The Challenge for Group Psychotherapy

Introduction to Psychoanalytic Group Psychotherapy, Part 1

The theoretical assumptions and techniques employed by therapists engaged in psychoanalytically oriented group therapy have greatly changed over the last three decades. It would be impossible within the limits of this volume—and unnecessary—even to outline the gradual evolution as well as the manifold ramifications. Just as there are numerous forms of individual psychotherapy, there now exist many types of group psychotherapy.

This chapter describes some essentials of psychoanalytic group therapy based on twenty years of intensive research undertaken by the American Mental Health Foundation. Further work and experimentation may bring changes and improvements of the theoretical assumptions and techniques presented here. The points of view of the authors in this volume offer avenues for such future explorations. The description in this chapter of the functioning of psychoanalytically oriented groups will be of help to readers who have not practiced group therapy at all or may have engaged in forms of group therapy that have not included some of the practices reported here.

In the following pages, some of the techniques and procedures that Foundation research has proved to be the most helpful are described. However, it should be stressed that the intention of this chapter is to present a number of basic approaches that are useful for all forms of psychoanalytically oriented group therapy. In a later chapter a specific intensive group-therapy method developed by the Foundation is described.

Dr. de Schill is Director of Research, American Mental Health Foundation; Vice President, International Institute for Mental Health Research, Zurich. The results of the Foundation’s research on psychoanalytic group therapy have been continually communicated to the professions by means of lectures, conferences, seminars and workshops, participation in national and international conferences, but most of all through publications. The most successful of these publications, Introduction to Psychoanalytic Group Therapy, was especially written to communicate the Foundation’s findings to the mental health professions, thereby helping therapists to learn, clarify, and improve their own understanding of group techniques. Secondary aims of the text were to enlighten interested persons regarding this work and the value of psychoanalytic group therapy, as well as to put into the hands of psychotherapists engaged in psychoanalytic group therapy an informative booklet they could give to prospective patients. To fulfill these aims simultaneously a special format and style were necessary. As the clinical studies and experimental work of the Foundation progressed, revised editions had to be published. The findings could easily have filled a large volume. The disadvantages of condensing the material to booklet form were outweighed by the benefit of being able to reach a large number of readers. Within a short period this booklet became the most widely used text in the field of group therapy in the United States. Approximately 80,000 copies have been purchased by medical schools, clinics, and mental health professionals.

It should be remembered that this text was initially written almost twenty years ago, when group psychotherapy was attacked and denounced by the vast majority of professionals. The change in attitudes over this period has been remarkable, and group psychotherapy is now accepted as a valid and valuable treatment procedure. The printing of the French edition of this book under the auspices of the Library of the Psychoanalytic Institute in Paris is just one example of the growing recognition of group therapy procedures.

Prior to 1956, it was observed that about two-thirds of the people to whom the Foundation recommended group therapy either disliked the idea or rejected it outright, requesting individual therapy. Furthermore, about fifteen percent of those who did enter a group dropped out in the first five weeks. In this connection, it is important to note that most of the people who were referred to some form of group therapy had not had any previous psychotherapeutic experience.

However, in the period during which the booklets have been given to patients about to enter group therapy, both figures—those who rejected group therapy and those who dropped out—were reduced by more than half. Similar results have been reported by other users of the booklets.

Whether or not a patient selected for group psychotherapy shows initial resistance to the idea of group work, his preparation for it by the therapist is a necessary, but often burdensome task. One patient after another will ask the same questions concerning the principles and practices of group psychotherapy. If the therapists conducts the intake interviews of an organization or clinic, these repetitive questions may cause him to be less patient and explicit than is necessary to sufficiently diminish the patient’s initial anxiety. The same problem is experienced by therapists in private practice who work with groups.

Experience in individual treatment will not necessarily reduce a patient’s questions about the group therapeutic procedure he is about to share. Often the contrary is true: anxiety over being placed in an entirely new clinical situation and resentment against sharing the therapist’s attention with other patients frequently induce strong resistance against group work, which is manifested by the expression of innumerable questions and objections.

Inasmuch as a great number of the applicants for referral through the Foundation were found suitable for group therapy, considerable experience has been gained as to the nature and scope of the questions typically posed by prospective patients.

Eventually it was felt that much unnecessary work could be eliminated for a therapist, whether he sees patients in a clinical or in a private setting, if his patients could be given literature providing basic explanations about psychoanalytic group therapy. Since patients frequently forget some of the verbal information given them and tend to repeat questions, such literature would be doubly useful.

The “Introduction” is divided into two sections. Part I is to be given to patients to whom group therapy is being recommended. Part II is for those patients who, after reading the first part, and possibly after further therapeutic assistance by their analysts, are willing to enter group therapy. For the convenience of these readers, the text has been arranged in question-and-answer form.

Part I
1. How do I know that I need professional help with my emotional problems?
Everyone, no matter how stable and emotionally mature, can benefit from adequate professional help. Yet attention must first be given to the many persons who are prevented from leading useful and satisfactory lives by their emotional difficulties.

People with emotional disturbances often misunderstand or even ignore their manifestations and symptoms and fail to take the proper steps for their elimination. Some people hesitate to admit to themselves, much less to others, that they cannot cope adequately with their own emotional reactions. They may not realize that the inability to overcome emotional problems by oneself is by no means a sign of weakness or of lack of intelligence. Direct application of will power for such purpose tends to be useless. This is true even for those who know a great deal about psychology and psychotherapy.

The following are some of the problems that indicate a need for professional help:
Difficulties in interpersonal relations, marriage, and parenthood; loneliness and withdrawal; feelings of losing touch with reality; feelings of failure; general dissatisfaction with yourself or your life; inability to do things which you feel you should be able to do, such as concentrate, study, or work; feeling compelled to do things which you do not want to do; frequent feelings of unhappiness; expectations that something bad will happen; continued worries and anxieties of all sorts; nightmares; depressed moods and sadness; persistent feelings of being persecuted, blamed, or taken advantage of; pervasive feelings of hate or contempt; feelings of being inferior, of being disliked and rejected by others, of disliking yourself; feelings of great tension, irritability, or excitability; persistent feelings of restlessness.

Because the human mind is intimately connected with the body, one may have physical complaints for which the physician is unable to find an organic cause. These symptoms are often of psychological origin and, in such cases, indicate the need for psychotherapeutic help. Examples are sleeplessness, headaches, sexual difficulties and dysfunctions, heart palpitations, excessive perspiration, fatigue, and digestive troubles, such as frequent constipation, diarrhea, and stomach pain.

2. How do I know what type of help I need
Many persons erroneously attempt to select a form of psychotherapy merely on the basis of personal prejudice, hearsay, or pressure from others. A better way of finding just which type of psychotherapy is most suitable for you is to consult an experienced, well-qualified diagnostician who is fully acquainted with the wide range of existing psychotherapeutic techniques. Such professionals can advise you about the type of help that will be most appropriate for your individual needs. Furthermore, many psychotherapeutic organizations and clinics offer diagnostic interviews for this purpose. In these sessions the applicant is interviewed by a competent professional who is thoroughly equipped to determine his psycho-therapeutic requirements.

Remember that any information you may give a psychotherapist about yourself is held in strict confidence. Therefore, allow yourself to be as frank as possible in the diagnostic session to enable the interviewing psychotherapist to make a complete and valid evaluation.

Clinical experience and research have shown that a majority of people in need of professional assistance can benefit greatly from certain forms of group psychotherapy known as “psychoanalytic group therapy,” “group psychoanalysis,” or “psychoanalysis in groups.” This therapy is often combined with regular or occasional individual sessions. In many instances dynamic results have been brought about in emotional disturbances which did not yield even to intensive individual treatment.

3. What is the setting of such a “psychoanalytic group?”
The group consists of five to ten persons. The majority of groups are composed of both males and females, while in other groups membership is limited to the same sex. Meetings last one and a half hours or longer, depending on the analyst’s method.

The therapist will always carefully discuss with each new group member the number and nature of the weekly sessions. Many groups meet twice a week, once with the analyst and once without him. Some groups meet for three sessions weekly, two of them with the analyst. In other instances the analyst will suggest that a person participate in two different groups. The specific group, or groups, to which the person is assigned is determined by his particular needs.

“Alternate meetings,” those held without the therapist, have extreme value, since a person’s feelings and attitudes in the group usually vary considerably depending on the presence or absence of the therapist. This situation brings about more definite clues to self-understanding. Furthermore, alternate sessions help to pave the way to self-assertion and emotional independence. However, some therapists organize their groups in such a way that alternate sessions are not provided.

The analyst will recommend whether regular or only occasional individual sessions will be of the greatest benefit to the particular group member. Individual sessions may be particularly indicated when feelings of reluctance toward psychotherapy or the therapist are very strong. Naturally, such feelings of resistance occur not only in group therapy but in any form of valid psychotherapy.