An understanding of the basic dynamics of group process and the appropriate use of this knowledge will enable the group therapist to maintain an intensification of group interaction so that members will be able to work through their problems. Three dimensions, suggested by Moreno11 and his colleague Jennings,9 must be the focus of the leader's attention if group process is to create a milieu in which group members can change their neurotic behavior: (1) the projective dimension, (2) the problem-solving dimension, and (3) the choice-rejection dimension, i.e. the choices group members make concerning who communicates with whom, at what time, in what way and for what reason.
The leader's goal is to operate in such a way that the defensive operations will not solidify and the group members will not engage in an interlocking defensive maneuver which bogs down communication and interferes with problem-solving. While the patient has come to work out his problem, he nevertheless resists this process, probably because of some subliminal recognition that in order to change he will have to give up some of his behavior which was originally organized to allay anxiety in interpersonal relationships. He fears change; he dreads the feelings of anxiety which he will have to suffer if he challenges his defenses. Yet his defenses are exposed the moment he gets into the group. Since the aims in all treatment, as pointed out by Reich 13 and Fenichel,5 are to show the patient that he is defending, and how and when he defends, and then finally to discover what W is that he is defending against, the group lends itself admirably to this task.
The word interaction is synonymous with communication, both verbal and non-verbal. Why do we wish to intensify group process in therapy? The answer lies in the nature of group process itself. It has been discovered that special techniques are necessary to maximize individual participation in groups, since without such measures a group will tend to polarize around the attitudes of the stronger members. In a psychotherapeutic group, this means a consolidation of interlocking defenses. This phenomenon has been demonstrated in the early work of Dashiell4 and more recently by Asch1 in his studies on communication directed towards deviates and the rejection of unyielding deviates, as well as in his experiments involving the massive effects of large majorities.
A second source of information comes from the work of Maier and Solom 10 relative to the idea that a multiplicity of opinions is the real basis for the formation of accurate and undistorted judgments in a group.
A third point of interest for the group therapist makes the distinction between the individual and the group, in that even though an individual participates in a group solution to a problem, he cannot duplicate the excellence of the solution by himself. Perlmutter and DeMontmellin 12 did an interesting study which indicated this fact, and Gurnee8 found that there is "no evidence of superior learning in the process of problem solving in subsequent individual performances." While the group can solve problems, only the individual can learn. The members of the group solve problems, but the group has no "mind" - only individuals have minds, only individuals have emotional conflicts, and only individuals can work through those conflicts. The group helps the individual learn about his problem; the individual himself must change his behavior.
Problem-solving is the individual intellectual mental process connected with so-called ego functions, and is the method by which the individual learns in the here and now. Problem-solving is a process that is inherent in group process, if the group persists and maintains itself. Choice-rejection interactions are also essential aspects of group process. Indeed, they are the basis upon which interactions of any kind occur, and so they are a function of both neurotic and normal behavior, the former as an aspect of defense, and the latter as an integral part of the problem-solving process. The choice-rejection concept derives from sociometry and delineates who chooses whom for purposes of interaction (communication), at what time and in what way. Sociometric choice is a measurable and observable variable in group process. At various times a person rejects one person and chooses another, but on another occasion the same individual who was chosen can be rejected. The individual chooses one or two or three persons, depending upon whether he believes the choice can be of help in a given situation. In the therapy group choices can be made for defensive purposes, or for purposes of problem-solving. The projective dimension can best be understood in the context of psychoanalytic concepts. It is in the group that projections are most clear; they reveal the transference operations based on identification with parental figures.*
The group process is intensified as the group therapist learns to move from the problem-solving process to the projective process and back, using the choice-rejection patterns as the indicators for his therapeutic interventions.
Freud made two important points concerning therapeutic intervention. One related to interpretation: Interpretation should always be made to an individual, or if in a group, to two or more interacting individuals at the point of least resistance. This means that the therapist must gauge the point, at any given moment of any given problem, at which each individual has the least anxiety, for in making an interpretation one wishes to decrease the ego's need for organizing defense rather than to increase the defense. Such a method of interpretation requires much study and skill on the part of the therapist; often he must be inventive, since there are innumerable ways by which each individual in his own uniqueness manages to defend himself.
The second point relates the content the patient presents in light of its effects on defense and monopolizing in the group. If the patient talks at length about the past, one brings him back to the present, in a meaningful way; and if he speaks too much about the present, one brings him back to the past. This process can be accomplished by referring to dreams and fantasies, for it is in the dreams and fantasies that present and past meet. The principle of interpretation at the point of least resistance must be used in the interpretation operations within the group.
Social psychologists have discovered that if the individual dwells on his own "self-oriented needs," his dependency, his anger, his competitiveness, etc., to the point where he excludes others in a problem-solving process, the group members become dissatisfied and angry, and they deal with the individual as a deviant. The group therapist may forestall this kind of event, which is nonproductive and time-consuming for the members, by using techniques that relate to the principle of shifting - from projection to problem-solving, or from present to past, or from self to others.
The therapist may, at times, have to act in one of the roles of the problemsolver, while at other times he may focus on interactions which are defensive. At one time, he will engage one individual in the group, while on other occasions he will focus on intrapsychic processes rather than interpersonal maneuvers.
A final essential point centers around the problem of confusion and clarification in communication. Many different studies have shown that confusion in communication creates anxiety in group members. The neurotic patient reacts to confusion with an intensification of symptoms and an exacerbation of transference behavior or acting-out. Sherif and Harvey 14 studied ego functions in the elimination of stable situations and in changing group situations, and found that confusion increases suggestibility. Suggestibility has historically been connected with transference behavior in the psychoanalytic literature.6,7 Stanton and Schwartz5 found that patients in the hospital developed symptoms when they realized there were arguments and disagreements among the staff. When the therapist communicates to the group members, he should be as explicit and clear as possible.
The group therapist is, according to the scheme presented here, rather active; this is perhaps why Foulkes has compared him to the conductor of a symphony.
ARLENE WOLBERG, M.S.S.
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