective
processes.
Large as 50-100s
Dialogue to bring society to a more constructive state of
existence
Large group as therapy, or political?
Large group as a place where aggressive feelings can be
expressed as the group can protect the individual from things getting out of
hand
Fear of individual getting lost in the group or being part
of a powerful group, group as mass and individual responsibility for its views.
Large groups are a ready made audience
Lack of structure and heightened anxiety leads the LG to
primitive defences polarised subgroups, men against women.
Median group as 15-40
Chapter 16 All in the same boat: the value of
homogenous groups
Whilst a homogenous group, brings a normalising effect and
possibly different perspectives on the same, and different resources, and a
movement from isolation, to belonging, however it can also get in the way of
individuation. So increasing their sense of heterogeneity can at some point be
useful.
Presenting issue as membership of the club?
Usefulness of homogenous groups for the standard life stage
transition. Retirement, bereavement, parenthood, teenage ? But these groups
don’t generally exist, and its only on illness \trauma that groups are created.
Chapter 17 Groups for children and adolescents
Fear of being humiliated by peers is strong. Conductor needs
to make sure no one is marginalised or scapegoated.
CYP groups need to be supported by parents, but parents fear
that MH is contagious\the family secrets get out.
If their MH difficulty has overtaken their sense of self
then start in homogenous group.
Group size 5-6 larger, harder to contain.
Groups give other ways to deal with problems, other
perspectives, that helpers are not just adults
The group can be a mirror, but the child can attack people
in whom they see their unwanted aspects.
The group can mirror differently to the family.
In a therapy group the innate urge to support other people
is there, which increases self esteem.
Being too silent\interpretive\group process focussed wont
work with children.
To stop scapegoating then the therapist has to align
themselves with the scapegoat.
The scapegoater has to be confronted and the group too with
their projections. Notice what the
others and the scapegoat have in common.
Then the scape goat needs to be involved and see what they
contributed.
Teasing is an ambiguous communication which treads a fine
line between affection and aggression.
If someone is teasing, ask them about their experience of
being teased.
Adolescent as extremes, good and bad, anti prevailing
culture. Same happens in therapy groups
Adolescent preoccupation with sexuality and sexual identity
often emerges aggressively and provocatively by way of denying the underlying
insecurity and anxiety.
Two therapists, can model relationship and disagreement.
Chapter 18 Family therapy: a group analytic
perspective
Difference between the group of strangers and a family
group, that hold myth, traditions, a family culture
Skynner family therapy based on systemic thinking. Systems
interventions as directive
Families unlike stranger groups cant be left to be their own
therapist!
Therapist: joins stranger group, but outsider joins into
family group.
Therapist as leader and setter of rules in family therapy.
If the therapist becomes scapegoat, family therapy will
fail.
Therapist can also slip into idealisation which is a
precarious position prior to scapegoating.;
Idealisation of therapist=>family helpless and compliant
Skynner=therapist takes over the scapegoat roles and can question
the family projections.
How to talk in a family with different ages? Higher use of
metaphor and symbolic language.
In stranger group, other members mirror hidden aspects of
themselves, and you can learn like that.
The dysfunctional family can be a grotesque distorting mirror. Therapist
as mirror to the family.
Therapist needs to resonate with the family to be accepted,
so speak within its patterns of communication, which then can slide into
colluding with the mirror
Enabling family members to tell their stories is therapeutic
and can be enabled by the an outsiders presence. Their silence can build into resentment, or
symptom formation. Importance of bringing in the silent members of the family,
through, couching words could it be that you are feeling\thinking x.
Low levels of difficulty telling the story is enough, with families
trying to integrate new family members more is needed.
Conflict in stranger group can be addressed through analysis
of transferential relationships which lie behind them (?)
In families conflict is ineffectually managed by storming
out, or displays of verbal\physical aggression.
Families sensitised to loss develop an over close pattern of
relating which seems over protective and
excluding of others. This can occur with
a mother and a child.
Cohesiveness, leads to oppressive closeness, avoidance of
expressions of anger, individuality is stifled, the inner self is intruded on.
The flow between these family members and the outside world becomes impermeable
Conflict avoidance produces phobic anxiety states and psychosomatic
problems.
Family secrets creates a symptomatic areas where fantasies
can be projected on.
Individuals in a stranger group harbour secrets until the
levels of tension accompanying them have dropped to a point where they feel
they can disclose their secrets. Secrets
are accompanied by shame and guilt and a fear of punishment.
Multiple family group therapy, needs a strong leader, and to
ensure each of the children has a voice.
Chapter 19 The application of group analysis to non
clinical settings
Who is the patient, systemic approaches would say the
family\group. In the very individualistic times, all other modalities would
argue the individual.
Rapid change, and innovation, increases stress, leads to
absenteeism, sick leave, rapid turnover of staff…
Organisational group work.
Triggers to organisational stress, reorganization, new legislation,
redundancies, financial stress, new management\owners.
Group objectives? Manifest\latent, purpose of having the
group: taking problem off management hands, getting rid of difficult people.
This isn’t a therapy group, but a business group with
objectives. The aim is to engender communication and creative dialogue
Therapist should be briefed to the current structure,
history, and issues of the organization.
Difference between corporate groups and organizations that
work in the helping professions, who are more therapeutically aware.
Resistance of SLT in group therapy as outsider looks at
interior of business
Types of leadership autocratic, democratic and laissez
faire.
Indicator of leadership style is the system of channels
through which information flows between senior and junior starr
Chapter 20 The supervision of group therapy
Nothing to be seen here.
The minutiae of training group, supervision group, therapy
group.
Chapter 21 The group analyst as a professional
Tricky area as a therapist, dealing with sensitive areas,
with people who have had unpleasant and powerful events happen in their lives.
Nothing much to be seen here either, the business of therapy
Chapter 22 The changing landscape of group analysis
The social unconscious
The systems of complexity
The creative element of group creating new symbols and
gestures
Tension between Foulkes Freudian individual and the social
of Elias
Linear causality and circular , breaking down the berlin
walls of the internal and external psychic worlds
Anti group forces, if the containment of the group breaks
down, as movement between groups? Scapegoating, and malignant mirroring would
be part of this force
Psyche= an outcome of internal factors or external,
social\cultural etc
Equality of opportunity , inequality of skill, levels of development,
person worth
Conflict resolutions
Self and other as fluid, fixity and absoluteness dehumanise.
Merging into one big unity denies diversity
Group identity vs individual identity
Apprey 4 stages
Define sub Group and demonise the other
Differentiate within sub Group and identify the multiplicity
in the other
Metapho9r and dialogue can cross the border
Creating of combined projects