Psychotherapeutic Change Through the Group Process

Dorothy Stock Whittaker

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351495844
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Psychotherapeutic Change through the Group Process discusses the relation between the properties of groups and therapeutic change. The purpose is to develop a view of groups that accounts for the diversity, complexity, and fluidity of the group situation. The view examines the group in depth, attending not only to overt events, but also to covert aspects of specific situations. The work addresses manifest behaviors, underlying motivations; and the cognitive, rational aspects of the group. It explores the intense affect which may be generated under conditions of group interaction; not merely to the group or individual, but to the individual in the group and to the group as the context for personal experience and change.The research presented here was initially explored in small group studies. Separate investigations considered the ways in which patients and therapists view group events, the nature of deviation, and the development of group standards. They consider factors associated with therapeutic improvement and therapeutic failure; and characteristic concerns of early sessions. These, plus several discussions of theory and methodology have been published separately.The authors' working procedure has been to study intensively a relatively small number of groups, relying upon careful observation of natural groups rather than upon laboratory experimentation. The overall effort has been to understand the processes of therapy groups in all their clinical richness and intricacy and yet to impose a scientific discipline and control on our analyses. This has meant a continuing attempt to develop appropriate analytic procedures so that clinical analyses can be as firmly rooted as possible in concrete data and reproducible methods. This book is a unique effort at the scientific grounding of social work practice.

I
The Group Processes: The Context of Therapy

Arguments about “existence” may seem metaphysical in nature and may therefore not be expected to be brought up in empirical sciences. Actually, opinions about existence or nonexistence are quite common in the empirical sciences and have greatly influenced scientific development in a positive and a negative way. Labeling something as “nonexisting” is equivalent to declaring it “out of bounds” for the scientist. Attributing “existence” to an item automatically makes it a duty of the scientist to consider this item as an object of research; it includes the necessity of considering its properties as “facts” which cannot be neglected in a total system of theories; finally, it implies that the terms with which one refers to the items are acceptable as scientific “concepts” (rather than as “mere words”).

—Kurt Lewin

1
Problem and Purposes

Processes characteristic of the group as a whole are an intrinsic and inevitable aspect of all groups no matter what their size or function. In a therapy group, group processes not only “exist,” but are a major factor influencing the nature of each patient’s therapeutic experience. The manner in which each patient contributes to, participates in, and is affected by the group processes determines to a considerable degree whether he will profit from his group therapy experience, be untouched by it, or be harmed by it. The therapist can influence the character and development of the group and thereby influence the individual’s therapeutic experience. It is, therefore, important that the therapist have some understanding of the group processes and their meaning for the therapeutic process.

As this over-all statement of our position suggests, we regard the group processes which emerge in therapy groups as worthy of serious and careful investigation. To paraphrase Kurt Lewin, we shall attribute “existence” to these group processes and shall systematically discuss their character, their relevance to the therapeutic experience, and their implications for the therapist’s role.

Two questions may be asked about group processes in therapy groups. The first is whether such processes can be observed; the second is whether and in what manner group processes are relevant to the therapeutic progress of individual patients. In our view, the first question is no longer an issue, but the second is both crucial and unresolved.

Although it is now generally accepted that any small face-to-face group, including a therapy group, can be described in terms of its characteristics as a social system, this was not always so. During the 1920’s, concepts such as “group mind” or “group unconscious” were matters of controversy in social psychology. Such terms are no longer in general use, not because they have no meaningful elements, but because the phenomena to which they refer are now better understood and no longer need to be discussed in such mystical terms. Although social psychologists no longer talk about the group mind, they do talk about group goals, atmosphere, sociometric structure, or communication pattern. These are characteristics or properties of the group as a whole. They derive from the interaction of the members in lawful ways, yet constitute attributes of the group as a system.

Historically, the factor which probably contributed more than any other to the resolution of these early issues was the development of relevant methodology. Until appropriate techniques were available, there were no means for exploring group phenomena. Pioneer work by Lewin, S. E. Asch, and others paved the way for the controlled observation of groups and the experimental manipulation and examination of group variables.¹ Evidence accumulated to show that small face-to-face groups can be described in terms of properties belonging to the group as a whole. That is, many diverse phenomena can be understood if the group is conceptualized as a social system comprised of elements which have a lawful relation to one another. Such elements can be shown to operate in a variety of groups independently of the specific membership of the group. Furthermore, such total group characteristics have been shown to have an important impact on the behavior of individual members.

The crucial question for group therapists is no longer whether the therapy group can be described in terms of such variables as atmosphere, cohesion, communication patterns, roles, standards, and the like. Rather, the issue is whether regarding the group in these terms is of any use to the therapist in the light of his primary goal, contributing to the personal growth of the patient. To state this more formally, the real question is whether and in what manner characteristics of the therapy group as a social system are relevant to the therapeutic process.

In the literature on group therapy, one finds a range of positions on this issue. Group processes are variously regarded as factors to be utilized, overcome, or ignored. One position is that, although therapy groups may be described in terms of the “dynamics of the group,” group dynamics are detrimental to the therapeutic aim. Perhaps the most articulate proponent of this point of view is S. R. Slavson:

Thus, even the most common group dynamics described are not permitted to operate, for it is the task of the therapist ... to uncover the underlying, most often the hostile feelings, from which reactions flow. Thus, dynamics in therapy groups are “nipped in the bud” as it were, for just as soon as responses are analyzed and related to their emotional sources, they no longer operate. . . . Thus, the therapeutic aim in its very nature is antagonistic to group formation and group dynamics.²

Wolf and Schwartz are even more strongly convinced that attention to group-level processes in therapy groups is likely to defeat the therapeutic goal; they regard group processes as inherently destructive to the individual.³ Nathan Locke suggests that the characteristics of the group are a side issue; a similar position is advanced by Helen Durkin, who suggests that, although forces exist which may be described as belonging to the group as a whole, they tend to be irrelevant to the therapeutic work of the group.⁴

In sharp contrast to these positions are the views put forth by such group therapists as S. H. Foulkes, W. R. Bion, George Bach, Henry Ezriel, and Jerome D. Frank.⁵ Although they differ in many respects, these writers share the view that group processes are central to the therapeutic process.

Bion views the group as the vital instrument of therapy which must be properly utilized and exploited by the therapist: “. . . [W]e are not concerned to give individual treatment in public, but to draw attention to the actual experiences of the group, and . . . the way in which the group and individual deal with the individual.” And, later:

This point is critical; if the psychiatrist can manage boldly to use the group instead of spending his time more or less unconsciously apologizing for its presence, he will find that the immediate difficulties produced are more than neutralized by the advantages of a proper use of his medium.⁶

The stand which one takes on this general issue may depend in part on underlying assumptions about the character of therapy and the nature of emotional illness. Most group therapists recognize important differences between therapy conducted in a group and therapy conducted in a two-person situation. However, the curative model—assumptions about what it is in the treatment situation that helps the patient—is usually translated rather directly from individual to group psychotherapy. For example, the exploration of transference relationships and interpretations of resistance by means similar to those used in individual therapy may be seen as the heart of the treatment. Given such a position, it might seem to follow that attention to total group processes is foreign, useless, or even harmful to these essential therapeutic maneuvers. The way in which the therapist defines emotional illness is also a factor. Slavson’s model is essentially an intrapersonal one in which psychotherapy is aimed at freeing the patient from his neurotic inhibitions and problems. Foulkes, on the other hand, is inclined to see emotional illness as rooted in disturbed interpersonal relationships:

We conceive all illness as occurring and originating within a complex of interpersonal relationships. Group psychotherapy is an attempt to treat the total network of disturbance either at the point of origin in the root—or primary—group, or, through placing the disturbed individual under conditions of transference, in a group of strangers or proxy group.⁷

In our view, the eventual resolution of these issues will not require a choice between irreconcilable alternatives—either the psychoanalytic or the group dynamic explanation. Rather, what is required is an understanding of the manner in which group processes, individual processes, and therapeutic processes exist in complex relationships. We do not see group processes as either consistently constructive or consistently destructive to therapeutic goals. Rather, our position is that they have no such universal and unilateral impact. Depending on their character, group processes may sometimes facilitate therapy. Sometimes they may interfere. The real questions are how and when the therapist can use them to produce useful therapeutic experiences. In order to answer these questions, it is necessary to examine group-level aspects of therapy groups in some detail to determine their impact on the individual and the therapeutic process.

One might wonder why it is that group therapists have not turned to social psychology for an understanding of group processes in therapy groups.⁸ We believe it is not because the concepts developed by social psychologists cannot be applied to therapy groups, but because many of the concepts seem irrelevant to the therapeutic process or of only academic interest because they deal with variables which the therapist cannot influence. The social psychologist who studies groups usually does so in order to understand certain properties of the group or relationships among certain properties. He may be interested in the problem-solving process, the decision-making process, the distribution of power in the group, or the communication pattern. Although such phenomena can be observed in therapy groups, they are likely to be of little interest to the group therapist because they seem so removed from his primary interest—therapeutic change in the individual. Even when the social psychologist focuses on the impact of group variables on the individual, he is likely to be interested in such variables as sense of achievement, changes in attitude or judgment, and so on. Although these are attributes of the individual, they are related only indirectly to the kind of change in which the group therapist is interested.

The group therapist may also feel that the work of the social psychologist has little practical importance because many of the variables cannot be manipulated in the group therapeutic setting. For purposes of experimentation and study, the social psychologist may, for example, open or close certain channels of communication or distribute relevant information unevenly among the group members. Such manipulations are outside the tradition of group therapy and, in general, are inconsistent with his goals.

What is required is a theory of group processes relevant to the task and goals of psychotherapy. To be useful to the group therapist, a theory of group functioning must focus on factors which bear on the therapeutic process and which are subject to the influence of the practicing therapist. We assume that the therapeutic process—that which must occur within the individual if positive personal change is to take place—is essentially the same no matter what the therapeutic setting. The corrective emotional experience, sometimes accompanied by insight, is regarded as fundamental to therapeutic change. A useful theory of group therapy must, then, examine the manner in which this therapeutic process occurs in the special milieu of the group. The group processes form the context of therapy. The group situation is in constant flux, and the individual in a continuously shifting position with relation to group forces. Under certain group conditions, potentially useful experiences may occur. Under others, anti-therapeutic experiences take place. Thus, it becomes important to identify the character of the group context in order to understand its impact on the individual.

The list of variables which the group therapist can influence is a brief one: the size and composition of the group, the physical setting and the frequency of the sessions, the kind of outside individual contacts (if any) he provides for each of the patients, and his own participation during the group sessions. A useful theory of group therapy should aid the therapist in selecting the techniques and situations which are most likely to help the patients. Of the variables which the therapist can control, his own participation—what he says and when he says it—seems the most crucial. And in order to study the impact of the therapist’s participation, it is necessary to understand the character and impact of his interventions in the context of the fluctuating group situation.

For several reasons, then, a theory about group therapy must establish a way of conceptualizing the changing group situation. This situation is important because it is the background against which to examine the therapist’s participation, the patients’ participation, and the shifting meaning of the group experience for each patient. The following appear to be significant questions:

1. What kinds of emotional issues emerge in therapy groups; how are these expressed and handled?
2. How can one conceptualize the diverse and shifting events of a single therapy session?
3. What are the long-term developmental characteristics of a therapy group?
4. In what ways does the past history of a therapy group affect its current operation?
5. What are the relationships among personality, individual behavior, and the character of the group?
6. What is the impact of the group on the patient’s experience: which group conditions contribute to personal growth and which interfere?
7. How does the group therapist contribute to the patient’s therapeutic experience?

We shall present a series of propositions which attempt to deal in detail with these and related questions. Part I deals primarily with the character of the group process and is directed to questions 1, 2, 3, and 4; it defines the character of the group therapeutic milieu. Because the group’s only constant feature is change, our efforts are directed to understanding the pattern of diversity and the order in change. In Chapter 2, we suggest a view of group events which perceives the diverse elements of the group situation in relation to shared, covert, affective issues. Crucial affective issues and shared conflicts develop to which the patients direct coping efforts. Chapters 3 and 4 are devoted to understanding continuity and change in the group process—first in a single group session and then in a series of sessions linked by the same theme or shared emotional concern. Chapter 5 considers the issue of the group’s culture—the unique and usually implicit standards, practices, and values which develop in each group and which, in our view, can have both limiting and enabling effects on the therapeutic experience. Chapter 6 returns to the problem of change, taking a long-range view and considering the over-all developmental characteristics of the group. Both theme (Chapter 4) and culture (Chapter 5) are basic to our view of group development, for we emphasize the recurrence of basic affective issues and themes under broadening cultural conditions. Part I, then, attempts to formulate the character of the group processes in ways which we think are important for understanding the context of therapy. Although we do not consider, except by implication, the relevance of the group processes for the therapeutic process or the therapist’s role, this part of the book lays the essential groundwork for the discussion which follows.

Part II considers the individual’s experience in the group, particularly the impact of the group processes on the therapeutic experience. This section is directed to questions 5 and 6. In it, we discuss the individual’s neurotic dilemma on entering the group, the manner in which he experiences the group situation, and the motives which underlie his behavior in the specific setting (Chapter 7). In Chapter 8, there is a more specific discussion of the therapeutic process—the kinds of experiences which the patient must undergo if positive therapeutic change is to take place and the various ways in which the group processes may affect the individual. In this chapter, we consider the specifics of the therapeutic experience, attempting to delineate the various positions in which the patient may find himself with regard to group forces and to define the group conditions under which positive therapeutic, as opposed to damaging, experiences are likely to occur.

Part III focuses on the manner in which the therapist can contribute to the therapeutic process. The previous sections have defined the character of the group processes and their impact on the individual’s therapeutic experience; this section takes up the issue of what ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Table of Contents
• PREFACE
• PART I: THE GROUP PROCESSES: THE CONTEXT OF THERAPY
• PART II: THE INDIVIDUAL’S THERAPEUTIC EXPERIENCE
• PART III: THE THERAPIST’S CONTRIBUTION
• PERSPECTIVE
• BIBLIOGRAPHY
• INDEX