Group psychotherapy is a uniquely American contribution to helping techniques. As the contributors to this issue of PSYCHIATRIC ANNALS note, its variants are many. Its popularity has been enhanced recently to the point where it has generated a keen interest in the psychosocial dynamics of small as well as large groups. Yet it is difficult to define the boundaries of this rapidly changing field, for it includes all manner of new techniques: T-groups (which, the founders insist, are techniques of education and not techniques of therapy), sensory awareness groups, marathon groups, truth labs, psychological karate groups, human relations groups, personal growth groups, psychodrama groups, and human potential groups. Our authors agree with other authorities when they observe there is little systematic information available to determine whether each of these types, in addition to its palpable distinction from others, represents a true difference in its theoretical as well as in its technical aspects. The question is open.
In April, 1970, a Task Force of the American Psychiatric Association, in its publication Encounter Groups in Psychiatry, used "for stylistic convenience" the term encounter group to summarize these various group approaches to interpersonal relationships. Dr. Lewis Wolberg characterizes these by a more descriptive term, experiential.
Most groups share the common feature of attempting to provide an intensive communal experience among more than two persons. Usually these groups are composed of not more than six to 24 members; this provides ample opportunity for interaction, which Arlene Wolberg speaks of as being synonymous with communication, both verbal and non-verbal. However, most of these group experiences - the psychoanalytically derived groups are an exception - focus on the here-and-now events, with only collateral reference to individually-experienced antecedent events. Most experiential groups encourage, indeed enforce, participation by their emphasis on interpersonal confrontation and insistence on self-disclosure. At times they reach the point of resembling the confessional atmosphere of such self-help groups as Phoenix House, Synanon, Daytop, and Alcoholics Anonymous. Their intention, as Dr. Schwartz mentions, is to counteract the alienation which is today thought to lie close to the heart of every man.
Inasmuch as these encounters deliberately foster the expression of strong emotions, they rely heavily on the purging effect of catharsis and abreaction, although they rarely identify the behavior by those technical terms. As a matter of fact, they usually avoid the term "therapy," although they have as an explicit purpose an effort to increase what they call inner awareness, a prerequisite for , changing overt behavior.
The more orthodox techniques are derived from their clinical antecedents rooted in dyadic psychotherapy. Their setting is strictly clinical; members are patients and as such are considered "sick." The leader is a professional, identified as a member of a medical team whose objective is treatment. Thus the leader is (or acts as if he were) a psychiatrist whose aim is to understand what goes on in the group. His mode is analytic; he attempts to "dissect, disentangle, and decipher on manifest and latent, conscious and unconscious, cognitive and symbolic levels the whences, whys, the functions and the consequences of as small a bit of life as the single event." j But Lieberman has asserted that "the therapeutic group is a unique interpersonal setting differing radically from the interpersonal setting of the dyadic relationship,"2 and Bion3 has gone even further in his claims for group therapy's separateness. He holds that a member's account of an outside event would have a basically different psychodynamic meaning when related in an individual session and when related in the group, despite its being the same story and the same therapist.
The so-called British School has postulated the emergence of group emotional expressions that they call "common group tension" or "basic assumptions." These hypothesized group manifestations contain covert shared fantasies and conflicts. They are posed as a challenge to the therapist, whose task then consists of confronting the group with its emotionality and by appropriate interpretations hopefully bringing about insight and improved behavior.
Experiential groups have in common one thing above all: a concerted effort to change the individual by a dramatic confrontation of his behavior as mirrored in the eyes of fellow group members. The goal is to provide a dramatic experience which is best described as being "turned on." In this sense, these variants of group therapy are analogous to confrontations that have occurred since the beginning of man's history. The association with religion and religious movements is obvious.
In elaboration of Dr. Durkin's account of "The Group Therapy Movement," some historical antecedents should be noted. In the 14th century, Europe was ravaged by the Black Death. Millions of its victims, by their death, inadvertently were responsible for a movement which began in Germany and spread like wildfire over the whole of Western Europe and Northern Africa, even reaching into Russia and the provinces of China. For the moral effect of the Black Death was as contagious as the plague itself. The medical historian Justus Hecker4 described it thus: "It was a convulsion which in the most extraordinary manner infuriated the human frame, and excited the astonishment of contemporaries for more than two centuries, since which time it has never reappeared. It was called the Dance of St. John or of St. Vitus, on account of the Bacchantic leaps by which it was characterized, and which gave to those affected, whilst performing their wild dance, and screaming and foaming with fury, all the appearance of persons possessed." Hecker's account, published in 1837, describes marathon encounters similar to those recorded by Euripides: "assemblages of men and women united by one common delusion, exhibited to the public both in the streets and in the churches the following strange spectacle. They form circles hand in hand and, appearing to have lost all control over their senses, continue dancing, regardless of the bystanders, for hours together, in wild delirium, until at length, they fell to the ground in a state of exhaustion. . . . While dancing they neither saw nor heard, being insensible to external impressions through the senses, but were haunted by visions, their fantasies conjuring up spirits whose names they shrieked out; and some of them afterwards asserted that they felt as if they had been emersed in a stream of blood, which obliged them to leap so high. . . . Many who were seized at the sight of those affected, excited attention at first by their confused and absurd behavior, and then by their constantly following the swarms of dancers. These were seen day and night passing through the streets accompanied by musicians and by innumerable spectators attracted by curiosity, to which were added anxious parents and relations, who came to look after those among the misguided multitude who belonged to their respective families."
It was not until the beginning of the 16th century that the St. Vitus' Dance was made the subject of medical research and "stripped of its unhallowed character as a work of demons. This was effected by Paracelsus, that mighty, but as yet scarcely comprehended, reformer of medicine, whose aim it was to withdraw diseases from the pale of miraculous interpositions and saintly influences, and explain their causes upon principles deduced from his knowledge of the human frame:
"'We will not, however, admit that the saints have power to inflict diseases, and that these ought to be named after them, although many there are, who in their theology, lay great stress on this supposition, ascribing them rather to God than to nature, which is but idle talk. We dislike such nonsensical gossip as is not supported by symptoms, but only by faith, which is a thing not human, whereon the gods themselves set no value.'"
These historical descriptions of group behavior bear out the observations of Slavson5 to the effect that "all human contacts initially activate some degree of uncertainty and anxiety. . . . The style and the intensity of the threat varies to a considerable degree with the cultural level of the participants. ... By and large, the individual re-enacts in his interpersonal relationships response patterns of his formative years, and by their permissiveness and emotional intensification therapy groups maximize individual patterns of response. . . . Release of affect may reduce tensions, but its ultimate value lies in the insight it can give into the individual's specific psychodynamics."
In this context, insight has to be understood as meaning more than intellectual knowledge. Like all emotional growth, it is the consequence of working through resistances and defenses. It requires the repeated confrontations of the self by the self. Ultimately, this leads to the acquisition of a new perspective which is gained only gradually (and painfully) by a series of encounters with meaningful others who, in effect, hold up mirrors to the individual.
HOWARD P. ROME, M.D.
1. Mills, Theodore M. Group Transformation: An Analysis of a Learning Group. Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1964, 2.
2. Lieberman, M.A. The implications of total group phenomena analysis for patients and therapists. Int. J. Group Psychotherapy 17 C1967),71.
3. Bion, W. R. Experiences in Groups. New York: Basic Books, 1959.
4. Hecker, J.F.C. The Epidemics of the Middle Ages: The Black Death in the 14th Century. Philadelphia: Haswell, Barrington, and Haswell.1837.
5. Slavson, S. R. The anatomy and clinical applications of group interaction. Int. J. Group Psychotherapy 19 0 969), 3-15.