Psychoanalysis and Psychotherapy |
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Robert M. Young Online WritingsGROUP THERAPIES AND GROUP DYNAMICS I have been asked to give a talk about the various approaches to Group Therapy. I trained as a group therapist using the approach of W. R. Bion and was in a supervision group with people being trained in group analysis according to the approach of S. H. Foulkes. I also have considerable experience of the group relations approach developed from the ideas of Bion by Rice, Turquet, Lawrence and others at the Tavistock Clinic the so-called Tavistock/Leicester Model. I am going to speak largely about that, but Ill begin by saying something on the precise topic about which I was asked to speak. I have more than a shelf of books on group therapies and am a member of an email forum which discusses group-psychotherapy. I plumbed these and confirmed my initial response: it cannot be done in a single lecture. Even if I used the compare and contrast method I still say it couldnt be done. For example, in the supervision group I attended someone once said, as if everyone knew it, that the transference is to the group. I said, believing myself to be correcting a simple blunder, that surely the transference was to the therapist. Instant gridlock. The matter could not, in any degree, be discussed. The supervisor took me aside after the meeting and gently chided me. You have a degree in philosophy; you think anything can be made a topic for reflective, critical discussion. Most of the people here tonight believe that what they are taught is the use of certain technical tools. As far as they are concerned, for you to question any one of them is like saying to a brain surgeon in mid-operation, Dont use that tool; use this one. It would induce sheer panic. Dont raise an issue like that again. Thus ended my career as a comparer and contraster of approaches to group therapy. I have since been told that some approaches allow the group to meet even if the therapist is not present. I have also been told that existential therapists do not work in the transference and on another occasion that this is not true. What follows, therefore, is an outline, followed by some thoughts about certain approaches to group dynamics and then some genuinely puzzling questions. First, I will give you a list of group therapies I have compiled. There are basically three parameters: orientation, participants and setting, as well as some other variables such as size of the group and duration of the course of meetings. Certain of these can, of course, be mixed, e.g., a psychoanalytic group for men who commit domestic violence and are in prison, meeting for, say, fifteen sessions. Here is a useful summary:
You will note that many of the matters of orientation reflect the kinds of individual psychotherapy which are available. Here is my list: psychoanalytic group therapy Here are some journals: International Journal of Group Psychotherapy; Group Analysis, GROUP, The Journal of the Eastern Group Psychotherapy Society; Social Work with Groups; Group Dynamics: Theory, Research, and Practice (sponsored by Division 49 of the American Psychological Association); International Journal of Action Methods: Psychodrama, Skill Training, and Role Playing; Group & Organization Management; Human Relations; Free Associations (which I edit and which has a heavy emphasis on groups & organizations) I would be glad to supply to anyone interested this list, information about the email forum, web sites I know about and reading lists. Now to the heart of my lecture. I have read or heard things about various of these approaches and have even published books and articles about a few of them. The truth is, however, that I only know about psychoanalytic groups and group relations. in any sense which makes it appropriate for me to give a lecture about them. I am going to reflect now on what I believe to be an important difference in approaches to these matters based on issues raised by Wilfred Bion. He wrote the founding document of the Tavistock approach, Experiences in Groups. In much of the book he focuses on primitive Oedipal conflicts, part-object relations and psychotic anxieties. But by the time he gets to his concluding summary, he is quite blunt in challenging the traditional Freudian view of what is happening in groups. You will recall that id, ego and superego and the Oedipal triangle were believed by Freud to be all you need to figure out anything in the individual, in groups and in society. Freud said of The Future of an Illusion and Civilization and Its Discontents,
His biographer, Peter Gay, concludes, 'He could not have stated the essential unity of his thought any more forcefully' (Ibid.). There is no place in Freud's thinking for what the social scientists call 'the autonomy of the social', that is, for social causes operating at a different level from the psychological and deriving from genuinely social forces, even though they are mediated through the individual psyche. There is not even relative autonomy. When he wrote about group psychology, the central dynamic was the ceding of authority and conscience to the group leader, once again, an Oedipal dynamic. Bion challenged this quite fundamentally. He wrote, 'Freud's view of the dynamics of the group seems to me to require supplementing rather than correction' (Bion, 1955, p. 475). He accepts Freud's claim that the family group is the basis for all groups but adds that
of the basic assumption group. Such groups have aims
In Bion's view, then, what matters in individual and group behaviour is more primitive than the Freudian level of explanation. The ultimate sources of our distress are psychotic anxieties, and much of what happens in individuals and groups is a result of defences erected against psychotic anxieties, so that we do not have to endure them consciously. Bion says of the group,
The psychotic anxieties in question involve splitting and projective identification, part-object relations and punitive guilt feelings which are characteristic of the paranoid-schizoid position. These alternate with whole-object relations, concern for the object, and constructive or reparative guilt - which are characteristics of the depressive position (p. 457). According to Bion, the move from the individual to the group does not raise new issues about explanation. He says a little further on, 'The apparent difference between group psychology and individual psychology is an illusion produced by the fact that the group brings into prominence phenomena which appear alien to an observer unaccustomed to using the group' (p. 461). This is an important claim, one which I make sense of by believing that social and other causes operate for Bion via their unconscious representations. This passage had a big impact on my thinking, as did the following one from Joan Riviere's classic Kleinian essay 'On the Genesis of Psychical Conflict in Early Infancy' (1952):
In claiming that experience is characteristically misinterpreted at source and that distortion to the point of hallucination is at the very foundation of experience, Riviere is saying that there are no uninterpreted experiences, and there is no neutral observation language in everyday life. You don't start with pure sense data which then get subjectively distorted. The very act of having experience is coloured by profoundly irrational processes. Looking more broadly, by the way, the same claim about there being no neutral observation language is made of science in recent work in the philosophy of science. Clearly, if we approach group phenomena and group therapy from this point of view, we are perpetually immersed in processes which psychiatrists call psychotic. Bion made the distinction between work groups, roughly speaking, groups which were getting on with their appointed tasks, and what he called above basic assumption groups, groups in the grip of a primitive unconscious phantasy. The first basic assumption is dependency: 'that the group is met in order to be sustained by a leader on whom it depends for nourishment, material and spiritual, and protection' (p. 444). The second basic assumption of pairing involves a Messianic hope that something or someone as-yet unborn, not-yet present or not yet in role will save the group 'from feelings of hatred, destructiveness and despair, of its own or of another group, but in order to do this, obviously the Messianic hope must never be fulfilled' (pp. 446-8). The third basic assumption is fight or flight: - 'that the group has met to fight something or run away from it' (p.448), the emotions appropriate to the physiological emergency response of the sympathetic nervous system, energised by adrenaline. He contends that 'panic flight and uncontrolled attack are really the same' (p. 469). Isabel Menzies Lyth comments that 'They have in common massive splitting and projective identification, loss of individual distinctiveness or depersonalization, diminution of effective contact with reality, lack of belief in progress and development through work and suffering' (Menzies Lyth, 1959, p. 21). Bion stresses that these are in no way voluntary or conscious reactions: 'Participation in basic assumption activity requires no training, experience or mental development. It is instantaneous, inevitable and instinctive...' (Bion, 1955, p. 449; cf. p. 458). All of the basic assumptions involve a leader, but this need not be a person; it could be an idea or inanimate object (p. 450). When the 'leader' is a person, he or she 'is as much the creature of the basic assumption as any other member of the group... The "loss of individual distinctiveness" applies to the leader of the group as much as to anyone else a fact which probably accounts for some of the posturing to which leading figures are prone' (p. 467). These defensive actions derive from group processes which lead individuals to regress. Once again, he places the main emphasis on the primitiveness of the reactions:
Various people have tried to add to Bions list of three basic assumptions but without making much impact on the received view. I confess that I am less taken with the particulars of them than I am struck by the underlying claim that groups are very often quite mad. That is certainly my experience, and until I read Bion I was pretty sure it was my fault. Now I know that although I am well and truly a contributor, I am usually not the main problem. I want to share two sets of thoughts about where this line of thinking leads. First, it makes groups and institutions, including and especially therapy groups and institutions for disturbed people, very dangerous places. That has certainly been my experience. For a long time I would change work settings and soon say, How on earth did I fall among wackos yet again?, until Bion helped me to see that this is human nature on the hoof. Second, it means that we are defending ourselves against anxieties of disintegration, nameless dread and annihilation in much of our lives. I have at least two patients who exemplify this dramatically. One can practically never speak in meetings, though he is a tenured official in a major banking institution, and the other cannot go to them at all, though she is a graphic designer for grand magazines, a job calling for group consultations on a daily basis. As some of you will know, there is a thriving tradition and a considerable literature conducted in the wake of Bions work with groups, even though he soon left the field and worked exclusively as an individual analyst. In particular, Elliott Jaques investigated factories and other institutions in this light. He begins his essay on 'Social Systems as a Defence against Persecutory and Depressive Anxiety' (1955) by reiterating that 'social phenomena show a striking correspondence with psychotic processes in individuals', that 'institutions are used by their individual members to reinforce individual mechanisms of defence against anxiety', and 'that the mechanisms of projective and introjective identification operate in linking individual and social behaviour'. He argues the thesis that 'the primary cohesive elements binding individuals into institutionalised human association is that of defence against psychotic anxiety' (Jaques, 1955, pp. 478-9). He points out that the projective and introjective processes he is investigating are basic to even the most complex social processes (p. 481, cf. 481n). His conclusion is cautionary and points out the conservative even reactionary consequences of our psychotic anxieties and our group and institutional defences against them. He suggests that as a result of these reflections on human nature
The investigator who, in my opinion, has made the most of this perspective is Isabel Menzies Lyth, who built her research on the shoulders of Bion and Jaques. She has investigated a number of fraught settings, but the piece of research which has deservedly made her world-famous is described in a report entitled 'The Functioning of Social Systems as a Defence against Anxiety' (1959). It is a particularly poignant document, which addresses the question why people of good will and idealistic motives do not do what they intend, that is, in this study, why nurses find themselves, to an astonishing degree, not caring for patients as they had originally wished to do and leaving the nursing service in droves. The mechanisms she describes are the ones discussed above, now operating to create routine, to inhibit real human contact, to lead to rigid and sometimes inhuman rules in hospitals. What is so distressing is that these forces operate overwhelmingly in a setting which has as its very reason for existence the provision of sensitivity and care. Yet that setting is full of threats to life itself and arouses the psychotic anxieties I have outlined. She says,
The result is the evolution of socially structured defence mechanisms which take the form of routines and division of tasks which effectively preclude the nurse relating as a whole person to the patient as a whole person. If you havent already, I urge you to read it: she explains why the refers to patients as the liver in bed 5 and the spleen in bed 12. 'The implicit aim of such devices, which operate both structurally and culturally, may be described as a kind of depersonalisation or elimination of individual distinctiveness in both nurse and patient (pp. 51-2). She lists and discusses the reifying devices which reduce everyone involved to part-objects, including insight into why nurses mechanically follow orders in ways that defy common sense (p. 69), for example, why the nurse wakes you up to give you your sleeping pill. There is a whole system of overlapping ways of evading the full force of the anxieties associated with death, the ones which lie at the heart of the mechanisms which Klein described (pp. 63-64; cf. Riviere, 1952a, p. 43). Menzies Lyth draws a cautionary conclusion rather like Jaques: 'In general, it may be postulated that resistance to social change is likely to be greatest in institutions whose social defence systems are dominated by primitive psychic defence mechanisms, those which have been collectively described by Melanie Klein as the paranoid-schizoid defences' (Menzies Lyth, 1959, p. 79). In recent reflections on her work and that of her colleagues, she has reiterated just how refractory to change institutions are (Menzies Lyth, 1988, pp. 1-42, and personal communications). You wont be surprised that psychiatric, psychoanalytic and psychotherapeutic institutions are among them, as I shall indicate in a few minutes. First, however, I want to speak about the Leicester Conferences on group and organisational behaviour, with particular emphasis on authority and leadership. They have been held at least once a year since 1957. They are heir to the traditions discussed above, especially the work of Klein, Bion, Jaques and Menzies Lyth. (Other influences are mentioned in Miller, 1990, pp. 165-69.) One among several interrelated ways of characterising the two-week residential conferences is that they are so arranged as to facilitate experiential learning about the ways in which group processes can generate psychotic anxieties and institutional defences against them (p. 171). The struggles that ensue in the members' minds between individuation and incorporation, as a result of the conference group events, is hard to credit by anyone who has not taken part in a Leicester Conference or related 'mini-Leicester' events. Similarly, descriptions of events and feelings are likely to seem odd to anyone not familiar with the sorts of events around which the conferences are structured. I believe, however, that the relevant emotional points will be sufficiently clear without a (necessarily) long description of the conference rubric. My first experience of a Leicester Conference involved feeling continually on the edge of disintegration as a result of behaviour in the various group events (ranging in size from a dozen to more than a hundred people) which I found appalling and from which there seemed no escape, while efforts to persuade people to behave well produced flight, sadism, collusive lowering of the stakes or denial. The potential of the group for uniting around (what was called on occasion) 'cheap reconciliation' or for cruelty, brought me to the point of leaving on several occasions, and I frequently had the experience of having to use all my resources to hold myself together against forces which I experienced as profoundly immoral, amoral or pathetically conformist. No appeal to standards of group decency was of much avail. I ended up forming a group in my mind which consisted of all the people I admired in history and in my lifetime, e.g., Socrates, Lincoln, Gandhi, King, Bonhoeffer, Marcuse, Mandela, who had stood up to intolerable social forces without quitting the field or having their spirits broken. I dubbed this The PS ÷D Solidarity Group and, armed with their mandate (bestowed by one part of my mind onto another), managed to talk my way into a meeting with the staff, for the purpose of mounting a critique of the rubric of the so-called institutional event. I felt contained by the inner solidarity provided by my imagined group, while I was, in truth, actually on my own in the phenomenal context of the conference events. I had blown out of a group in considerable distress, because it had utterly failed to live up to its self-designation of advocating and practising decency and civility among its members and urging such standards on the larger group of conference members.Just as I was on the point of sitting down to confront the staff group in the name of my inner world group (vainly hoping they would show some interest in its name, membership and values), a representative of the group I had left appeared and bestowed 'plenipotentiary powers' (the highest of the designated forms of delegation of authority) on me, freeing me from the dreaded status of 'singleton'. A singleton is a person with no role status in the large group (see Miller, 1990, p. 179 and Turquet, 1975, where the plight of the singleton is insightfully and poignantly described). I had felt unutterably alone, almost totally in the grip of paranoid persecutions, holding on for dear life to my hallucinated historical group. The bestowal of my conference group's trust reincorporated me into the social whole on terms I could accept. My confrontation with the staff group, acting in this exercise as 'Management, was predictably without issue, but I went away feeling that I had spoken my piece without suffering the humiliation that many others had experienced. I had offered my analysis of the situation and their role in it, one dimension of which was that they would as a part of the point of the exercise continue to behave as they were doing, i. e., act as an immovable object onto which the groups would project their phantasies about authority and (hopefully) begin to take responsibility for themselves. I felt that I had done that and negotiated my own rite of passage just. Having gone some way toward resolving my own temporary insanity (though not my omnipotence) I was only able to bask pleasantly in group membership for a few minutes before members of another group, who had sought a form of security in being regressed and silly (they had all been to previous conferences and might have been expected to be street wise, but they took refuge in regression and called themselves 'The Potty Training Group'), stormed into the room where the staff/Management group were holding court. The person whom I had considered to be the mildest member of that group physically attacked a German member of staff with shouts of 'fascist' and other violent epithets. He was aided and cheered on by other members of his group, until one, a woman I felt sure was a Jew but I now recollect was probably not but was a German, broke down sobbing and shouted for all this to stop, which it did. The descent from work or task-oriented groups to groups in the thrall of psychotic basic assumptions is, as youll recall Bion pointed out, spontaneous and inevitable (Bion, 1961, p. 165), even in a situation which all concerned know to be temporary and 'artificial'. I continue to find this profoundly sobering. I also continue to ruminate it and am far from having digested the experience, though I have found it increasingly helpful in my work and related activities. By this, I, of course, mean to include psychoanalytic group therapy, where I have found that thinking in terms of psychotic anxieties and defences against them takes me to the parts which other therapies do not reach (to paraphrase a slogan for Heineken lager). But I am also thinking today about work groups in my life as an editor, publisher, professor and member of the psychotherapy profession. It about this last subculture which I want to invite you to think in my concluding section. I am not going to propose a solution but share a problem. I cannot say how much you experience it professionally, but I certainly do. The problem is that these anxieties and splits characterise the psychotherapy world, the psychoanalytic world and especially the world of group relations itself. I am a professor in a psychiatry department, and I am sorry to say that they are there, too. Bion pioneered this work during the Second World War at a place called Northfield Hospital in working with military service personnel who would not fight - the sorts of people who were called shell-shocked in World War I, where he had himself been a tank commander and was decorated with the Military Cross. A number of people who became eminent in the world of therapeutic communities and group work were his colleague. He had dramatically successful results, results which laid the foundations for the subsequernt group relations tradidion and he was sacked in six weeks. He also eventually found the environment in London so uncongenial to his creativity that he emigrated and moved to Los Angeles, where the people who invited him took their time in sending him enough referrals to make ends meet. Untoward things happened to many of his colleagues and people inspired by his work. One founded a famous therapeutic community, but he ran it in a way that meant that no one could come along behind him. The group which grew up around Bions work at the Tavistock Institute of Human Relations blew apart. One went to America, another to Australia, another to a college in London. Another worked largely in France, where he had to move on and came back to an institute in London where the ageing head would not retire, so he moved on quickly, and others soon left, too. The person left in charge of the Tavistock institute the last man standing, as it were would not allow a next generation to rise up so that when he belatedly retired a head hunter had to be hired to create a field of candidates for the directorship. I think next of the co-authors of a leading book in the field. One was not so long ago removed from being director of a group relations conference. The other, an eminent clergyman, has recently been the object of a very public and dramatic example of dubious leadership involving the Queen and Westminster Abbey in which he was legally vindicated but widely criticised for dreadful management practices not for the first time. The founder of a similar institution in Germany was thrown out by his colleagues. I invite you to conclude that the group relations of the group relations community for all their putative expertise in understanding primitive processes leave something to be desired. But this regrettable situation is not confined to that part of the psychoanalytic field. Yet another prominent figure in both group relations and psychoanalysis has been an important but unacknowledged leader in creating a massive split between the psychoanalysts and those deferential to them, on the one hand and the rest of the psychoanalytic psychotherapy population in Britain, on the other. In this conflict there have been dreadfully manipulative and autocratic moves, including, for example, refusing to accede to three successive votes on the part of the membership of a training organisation, of which he was head, to rejoin the more democratic an widely based organization. (I have written a number of essays about this saga and related matters which you can find on the web.) Looking further into psychotherapy profession, the dynamics within organizations I know about have led to recent acrimonious splits in at least three of them. There was, of course, the earlier problem of succession after Freud died and Ernest Jones stepped down in the British Psycho-analytic Society, known as the Freud-Klein Controversies. The society stayed together but did so on the basis of a structural compromise which has had and continues to have some sclerotic consequences. Finally, I am about to publish a book by Douglas Kirsner, entitled Unfree Asssociations, detailing the histories of four major analytic societies in America New York, Boston, Chicago and LA involved in prolonged and violent disputes over who shall be training analysts, who shall rule, what shall be taught and who shall be in the succession of authority. Kenneth Eisold has written about some of these splits in the most recent IJPA, especially the New York one, and wrote previously about the intolerance of diversity in psychoanalytic institutions. Casting my net more widely, such splits are, of course, the stuff of novels and thrillers, .e.g., C P Snows The Master,s on Cambridge college life, of which I have considerable experience which confirms his account. Then there is John Le Carres well-informed but fictional account of intrigues in the British Secret Service, Tinker, Tailor, Soldier, Spy, which involves some of the same dynamics. I am of the opinion that, bad as these splits are, they are not as bad as the ones in the analytic world. Perhaps I should say that perhaps the splits are sometimes as bad, but the process of conflict resolution is less potentially irreparable. The thought with which I want to leave you is a problem about which I think people interested in psychodynamic approach to groups, institutions and wider social forces needs to think much harder. How are such matters contained and detoxified in settings where the structures are not as secure as they are in (most) universities and stable governments? How can groups, businesses and temporary institutions create structures which can bear diversity, spread legitimacy and conduct processes of succession in an orderly and constructive way? Bion, Jaques, Menzies Lyth (each f whom moved on, youll recall) and the group relations tradition associated with the Tavistock Institute of Human Relations and the Leicester Conferences have, I submit, posed a problem which is central to the husbanding of human civility. They have also drawn our attention to the underlying unconscious forces involved, but they and we are far from solving it, just as those creative people and other psychoanalytic organizations have yet to do so. It is, not for the first time, a challenge: Physician, heal thyself! We are right to look for the answers in group dynamics, and I believe that those inspired by Bion are right to dig deeper into the unconscious, yet I dont think we are very near to refining what we have unearthed. This is the text of a talk delivered to the Department of Psychiatry, University of Manitoba, 12 January 1999. Copyright: The Author Address for correspondence: 26 Freegrove Road, London N7 9RQ
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