Why the Group?

Introduction to Group-Analytic Psychotherapy Seminar 2018-2019

Second Introduction: Why the group?

Coordinator: Lena Teliani

The previous presentation: ‘Group Analysis and the Spirit of the Times’ introduced the concept of group and described the historical journey of group-analytic psychotherapy. In this presentation we will address the “why” the group is proposed as a therapeutic tool, hence the title: “why the group?” We will first address “how” the interest of psychoanalysts in group phenomena emerged, as Group Analysis has its roots in Psychoanalysis. We will need to reiterate and elaborate on some points that you heard in the previous presentation, in an attempt to understand “how” the need for the new therapeutic framework, i.e. that of the group, arose. Finally, we will attempt to describe as fully as possible, the approach called Group Analytic Psychotherapy.

Freud in 1921 in his work Group Psychology and the analysis of the Ego wrote that “the psychology of the masses is the oldest psychology”. His observations concerned organized large groups such as the church and the military as well as mass phenomena manifested in mobs and crowds. He observed that regressive characteristics such as impulsiveness, omnipotence, and contagiousness of emotions appeared in the mob. At the same time, he recognized that high ideals such as disinterestedness and self-denial could be expressed in the mob. In his study of artificial groups, such as those of the army and the church, he pointed out that their members shared the illusion that there was a leader, a substitute for a father, who by his presence created feelings of camaraderie among them. This idealized object of love serves as a substitute for the unattainable ideal of each member’s ego. ‘When the object, which is placed in the place of the ego ideal (ego ideal: psychic system of personality resulting from the convergence of narcissism (ego idealization) and identifications with parents, their surrogates, and collective ideals. The standard with which the individual tries to conform) is shared by a number of individuals who have put in place of their ego ideal the same object, a group is formed through identification with the egos of each individual. The feelings of love shared between members are accompanied by negative feelings for those outside the group. Freud believed that the narcissistic limit of self-love causes aversion to others and wrote that “self-love knows only one obstacle, the love of others, the love of objects.” The background to Freud’s thought was an attempt to explore the way in which impulses manifest themselves in social life; he saw the power of identification (identification: a psychological process by which the subject assimilates aspects, qualities and characteristics of another and is transformed wholly or partly on the basis of the model that the other offers him) and transmuted libido in relations between members of a large group and with the leader. (Transubstantiation: a process described by Freud to analyze human activities, seemingly unrelated to sexuality, whose deeper motivations derive from the power of sexual intuition. He described artistic activity and intellectual pursuits as transubstantiation activities. A kind of transformation of sexuality. The substitution of certain goals, essentially sexual, for others that are not sexual.)

Although Freud highlighted the ways in which the unconscious can emerge in group settings, his observations were directed at very large groups (army, church) and the mob. He was not interested in the therapeutic use of groups and was hostile to the first analyst to become interested in it (Pines, 1978). This was Trigant Burrow, Jung’s analyst and president of the American Psychoanalytic Association in the early 1920s. Burrow is not well known to psychoanalysts. He wrote an article on Primary Identification (primary identification: primitive way of constituting the subject by modeling the other. It does not arise from preformed relationships where the other is perceived as an independent object), emphasizing the importance of the child’s bond with the mother and its identification with her. In this bond he saw an early interest in object relations when psychoanalysis was based mainly on the theory of impulses. His interest in groups emerged in a dramatic way. One of his patients pointed out to him that the transference phenomena he was analyzing were not only emerging because of the patients’ past and psychopathology but were also due to the social roles of patient and therapist played out in the psychoanalytic context, a dimension that had not been adequately explored in transference. Burrow’s patient insisted that the reversal of roles would also bring the analyst, however well-analysed, face to face with the impact of the effect of these roles. Burrow accepted his analyst’s challenge, which cost him his expulsion from the International Psychoanalytic Association, reversed the roles and was persuaded! Thus he began to study group relations and group phenomena

The next analyst who became interested in group psychotherapy was P. Schilder (1930). Schilder observed that his patients, through their identification with each other, could learn. He also observed that transference phenomena (transference: a process through which unconscious desires are reactivated and acquire the status of a current event) also occurred in the group and could be processed there as well.

In 1939 F. Redl (Group Emotions and Leadership) contributed to group theory by studying children in school. There he recognized Freud’s observations about the relationship between the group and its leader.

At the same time, in 1930, a number of psychoanalysts, independent of each other, began to experiment by putting their patients together in a group. In America, A. Wolff, like Schilder, was impressed by the fact that the psychopathology of individual patients emerged when they interacted with each other and with the therapist in a group and by the fact that the interpretation of transference, defenses and unconscious processes were equally effective in the group. Together with Slavson (1943) they influenced the development of group psychotherapy in America, which could be called: “Group Psychoanalysis”. In this one could imagine a group centred on the therapist, who interacts with each member individually in the presence of the others and who additionally uses as therapeutic material the phenomena in the group related to competition between members, aggression, independence-dependence issues and oedipal problematics.

This approach differed significantly from that of Foulkes with which we will deal in this presentation. Foulkeswas notsimply interested in how individuals in a group behaved, he mainly believed that members of a group manifested a remarkable understanding of each other, so he expressed the belief that each member was able to contribute both to his own treatment and to the treatment of other members. Thus, he became the pioneer of what we might call the approach: “Psychoanalysis by the Group”.

The third approach to group psychotherapy influenced by psychoanalysis is what we could call“Group Psychoanalysis”. Its main representatives are Bion and Ezriel. In it, the therapist perceives the group phenomenon as being the expression of a set of individuals who somehow combine their psychic components in order to form a group, which then reacts to the therapist more or less as if it were an individual entity. According to this view, the therapist limits his interventions and understanding of transference to the group, which he perceives as a whole. This school has been greatly influenced by Kleinian object relations theory and partly by Fairbairn’s theory. This school also emphasizes the primitive mechanisms of early mental life (i.e. primitive thought processes, anxiety, etc.).

Based on this review, we can see that the psychoanalysts’ interest in group phenomena reflects in psychoanalytic theory the shift in emphasis from the impulse model (impulse: an impulse that causes the organism to tend toward a goal. It has its source in a bodily arousal. Its purpose is to remove the state of tension) to that of object-motivated relations (object-motivated relation: the relation of the ego to an object in its totality). Moreover, the gradual attention paid to transference and countertransference (the set of unconscious reactions of the analyst to his or her analysand and specifically to his or her transference) highlighted the importance of a working context (the setting) and, above all, the importance of the interpersonal patient-therapist relationship.

About the context: when Freud appeared on the psychiatric scene at the end of the ^19th century, he found the psychiatric patient treated as a curious social fetish or a family “nuisance”. What Freud did was to take the patient out of his social context and place him in a therapeutic context. This is the analytic situation. In it, the alienated person was able to find symbolic and therapeutic expression and speech (M.Kahn in Pines, 2015). By isolating the potentially psychiatric patient in the therapeutic context, Freud succeeded in creating a situation in which patient and analyst worked together in order to understand the patient’s illness, which gradually led to the integration and assimilation of the illness by the patient’s personality.

What group analysis did, especially Foulkes, is to broaden the therapeutic context from the individual patient and his analyst to a group of patients who form a therapeutic social context in which, in addition to individual processes, it is possible to occur, observe and understand group-social processes (society: term used to describe an interaction between people…) . In this situation, the group situation, there is an emphasis on pluralism i.e. many opinions are heard. What we observe and try to understand are the processes of communication (communication: is the process of exchanging information between two or more parties for whom the information is meaningful and therefore the exchange as an act becomes meaningful) (Foulkes: “the individual is born into a network of communications…”, “all phenomena in an analytic therapeutic group are considered potential communications”) and the way in which individuals manifest their personality, connecting with each other and with the group.

According to John Rickman (1957) there are three types of psychological theories that can be related to a numbers framework. We can have an individual psychology in which the individual person is studied. To this, according to the author, we could say that Freud’s theory of impulses corresponds. Then there is binary psychology whereby we have the beginning of the study of object relations as well as the study of the relationship between two individuals with the emphasis on transference and countertransference. This includes the study of the mother-child relationship. This is followed by triadic psychology, which leads to the study of oedipal relationships and the family condition. According to Pines (2015), although in psychoanalysis we start from individual psychology, it would be more natural to start from triadic conditions as no child is born and survives outside of a social unit. The main exponent of this position in psychoanalysis was Erik Erikson (1950), who matched the stages of psycho-sexual development with those of psycho-social development.

The shift of emphasis in psychoanalytic thought from the theory of impulses to the theory of object relations appeared in the work of Fairbairn, Winnicott, Balint and Klein.

For Winnicott, the environment is of primary importance. According to his theory, in addition to the mother object and the relationship the child will develop with her, there is also the mother environment (the context in the analysis) with which the child can develop the ability to be alone while she is present. This ability is what Winnicott called “basic ego relatedness”. In analysis, it corresponds to the ability of the analysand to be able to remain silent in the presence of the analysand while thinking and/or not thinking. Winnicott showed us the importance of the function of play and creativity as a space, the transitional space, which enables the child to move from symbiosis to dependence and then to the world of other human relations.

Winnicott’s concept of context sheds further light on the importance of the psychoanalytic framework and even more so on what it means to be in a group situation. As far as the group situation is concerned, it is a space initially created by the therapist, who manages it as a special place where individuals come together available for each other. These individuals connect and together they explore themselves. This situation, the group situation, can function as a transitional space and the group as a transitional object (transitional object: a material object of special value to the infant or young child used primarily for sleep. It allows the child to make the transition from the first oral relationship with the mother to actual object love). How is this done?

As interactions develop and relationships are built in a therapeutic group, what Erickson calls basic trust begins to be established. According to Erikson’s theory, the basic trust stage is the earliest social relationship, which is achieved during the oral phase. In the group, it is preceded by a period during which members fear intimacy, disclosure and exploration of themselves. To overcome these fears and establish basic trust takes time. The therapist contributes to this process with his or her attitude and technique and gradually encourages communication between group members so that a conversation that Foulkes describes as “free-flowing” develops, with the ultimate goal of understanding it at a deeper conscious level and making sense of it (Pines, 2015). (Free-flowing: a method which consists of expressing all, without any discrimination, the thoughts that pass through the mind either on the occasion of a specific element (word, number, image) or spontaneously. Free-flowing conversation: “a kind of group association”, the equivalent of free association in the group; in practice it is a free, from the usual social censorship, discussion about the thoughts and feelings of the members of a group).

The attribution of meaning to the communications observed in a group is the feature that differentiates a social from a therapeutic-analytic group. To achieve this, the therapist subjects all communications to the process of interpretation.

In the group-analytic group in particular, the analyst encourages the interaction of the participants who, by combining both their emotional response and their cognitive perception, “take it upon themselves” to assign a meaning to what is happening among themselves in the group. They achieve this by relying on their shared experience, i.e. what they feel is happening between them, including the analyst. According to Foulkes, the ‘best’ interpretations (i.e. those that the participants in the group are able to ‘hear’) are those that come from the members of the group and are based precisely on their shared experience in the group.

The common experience that emerges in a group-analytic group is the basis on which a “common mind“, a “common sense“(Foulkes: “the power of community”) is collectively built, which results in members trying to share, “put into words” and understand what was until that moment “incomprehensible”, e.g. symptoms, neurotic behaviours, “irrational” experiences. The active interaction and ongoing work of adaptation to the group on the part of each member personally is the process that Foulkes defines as “ego training inaction”.

The adaptation that Foulkes has in mind is not the adaptation to the superficial aspects of the common life of the group, but that adaptation which frees the creative potential of each member from neurotic inhibitions and allows him or her to communicate freely as well as to participate in an integrated way in the life of the group.

This kind of adaptation implies the transformation of the destructive impulses of each individual member into more ‘healthy’ forms of aggression. Specifically: “each member attacks another member’s neurotic defenses because they are destructive to the group. In this way, destructive energy-aggression is used to undermine the neurotic position of the other. In other words, it becomes creative energy in terms of the group process…” (Pines, 1983).

” Destructive forces are subject to mutual analysis, but creative ones are used to deconstruct individuals and the group as a whole,” says Foulkes in Introduction to Group- Analytic Psychotherapy (p. 31, 1948). Crucial to this process is the role of the group conductor, who uses the evolutionary tendency of the group and allows aggression to be released so that it can be used creatively. (In the next introduction we will discuss in detail the role of the coordinator-therapist and in the last one the destructive forces in the group when we talk about the Anti-group.)

Specifically, Foulkes defines the group-analytic group as “a form of psychoanalytic therapy that has as its frame of reference the group as a whole. Like all psychoanalytic therapies it puts the individual at the centre of its concern.” (Foulkes, 1964 Therapeutic Group Analysis, p. 90).

Let us be more specific: the group-analytic group is a small face-to-face group of seven or eight people at most. There is no schedule or discussion agenda. The conductor-therapist encourages participants to express themselves spontaneously so that a culture develops in which members feel free, from the usual social censorship, concerning their thoughts and feelings. The ‘obligation’ of the group is to ‘come out’ what the members wish to talk about. (Foulkes wrote that the dynamic equivalent of repression in the group is when “something” is not discussed (in Pines, 2015). Repulsion: an endeavour by which the subject seeks to remove from the conscious to the unconscious unwanted thoughts, images, and memories). An important part of the group-analytic situation is the attitude of the conductor.

The group participants are adult individuals who in the group situation are observed to be partially regressing (Scheidlinger) as in any therapy. What does this mean? In the group, the most “experienced” member is the group conductor who, because of the qualities attributed to him by the members (representative of the group’s superego, source of knowledge, control and defence against internal dangers), is idealised and becomes an ideal with whom each member identifies and wishes to have a special, secret relationship, which creates antagonistic feelings between the members. When the members regress, focus on the leader and delegate everything to him, they lose their personality traits and become assimilated to each other. We could say that the members give something of themselves to form the group to which they belong (Freud). There is then a contagiousness of this situation. This is what happens in the initial phase of a group.

As the group process evolves, the group structure moves from a hierarchical to a more peer-cooperative state (De Mare). How does this happen? The members slowly realize that they have to “share” the conductor, at the same time, they become “frustrated” as the conductor does not respond to their mythical desires. So, they withdraw from the conductor or pretend to withdraw and turn to each other. Relationships between members are strengthened to mask the frustration with the therapist. The “magic” of the therapist recedes.

At this point, we should perhaps refer to Bion’s “basic assumptions”. In summary, Bion (a Kleinian psychoanalyst) described “basic assumptions” as early mental states (primary fantasies and emotions) that are automatically generated when individuals join together in a group. He spoke of three “basic assumptions”:

-of “dependency”, this is the phase in which the group expects everything from the therapist-leader,

-‘fight/flight ‘, when the group runs away or gets into a fight with opponents, in particular with those outside the group,

– ‘mating‘ when members seek to mate with each other to give birth to a child (symbolically) or an idea that will save them.

It is possible to imagine that the three ‘basic assumptions’ correspond to the oral-dependent stage, to that of separation-individuation and to the oedipal stage of development. As far as the theory of impulses is concerned, they correspond to the oral, anal and phallic stages of psychosexual development.

Returning to the group-analytic group, as it develops, the more its members acquire a sense of intimacy. Each member compares himself to others, and as others become the trigger for each member to express his own conflicts, each becomes more aware of his own “passions.” Gradually the fear of disclosure diminishes, each becoming more intimate with the other. The intimacy that develops includes the expression of aggression as well as erotic feelings between members.

A mature oedipal group becomes and is experienced by its members as a processing space where conscious and unconscious events take place. Foulkes used the concept of the group matrix to describe what happens when a small group of individuals come together and form close relationships.

The concept of the group matrix is central to Foulkes’ theory, and he described it in many different ways, including: -the general framework of the group that is the background in which the individual is the figure (Gestalt theory); -an overall, unified field of psychic events of which the individual is a part; -interpersonal processes that go directly to individuals, like X-rays but which, particular individuals can modify, process and influence them in their own way, -psychic processes of interaction that transcend the individual (where for Foulkes “psychic processes” seem to be conscious and unconscious communications) (R. Stacey, 2015).

Although Foulkes initially referred to the group matrix as the “group mind”, he subsequently rejected this term and spoke of “the mind” as an interpersonal interaction process or as a multi-personal phenomenon. That is, he argued that the individual mind is the interpersonal processes that completely permeate it down to its core so that it is a multi-personal phenomenon. By extension, he suggested the view that when individuals come together in a group, through their interactions acting Aeneas, they create a new transpersonal psychic system or group matrix.

According to Foulkes, part of this psychic supersystem consists of the foundation matrix that each individual brings with him or her into the group. The concept of the foundation matrix refers to the interaction of psychic processes that are in some way determined by instincts, intuitions, idiosyncratic factors and family experiences. To this foundation matrix, which each individual brings with him or her into the group, is added, through intimacy and constant exchange with other members, a current, constantly moving and constantly evolving dynamic matrix.

When a group evolves, that is, when, according to Foulkes, it develops its matrix, it involves co-therapists and therapists, and each member combines both of these functions at the same time. This means that all the desirable and hated qualities of omnipotence and wisdom, all the parental characteristics that were originally projected and contained in the symbolic representation of the therapist and the group as a whole, now become part of each member. A cycle of projections and introspections is then observed, through which new internalizations take place (Pines, 2015). (Projection: a function through which the subject expands out of himself and locates in others qualities, feelings, and desires that he misrecognizes or denies in himself. Introspection: the subject transfers from “outside” to “inside”, objects and their inherent properties. Introversion is in connection with identification. Internalization: process in which intersubjective relations are transformed into intersubjective relations (internalization of a conflict, a prohibition). When e.g. during the decline of the Oedipus, the subject internalizes the father figure and internalizes the conflict with the father).

We will cite an example of a group which is in the aforementioned (peer) situation where each member feels more secure and free to both project and internalize, so that he can say to another member, “I know that right now your manner makes me feel like when my mother disapproved of me for trying to get my father’s attention” and the one he is addressing can respond: “no it’s not like that, to me you are like my older sister who is successful, married and has children” (regardless of whether the member she is talking to has just been divorced and has no children) (in Pines, p.94, 2015). This vignette reveals how each member while experiencing a transitive relationship, has begun to become aware of the deeper motivations for their behaviour, related to feelings of guilt, jealousy and fear, which affect their perception but which they are now better able to manage. The aforementioned conversation involves not only those directly involved but all members of the group who also gain access to similar areas of their own experience. Thus members can perceive their particularities (e.g. envy, the need for exclusivity, etc.) within the relationships.

According to Foulkes (1964), when a group has succeeded in functioning maturely, specific therapeutic factors emerge in this group situation. Some are similar to those of the psychoanalytic process such as becoming conscious of what was previously unconscious, catharsis (the opportune discharge of pathogenic emotions), processing (working through), insight (insight) and the analysis of defence mechanisms. Beyond these, however, some are group-specific and arise from the group situation itself (Pines).

Foulkes referred to specific group phenomena which can be used therapeutically, such as:

• • Socialization: through the process of sharing, through the experience of group acceptance and belonging, the patient comes out of his isolation and enters a social situation in which he can feel more adequate.
  • Mirroring: the patient can see aspects of himself ‘mirrored’ in the behaviour and problems of other group members. Through this, he can compare different aspects of his social, psychological as well as physical image. The “mirroring” is done through “identifications with” and “projections to” the other members of the group (Pines). Thus, a member can say: “One side of me resembles one side of you, another side of you reminds me of my mother or father, and your behaviour evokes feelings, which I can currently perceive and process” (Pines, 2015).
  • The capacitor: Foulkes observed that even deep unconscious material can be expressed more directly and more fully in the group because of the relaxing as well as stimulating effect of one member towards the other. We notice this when a dream or some symptoms occur in the group, which we can better understand through the concentration of group associations. It is as if the symbolism that appears in the dream and/or symptoms expresses something in common, i.e. something that concerns all members of the group. (In electricity, a capacitor is a device that stores energy and delivers it when called upon, instantaneously; a typical example of the use of a capacitor is a flashlight.
  • The chain and habituation (or resonance) phenomena: when a topic in the group triggers a “chain” of associations and reactions which are linked to the members’ attachments and developmental level. For example: let’s say a group is discussing a topic related to violence, we can see how some members retreat into silence while others show a particular interest by projecting or revealing their fantasies.

To these Foulkes (1948) added two others which he thought related to the group analytic situation specifically:

• The group as a support: in any therapy analysis and interpretations may provoke defensive reactions on the part of the therapist. In the group situation, when one member accepts an interpretation he/she can better manage the shame he/she feels, knowing that other members have been in a similar position. In addition, members actively support and help each other to work through their conflicts. This of course is Foulkes’ idealization of groups, since sometimes the group may attack a suffering member and marginalize them (the scapegoat effect). Therefore, it is important to be aware of and work through destructive impulses and movements in the group to prevent such phenomena as much as possible. We will discuss these in detail in the presentation on Anti-Group. Regarding supportive group action, it is often observed that members accept interpretations and comments from other group members when they would be unlikely to accept them from the therapist. This is because the member who interprets usually offers himself as a person with whom the other member can identify when, for example, he says: “I am telling you because what you are going through reminds me of mine, which is why I think I understand you so well”.
• Communication: according to Foulkes, communication in the group is equivalent to the therapeutic process itself (Foulkes, Therapeutic Group Analysis, 1964). In his thinking, neurotic and psychotic disorders are always associated with an exclusion from the patient’s system of communication and socialisation. The purpose of the analysis is to translate the symptoms into problems that can be discussed. Thus each member benefits when he tries to speak freely in the group about his conflicts, as well as those of his co-therapists. As communication in the group expands and understanding deepens, members gain access to the unconscious meaning of what they express. It is a process similar to that of training (Pines) in which the group deepens its understanding by broadening its vocabulary so that each member in the group has access to all levels of communication, from the surface to the more profoundly unconscious (Foulkes and Anthony, Group Psychotherapy: The Psychoanalytic Process, 1957).

The group-analytic situation is not a static state. A group that develops its communication network and builds its matrix enables its members to “correct” the alterations that have occurred in the course of their development (the concept of habituation or resonance), to redefine themselves and to reconcile their individual and social aspects. Concerning the individual and social dimension of each person, G. Klein wrote: “we must recognize two tendencies in the self, a centrifugal one leading to autonomy and a centripetal one expressing an individual’s need to be part of a larger whole, a social entity. The interplay of these tendencies while being the precondition for a more integrated self is also a source of potential conflict” (p. 33, 1976 Psychoanalytic Theory in Brown, 2015 p. 105)). Foulkes understood the individual’s need to balance this paradoxical struggle for both individuality and a sense of belonging (Brown, 2015).

In an analytic group, members need to work together to discover their individuality. In other words, the group and the individual discover their complementarity. The group space offers, through the members’ interactions, for past conflicts to be revived and resolved, potentially leading to the emotional maturation of each member. Ultimately, as we have already mentioned, Foulkes has always focused on healing the individual: “The individual is treated in the context of a group with the active participation of the group” (Foulkes and Anthony, 1975).