Foundations of Group Psychotherapy—II, Part 1
This is an attempt to compare our more than forty years of experience with groups of emotionally disturbed individuals with group experiences among medical and paramedical personnel. These ex-periences were gained in the training of group psychotherapists, as well as with self-study groups of students and physicians. They were compared with data gleaned in group supervisions by social workers and physicians who themselves are engaged in therapeutic work. We shall not attempt here to set down in detail the specific experiences of a lifetime, which, to a large extent, were recorded by means of shorthand or tape; instead, we shall attempt to condense from these experiences a theoretical basis for group psychotherapy.
Let us first give recognition to those authors in whose works we have found important substantiation of our theories. In first place, quite naturally, is Sigmund Freud, in addition to which our thanks are due especially to the two Balints, Federn, Ferenczi, Anna Freud, Meng, Pfister, Schilder and Zulliger. In the area of actual group therapy, many thoughts similar to ours could be traced in the works of Battegay, Foulkes, Levin, Moreno, Preuss, Slavson, Lattke, Henckley, Hermann, Raoul and WaIter Schindler, to name only a few.
Development and Definition of a Group
Groups form wherever living beings meet. In the specifically human sense, a group exists wherever people congregate to set themselves off spiritually, emotionally, or physically to form a community or society. Every man, be he conscious of it or not, is a whole entity as an individual and, at the same time, a member of a group. Significantly, the Latin word communis, from which our concepts of commune and community derive, refers to a community which originally lived within city walls to protect itself cum minibus—by means of these walls.
The psychotherapeutic effectiveness of a group consists in the congregation of several individuals with differing degrees of ego development. Each experiences himself as a whole while sharing to a certain extent the responsibilities and achievements of the group. In the group, the individual becomes part of a new whole whose characteristics are determined by the character traits of all participants. Each ego in the group gives to and takes from all the other participating egos. Thus, there exists in the group a constant interchange of human expressions which range from simple nonverbal and emotional reactions all the way to highly intellectualized verbal exchanges. These interchanges express drives and attitudes which are being integrated within the framework of the group as a result of every ego yielding a part of itself. From this system of interrelationships a group personally emerges—a group ego capable of considerable development if group dynamics are kept in flow.
The Ego
In the philosophical sense the ego is the “essence” in us, that which is capable of thought and is endowed with consciousness, somewhat analagous to Descartes’ classical concept of cogito ergo sum. In other words, the ego is largely identical with being and existing.
Analytically, my ego differentiates me from all others. Freud taught us that this ego and its drives develop only gradually from the purely instinctual structure of the id. The infant comes into the world as an instinctual being. His ego develops in the third year of his life. Significantly, the human capacity for group interaction is found only when the ego already has assumed relative independence. In any case, the participation of the ego in a group only then becomes effective once an ego consciousness can form within the group. Indeed, ego development allows me to experience with increasing consciousness my own personal qualities and my own capabilities. More and more, “I” am able to avail myself of the possibility to assimilate rationally impressions and experiences, thus empowering the “self” to perform rationally. Contrary to essentially authoritarian group rearing and group pedagogy directed by the superego, an increasing number of attitudes, expressions, and experiences will thus fall under the control of the ego and can thus be confronted with rational consciousness. Within the group, each member assesses the possibilities and the consequences of each ego expression of all the other group members. Thus, it is the group ego that also establishes the rules which become binding for each member.
The ego development within the group, to a large extent, is closely related, therefore, to the discovery, the conscious realization, and the further development of the ego within the individual. While the pedagogic group pursues an educational goal serving the ego formation, the vocational group merely strives for a goal consonant with professional adjustment.
The psychotherapeutic group, however, aims at a level of mental health compatible with the group ideal. The major insights into this ego development are due to Sigmund and Anna Freud, as well as to Federn; and these insights are as valid for the ego of the group as for that of the individual. Corresponding to the original concept of the development of the ego aspirations, the ego, together with a whole series of instinctual drives, is governed by this instinct for self-preservation, while the actual fulfillment of these drives is then largely impelled by corollary drives that eventually organize themselves to form the sexual behavior pattern of the individual. According to Freud, the ego on every level and at all times strives to “fit into and adapt itself in concordance with the original sexual behaviour pattern,” and he states further that a break in this close concordance between ego and libido in the various phases of their development “may well evolve into a pathogenic factor.” This important relationship between the libido theory and the theory of narcissism, as developed foremost by Ferenczi, cannot be discussed here more fully. It is significant, however, that the defense mechanisms, as compiled in particular by Anna Freud, are evident as such within the group; in the interactions of its members, any trained analyst can detect readily the appearance and the working through of these basic types of defense mechanisms: inhibition, regression, reaction formation, undoing, projection, introjection, autoaggression, reversal, and, finally, sublimation or displacement of instinctual goals.
The Experience of Ego Boundaries
The understanding of the development of the group-ego has been helped significantly by the theory of ego psychology evolved by Federn, according to which the development of the ego parallels the ego’s own awakening in the dream, a development which. Federn terms “orthriogenesis”—”orthria” meaning dawn and morning, in other words, the dawning of the day. Thus, orthriogenesis means for Federn the rapid, daily reiterated ego awakening from deep sleep to the dreaming state and from that preconscious twilight phase to full consciousness, therein allowing the awakening person to re-experience each day all of the stages of his ego development until he reaches complete conscious wakefulness. The dream ego, then, is only partially awake and the ego boundary corresponds to the respective dream boundary. Therefore, what we experience in our dreams is “the ego between yesterday and today,” awakening in that phase only to the consciousness level of “an early stage in our life”: in our dreams we regain our childhood. According to Federn, the ego is “the constant or continuously restored psychic continuity of body and psyche in relation to space, time, and causality.”
Phenomenologically speaking, the ego is being preserved by the individual, both sensorially and rationally, as an entity since it is felt as a constant and continuously reiterated relation of the physical and psychic experience in terms of space, time, and causality.
In metapsychological terms the ego rests on the simultaneous and interrelated psychic cathexis of functions and contents which, physically and psychically, are continuously interdependent upon each other.
Therein, the ego is both the carrier of consciousness (myself) and the object of that same consciousness (as in the above-quoted cogito ergo sum). Moreover, there are patent connections to the preconscious state in the degree of cathexis which actually forms the ego, since the ego only gains actuality in so far as the functions and contents proper to the ego are fully cathected. The actual ego becomes conscious upon awakening, while “the balance of the ego is made available for the coordinated functioning, it is being precathected in its self-like capacity.”
If we now consider the development of a group, we may well speak, within the meaning postulated by Federn, of an “orthriogenesis” of the group ego, for in the formation of groups one can recognize readily all kinds of symbol transferences and more or less censored expressions, exactly like those that are familiar from the work done on dreams and their interpretations. In its relation with the outside world, the group, provided it is in sound functioning order, behaves exactly like the individual ego, in elaboration. To quote Federn (1956):
The extent of cathexis constituting the ego is of a changing nature; its specific boundary is the ego-boundary and as such it is being consciously perceived. When an ego-boundary is felt as strongly libidinal (that is, infused with the instinctual drives of love and hate) and is not being perceived intellectually in its contents, a feeling of ecstasy ensues while, inversely, this experience becomes alienated if the boundary is only recognized intellectually but not felt.
We differentiate subjectively between a physical and an emotional ego-experience and, consequently, we also differentiate between emotional and physical ego-boundaries. Whatever confronts an emotional and physical ego-boundary outside is endowed with full reality. This reality is empirically self-evident and, as such, not subject to further critical reassessment. A corroboration of this reality only becomes possible because new ego-boundaries have been formed empirically which are then no longer affected by the same outside impressions. However, in both psychosis and in the dream, the later acquired ego-boundaries have either lost or have not been reinvested with their original cathexis. As a result, the reality corroboration either becomes defective or is totally lacking. Whatever confronts from the outside an ego-boundary that in only emotional, is endowed with emotional reality (revelation). Whatever confronts only a physical or an emotional ego-boundary is felt as fear-inspiring if, instead and on the strength of past experience, the simultaneous confrontation with several ego-boundaries was to be expected.
If libidinally cathected ego-boundaries are confronted not by objects but, instead, by other libidinally cathected ego-boundaries, affect reactions either result or are being triggered which, in their quality, are being determined by the nature of the libidinal cathexis of these causal ego-boundaries.
The normal person experiences considerable difficulty in becoming aware of the ego boundaries. He requires special training under appropriate guidance and a concentrated effort at self-control, or—to use Federn’s term—an effort to achieve “an introspection into the egotized data.” This means nothing less than to record one’s own experiences when falling asleep, when under the impact of emotional stress, or, quite generally, when on the threshold of consciousness, in contrast to the sphere of the nonego and also in contrast to the extraspection of the outside world. It is quite conceivable that in exactly the same manner the group ego not only may be taught by extraspection to perceive rationally the outside reality but could, by suitable guidance in introspection, also be brought to the realization of its inner psychic workings and of the boundaries circumscribing its own group ego.
Cathexis
Another problem raised by the expansion of the ego-boundaries may be described as being epitomized generally by the phenomenon, discovered by Federn, of the so-called ego-cathexis (cathekein: get to or reach a certain place), i.e., the specific channeling of the object libido within the sphere of the ego. It is here that the anxiety experience as well as the attempt at overcoming this anxiety manifest themselves most clearly, both in individual analysis and in group therapy, primarily through the awakening to the “I am” of the conscious perception “I feel anxiety”—a process in which, at first and within the group, the real fear of group treason is being camouflaged. This instinctual anxiety remains active as a floating, nondirected anxiety for as long as the group has not been channeled towards a common task and a unifying goal.
As is well known, group anxiety can manifest itself in diverse ways. If the group is left to its own devices and is disappointed in its natural expectation that the group leader is to set it a unifying task, this anxiety is expressed in projections of the inner dissatisfaction directed at the outside world, most frequently at the group leader himself, who will have to bear the brunt of more-or-less overtly aggressive manifestations by the group. According to the degree of overriding censorship, such aggressions take on more or less humorous, playful, ironical, or outraged forms. The group leader, seen as the group father, is expected to assume archfather functions; but were he to do so, he would merely “infantilize” the group.
In the interplay of normal society, the meeting of free groups has developed conventions through which anxiety defenses can manifest themselves in inconsequential conversational gambits, designed to elicit information: from the partners, which later may be used in competitive confrontations. This can place the unwary or the overly trusting individual in unpleasant situations: for even at the inception of group formation the stage is set for a confrontation which, according to the personality of the participants and depending on the group atmosphere, repeats episodes of friendly or hostile encounters that had already been collected in such earlier experiences. Thus, group confrontations even in their earlier stages mirror experiences which allow us, precisely as in individual analysis, to recognize time and again the incisive role of the family background and the development of the ego in its “cathectic” meaning and in its various transformations—a fact clearly seen and enunciated by Freud himself.
These confrontations, these “power struggles,” may manifest themselves as lust for power, as jealousy, and as a compulsion to subjugate others; or, in their more refined and socially more acceptable forms, they may be expressed as competitive spirit, as ambition, or finally—once insights have been gained into the underlying meaning of these confrontations—as acceptance of the group structure, as self-discipline, and as the voluntary shouldering of responsibilities which can help the group as a whole in its process of maturation. Within the framework of the group, these confrontations are always dominated by the instinctual drives, such as the search for love, for comfort, and for security—drives that must come to terms with the superego of the group and, beyond that, with the egocentric tendencies of the group ego. A conventional frame is being provided for the association and the togetherness of individuals who do not “know” each other as yet. Each participant has a need to achieve “contact” with other human beings, to get to know them. Likewise, each has learned from his own experience that these others will not be willing readily to subordinate their own claims to those of others in the group. The experience is the same as that of the infant when it realizes the unfulfillability of its excessive desires—an experience that is repeated in the early life of every person through the failure of infantile attempts, within the respective family, at gaining satisfaction for expectations that simply exceed the reality potential.
All such claims are bound to elicit from the outside world antagonistic reactions of various degrees of severity, from the merely partial and inadequate satisfaction of such instinctual claims to their total denial and, finally, to the confrontation of even stronger counterclaims which lead ultimately to outright aggressions.
Thus, each participant in the group has at his command a store of earlier experiences that are more than sufficient grounds for his initial vacillation between a desire for contact and anticipatory fear. This unique experience of initial anxiety creates within the emerging group—very much as in the awakening from sleep—a strange twilight condition in which the group-ego very gradually takes shape. This condition also reveals itself clearly when group communications between participants have “fallen asleep” for some time and are then reactivated in their subsequent meetings, thus affording a convincing example of the actuality of Federn’s orthriogenesis. In fact, Federn’s ego psychology provides a theoretical elucidation not only of the ego function in the individual but, at the same time, of the development of the group’s ego and consciousness.
On the basis of these thoughts, we also may gain an insight into the phenomenon which Freud, in individual analysis, has termed “the meeting within the subconscious,” a phenomenon which, in group therapy, is expressed in the remarkable fact that problems are brought to the surface without having been mentioned by those persons who are most intimately affected by them.
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