Psychiatric Annals

WHY GROUP THERAPY, NOW?

Emanuel K Schwartz, PhD

Abstract

1 . balint, m. the basic fault. london: tavistock, 1968.

2. caplow, t. two against one: coalition in triads. englewood cliffs, n.j.: prentice-half, 1968.

3. erikson, e. h. insight and responsibility. new york: norton, 1964.

4. grotjahn, m. analytic group therapy with psychotherapists. international journal of group psychotherapy xix c1969). 326-333.

5. laing. r. d. the divided self. pantheon, 1960.

6. laing. r. d. the politics of experience. pantheon. 1967.

7. lystad, mh. alienation. an annotated bibliogrphy. national institute for mental health, 1969.

8. rank. o. beyond psychology. privately printed, 1941.

9. schwartz. e. k. the trend to grouping. international journal of psychiatry ix (1970), 205-211.

10. Schwartz, E. K. To Group or Not to Group. Contemporary Psychology XVI (1972), 423425

11. Schwartz, E. K. Self-Help Organizations: Lessons to be Learned for Community Psychology. In Psychoanalytic Contributions to Community Psychology. Edited by D. S. Milman & G. D. Goldman. Springfield, III: C. C.Thomas. 1971. 159-174.

12. Schwartz. E. K. and Schwartz, R. S. No-Art: An American Psycho-social Phenomenon. Leonardo 4 (1971), 245-254.

13. Schwartz. E. K. and Wolf. A. Psychoanalysis in Groups: As Creative Process. In ?/ew Directions in Mental Health. Edited by B. F. Riess. New York: Grune & Stratton, 1 967, 57-68.

14. Wolf . A. and Schwartz, EK. Psychoana/ysis in Groups. New York: Grune & Stratton, 1962.

15. Wolf. A.. Schwartz. E. K., McCarty, G. J. and Goldberg,!. A. Beyond the Couch. New York: Science House. 1 970.…

There was a time when such a question was easier to answer; in its early development, group psychotherapy could be given many justifications. First, there was an insufficient number of trained professionals to supply mental health services. Second, the cost of such services put them beyond the means of most. Third, the traditional forms of one-to-one treatment seemed not to be effective for most patients. Fourth, a positive attitude toward collective cooperative effort developed in the society at large during the Great Depression. These were among the major factors promoting the group therapy movement in the 1930's and in the early 40's, and World War Il provided it with the greatest impetus.15 They continue to be good reasons for group therapy today. But the present trend in group activity seems to transcend the immediate necessities of treatment and raises a host of new questions which need to be understood.9

Alienation is possibly the most important problem of contemporary man. Alienation, used originally to describe the distance between the worker and his product, is now more generally applied socially to the growing gap between man and his world and is further elaborated psychologically to a sense of personal dissatisfaction with oneself and the world around. It is characterized by a sense of meaninglessness, powerlessness, and social isolation; of being disengaged and withdrawn. In a single volume more than 200 recent articles are summarized, all devoted to various aspects of alienation: the alienated worker, the alienated voter, the alienated young, the alienated old, the alienated black, the alienated white, the alienated rich, the alienated poor, and alienation as a psychopathological state.7

Clearly, alienation now reflects a deeply personal and complex state of existential despair, estrangement, and anomie. Being disconnected from the self and unable to experience relationships constitute the psychological manifestations of what is currently meant by alienation. It has become a humanistic term synonymous with grief, misery, anger, despair, and feelings of being victimized; it is related to a sense of feeling sinful, guilty, and blamed for being defective and faulty.1 And it has become a kind of diagnostic description for a category of persons who increasingly present themselves for psychotherapy.

There is much confusion of opinion concerning the origin and nature of contemporary man's existential despair, his present unhappiness. Laing, a specialist in alienation, emphasizes it as a human experience deriving from the way in which one relates to others. He is convinced that this crippling isolation and withdrawal is not only a consequence of the deforming and destructive agents in one's unaccepted impulses, in parental misattributions, or in the patterns of family interaction, but is produced by the very nature of society.5

Laing's view that alienation is the "essential springboard for any serious reflection on any aspect of present interhuman life" 6 merits consideration. It is in keeping with the progressive history of psychotherapy. The shift of emphasis has been from the individual patient to his relationship in the dyad, and more recently to his relationships in triads and multiple-person groups, including the family, the community and society. Like Searles and others, Laing holds that certain kinds of interpersonal transactions produce pathology and that definite patterns of family interaction exist which are directed toward "driving the other crazy." Such assumptions move us away from a one-person or even a two-person psychology to a multiperson psychology in which not fewer than three people are involved.2

Since behavior is multidetermined, we must seek also other causal factors. In addition to the idea that pathology is a consequence of pathogenic ways of relating that arise in the family and are sponsored by the community, it is important to recognize that our nation is rapidly entering a post-industrial era. In this new electronic age, mass migrations are occurring. Urbanization and the population explosion have created a housing situation in which extended families have little chance of survival. In modern urban and suburban dwellings the immediate nuclear family has become the prevailing unit. "The group therapist perhaps more than anyone else has become a substitute, reparative for the lost extended family".9 In addition, the McCarthy era was experienced as a strong force for separating man from man, for sponsoring fearful isolation.12 Thus difficulties in relating to others were enhanced, leading to isolation in psychedelic drugs and multi-media crash attacks upon the senses.

Violence and antagonism are to be seen on all sides: the old against the young, the conservative against the progressive, the blacks against the whites, the women against the men, the children against the parents, and the parents against the children. There is an urgent need to work against these pervasive feelings of isolation and antagonism.

Psychotherapy is one force dedicated to coping with these socio-psychological problems. However, "sellers and buyers in the therapy marketplace seem now to be preferring the group to the dyad."10 Why? Let us examine group therapy to see how these and other problems are handled, as contrasted with individual therapy.16 The following is a partial listing of the theoretical and practical virtues of group therapy, with a brief discussion of each.

1) Group therapy presents the advantage of peer-patient relationships. In individual treatment the patient stands alone before the therapist in an authority-subordinate association. In the group, on the other hand, there are peers with whom the patient can identify.

This kind of arrangement presents many advantages. The individual therapist is only one kind of person. Even with the greatest versatility, he will nevertheless still provoke only certain kinds of transferences. The reality of his authority position limits the number of transactional, including transferential, possibilities that may exist between the therapist and the patient. The presence of a multiplicity of other persons allows for a greater variety of transactions and the possibility that more can appear and be worked through. Nuclear family relationships are reactivated, and the resolution of these has the greatest reconstructive potential.

2) The repertory of behavior patterns that are aspects of character structure in operation become more easily recognized in the group where the patient actively relates himself to others. The bilateral, interactive nature of behavior is more quickly perceived and learned. Not only response patterns, but also provocative roles, become apparent.

3) The distance between the therapist and the patient in the group is lessened, because the patient has the support of the other group members. The patient can more easily express his reactions to the therapist, his hostility as well as his good feelings, and he is enabled to question the source of power. In the individual treatment there is often a bilateral assumption that all help, knowledge and truth stem from the expert, and the patient is put in the position of having to submit to the authority figure. In the group, however, this does not so easily come to pass.

4) The presence of peers is one of the most potent factors for breaking through the isolation of patients and overcoming some of their basic inhibitions. The participation of co-patients tends to lessen the sense of separateness and aloneness, neutralizing the idea of being the only one of a kind. As a consequence, tolerance for the self as well as for others is given a greater chance to develop.

5) The group provides an opportunity for expression and activity. Greater spontaneity comes about on the part of both leader and patients, leavened by a kind of control, an assurance afforded by the presence of others that more spontaneous expressions, even of irrational reactions on the part of the therapist, will be limited. The activity of each patient is thus simultaneously both fostered and controlled. There is a greater likelihood that more hostility will be expressed to peers and to authority figures in the group, but also more positive and related feelings. "The human will, moreover, produces not only creative values, but also undesirable reactions equally unpredictable. Collective therapy manifested in spontaneous reactions of the people seems to follow the same tendency of automatically liberating frustrated forces in the human being."8

6) The group helps avoid a too-intense parentifying relationship with the therapist. Human beings retain a residue of need for a parent-child alliance. As society becomes more fatherless, we may anticipate greater residual symbiotic attachment to the mothering parent. In the group, the presence of others tends to be a force against the repetition of the symbiotic attachment to the leader, as mother or father.

7) Dyadic therapy tends to foster aloneness and isolation with the authority figure, symbolically the mother or father, restricting the reality of the pressures from the world outside. The collaborative and compromise existence which arises in any group working together is a more healthy and immediate preparation for life.

8) Grotjahn4 is convinced that resistance to treatment is much more easily maintained in individual than in group therapy. In the former instance, one learns how to disarm, entrap, and seduce the therapist much more easily than is possible in the group. In the latter, co-patients more rapidly help to break through resistive maneuvers and efforts to manipulate and to obstruct. Interfering, defensive tactics are often more obvious to and more directly confronted by a group than by an individual therapist.

9) The group promotes an atmosphere of democracy. There are shared feelings about the therapist as an authority figure which allow for a more realistic examination.14 The group also encourages struggle against the need to submit to authority, which is one of the pathogenic forces in the contemporary human condition. The prevalence of others fosters a regard for others, for cooperative sharing, and for tolerance of those who are different.

10) Although treatment in a group, like individual treatment, has traditionally operated as a middle-class service, group therapy can nevertheless reach more persons without more personnel and so is less costly. This is especially important for the third world population. "Mutual activation is the crux of the matter; for human ego strength, while employing all means of testing reality, depends from stage to stage upon a network of mutual influences within which the person actuates others as he is actuated, and within which the person is 'inspired with active properties' even as he so inspires others." 3

11) The socializing process of group therapy promotes an awareness that help can be widely distributed. Members of the group learn that they can support one another and be helpful to one another. The fact that the patient learns that he, too, can be a source of help builds a more specific bridge to social reality.11 An understanding of distributed help is a powerful antidote to fusion, symbiotic attachment to parents and their surrogates, and blind submission to authority figures.

12) In the group it is possible to facilitate greater individuation of the members and at the same time increased realistic interdependence. Mutual interdependence of peer on peer, rather than upon the therapist, accelerates a preparation for a bridging into life.

13) the therapy group stresses heterogeneity and difference. this prizing of individual differences is one of the basic ingrethents of mental health. at the same time the group sponsors the loss of isolative uniqueness, and encourages more humility and realistic self-evaluation.

14) much intragroup and intergroup intolerance results from not knowing, not experiencing, not sharing, not communicating. group therapy is a democratizing process which sponsors breakdown of ingroup and outgroup barriers.

15) the group setting uniquely provides the patient with the possibility of experiencing many roles. he alternates between being observer and participant, helper and helped, antagonist and protagonist. greater expression of spontaneous and selectively-controlled feelings is possible. hostility is more freely given and taken, because each member knows that he will not be punished or isolated by its appearance. affection is also more directly given and received, without fear of rejection or ridicule. the presence of peers not only permits the alternation of roles, but it allows the individual to develop a realistic sense of competence and mastery that contributes to his self-esteem.

16) the patient who comes from a family in which he is the only child, or at most has one sibling, may find group therapy an optimal treatment setting.13 individual therapists often reinforce the view that the patient is his only and favorite "child." patients prefer to hold to the wish that power and help are not distributed, but are exclusively in the expert's hands. the group tends to neutralize this distortion. it is soon apparent that persons other than the manifest leader can say perceptive and useful things. in this and other ways the overevaluation of authority becomes attenuated.

17) group therapy is not only a bridge into interpersonal social reality, but into political reality as well. in front of a group, it is more difficult to get away with false or dictatorial leadership. the distortion about who is peer and who is authority is more clearly illuminated in the group. the presence of peers allows for challenge and re-examination of the authority, regardless of his leadership style. it sponsors an awareness of distributed authority. a conviction about the distribution of power is an important step forward, not only for the individual and the group, but also for the community and the nation.

18) group therapy implies a new ethical relationship of the individual to the group, to his nuclear family, to his present family, and to the social groups around him. ethical and social modeling take place. new values are taught and learned. this has direct bearing on how the individual relates to the larger social scene. group therapy provides an opportunity for such transactions as giving and getting tolerance; for argumentation without violating friendship; for relating to authority without submission; for esteeming peers; for being able to survive without over-sensitivity, even though the others (including the leader) are different. the acquisition of more adaptive social values and skills provides a basis for more successful social integration.

19) the group therapist is an important neutralizer to some of our society's myths. one myth demands that a person have no strong loves or hates, no passions, no commitments. value is placed upon quietness and stability. another myth promotes the view that authority knows all and that it is important to follow the precepts of the expert. a person must not demand an understanding of the external reality nor question that expert, who like the father is "the autocrat at the breakfast table."

the group experience is a force for questioning such myths. it allows the expression of strong loves and hates, even of irrational feelings. The therapy group is intolerant of an affectless middle-tone. It does not ask for quiet, stability, and non-movement; it demands change. It rejects the concept of undistributed authority, and substitutes the democratic ideal in its place. The group promotes an atmosphere in which a person may think for himself and grasp external reality through his own efforts and those of his peers. The authority is not necessarily the center of the universe. The possibility exists of struggling against authority and freeing oneself from the necessity of being submissive to authority. "In this sense, I conceive of human help for the individual not as a planned method of psychotherapeutic techniques with respect to a conìroì of his stimuli and responses but as his experiencing of the irrational forces within himself which he has not heretofore dared to express spontaneously. Such a conception, however, does not mean giving free range to the hidden desires of the ego, but rather permits the individual to accept his inner limitations or outer restrictions in his own terms and on his free volition." 8

As early as 1895 Freud developed analytic ethics and methods that promoted a progressive tolerance and sublimation of the abnormal and the irrational. There is urgent need for an expansion of basic trust among people to allow for a freeing of spontaneity and self-confidence. Trust is broadly regarded as the basis for human relationships.3 It is a central determinant of how others and the self are experienced. Clinical experience indicates that it is generally easier to induce and maintain an attitude of trusting in the group than in the dyadic relationship. Freedom of expression proceeds in large part from a reliance on group consensus and controls. The swing between freedom and control describes a spiral that goes through advancing exploratory regressions and progressions. New awareness is engaged with a larger selfinsight and self-responsibility.

EMANUEL K. SCHWARTZ, PH.D.

EMANUEL K. SCHWARTZ, PH.D.

BIBLIOGRAPHY

1 . balint, m. the basic fault. london: tavistock, 1968.

2. caplow, t. two against one: coalition in triads. englewood cliffs, n.j.: prentice-half, 1968.

3. erikson, e. h. insight and responsibility. new york: norton, 1964.

4. grotjahn, m. analytic group therapy with psychotherapists. international journal of group psychotherapy xix c1969). 326-333.

5. laing. r. d. the divided self. pantheon, 1960.

6. laing. r. d. the politics of experience. pantheon. 1967.

7. lystad, mh. alienation. an annotated bibliogrphy. national institute for mental health, 1969.

8. rank. o. beyond psychology. privately printed, 1941.

9. schwartz. e. k. the trend to grouping. international journal of psychiatry ix (1970), 205-211.

10. Schwartz, E. K. To Group or Not to Group. Contemporary Psychology XVI (1972), 423425

11. Schwartz, E. K. Self-Help Organizations: Lessons to be Learned for Community Psychology. In Psychoanalytic Contributions to Community Psychology. Edited by D. S. Milman & G. D. Goldman. Springfield, III: C. C.Thomas. 1971. 159-174.

12. Schwartz. E. K. and Schwartz, R. S. No-Art: An American Psycho-social Phenomenon. Leonardo 4 (1971), 245-254.

13. Schwartz. E. K. and Wolf. A. Psychoanalysis in Groups: As Creative Process. In ?/ew Directions in Mental Health. Edited by B. F. Riess. New York: Grune & Stratton, 1 967, 57-68.

14. Wolf . A. and Schwartz, EK. Psychoana/ysis in Groups. New York: Grune & Stratton, 1962.

15. Wolf. A.. Schwartz. E. K., McCarty, G. J. and Goldberg,!. A. Beyond the Couch. New York: Science House. 1 970.

10.3928/0048-5713-19720301-05

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