Chapter 11 – Group Analytic Psychotherapy and the Group Analytic Model: A Clinician’s Guide




Abstract




Group analytic psychotherapy is an important psychotherapeutic treatment, both in the NHS and the private sector. Many patients seek help for difficulties in social relating and maintaining intimate and supportive relationships with families, colleagues, friends and partners. Relationships are key to how we live, function, develop and respond to adversity. Harmful patterns of relating and difficulties with intimacy predispose to mental health difficulties, and impact powerfully on the ability to recover. For many people presenting in distress and seeking psychotherapy, group analytic psychotherapy should be viewed as a treatment of choice.





Chapter 11 Group Analytic Psychotherapy and the Group Analytic Model: A Clinician’s Guide



Maria Papanastassiou



Introduction



You meet regularly with a group of people who also have problems and a psychotherapist. It is not provided because it is cheaper but because it is the best treatment for some people.  It is particularly helpful if you have problems in relationships that happen again and again.  It is actually powerful and encouraging to find that you aren’t alone with your problem – and that you may even be able to help other people in the group [1]


Group analytic psychotherapy is an important psychotherapeutic treatment, both in the NHS and the private sector. Many patients seek help for difficulties in social relating and maintaining intimate and supportive relationships with families, colleagues, friends and partners. Relationships are key to how we live, function, develop and respond to adversity. Harmful patterns of relating and difficulties with intimacy predispose to mental health difficulties, and impact powerfully on the ability to recover. For many people presenting in distress and seeking psychotherapy, group analytic psychotherapy should be viewed as a treatment of choice.


In addition to being an important treatment option, group analytic psychotherapy has made a significant contribution to understanding how group processes influence and underlie human behaviour. This has implications for international relationships, sociocultural, political and organisational structures.


This chapter is divided in the following sections:




  1. 1. Historical context and emergence of group analysis in the UK



  2. 2. The group analytic treatment model



  3. 3. The role of the group therapist/conductor



  4. 4. Some important concepts in group analytic psychotherapy



  5. 5. Setting up a group: indications and contraindications



  6. 6. Setting up a group: practical considerations



  7. 7. Conclusion



Historical Context and Emergence of Group Analysis in the UK


The UK has led the way internationally in group psychotherapy with Foulkes and Bion being the two major contributors to the development of both theory and practice. In the USA Yalom has had a major impact and his views about therapeutic factors are widely used [2]. This chapter will mainly focus on the group analytic model which originated from Foulkes. In addition, it will briefly describe Bion’s main group concepts.


S H Foulkes (1898–1976), a Jewish psychiatrist and psychoanalyst, arrived from Frankfurt, Germany to the UK in 1933. He developed ideas about treating patients therapeutically in groups having witnessed the utter destructiveness of War and how murderous processes can be enacted between groups. He worked as a psychiatrist at Northfield military hospital [3] introducing group methods as a method of treating soldiers who returned traumatised from the brutal experiences in battlefield [4]. Foulkes founded the Group Analytic Society in London in 1952. Group analysis is nowadays flourishing in many different countries under the auspices of the Group Analytic Society International (GASI).


W R Bion (1897–1979), a psychiatrist and psychoanalyst who was also based at the Northfield’s Military Hospital, developed his own ideas about how people are affected by group processes around the same time as Foulkes. Bion was involved in the first ‘Northfield experiment’ but his approach was somewhat different to that of Foulkes and he left Northfield to further develop his ideas at the Tavistock Clinic in London. He introduced the term ‘Work group’ to describe a group which is functioning effectively in relation to its task, and the ‘Basic assumption group’ which functions more defensively in response to anxiety. According to Bion, groups can function both constructively and defensively, the balance between these forces can rapidly fluctuate and is influenced by powerful unconscious processes.


Bion described basic assumption groups as taking on three main forms;




  1. 1. Fight/flight – when the group acts as if its main task is self-preservation against extreme threat. The group then functions in an aggressive or hostile manner (fight mode) or takes flight from therapeutic work through avoidance strategies, for example lateness, social chat



  2. 2. Dependency – refers to an assumption that the group members’ needs will be magically met by another, leading to passive behaviour by the group and the leader being seen as omnipotent or idealised. This is unstable and may lead to an attack and an unconscious wish to get rid of the leader



  3. 3. Pairing – when the defensive formation of ‘couples’ takes place in a group in light of extreme anxiety. A position of ‘shared’ understanding in the group then emerges and the ‘couple’ jointly takes on the work of the group through their interactions as a pair. The group may see the couple as if a sexualised pair and all creativity may become located within the couple


Group members vary in their tendencies towards these basic assumption positions and can oscillate between them, depending on the nature and intensity of the anxiety emerging in the group. These ideas describe universal processes in groups – be they therapeutic, social, political, organisational and so on. At times, these qualities may be necessary and desirable – for example the need for military discipline during conflict where dependency on the leaders to follow instructions may be vital. Bion’s ideas have made a major contribution to the understanding of group processes, particularly in elucidating destructive forces. These ideas have informed the development of group consultancy for organisations, and group relations events such as the Leicester Conference, a highly regarded annual large group relations event in the UK [5].


In terms of group psychotherapy and overall clinical practice, the ideas of Foulkes and his group analytic approach have been widely spread across the UK and internationally, forming the primary group analytic treatment model.



The Group Analytic Treatment Model


The group analytic model embraces concepts from various disciplines such as psychoanalysis, sociology, systemic theory, and anthropology. Foulkes viewed the individual as a ‘nodal point in a network of relationships’ and the group as being ‘larger than the sum of its parts’. He coined the term ‘matrix’ [6], which is a central concept in group analysis. The term refers to the hypothetical web of communication in the group that takes place both consciously and unconsciously during the group. He divided the matrix into the ‘foundation’ and the ‘dynamic’ matrix. A group member arrives in the group with the foundation matrix (his/her own history, culture, nationality, race, traumas, sex, gender, social status etc.) and this is quite a static position. What then occurs is an interweaving of processes and narratives between group members throughout the life of the group which forms the dynamic group matrix, which is an ever-changing, creative space between people that has a potential for transformation and change for its members. The group and its members co-create something similar to a piece of music produced by an orchestra, a ‘creative intersubjective space between people’ where each group member learns to adjust to the rhythm of the group [7] and each individual’s contribution is understood in the context of the whole [8].


Foulkes was influenced by the sociologist Elias (1897–1990) and emphasised the fundamental need to relate and belong, as primary, and man’s social instinct as an ‘irreducible basic fact’ [9]. Humans cannot exist in isolation like a fish cannot live without water. They are interdependent, always part of one group or another, inseparable from their societies. According to Elias the individual is the singular, and the social is the plural of the same phenomenon [10, 11]. Each individual is both enabled and constrained by the expectations and demands of both themselves and others.


Mental health difficulties arise in the context of family and social groups. Within the therapy group, this complex web of family and interpersonal relationships becomes manifest through the transference relationships, between the therapist and the patient, the therapist and the group and between the patients themselves. New meaning is created through the group’s common narrative which can be understood and offer new insights, allowing the possibility for different ways of perceiving and responding to others. The individual can then mature and grow through this process. The group as the ‘environment mother’ and the matrix of communication is the transformational object that in itself provides the basis and containment for psychological development.


While Foulkes has been criticised for neglecting the group’s destructive forces in groups, several authors have further enriched group analytic theory [1217] by paying attention to those processes. Nitsun for example, introduced the ‘anti-group’ concept which incorporates the destructive processes that take place during the group experience [15]. He suggested that the therapist must hold both creative and destructive processes in mind for the group’s transformative potential to be reached. Without the therapist’s awareness of these destructive processes, there is a danger of idealisation of the group which cannot be sustained and which limits the potential growth and is a threat to the group’s survival.



The Role of the Group Therapist/Conductor


Foulkes defined group psychotherapy as ‘psychotherapy for the group, of the group, including its conductor’ [18], emphasising that the therapist is also a group member who learns from, and to an extent is altered by, the group experience. He renamed the group therapist as ‘conductor’, a term reflecting the orchestra-conductor’s fluctuating authority and nuanced facilitatory role. The conductor, in the early stages, is responsible for ‘modulating the tempo, linking various instruments together, interpreting the score’ [19]. As the group progresses, the conductor acts more as a facilitator and a convenor rather than a leader, relinquishing his/her authority to the group with exception at times of great anxiety or change in the group where greater containment is needed, for example when members join or leave the group.



Dynamic Administration


The group therapist’s primary task, during its early group formation is called dynamic administration. Dynamic administration ‘refers to various activities which the conductor performs in order to maintain this setting. The concept includes such apparently mundane tasks such as arranging the furniture in the room and drafting letters to group members which in the face of it might be delegated to a secretary or administrator. The conductor takes on these tasks because they have dynamic significance and have to be woven into the material which forms the analytic process’ [8]. In the early phases of the group the anxiety tends to run high as in other forms of psychotherapy but in a group this is much amplified by the presence of other group members who are effectively strangers. The group may evoke a fear of contagion of others’ ‘madness or depression’, exposure of weakness, vulnerability, helplessness and dependency as well as fear of the responses of others, annihilation of the self and loss of identity in the face of the group. The conductor’s authority and leadership style is crucial at this point.


Particularly in the early stages of joining a group, patients may find ways to reduce anxiety by challenging the boundaries of the group, for example forming subgroups or deciding to meet outside the sessions. This undermines the task of the group and may also repeat early life boundary violations. The analyst’s firm, curious but non-critical authority is required in these circumstances in order to recover safe boundaries and the capacity for the group to act as a safe and effective container [20].



The Conductor’s Interventions


The conductor is responsible for cultivating the group’s therapeutic culture. He/she is simultaneously a conductor, convenor and a group member, generating exchange in order to facilitate communication. As the group progresses, and the search is on for the ‘language of the group’, communication moves from monologue, to dialogue and then, in a mature group, to discourse [21].


Psychoanalytic concepts – transference, countertransference, projection and projective identification are drawn upon and are helpful in understanding the powerful processes within the group. Transference is understood not only as vertical (from patient to therapist or from therapist to the group) but also horizontal (between patients) and from the patient to the group as a whole. Attention is paid to both verbal and non-verbal communication. Interventions can be directed towards anyone person in the group, or towards the group as a whole. Free-floating discussion is the group analytic equivalent to psychoanalytic free association when meaning emerges via metaphors, dreams, feedback, exchange of ideas, feelings and narratives, all ‘capable of bringing moments of significance and illumination where change can take place’ [21].



The Conductor’s Subjectivity

The conductor is both a ‘participant and an observer’ and ‘not a neutral bystander in the group’s ever changing processes’ [9]. There can therefore be no proper examination of the interactions and pathology in groups without also examining oneself as a group member. The conductor’s unconscious is activated from the very start, group events are unknown and unpredictable and the anxiety evoked also affects the conductor. Therefore, in order to qualify as a group analyst, the therapists themselves need a rigorous experience of being a patient in a group.


The way the group functions will in part be related to the conductor’s strengths, vulnerabilities and blind spots. For example, if the conductor’s anger or frustration for the group is not adequately processed, then the group can get stuck and patients may find themselves unable to express aggression, rage and hatred [22]. The conductor should also be acutely aware of the impact of sociocultural events and social unconscious forces on the individual’s and group’s development and how this continuously gets re-enacted in the here and now of the group.



Some Important Concepts in Group Analytic Psychotherapy



The Matrix


Foulkes believed that the transformational nature of the group lay in the group’s ‘Matrix’, the hypothetical web of interpersonal and transpersonal communications that takes place in the group. The word ‘matrix’ originates from the symbolic derivation of the womb, emphasising the group’s generative and containing properties. This concept is central in group analytic theory but is also at times seen as a nebulous and confusing concept. It forms an ever-changing, non-linear, interactive process among its members, and the group as a whole and is the active agent of transformation and change.


The transpersonal refers to universal themes that are unconsciously shared and go ‘through’ a person, whereas the interpersonal relates to the interaction between people and to the potential interactive processes that take place in the group.

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Jun 6, 2021 | Posted by in PSYCHOLOGY | Comments Off on Chapter 11 – Group Analytic Psychotherapy and the Group Analytic Model: A Clinician’s Guide
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