Ring of Fire

Primitive affects and object relations in group Psychotherapy

Malcolm Pines, Victor Schermer

• Publisher: Routledge
• Year: 2003
• ISBN:
  9781134919062
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

The ring of fire stands for the life cycle of both the universe and each individual being: the circular dance of nature in the eternal process of creation and destruction. At the same time, the light radiated by the ring of flames symbolizes eternal wisdom and transcendental illumination. -J.E. Cirlot. A Dictionary of Symbols The circular form in which the group is seated symbolizes its unity, connectedness, and cohesion as well as its microcosmic relation to the larger world of human evolution, culture, and the life cycle. Foulkes, Bion, and others have identified primitive layers of affect and object relations where universal collective themes and early infantile object relations are re-experienced and repeated in the meeting place for healing called the therapy group. In this context, very profound emotions and energies are released which have deep implications for change and growth, provided the therapist can manage and respond to them effectively. This book brings together a collection of new and original contributions to an understanding of primitive object relations and intensely critical emotional states which present the maximum challenge to the group psychotherapist: the ring of fire. An international group of colleagues, based primarily in Great Britain and the United States, address areas of special interest to them and to which they have devoted considerable research and therapeutic effort. They provide insights into the dynamics of these issues and guide the therapist in the management and interpretation of the group events as they unfold. While much has been written on primitive group states, the information is scattered throughout many journals and books and all too often does not address the practical problems faced by the group therapist in Practical terms. Furthermore, there have been significant developments in affect theory and object relations theory which have yet to be assimilated sufficiently into the theory and technique of group psychotherapy. This book attempts to reduce that gap as it concentrates on the relevance of concepts to treatment in accordance with Kurt Lewin's maxim, There is nothing so practical as a good theory. Ring of Fire will be invaluable to group psychotherapy supervisors, beginning and experienced group therapists, students and supervisers of group psychotherapy and group dynamics, and organizational consultants who utilize group dynamics principles in their work. Victor L. Schermer is a clinical psychologist in private practice in Philadelphia. He is Executive Director of the Study Group for Contemporary Psychoanalytic Process and Director of the Institute for the Study of Human Conflict. Malcolm Pines was, until his recent retirement, Consultant Psychiatrist at the Tavistock Clinic, London and is a member of the Group-Analytic Practice.

1 An editorial introduction
Silence=death

Malcolm Pines and Victor L.Schermer

The ring of fire ‘stands for the life cycle of both the universe and each individual being: the circular dance of nature in the eternal process of creation and destruction. At the same time, the light radiated by the ring of flames symbolizes eternal wisdom and transcendental illumination.’

J.E.Cirlot, A Dictionary of Symbols

To everything there is a season, and a time for every purpose under heaven.

Ecclesiastes

Group psychotherapy, like the human life cycle, has its universal ongoing themes punctuated by periods of intense emotionality, crisis, regression and transformation. The circular form in which the group is seated symbolizes its unity, connectedness and cohesion as well as its microcosmic relation to the larger world of human evolution, culture and the life cycle. Foulkes, Bion, Ezriel and others have identified primitive layers of affect and object relations where universal collective themes and early infantile object relations are re-experienced and repeated in the meeting place for healing called the therapy group. In this cauldron of group emotionality, profound energies are released which have a wide range of implications for change and growth.

This book brings together a collection of new and original contributions to an understanding of primitive object relations and of those highly charged emotional states which present the maximum challenge to the group psychotherapist: the ‘Ring of Fire’. In the present volume, an international group of colleagues, based in Great Britain, France and the United States, address areas of special interest to them and to which they have devoted considerable research and therapeutic effort. They will provide insights into the dynamics of these issues and guide the therapist in the management and interpretation of the group events as they unfold.

When Ring of Fire was initially conceived, and each of the contributing authors was contacted, the editors specifically asked him or her to provide, in effect, a teaching and supervisory experience about a particular group issue or set of issues which had been of special interest for an extended time period. We think that the reader will find this goal of such an intimate learning experience with each author at the helm has been largely fulfilled. Certainly, a passionate and important ‘message’ about the conduct of group therapy is conveyed by each author, yet within the framework of careful observation and scholarly integration, and, thanks to some detailed vignettes and protocols, the reader gets a clear sense of what goes on in actual, ‘live’ group therapy sessions.

While much has been written about primitive group states, there have been recent developments in psychoanalytic ego psychology, self psychology and object-relations theory which cry out to be assimilated into the theory and technique of group psychotherapy.This book attempts to partially close that gap by emphasizing the relevance of newer concepts to treatment.

CURRENT DILEMMAS AND ISSUES IN THE FIELD OF GROUP PSYCHOTHERAPY

The incentive for bringing together this collection of articles and essays stems from the striking developments and changes in the context and the practice of group psychotherapy over the past ten to fifteen years, some of which are indeed heartening, but many of which have proved troubling to the serious and dedicated psychotherapist.

A matter of great concern to today’s therapist and, for that matter, any human being who inhabits this planet, is the increasing and sometimes traumatic impact of individual and group regressive phenomena on our lives. One could cogently argue that we are currently witnessing a global primitivization of emotional experience as a result of the population explosion, the catastrophic destructive power of modern weapons of war, and the overwhelming quality of advanced technology and modern self-consciousness with a backlash tendency towards primitive splitting, denial, avoidance and pathological narcissism.

Social observers have pointed out the extreme, psychotic-like nature of war in this century; the genocidal leadership pathology of Hitler, Stalin, Saddam Hussein, and so on, the collective paralysis and unresponsiveness to atrocities in the Holocaust and more recently in Serbo-Croatia; and the alienation and anomie of contemporary culture. More proximal to group treatment, numerous therapists have noted the increased influx of borderline and narcissistic patients into their practices. In many ways, life has always been difficult and conflictful, even violent, but these times do seem to be especially so, placing severe stresses on the personality and the social group. It is perhaps encouraging that, in small ways, therapists, negotiators and diplomats are beginning to join forces to apply psychotherapy principles to diplomacy and intergroup conflict resolution (cf.Volkan, Ettin and others).

Whether such primitivization is a result in part of the observer-influenced outcome of enhanced theoretical and observational skills which allows us to perceive the pre-oedipal layers below the oedipal complex, or whether it is the increasing impact of regression due to global communication, powerful technologies and population increase, the reality is that primitive regression is an increasingly impinging and insistent aspect of the ongoing context within which all group psychotherapy is conducted. The group therapist who does not attend to the primitive layers either engages in ‘whistling in the dark’, ignoring and not treating defects and deficits in the self and object relations which underlie the presenting symptoms, or at times sets up the group for catastrophic situations of acting out, loss of group cohesion and failure to thrive as a group. So many patients have been affected by regressive psychocultural and traumatic processes as they operate in childrearing practices, neglect and abuse; substance abuse, and other regressive expressions of culture and society. To be effective psychotherapists, we must be able to accompany such patients and groups through these very painful layers of experience.

An additional concern of far-reaching importance for the environment in which group therapy is conducted is the precipitous change in the health care systems and funding streams which support the therapy process. In the 1960s and 1970s, there was enormous enthusiasm for insight-orientated psychotherapy. Scholarship and research abounded, and public and private grants supported and encouraged pure and applied research, pioneering efforts in individual, family and group psychotherapy, and the start up of new mental health and addictions treatment programmes. Both patients and insurance companies were ready and willing to pay for long-term outpatient treatment, and even long-term hospital stays. In that context, a variety of group therapies thrived and proliferated and had social impact well beyond the professional and treatment sectors.

More recently, a number of trends have militated against dedicated, humanistic and psychodynamic long-term therapy efforts. The most clear-cut force against such work has come from so-called ‘third party’ funding sources, whether private insurance companies or government-provided health care. In efforts to stem the tide of astronomically increasing health care costs, an admittedly necessary goal, the funding sources have undercut and undermined effective treatment efforts. They have fostered the belief that treatment can be done quickly, and they have done so without the careful research and ‘hands on’ experience necessary to justify changes in practice where human lives are concerned. The more extreme and poorly thought through of these ‘utilization review’ and ‘managed care’ efforts have already had a devastating impact on treatment and research. In England, for example, the Cassel Hospital, the Tavistock Clinic and the Henderson Hospital, world-renowned centres for treatment and research in group psychotherapy, have only barely survived, despite vehement public agitation, the changed climate of the late 1980s and early 1990s. Similar stories could be provided for some of the most prestigious institutions in the United States.

This volume implicitly argues for and is a testimony to longer-term treatment efforts which consider the dynamics of the whole person and wrestle with the deeper levels of difficulty beyond the surface symptoms and which have to do with the quality and durability of treatment efforts rather than patching up and covering up the disorders.We all need to work together to make proper and appropriate intensive psychotherapy available and affordable to those who need it.

Such social and economic forces impacting upon the treatment process are further reinforced by the overall societal increase in pathological narcissism discussed by Christopher Lasch and others. Excessive self-centredness reinforced by social norms of isolation leads severely distressed and disturbed people either to avoid treatment entirely on account of the human contact and the admission of shortcomings it entails, or else to make demands for quick, painless ‘cures’ rather than self-explorations which uncover defences, resistances and areas of vulnerability in the self. The positions of both the psychoanalyst and the group analyst, looking objectively at individual and group phenomena yet with a deep concern for the patients’ well-being, is not easily maintained when people in increasing numbers are seeking ‘warm, fuzzy’ therapy experiences, self-appointed gurus who promise instant transformation, and medications which provide instant escape and relief.

Thus, the present volume, coming to publication as it does in the 1990s is at one level almost a cry in the wilderness, asking that, as therapists, we have the courage to stand up to some of these onslaughts. One place to begin doing this is in the consulting room itself, by practising better therapy, and by asserting the power of our work once again, the power to help persons change by achieving greater self-insight through the nurturing and developmental capacities of the group process. Each chapter of this volume seems to say that it is possible and necessary to dare to go with the group into the primitive realms, mindful of course of the defences, and, through the therapeutic alliance, to learn with the group what we are all made of.

THE NEED FOR A SCIENTIFIC FRAMEWORK INTEGRATING THEORY AND PRACTICE

The role of theory and a scientific framework for group psychotherapy has found proponents as well as opponents. It is certainly possible to justify, from both existential and phenomenological standpoints, that theory and empirical investigation can both cloud the therapist’s perception and potential for relating in an ‘I-thou’ relationship to the group members, a relationship which promotes ‘agape’, genuineness, positive self-regard and inner change. The existential approach focuses on our human condition of absurdity and aloneness. Phenomenology says, ‘What you see (or, more recently in self psychology, what you empathically understand) is what you get.’ In both views, ‘experience-distant’ theory is believed to interfere with the direct linkage in the here-and-now between patient and therapist. The French existentialist philosopher Jean-Paul Sartre once said, The worst crime is to make abstract that which is concrete’, by which he meant that abstraction distances us from the human condition and causes us to ignore forceful realities.There is much truth in these words, but we must remember that Sartre is referring to a misuse of abstraction to avoid painful realities and human compassion.

Psychoanalytic, group-dynamic, and group-analytic approaches have consistently emphasized the importance of theory in consolidating and systematizing data from human development and from the consulting room. Today, however, we are increasingly aware that theory does not entirely stand for ‘truth’ as such or for unchangeable patterns of events. As Werner Heisenberg, a founder of quantum theory, pointed out, scientific theory and the observations on which it is based are a function of the observer as well as the observed. In therapeutic parlance there is no observation, inference or theory that is without the subjective bias of countertransference.

So, in the present view, theory and the scientific frame of reference are an inherently paradoxical blend of the subjective and objective, like an Escher print; yet theory is necessary, as are the birds and the fish in one of Escher’s drawings.The latter are necessary, though neither ‘birds’ nor ‘fish’ ‘exist’ as such. What exists is the paradox. Modern physicists, with their quantum theory and chaos theory, would heartily agree with us. The symbolism of the ‘Ring of Fire’ reflects this paradox. The ring is the most perfect, aesthetic, parsimonious figure, representing the unity of thought which scientists seek.Yet it is burning, dissolving.

GROUP THERAPY SITUATIONS AND POPULATIONS OF THE ‘RING OF FIRE’

When the co-editors of this book explored possible themes, the one which stood out as the focus was the following: to examine the most difficult situations and dynamics in group psychotherapy and depict how particular therapists, each from his or her own perspective on primitive affects and object relations, deals with these situations and dynamics. If we were to take a survey of what therapists at various levels of training and experience found ‘most difficult’, we would undoubtedly find individual and subgroup differences as well as commonalities. A beginning therapist, for example, might say that ‘screening for a proper mix of group members’ or ‘developing a cohesive group’ are the most difficult tasks. A therapist working with a population of severely depressed patients might say, ‘a suicidal crisis’.

One criterion used in the present volume has been the sorts of difficulties which are not only of interest to beginners but continue to be of ongoing concern to therapists who have completed basic training sequences in group psychotherapy and have honed their group skills with some supervised group therapy experience. For example, the ‘perpetual motion’ of separation, loss, grief and mourning which characterizes groups, and especially ‘bereavement groups’, may distress and baffle the therapist. Jeffrey Kauffman holds that such mourning processes are the very ‘Rosetta Stone’ of what propels groups in the first place, offering for our consideration a new group psychology based on mourning as the central process.

Another instance of a ‘primary preoccupation’ of the group therapist is the intense aggression which may occur in almost any group, and the management of which most therapists find of great concern. Saul Tuttman, although he focuses primarily on patients we would consider ‘character disordered’, discusses ways that an object-relations/ego psychological model might be applied in almost any group therapy context to manage and work through severe anger and hostility.

Ring of Fire addresses such issues of ongoing concern. Further examples include pressure on the therapist to join in collusive, projective and scapegoating events and processes (Hinshelwood), attacks on thought and emotional growth (Gordon), group treatment of borderlines (Pines) and psychotic patients (Resnik), problems of the co-therapy dyad (Klein and Bernard), and difficulties that come up in milieu therapy situations (Skolnick).

A second criterion for the choice of situations and populations for this volume is the usefulness of contemporary theoretical perspectives in addressing the problem, Self psychology and object-relations theory, for example, have proved very helpful in working with borderline, narcissistic and psychotic patients.As we have said, Malcolm Pines focuses on borderline and narcissistic patients in outpatient open-ended therapy groups. Harold Bernard and Robert Klein delve into the co-therapy issues attendant on work with such patients, utilizing what they term an integrated ‘systems/developmental’ perspective, emphasizing ‘boundary and decider subsystems’ of the group along with developmental insights on borderline and narcissistic personality from Kernberg, Masterson and others. Salomon Resnik and Marvin Skolnick each independently address issues centring around the most profoundly difficult patients’ intensive group and milieu treatment: chronically mentally ill borderline and psychotic patients. Resnik is indebted to Bion’s work on both group assumptions and on psychosis. Skolnick applies the A.K.Rice ‘Systems of Organization’ model to the therapeutic community. Yvonne Agazarian uses a synthesis of systems theory and object-relations theory to provide a schema for therapeutic interventions in each phase of group development. One of the editors,Victor Schermer, has contributed a chapter on theory, which will take the reader on a ‘guided tour’ of such conceptual developments in group psychology and psychoanalysis.

A third and quite unavoidable criterion of chapters for Ring of Fire has, like it or not, turned out to be Darwinian natural selection! There were profound and precious time and space constraints imposed on putting together a collection of articles for a book such as this. If time had permitted the sifting, sorting and soliciting of more material, and if the size of the volume were considerably larger, the editors would almost certainly have included topics additional to those which finally have gone to press. For example we would definitely ...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• CONTRIBUTORS
• FOREWORD
• 1. AN EDITORIAL INTRODUCTION: SILENCE=DEATH
• 2. BETWEEN THEORY AND PRACTICE, LIGHT AND HEAT: ON THE USE OF THEORY IN THE ‘RING OF FIRE’
• 3. THE PHASES OF GROUP DEVELOPMENT AND THE SYSTEMS-CENTRED GROUP
• 4. ATTACKS ON THE REFLECTIVE SPACE: CONTAINING PRIMITIVE EMOTIONAL STATES
• 5. BION’S POST-EXPERIENCES IN GROUPS THINKING ON GROUPS: A CLINICAL EXAMPLE OF -K
• 6. BORDERLINE PHENOMENA IN ANALYTIC GROUPS
• 7. GROUP THANATROPICS
• 8. THERAPEUTIC RESPONSES TO THE EXPRESSION OF AGGRESSION BY MEMBERS IN GROUPS
• 9. UTILIZING CO-THERAPY IN THE GROUP TREATMENT OF BORDERLINE AND NARCISSISTIC PATIENTS
• 10. INTENSIVE GROUP AND SOCIAL SYSTEMS TREATMENT OF PSYCHOTIC AND BORDERLINE PATIENTS
• 11. GLACIAL TIMES IN PSYCHOTIC REGRESSION