Group Therapy Explained: Berwick
Contents
Foreword 1
Prologue 1
Chapter 1 The development of group analysis 2
Chapter 2 Core concepts What goes on in groups part 1 4
Chapter 3 Core concepts What goes on in group part 2 7
Chapter 4 What does the conductor do Part 1 10
Chapter 5 What does the conductor do Part 2 12
Chapter 6 Development in Group analysis The mother approach 15
Chapter 7 Development in group analysis 18
Chapter 8 Working within groups 19
Chapter 9 Beginnings 20
Chapter 10 A group in action 21
Chapter 11 A Group in action (making room) 22
Chapter 12 Endings 23
Foreword
Group analytic therapy comes from diverse sources; its openness
means that it is a more experiential
rich than theoretically definable approach.
Individual\group focus=anti group. Foulkes pro group anti
individual=the individual is an abstraction.
Prologue
Context=with and weave\tissue
A thread and its properties that are governed by where it is,
within the larger whole
Context of nationalism which given the advances of
inter-nationalism, leaves the have nots wanting to erect barriers to return to
their solid identity and group, the group in the past that had so much, its
golden age
Foulkes the group is a microcosm of the society. microcosm of
the society.
Safety of isolation. Fear and excitement of otherness,
individuality vs belonging
Group analysts view individual pathology as indicative of
wider social ills.
Group as both dangerous and life enhancing, a representative of inter connectedness.
With division, e.g. Brexit, a call for dialogue and to
really talk about the fear, the loss of identity etc.
Chapter 1 The development of group analysis
Group analysis formed from gestalt, psychoanalysis, and
sociology. Emerged out of the desperation of post WW2 psychology needs.
Foulkes
Psychoanalysis 3 main tools
Free association, analysing the transference, and
understanding the unconscious..
Believes individuals are formed from groups, family\society,
as opposed to internal drives.
Internal world of ego\superego\id, an internalisation of
their outer world.
Freud saw man in group a return to an earlier stage, a
barbarism. Sibling rivalry only transformed to hate other groups, e.g. English
hate French etc.
Social justice, merely how we manage envy and jealousy
Groups have never thirsted for truth but rather illusion
(religious\political groups?)
Burrow
Hyper individualised individuals have cut their ties from
society
Influenced by Goldstein, holistic approach.
Concrete\abstract operations.
Systemic: Disturbance as representative of the group, the
family.
Communication, likewise, to be understood as expression of
the group, and from the group
Individuals when healthy their whole system self
regulates. And this system interacts
with broader systems.
Gave birth to the Frankfurt school, Adorno, inter
disciplinary, critical theory, a Marxian
critique of bourgeoise individualism.
Elias: sociologist + Goldstein Gestalt psychologist
Closed man vs open man. Super ego held within society, that
mould individual’s superego. in society, that mould individual’s superego.
Foulkes, group\individual merge, they are not essentially
distinct. And there are many groups!
Burrow:
Individual as part of the environment and cannot be
separated from it.
Individual as formed by the groups it’s been in, the family,
in turn shaped by the society, culture and historical period.
Psychopathology as an outcome of the group, by the crowd
they have been broken by the crowd they shall be healed.
Chapter 2 Core concepts What goes on in groups part
1
Slow open, members join and leave in their own time.
Too small a group <8 less likely to see the group
dynamics unfold(?).
Preference mixed group, but no one isolated, i.e. all men
and one woman, socially\psychologically.
Sameness provides safety, difference provides growth
Same brings cohesion, we ness, and reduces shame and
abnormality. Although sameness is an illusion.
From the cohesion of mother child and sameness to the
coherence, the interaction of different parts.
Tuckman: group development
1.
Engagement
a.
Ax of new situation
2.
Authority
a.
Who is in charge
3.
Intimacy
4.
Change
a.
With trust grows greater disclosure, and risk
5.
Termination
a.
What has been generalised what not
Goes in a spiral, not linear.
3 dimensions of therapy, relational, reparative, and
reflective.
Young group in relational: attraction? attachment and
friction.
These moments can provide reflection, which in turn can lead
to a reconfiguration of relations.
Core psychoanalytic concepts
Free association, transference and the unconscious are the
core of psychoanalytic theory and occur in group analytic psychotherapy.
UCS as outside the conscious, its desires, fears, memories,
beliefs, are kept UCS by defences, e.g. splitting and repression which are UCS
deployed (?)
The more defence in the Unconscious, the less psychic energy
available, likewise less learning from experience when something is frozen like
this.
Psychoanalytic aim: make the unconscious conscious
Freud Unconscious=biological and embodied
Foulkes Unconscious= personal id, social id, and
interpersonal id. Social and interpersonal unconscious are synonymous
Foulkes: mind as socially constructed.
Foulkes, light on social unconscious theory
Hopper: social unconscious is internalised social structures
that people are unaware of.
We not only have these structures but emerge from them,
collude, challenge etc.
Almost like we are children of our family, and we might
extend, mirror, reject, same with social structures.
Language effects what we see and how we see it. As much as
we enter into language , language enters into us.
We can resist the ideas coming up from the social
unconscious as
1.
It challenges our sense of free will
2.
We might feel guilty because of these ideas
3.
We might have advantage in these ideas.
Radical Foulkes: Instincts are internalisations of the
group.
Unconscious as political.
Without establishing the social aspects that cause communal
distress, IAPT can scapegoat those people suffering, saying it’s your fault,
your broken psyche, rather than a broken system.
Free association=all lines of thought lead to the
unconscious. Association being how the unconscious thinks(?),except where there
is resistance, (surely its relation
which can be in many shapes, see RFT ).
Every comment by members of the group, as being the free
association of the group unconscious, this is how we can approach the social
unconscious.
Free association being therapeutic in itself? How does that
work?
Transference of whole object (dad) and part objects the
split of parts of ourselves that we project, that we can’t tolerate, e.g.
aggression\anger etc.
Group analyst as supporting group association, as being a
transferential figure.
The Transference figure of group analyst being primal
mother\father, the omni potent figure. This also needs to be counteracted
otherwise the group turns into a mass.
Small group=family
Larger group=playground
Larger group=society
Classic psychoanalysis: unconscious-conscious
Group: training in democracy
Chapter 3 Core concepts What goes on in group part
2
Part 1: Unconscious, free association and transference
The matrix: root of word is mother. What is born, trapped in
the group, group members as nodes of an open system.
Individual as piece of the jigsaw.
Jigsaw: family, community, culture, society, history.
Group as dynamic matrix, based on previous matrixes.
Foundational matrix: what we share as a species biologically
and culturally: we share a commonality; we know each other to some degree.
Group communicate between their individual members but also
their social contexts. There are
personal\interpersonal and social layers of communication.
Different temporality
Foundational matrix, geologically slow
Personal matrix: conservatively slow
Dynamic matrix (current group dynamics): most rapid to
change
Location as figure\ground exposure within an event between 2
people for instance.
Locating as assigning roles, e.g. scapegoat, idol.
As someone is sacrificed, tough for them, the group loses
too.
What is health of the group, and what therefore defines, or
who defines illness
Four levels of
communication that need to be addressed
1.
Current
a.
Jane is late
2.
Transference and transference
a.
Jane sees conductor as he father
3.
Splitting\projection
a.
Jane recoils at marks anger but jane is angry
and isn’t aware
4.
Primordial level
a.
Collective unconscious, group is gripped by an
archetype
3 forms of communication
1.
Monologue
a.
1 person to audience
2.
Dialogue
a.
2 people
3.
Discourse
a.
3 people
Monologue as self-reflection\solliloquey
Dialogue as searching for a resolution
Discourse as the work of the chorus.
Monologue
AS defensive, protecting against intrusion, a hallucinatory
gratification, obliterating feared loss, and the need for others. A socially
deviant way of making contact by colonising the world
Resonance between people, the musicality, the harmony,
counter point and rhythm. The innate musicality of humans.
The social processes of belonging, identity and change.
A person sees himself or
a repressed part of himself in the interactions of others.
A group is a small hall of mirrors.
Within the group we can individuate. WE find ourselves and
who we are not by mirroring.
Negative mirrors:
Shrinking mirror
Differences are avoided
Magnifying mirror
Enhance affect, exaggerate, amplify.
All knowing mirror
No room for complexity and doubt: dogma
Lack of a mirror: everything is seen in terms of self.
Model of three
Couple and an observer
To bear witness is to tolerate exclusion, to be engaged but
not a part of.
Bearing witness also enables us to watch without being a
part, so also enables us to reflect on ourselves in interaction with other. Also,
it enables us to think about someone else’s point of view, without losing our
own
So, in the group seeing in others behaviours your own, is a
way of both watching them, and being a third, and observing yourself.
To really listen is to let a stranger into your home, it is
frightening, who knows what havoc they might create.
Connection in group being with the exchange of words, the
content but also the reciprocal awareness of feeling, of difference.
The group constitutes the norm from which others deviate, so
the group can help neurotic behaviour. The group defines the norm, and then
moves people closer to this, socialise, not uniformise.
Culture informs family, family socialises implicitly and explicitly
children , who accept or reject, or blend this.
Then the group meets with this aromatic introjection.
In the group there is equality, people are brought out of
social isolation. Socialisation means you are part of the world of human
beings, where you can develop insight and outsight (awareness of others)
Darwin as the support of social instinct, nos, of empathy\sympathy,
Ego develops in difference, nos develops in similarity. Is this Frankl’s nous?
Chapter 4 What does the conductor do Part 1
Conductor as musical, harmonising, drawing out themes and
individual instruments.
As being the administrative authority, and the cultural
lead, i.e. the group culture, expressing its values.
Group therapy is for the group by the group.
Compliance and conformity to leader as opposed to co-operation
amongst equals.
The conductor focuses on three aspects of group life,
structure, content and process.
Dynamic administrator: constancy allows things that change
to come up for therapeutic security.
Member with BPD, greater access to unconscious forces can
give fuel to the group. In return the group can manage the affective swings,
assuming the group is mature
Criteria for group membership. Able to work in a group, not
too narcistic to not be able to identify, not too needy that can’t share
attention, not too rigid that can empathise, not too unstable that can’t bear
the emotional storms in a group.
Relational disorders
1.
Can’t contain strengths and weakness leads to a
split of patient and caretaker
2.
Can’t contain aggression leads to a splitting of
rejecter and rejected
3.
Social over identification leads to an
impoverished self
4.
Splitting between socially central and
marginalised
Exclusion
1.
acute crisis
2.
history of broken attendance in therapy
3.
major
problems of self-disclosure
4.
major problems with reality testing
5.
pathological narcissism
6.
difficulties with intimacy generalised into
personal distrust
7.
defences that rely excessively on denial and
disassociation
8.
emotional unavailability
9.
verbally subdued or withdrawn
10. hostile
and aggressive, verbally or otherwise
Suitability for a group would require prospective members to
meet at least four inclusion and no more than four exclusion criteria.
Group culture is about values, not enforced rules, promoted,
not punished.
Conductor is a model, so them being reflective, thinking
about the group as a whole, permeates through the group. Also being a secure presence.
Passive and active intervention.
Not saying anything is a passive intervention (withholding
to some, enabling to others)
Saying something as an active intervention
Aim for conductor to contribute to the attitude of free
association for the group.
Group as superior in knowledge to the individual.
Maintenance interventions, to manage anti group activity
when the group doesn’t respond
Conductor interpretation as avoiding too much to primitive
depth and to the group not the individual.
Interpretation comes in where analysis fails (i.e. making
the unconscious conscious)
Conductor understands what’s going on, the symbolic process,
helps remove obstacles to group understanding.
Countertransference, as being the therapists own
transference, or their feelings to the client’s transference.
Chapter 5 What does the conductor do Part 2
Conductor as therapist, promoting discourse
Monologue, to dialogue to discourse (group communication,
group to life communication).
Communicational fluidity ensures all, or the group are parts
of the whole.
Four levels of communication
Primordial
Projective
Transference
Current
Resistance is a way
of managing anxiety.
Narratives can be
1.
There and then
a.
Outside history
2.
There and now
a.
Outside present
3.
Here and now
a.
Inside present
4.
Here and then
a.
Inside past
Phatic speech (small talk), gives bonds, shows safety.
Monopolisers belief that they are neither heard nor
understood, can motivate this action.
Turn taking stultifies interacting, in fact it prohibits it
for rule following.
Confrontation is important: allows different views, allows
the group to contain, aggression, competition and conflict.
But if confrontation comes with disgust, paralysis, hatred,
then intervention is needed. One way to
do it is to invite other members of the group, to say what they see, what it’s
like for them to witness this.
Triadic aversion
When what we want is lost it is likely with another.
Aversion to sharing
Primal experience of having lost because another has taken
Isolates are people who do not have the ability for
transient identification, i.e. to be able to identify with the other without
losing themselves.
The driving reason for isolates, is the disowning of a
feeling. If I avoid others I won’t have
to feel this way.
People being therapists, being co-conductor, a defence
against deeper connection, a challenge to the conductor
Scapegoating, as displaces aggression towards the conductor
(?), as used in a fragile group,
A taboo subject is a denying of difference.
One cannot not communicate
Silence as
Withdrawal
Communion
Deep reflection
Communication avoidance
Isolation
Existential silence: an intense rejecting, paralysing, helpless silence that won’t
acknowledge that you exist
In the face of existential silence, conductor noticing it
and the safety that is available to the group.
Silence as a reaction to loss of identity,
annihilation\engulfment, or to attachment
Importance of conductor offering half formed ideas, so the
group can step in and work.
Group therapy as therapy for adults, who no longer seek the omnipotent
parent to give them the answers.
Group benefits the individual, but they can only benefit
from it by giving up certain aspects of themselves.
Chapter 6 Development in Group analysis The mother
approach
Group as PCG, as caring, restorative, valuing all, holding
pain
Baby and PCG, gets understood, I am hungry, and trusts that
they will be understood, and responded to. I don’t need the anxiety that this
will not be attended to
Tolerating and understanding a feeling=containment
Projective identification as managing the unmanageable by
giving it to the other, containment as the process of tolerating and
understanding it which in relationship allows the projective identification to
soften.
The group as providing containment ,the conductor containing
the group, the supervisor…
The unity in the womb of child, need and environment, this
then initially continuing with the mother, then his separation and the child
faces distance between desire and satisfaction. Their self emerges as does the
environment as different.
The between world of play, and transitional objects of inner
and omnipotent and outer and important
An infant needs to know that they will be frustrated by the mothers
will and still loved, to know they are truly loved. Maybe that the mother is an
independent being, that I can be independent too.
As mother fails the child in small doses, the child is
exposed to reality.
Each member is both holding and held.
Holding others, means you need to hold back your own needs.
Explorers needs 2 beliefs
That they will find something that will enrich them IWM
If things are too difficult there is a safe place to come
back to. Secure base
A secure base promoting a sense of worth, I am worth caring
for. Resilience as an outcome of continual rupture repair.
Resilience I can cope with a rupture, repair, and I can re connect
hope.
Ambivalent attachment=over developed PNS, over developed
concern for the affective life as opposed to exploration.,
Disorganised attachment is known as BPD
IWM, what I can expect from self and others.
Group as the secure base.
Giving meaning, thoughts, to a child’s internal state, over
time becomes internalised, oh you’re happy\angry etc.
Likewise, the states of others are introduced in this way,
mummy is tired, your friend is sad etc. Mentalizing.
Parental misunderstandings, lead to a child not being able
to mentalize well. E.g. thinking the child is angry when frightened.
Mentalisation based therapy, is to treat disorganised
attachment\BPD, to help a person be aware of their own states and that of
others.
Free association loosens the boundary between
conscious\unconscious which helps work with repressed material. Like play does, like metaphor does
MBT-G changes trust the group, to teach it to mentalise.
Tolerable disappointment, allows for self-soothing
You in me and me in your rhythm of group experience
Self-objects are needed for mirroring (learning about self-other),
idealizing (inspiring), and kinship (affiliation)
The way a look can reduce, Sartre, and shame and disgust, to
the way a look can open, and enable, like an attentive mother.
To empathise, using mirror neurons to feel their feeling,
without capture in that feeling, so you can’t offer
help\relationship\perspective.
Empath as
Being sensitive to what emotions are being felt by the
other, through their signals
Knowing what your emotion is and what theirs is
Knowing what they might need and what you might.
The group as mother, that protects, but yet ensnares and
restricts.
The transformative mother, who encourages change,
individuation.
Chapter 7 Development in group analysis
Bion
Group as dependent: it feels safe under the leadership of
the conductor
Group meets to preserve itself by fighting an enemy. Low
introspection, intellectual as otherwise difference will emerge.
Group as basic assumption pairing: two people will come up
with a solution. The rest of the group gain from hope that the two will provide
a solution and not the actual solution offered.
3 aspects of love
1.
Grace
a.
Love is received as a gift
2.
Enchantment
a.
The world is now the potential of love by given
and received
3.
Miracle
a.
Life can be born
Person as body, mind and spirit.
Other as the same.
Three different ways of engaging with the bodily, sexual
attraction. Then there is erotic
attraction where the attraction is the psyche. This is known as infatuation.
The attraction is to the particular not unique psyche
Bion: Thanatos driven group
Foulkes: eros driven
Thanatos, death drive, return to inorganic state,
aggression, self-defeating behaviours, repetitive behaviours(?)
Bion\Tavistock=sphinx like leader=enigmatic provoking
disaster
Foulkes: conductor as enabling the group to do therapy
Primal scene: the coupling\intercourse of the parents,
evoking rage and exclusion of the child. Being in group as an ability to bear this.
Extending Bios basic assumptions
Oneness=surrendering individuality for group membership
Me-ness: only interested in self and protecting boundaries
from incursion
Incohesion: massification\aggregation.
Meness is a losing of faith in group and structure, and
possibly the culture of individualism
Contact too little, or too much, withholding (I know it’s there,
but you choose not to as you’re angry), withdrawn (it’s not there, I need to
get it back) Too much, an engulfing
Aggregation: so much individuality, no sense of group, no
shared gaze
Massification: merger hunger: no individual connection due
to fear of difference.
Reflection\Response vs reactions
Anti group as being an accumulation of aggressive responses.
To work with that you need to deconstruct and see all the variety of sources.
Surviving anti group, shows aggression isn’t just
destructive, integrating anti group, shows it can be creative.
Anti-group: shows tensions as being the basis for
transformation, so therefore helpful.
Chapter 8 Working within groups
To conduct a group, you need to look after the group as it
is the agent of change.
You need both wide and sharp focus, to look after the whole
group. You need to develop a culture of enquiry.
Groups need cohesion, which is the same as the working
alliance in 1:1
Trust needs tact and timing.
Cohesion as central, the group to stick together on its
interpersonal bonds. Cohesion, empathy is the foundation for the house. ON top of this can be built a capacity to
handle difference.
We’re sticking together because we value the meaning we can
make out of this.
A group that is ineffective, is where the level of cohesion isn’t strong
enough to contain the level of difference, and distress. This can lead to
stagnation, restricted communication or incoherence.
Tension and release are the compelling heart of music, drama
and the life of a group.
You want both cohesion but not so much that its stifling,
you need to let the air in, but not so much that it blows us over.
Whether a development is tolerable is only understandable
retrospectively.
Gadamer, understanding develops after the fact.
Three dimensions of therapy, reflect, relationship and
reparative.
Chapter 9 Beginnings
We often voice the opinions or the ways of speaking we most
disapprove of.
Things we carry, burdens, riches, abilities, weaknesses=cargos.
We carry symbolic groups, class, culture, family, school,
work etc
Therapist theory: a self-object to ground them and give them
confidence, a horizon to explore the meanings of other, a restrictive dogma to
go to when defensive.
Chapter 10 A group in action
Conductor skin as strengthened and more permeable.
3 dimensions of psychotherapy:
Relational
Reflective
Reparative
In the ring of fire, the conductor needs to survive such
that people can end up with that hope that they can too and move to be able to reflect
rather than reacting.
Humans are social creatures, in even the most isolated is
the wish to belong, individualism is a sign of pathology.
The paradox is that individualism signals a lack of
individuation. To individuate, I need to connect with what is within and what
is without.
Inner world of the individual are internalisations of the
world\groups to which they belong
Unless we have enough separation from what we belong we are
mindless, compliant, colonising. So, we might belong to the world of the
rational, we are taught that, we internalise it, but unless we have some
separation from it, see that I am not it, I am more, I am different, then we
might act mindlessly on it, trying to impose rationality everywhere, using it
in extreme
The mother’s face is the mirror in which the child finds
(creates) themselves, it therefore follows that distorting, projecting,
unreflecting mirrors have an effect on how the child finds\creates themselves.
If a child’s experience of how they are held int eh mind of
the other, is too destabilising, then they can stop wanting to know the mind of
the other.
We learn\create ourselves with others and at the same time
learn about others as we learn\create ourselves
With an incoherent self, you might yearn for intimacy, as
you feel lonely, but fear it, as it could annihilate this weak structure.
Cohesion =WA is the relation between individuals and group
as a whole. To start off with its
probably between client and conductor.
Crowding for attention. People who haven’t early
containment, might have little sense of space between them, so they jostle
against each other’s raw skin.
A groups neediness both of its members, and also of the
neediness of the people in their worlds. With high levels of neediness comes the threat
of fragmentation.
Identity evolves in reciprocity, my difference, your
difference. Monologue is partial expression, its verbalising the thought, so it
gets it out of the head, but it doesn’t get to engage with other people.
Speech, empathy, reflection. Connecting to another in
dialogue and in empathy, digesting what’s been said in reflection.
Early trauma, intimacy is both desired and terrifying.
Chapter 11 A Group in action (making room)
Some people when feel attacked develop a thick skin, which
can end up leaving them impermeable and unavailable to relate to others.
Winnicott: The therapist brings the client to being able to
play.
Metaphor as a form of play.
In play you can safely explore your experience?
Play as gateway to the unconscious.
We are intimate, we are dependent, we lose, we can learn
from that loss, about intimacy and dependence (?). if we have too many
unprocessed (?) previous losses then we don’t learn, go defensive, and panic,
or ameliorate fears.
When someone leaves a group, then you get to value what you
can no longer have, almost transferring them to you? So, you learn the value of
them to you?
Loss: finding strength in what remains.
Chapter 12 Endings
An ending that destroys the pleasure of an experience, the
remembering self and the experiencing self.
The Self enjoyed, the Self didn’t and it’s the Self we learn
from. Memory is shaped by the peak intensity and the ending.
Ending signifying loss and separation, connecting to all
other losses we have experienced.
The little deaths of life, disappointments, job losses, loss of money, house etc
These losses are a challenge to our omnipotence.
Primitive loss from womb or breast, the fear of
disintegration and death.
The power of the loss of a person, is the meaning that is
within them for us. They gave me a reason to live for instance.
You need to relinquish the past without repudiating it, to
carry forward to your future, the abstracted values from the loss.
You need to escape reminders of the lost relationships
whilst paradoxically abstracting from it and reintegrating it into yourself for
your future
We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
The leaver and the left.
Group ends, some people are not ready to leave, which
offends the sense of timelessness.
Most endings are experienced on a primitive level as a
challenge to the permanence of group illusion, you will always be there for me.
Safe in internal agency, I can discuss the ambivalent with
my group to develop greater agency.
Cork child, holding a container together, mother\child, as
otherwise it could explode.
The pattern of caring then goes into adulthood, when it’s
not as necessary, then care giving as
providing self-esteem at the cost of neglect of self?
Strength in what is left behind, through concrete repetition
and learning, through introjection, through memory
Ending can provoke a repetition of original symptoms.
Loss, leaving, is a separation and individuation, separating
from the group, being an individual without the group
We are haunted by the undone, unsaid things, E Jennings
ghosts.