From the Couch to the Circle

Group-Analytic Psychotherapy in Practice

John Schlapobersky

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317366072
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

Recipient ofthe 2017 Anne Alonso Award for Excellence in Psychodynamic Group Therapy, conferred by the Group Foundation for Advancing Mental Health, part of the American Group Psychotherapy Association.

From the Couch to the Circle: Group-Analytic Psychotherapy in Practice is a handbook of group therapy and a guide to the group-analytic model - the prevailing form of group therapy in Europe. The book draws on both John Schlapobersky's engagement as a practitioner and the words and experience of people in groups as they face psychotherapy's key challenges - understanding and change.

This book provides a manual of practice for therapists' use that includes detailed descriptions of groups at work; accounts of therapists' own experience and the issues they face in themselves and in their groups. The book is devoted to the Group-Analytic model but the other principally psychodynamic models of group therapy - the Tavistock, Interpersonal, Psychodynamic, Modern Analytic and Structural/Systemic models - are brought into a comparative discussion and drawn upon to create an integrated and coherent approach.

The book is divided into three sections:

Foundations – aimed at practitioners using groups of any kind and working at every level, including those providing supportive psychotherapy and providing groups for psychosis, trauma, the elderly, people at risk, the elderly and children;

The Group-Analytic Model – defines the group-analytic model at a basic and advanced level;

The Dynamics of Change – aimed at group analysts, psychotherapists and psychologists providing short-term psychotherapy and long-term group analysis

The book is illustrated with clinical vignettes including incisive, instructive commentaries to explain the concepts in use. It is intended for those seeking psychotherapy, whether to resolve personal problems or to find new sources of meaning in their lives. It is also intended for policy-makers in mental health, students of different models of psychotherapy and the psychosocial field. The comparative discussion running through the text about methods and models of practice will likely be of interest to the wider mental health and psychotherapy fields.

The author draws together the inherited wisdom of group analysis since Foulkes' time and makes his own lasting contribution. From the Couch to the Circle will be an invaluable, accessible resource for psychotherapists, psychoanalysts, psychologists, family therapists, academics, psychologists, mental health practitioners, academics and teachers in psychotherapy.

Section I

Foundations

Section overview

The seven chapters in this section lay the groundwork for the book. They are written for the interested general reader as well as for trainees new to the field and require no prior training or technical knowledge.

Chapter 1 calls on a series of vignettes to introduce the vocabulary of psychotherapy and the language, silence and music of groups at work. It discusses the aims of psychotherapy, the first principles for therapeutic practice and the fundamentals of technique. The scope of the book is based on this chapter and is unpacked through the sections that follow, guided by a special interest in the role of the spoken word, the nature of experience that may have no words, the place of words that function as gestures and the ‘syntax’ of non-verbal communication. It begins with the first principles of the early pioneers, including Freud, and goes on to the pioneers of group analysis, including Foulkes, Anthony and Pines, and then provides an empirical review of categories of need amongst those attending group therapy today.

Chapter 2 introduces three elementary dimensions to therapeutic experience – relational, reflective and corrective dimensions – that can arise separately or together, each of which builds on the one that goes before. The conductor faces a developmental challenge to help the group turn relational into reflective experience and then reflective into reparative experience.

Chapter 3 introduces a general theory of group development described as journey literature that is based on past and current writing. It summarizes the basic reciprocity between personal and group development to explore how the development stages of a person’s journey through a group or of a group’s journey over time are shaped by its formative purposes, membership, conductor and milieu. It considers the conductor’s responsibilities for dealing with group-based impasse, regression and resistance at key stages of development.

Chapter 4 explores free-floating discussion – Foulkes’s first therapeutic principle – and introduces the three primary speech forms that arise in a group, monologue, dialogue and discourse, which contribute to its semantic field. These language forms are located in a group’s field of meaning and are mapped against a corresponding progression from one-person to two-person and three-person psychologies that are located in a group’s relational field. The developmental challenge faced by the conductor involves helping a group turn monologue into dialogue and dialogue into discourse.

Chapter 5 explores speech and silence in group psychotherapy. It works from the real to the constructed and the representational, using Winnicott’s ideas to address the unspoken and the unspeakable. The non-verbal dimension of group life arises in the silences before, between and after words and in the ‘music’ of the group. Non-verbal communication can give access to profound areas of psychic life that are otherwise deeply hidden and that can emerge during silences in groups that speak more eloquently than words to those who can hear.

Chapter 6 explores basic definitions and the originating literature for different kinds of applications that the group-analytic model lends itself to in terms of duration, frequency, setting and form and points to the far-reaching influence of Foulkes’s original terms and ideas.

Chapter 7 explores methods, models and applications in group psychotherapy using the three-dimensional model of structure, process and content, as well as a diagram from Stone, Shay and Scott Rutan’s book to demarcate comparative differences between the six psychodynamic models discussed: Tavistock, Group-Analytic, Interpersonal, Psychodynamic, Modern Analytic and Systemic.

Chapter 1

Aims and vocabulary of psychotherapy

I feel so rich in knowledge and confident in skills in relation to my stranger-group work, even though I still find myself so hopelessly inadequate when I try to formulate it…The theory and practice required for really effective stranger-group therapy…is most complex of all. The problems and possibilities involved in this kind of therapy are very much greater than in the others…Stranger group psychotherapy has potentially far more power and possibility than the forms we have considered already and it is not surprising, therefore, that we should find it a far more difficult continent to conquer.

(Robin Skynner 1983/1987:231, 235)

Human communication rests on our innate musicality…human intention and emotion are immediately shareable with others through gestures of the body and voice. The very idea of intersubjectivity depends on the human capacity to develop a sense of intersubjective time within which to construct joint meaning…only by aligning ourselves alongside another – through being in time and in tune…might we be able to make sense of what Mead calls the conversation of gesture and response. The social nature of…experience is, in essence, musical.

Linde Wotton (2012:49)

We are one another’s weather…

Emma Rayfield (2013)

In the group-analytic approach the person responsible for the group is called the conductor. The first thing he or she will do is bring people together on the basis of their related needs and common capacity to contribute to a shared resource – the group – from which its members can each derive benefits. Second, the conductor calls this ‘community’ into the room where the group as a whole becomes the therapeutic agent. And third, the conductor does nothing for people in the context of the group that they can do for themselves and one another. A group that is well constructed and well led will release naturally occurring sources of renewal and resilience amongst its members that can bring profound benefits. This book is addressed to the ‘how to’ of making it work; the ‘why’ in why it works; the ‘for whom’ in whom it works for; and the ‘by whom’ about those who do the work. It explores the language, silence and music of groups to engage with words and with non-verbal and pre-verbal communication. It puts group therapy in the context of an oral tradition that involves storytelling so early stages of development, including regressed and hidden forms of infantile states, can be worked with productively in adult, child and adolescent populations long thought unreachable in psychotherapy (Nitsun 1988; Usandivaras 1989).

Embarking on a new book at this stage I feel something like Skynner did writing about group analysis in 1976 when he said in the passage quoted, ‘I still find myself so hopelessly inadequate when I try to formulate’ what makes group psychotherapy work. The foundation texts were addressed to a subject as complex in the days of our pioneers as it is in ours. Whilst they worked at the time with little to go by in terms of a field of literature and precedent, we have the immense advantages of their pioneering work to hand. However, until quite recently group-analytic psychotherapy remained a more advanced practice than its understanding could describe. Today there is a developing literature that the second and third of the quotations at the opening of this chapter point towards. This book brings such work forward by studying the model of practice. It faces the additional challenge of working against the customary divisions between ‘theory’ and ‘practice’. This is a study of clinical theory at work in the group room or, alternatively, of group-analytic practice informed by theory.

The recounting of stories is centre-stage in the journey from the couch to the circle. Some of these stories are tabled in the List of Vignettes. My paper The Language of the Group addressed Foulkes’s ideas about free-floating discussion. It was published in 1995 and is included here as Chapter 4. There were other early contributions to this focus including Wojciechowska (1993), and since then the field has been opened to the study of language in our groups. As well as the forms of speech first introduced – monologue, dialogue and discourse – there have been wider enquiries that many have taken forward. In group analysis they include von Fraunhofer (2008), Brooks (2009), Wotton (2011, 2012), Verebes-Weiss (2011), Levens (2011), Rayfield (2013), Tyerman (2012), Wainstein (2013) and Peleg (2012), and only some of these papers have been published. Further lines of enquiry and development in the language of group-analytic psychotherapy have been opened through Chapter 4 of Dalal’s Taking the Group Seriously (2000), through Nitsun’s three original texts (Nitsun 1996, 2006, 2015) and Weegmann’s many creative publications (Weegmann 2001 to 2015). Behind us are the pioneering publications of Pines, who helped establish the group-analytic field and whose collected papers will soon be available (Pines 2015); and beyond us are wider enquiries into field theory, language and metaphor in psychotherapy that include original contributions by Bollas (1987, 1990) and Wright (2009) and those by Montana Katz and her colleagues (2013) in an edited collection that includes Modell’s perspectives – drawing on Winnicott – that have bearing on what happens in groups (Modell 2013).

Table 1.1 The important lessons distilled from personal experience: Gans*

1 The important lessons distilled from personal experience become part of one’s therapeutic core.

2 Inflexible adherence to important principles learned in training can limit one’s therapeutic effectiveness.

3 It is important to oppose and, as a result, to neutralize the tendency…to focus on what is wrong with our patients and ourselves at the expense of recognizing our patients and our own strengths and successes.

* Table 1.1 is adapted from page xvii of: Gans, J. (2010) Difficult Topics In Group Psychotherapy: My Journey From Shame To Courage. Karnac, London. Grateful acknowledgements are made to the author and publisher.

Illustrating monologue, dialogue and discourse: Three vignettes and commentaries

The scope of this book is introduced by a preliminary series of vignettes that illustrate its focus on language. This is followed later by a study of the language of the group in Chapter 4 and the management of speech and silence in Chapter 5. The following vignettes move from the personal life of the therapist outside the consulting room to therapeutic practice inside it to make the work accessible to the general reader.

Monologue and dialogue

Vignette 1.1 The seer’s eye in the mirror

Outside the consulting room: someone close to me in a state of grief was going through the psychic dissolution that it can involve and was coming out the other side. She told me that as she began to recover she looked in the mirror and saw herself again. ‘I saw that I was there again’, she said – and the relief was tangible and palpable as we talked. As the seer’s eye captures itself anew in a glance, restoration of the lost sense of self, seen silently in a mirror, gives impetus to renewal. It can happen silently through the monologue of self-engagement in the privacy of the self. The recovery brought on can release natural powers of resilience, especially as it becomes part of a shared dialogue with someone else. Our discussions about her bereavement brought forward my own past sorrow and, in the course of our conversations, shared descriptions of my own grief and recovery were taken back to hers. The dialogue between us re-shaped the privacy of her monologue.

Commentary

This kind of restoration is much older than depth psychology. Intimate conversations generating movement from monologue to dialogue and back again are at the heart of all the other dynamics in psychotherapy and – in one way or another – they condition them all. Society has been governed by processes of this kind for as long as we have been able to speak, sing, cry and celebrate. Self-disclosure of the kind described here is outside a psychotherapist’s practice, but in the group-analytic model the person of the therapist is a crucial ...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of vignettes
• List of tables
• List of figures
• Foreword
• Tribute
• Historical Preview
• Acknowledgements
• Introduction
• Section I Foundations
• Section II The group-analytic model
• Section III Dynamics of change
• Index