Basic Aspects of Psychoanalytic Group Therapy (RLE: Group Therapy)

Peter Kutter

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317624660
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

First published in English in 1982 and based on more than five years of experience with therapy groups in the author's own practice, this book aims to introduce the reader to psychoanalytic group therapy. Assuming little previous knowledge, it presents the subject in a progressive and illustrative way, and gives a central place to case material that was otherwise rarely published. Theory remains in the background and serves only to direct light on to problems which arise in practice, such as working through the early mother child relationship and the Oedipus complex in the group situation, the theory of the group process, and the various forms of transference, including the group conductor's counter-transference.

The book's special value consists in its practical non-dogmatic orientation, in its integration of a variety of conceptions about groups, in its vividly illustrative case presentations, and in the open discussion of the problem of counter-transference. Written in non-technical language, it gives a lively picture of how 'the business of psychoanalytic group therapy' is managed, and will be of value to group analysts in practice and in training, as well as those interested in a more general way in psychoanalytic group therapy and what it is all about.

Chapter 1 Indication for treatment and the contract

DOI: 10.4324/9781315754628-1

The complex process that takes place within psychoanalytic group therapy runs through an initial phase, a middle or main phase, and an end phase. The process begins with the composition of the group which is either predetermined by the conductor who selects the group members, or by a colleague of his who puts a group together for him. In all cases the structure of a group is given from the start through its members.

Here we have to consider the selection of patients together with the question of indications for psychoanalytic group therapy. Both, indication and selection, are of great significance for the fate of the group and its entire development.

As in individual therapy, the candidate for group therapy should be able to establish a working alliance¹ with the analyst. The patient should have a sufficiently strong motivation to participate in psychoanalytic group therapy. Such a motivation implies that he sees this method as a way of overcoming his difficulties. Moreover, the patient should be able to imagine himself in the group situation. There he is, together with six to ten other people and will have to talk not only about his symptoms, but also about his emotional problems, without too much verbal inhibition and without being too ashamed.

The analyst and the patients agree on a contract that includes the following points: each patient is prepared to settle down in the group to the best of his ability; to attend the sessions regularly; to arrive on time; and, in the interest of the common good, to feel responsible vis-à-vis the conductor and the other members. The criteria for individual therapy should be added here, namely: motivation of the patient heightened through the pressure of suffering; interest in discovering the psychological background of one's complaints; a certain capacity for insight in relation to oneself and others; as well as perseverance and purposefulness. Each group member has to be ready to participate in the group process. As this process affects the whole person, members should be aware of the fact that temporary worsening of symptoms can occur and that this process can trigger off fundamental changes in their existing human relations outside the group.

Further preconditions are: a certain degree of ego-strength, which enables one to control and direct one's instinctual impulses, to cope with emotional stress and to defer gratification of drives of hatred and love as well as to channel them towards the attainment of socially more elevated goals. Klaus Frank mentions another criterion²: the patient has to be able to move and change back and forth between himself and the structure of the group-as-a-whole. In other words, he should be able constructively to perceive and manage himself in the group, as well as the group-as-a-whole. According to this criterion, personalities with a weak ego, with a propensity to impulsive explosions, and with little capacity to cope with frustration – that is to say to tolerate their own failures – would not be suitable for psychoanalytic group therapy. Such members might damage the group through the destructive aggressiveness which is peculiar to them. Should they be admitted to group therapy, sooner or later the group itself will push them out for the sake of its survival. On the other hand, a destructively aggressive member is not always forced to leave the group. Quite often the contrary happens. The group singles out such a member – predestined for its purpose – in order to project on to him, or her, unconscious parts of the other participants’ personalities. These projected aspects of personality are those against which group members defend themselves. The projection allows group members to fight against the rejected parts of themselves in the other person. This is the well-known defence mechanism of finding a scape-goat. This mechanism has to be worked through by the group, lest injustice befall the member singled out by the group.

The contract between patients and analyst also includes the so-called fundamental rule. As in individual therapy, this rule has to be honoured in order for the process to start. The fundamental rule, applied to the group, runs as follows: Each group member says as freely and spontaneously as possible whatever occurs to him, regardless of whether it is pleasant or not, whether it belongs to the dominant theme of the moment, whether it is embarrassing or whether it appears somehow irrelevant. In other words, group members agree that as far as possible they will lift the control exerted by critical thinking. Instead of ‘free associations’³, in psychoanalytic group therapy we speak of ‘group associations’ or ‘free-floating discussion’. This type of discussion can be considered as the equivalent of the Freudian ‘free associations’ in individual analysis.⁴ The interactions, underlying the free-floating discussion, are always determined through the presence of others. To put it differently, the individual member is free only to the extent to which the others allow him to be. On the other hand, despite the presence of others, each member is free to talk, but by doing so he limits the others. The alternating talking and not-talking of one group member and the others is characteristic of free discussion in a group.

Chapter 2 Understanding, observing, interpreting

DOI: 10.4324/9781315754628-2

In order to be able to grasp the great variety of phenomena which occur in groups and to find one's way among them, a general frame of reference is needed. Basically, there are three major paths which, in my opinion, complement each other and together constitute such a framework: understanding, observing, and interpreting.

1 The path of understanding

The first path for the conductor is that of understanding the group members through psychoanalytic empathy which is also called the hermeneutic method. As a conductor I try to understand what the group members feel and where they stand. I do this through empathy, by putting myself in their place so that I may feel as they do. I also try to understand what the other person says, what his talk manifestly means and what is the concealed meaning behind it. Since Freud, we know that we do not understand our patients if we only note the literal meaning of their statements. We will only understand them if we try to find out what meaning lies beyond their statements. The concealed meaning of what they say remains a mystery to them because they could not cope with it emotionally. This meaning is mostly aggravating and hurtful, so the real content is disguised in the same way as the dream disguises its true meaning behind images. The meaning of a dream image has to be uncovered progressively through interpretation. As far as possible, the concealed meaning should be interpreted with the co-operation of the patient. The latter has to bring his free associations and his ideas to the interpretation.

As a conductor I also try to understand individual members of the group and to find out what makes them tick. As for the group as a whole, I start with the theoretical assumption that the discussion in the group revolves at all times around a common theme of which the group members are not conscious. We talk of ‘common group tension’, of a ‘common denominator’¹ or of a ‘common unconscious fantasy’² in which all group members have a share, but to which each of them as an individual reacts differently.

Through empathy the conductor should be able to understand both the common unconscious fantasy as well as the specific individual reaction of each participant to it. As a result of the repetition compulsion,³ experiences which were too rejecting or too pampering to be worked through in childhood continue to affect the person's current behaviour. Therefore, we can start by assuming that each participant unconsciously attempts to act out those scenes to which he is traumatically fixated. Understanding the ‘scene’⁴ means that as a conductor I try to understand the situation which is developing by letting myself be part of it to a certain extent. At the same time, relying on my knowledge of the crucial stages of psychic development and social relationships, I try to find out which one of these developmental stages is being re-enacted. If I manage to do both, then I succeed in being as close as I possibly can to the participant's actual experience. The knowledge of how drives, love, hatred, the personality itself and interpersonal relationships develop is particularly helpful. Interpersonal relationships and their development are particularly important, such as: two-person relationships between mother and child, between child and father, as well as triangular relationships between mother, father and child, and, finally, multiple relationships within the family as a whole – especially with and among siblings – and the relationships in other groups, such as in the kindergarten, at school and so on.

Based on several years of self-training in this kind of observation, I try to pick out the pattern of relationships prevalent in the group at a given moment. Then I see whether my empathic feeling can be brought into harmony with my knowledge of the psychology of drives, ego-psychology and the psychology of object relations. After having examined it in the light of theory, I try to interpret my perception to the group. I try to say in appropriate sentences what I have perceived in an empathic and psychoanalytic way. In all this process it is my own feelings first and foremost which help me to understand what feelings prevail in the group.

2 The path of observing

The conductor not only feels the scene in an empathic way, but he is also an observer. He observes the group members’ behaviour, their facial expressions, gestures, postures, and speech: whether they sit in a tense, stiff manner or are relaxed and at ease; whether they speak in a low or loud voice, one at a time or all together in a confusion. He pays attention to signs of excitement or anxiety, such as blushing, flushing, trembling hands, sweating. In the first place, the conductor listens to the contents of the speech, to sentence and word and to how they are cathected by emotions. He is on the look out for the emotions underlying the contents. Jealousy and envy, hatred and love, revenge and attempts at reparation play a central part. The conductor should always be aware of defences being directed against the core of the communication which, therefore, is not expressed directly. Nevertheless, when former relationships with parents and siblings, aunts, uncles and grandparents are re-lived in the relationship with the conductor and other group members, the original emotions, anxieties or desires often become apparent in the excitement of the here and now.

3 The path of interpreting

The analyst's specialized knowledge of developmental and social psychology allows him to make interpretations. He has knowledge of the psychic mechanisms as described by psychoanalysis, and more precisely by the instinct-psychology, ego-psychology and the psychology of object relations. The knowledge of the so-called psycho-sexual development stages, as described by Sigmund Freud in his Three Essays on the Theory of Sexuality⁵ is essential. The significance of the ‘oral’ stage is not only food intake and gratification through the mouth, but also the question of whether one is accepted or rejected. The ‘anal’ stage does not hinge only on the excretory functions, but it has to do with self-assertion, with carrying through one's purpose, dominating or being dominated, with destroying or being destroyed. Finally, in the ‘genital’ stage the specificity of the sexes develops. The male-female polarity determines the instinctual life of the child during this stage. After a latency period, these three development stages are relived in an intensified form during puberty. Their reappearance has to do with a suddenly heightened drive progression resulting from physiological changes. Then, during adolescence and early adulthood, the three stages are integrated progessively into the personality.

Following Erik Erikson,⁶ one can conceive of the Freudian development stages as being a series of eight psycho-social crises through which a healthy personality grows. Each of these crises takes place between two opposite poles. The first of these opposites is trust versus basic mistrust, followed by autonomy versus shame and doubt, initiative versus guilt, industry versus inferiority, identity versus role diffusion, intimacy versus isolation, generativity versus stagnation, and the final stage of ego integrity versus despair. As Erikson's categories – unlike the Freudian development stages – make the social aspect of development very clear, they are most suitable to be applied to psychoanalytic group therapy.

Erikson's categories are particularly helpful to sort out group processes.⁷ After all the group is a social field in which crises and personality growth takes place. The problem of trust plays an important role right from a group's inception. Equally important is the question of the individual's identity in the group and the group's identity as a whole. The polarity intimacy versus isolation is one of the central themes concerning the individual in the group. Remarkably enough, it is by no means only the later stages of childhood and their multiple relationships which are revealed. Even the earliest relationship with the mother⁸ as well as the relationship with the father,⁹ comes to the surface in the group.

As a conductor I observe not only the relationship patterns as they are reactivated, but also their cathexis: whether they are characterized by love or hate; whether they are ruled by jealousy, and so on. For instance, jealousy in the group can be that of the child whose mother turns away from it in order to turn her attention to father. Often the envy that originally was directed against the mother is transferred to the analyst: he is envied for his skills, professional position, his wealth of experience and his relative independence. We shall return to this point in greater detail later on.

Chapter 3 Three theoretical models of psychoanalytic group therapy

DOI: 10.4324/9781315754628-3

1 Therapy of the individual in the group

The understanding, observing and interpreting of the group process goes hand-in-hand with the understanding, observing and interpreting of the changes that occur in each individual member. This view does not imply that I use the group only to treat a single individual at a time, as if the other members were not there or as if they assumed only psychoanalytic functions together with the conductor. Admittedly, this is one of the possible ways of sorting out the multiple processes in the group. This is the way, for instance, Alexander Wolf and Emanuel Schwartz work.¹ On the other hand, I have to mark off my position also vis-à-vis those writers who see the group only as a whole and consider the individual at most as the ‘speaker’ of the group.² In my view, the conductor has to pay the same attention to the individual as to the group. For this reason I prefer to see each participant in an individual interview before he joins the group. Such a pre-group interview gives each member an opportunity to establish a working alliance as well as a personal rapport with me. It also enables the participant to transfer on to me as an individual...

Table of contents

• Cover Page
• Half-Title Page
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• Preface to the English edition
• Preface to the German edition
• 1 Indication for treatment and the contract
• 2 Understanding, observing, interpreting
• 3 Three theoretical models of psychoanalytic group therapy
• 4 The first session of Group 1
• 5 Hatred and love between the sexes: continuation of the process in Group 1
• 6 Resistance and defence in psychoanalytic group therapy
• 7 Transference in psychoanalytic group therapy, exemplified by Group 2
• 8 The struggle with authority. Subsequent course of the group process in Group 2
• 9 The group process: each individual participates in shared events
• 10 Early mother-child relationship in the group: split into good and bad
• 11 Self-destruction of a group or the result of constructive separations?
• 12 Sexuality and the Oedipus complex in the group
• 13 Aggressiveness in the group
• 14 The conductor’s function
• 15 The relationship between individuals, the psychoanalyst and the group
• 16 The end phase of the group process
• 17 After group therapy has ended
• Notes
• Index