A Study of the Development of the Tranference Neurosis in Psychoanalytic Group Therapy, Part 2
After more than a year in treatment, he told the group of having made omissions in his ritual and even of having forgotten to shave himself before going to work. Simultaneously, there appeared in his dreams, as well as in his information, other symptoms of a tendency to exhibit. He spontaneously revealed that an elderly woman, one of his superiors at his place of work, showed great interest in him, which evidently he had provoked by an irresistible inclination to reveal very intimate matters to her. It seemed that she responded greedily to these revelations because of her interest in Jungian psychology and her need to meddle in his life. He told her his dreams, which we also discussed in group, creating thereby a collision of psychological conceptions, since she became irritated with “the shortsightedness of this Freudian analyst” and could not agree with the interpretations of the therapist. Obviously he had begun acting out and had sought another transference object outside the therapeutic situation. He seemed to have an inclination to seek intimacy with this woman, to bare himself emotionally and ask for care. In light of her great interest in psychology, he seemed also to have chosen a person comparable to the therapist and created an opportunity to play them against each other. This fact seems to be of greatest importance in the context of the transference neurosis. The patient was shocked to find that his woman friend considered the therapist’s ideas superficial and irritating. He told several dreams, apparently produced for this “other therapist,” that were of a typically exhibiting character, showing that he wished to be undressed for her but to remain concealed in the presence of men and the group. In one of these dreams he allowed a woman to sever his contact with a male teacher. The significance of these dreams became clearer with a knowledge of his life history. His parents lived in continuous conflict, and his position between them was most precarious. His swinging to and fro between them was repeated in the transference neurosis, as will be further described below.
The group’s failure to understand Pat’s actions was remarkable, and in order to shelter him I had to demonstrate clearly my unshocked attitude. Their irritation was most obvious when he told of complaints to his friend of therapy’s failure to ameliorate his symptoms and her reaction of heaping grim criticism upon the therapist. He gradually developed insight into emotions that drove him to betray his therapist by sharing in the criticism of his friend. This insight was accompanied by important infantile recollections, such as his mother’s aggressiveness, her expressed pity that he had not been a beautiful girl, and her teasing threats to give him away, especially when he displeased her. She also threatened to trade him to natives for a hen, an idea that was particularly frightening to him, since he was well acquainted with the cruel way chickens were slaughtered. More important was his recollection of a flight toward his father. When his mother became enraged, he ran for miles to his father, who received him kindly and allowed him to stay with him at his work. These experiences were in contrast to those of the other group members, who always sought the mother’s protection against the father’s aggression.
The separation of his parents was a very real fact for Pat, made more disturbing by his idea that he was not the child of this father, since he had learned during his latency period of extramarital experiences his mother had had before his birth. In the situation with his “second therapist,” it was evident that he was acting out in an opposite direction, fleeing from his father to his mother. He must, therefore, also have been very frightened by a positive tie toward a father figure. Pat himself became aware of a possible connection between his symptoms and homosexual inclinations. His bed-wetting seemed to play a special role in this conflict. When he was a child, the threat of trading him to the natives for a hen was made because of his enuresis. One may suspect, therefore, that he subsequently used this symptom with the hope of thereby being thrown among men. This idea seems supported by the fact that the enuresis reappeared when his father was again living with his mother, shortly before he disappeared forever. When Pat discussed this history with his “Jungian therapist,” he ended by having a migraine attack, a symptom he had never shown and that seemed in this situation to repeat his fear of the overactive, interfering mother.
Pat then began to feel that his behavior in the group was in outstanding contrast to his behavior under other circumstances. In the group he was less tense and felt freer, but he perceived nothing of this in his daily life. A few weeks after this realization he informed us that there had come a crack in his “neurotic facade.” This crack was his discovery that he had forgotten to perform some of his meticulous measures of checking and that these omissions caused him no anxiety. Thereafter, his actions became much quicker and smoother. Especially noteworthy was his improved performance at his office. Pat was very disappointed that the group did not react with what he could consider appropriate enthusiasm to these revelations. His disappointment was particularly outspoken toward the therapist at the point when he also revealed his break with his “substitute therapist.” Naturally this was a great gain, in that he was able to stop his acting out and openly express his need for love.
After a short vacation, Pat reported a dream that was an obvious expression of his positive transference toward the analyst. Thus ended the little drama within the transference neurosis, which had lasted only a few months but involved strong and complex emotions. He apparently acted out the conflict with his parents, a longing for a father to love and to protect him against the aggressive mother. He found this father in the group therapist, a father who did not leave him and who was able to protect him from the aggressive transference figure who took the place of his mother. The beginning of his neurosis was in pre-puberty, when his father disappeared forever and he was left unprotected against the aggressive and erotic capriciousness of his psychopathic mother. His brothers and sisters were many years older than he and no longer living at home.
Because of his fear of homosexuality, too intimate a relationship with the father threatened Pat, and he soon submerged himself into the group as much as possible. Nevertheless, through the “reliving” experience of the transference neurosis and the analysis of it, he was able to give up some of the most serious symptoms. He estimated that his work capacity had increased about five times.
Shortly afterward, there was an occurrence that confirmed our idea about Pat’s fears of homosexuality. When a man whose homosexual tendencies were known to him came to work in his office, Pat was disturbed by his presence and entertained thoughts of giving up his job. He remained at work, however, and his anxiety toward the homosexual lessened and in turn he lost more of his compulsive symptoms. During this time, Pat recalled his fear of other homosexual men during the period of living alone at the university, and he saw a possible connection between these fears and the increase of his manifest compulsion neurosis. Simultaneously, he remembered a very disturbing conflict with his father when he was about three years old. His father punished his disobedience by breaking some of his most beloved gramophone records, whereupon Pat sought protection on the lap of his mother. This was a disturbing incident to a boy who loved records above all things. Clearly, Pat never felt entirely safe in his youth and could not trust his parents, since both behaved toward him in a castrating manner. The nucleus of his neurosis is his running back and forth between them for protection, a pattern repeated twice during therapy, first in his flight to the Jungian woman friend, and secondly when he felt threatened by the homosexual man at his office.
Following the loss of symptoms discussed above, Pat remained in group therapy for several years with relatively little further gain. He continued to be less tense and worked very well, but he continued to live alone and without friends. It seemed impossible for him to make contact. All his attempts to find a girl friend failed. His only hobby and source of “companionship” was a cherished record collection. His increased work capacity made it possible for him to become a technical specialist, even though he had given up his university studies. He developed into an excellent research man, competent in following studies in his profession without difficulty. Nothing more was achieved in the four years following the developments described above. Pat merged into the group, since he found it the only trustworthy contact he had, and he remained a somewhat paranoid member, gossiping about events in his life and showing a typically paranoid fear of being suggestible. In reality, he was not suggestible at all. Although he himself remarked upon his lack of improvement, he continued to come to group meetings, since he knew how lonely he would be without these contacts. Nevertheless, he experienced group communication as an empty, annoying routine. It seemed clear that this feeling masked his severe aggression against the others, especially with regard to his jealousy and competitiveness; but it was impossible to bring him into contact with these emotions. Therefore, Pat left therapy with his compulsion neurosis limited to those symptoms in his private life, which concerned his toilet activities. It seemed unlikely that there would be much later change in this syndrome, which remained static following the analysis of the short transference neurosis. Data obtained after two and a half years confirmed this prediction. He works well and with pleasure, but lives without contacts.
Case B: Frank was a physics student for ten years without any appreciable accomplishment despite his superior intellectual gifts. When he came for treatment on account of study difficulties, he was totally unaware of his neurosis but soon became very much interested in therapy. He appeared to possess deep introspective capacities. His life was chaotic, and he was always in debt. He had worked his way through college but now “floated” from job to job. Behind a forced gregarious behavior, shown mainly by his ready wit and bon mots that enabled him to compete with everybody, there was a deep-lying depression and depersonalization with strong homosexual tendencies. Frank gained insight into these aspects of himself as a direct consequence of his contact with other group members from whom he received an unprejudiced view of his neurosis and its symptoms. Naturally, the therapist played a definitely meaningful role in Frank’s acquisition of these initial insights. Ultimately it is always the therapist who determines the depth and quality of communication by interpretation of the resistances to the revelation of the deeper layers of an individuality.
After a time, Frank began to stand out in the group, since he was well provided with gifts for verbal expression, and his personal relationship with the therapist came into the foreground. Through this relationship he developed a passive transference to the therapist, acting out his feeling of being doomed to failure. He had a good reason for these feelings, since his family life had shipwrecked when he was twelve and his father committed suicide in a very dramatic way. In relation to this event, the fantasy that he acted out with the therapist soon came to light: if things go very badly, father will come back to the rescue; if they go successfully, father will never come back. In group, therefore, the relation to the therapist was very involved because it meant being with father again, receiving power and strength. Homoerotic masturbation fantasies, previously vague, were now recognized by him as being of a definitely feminine nature. Indications of oral fixations occurred again and again. He became aware of greediness and a longing for fellatio, but it was impossible to bring to the surface the roots of this relation with the mother, of which only a slight indication appeared in the transference.
Working through of the internalized traumata in the transference took only a relatively short period. It came about in a way entirely comparable with common psychoanalytic experience, and Frank showed a definite change. After two years of treatment he ceased being hypomanic, became more stable, and began to adapt well socially. He gave up his studies and devoted himself to the commercial career for which he was well suited and became successful in it. His condition remained the same after the period of working through his transference neurosis, with very little new material brought forward during the last three years of treatment. There remained remnants of serious neurotic complaints, such as ejaculation praecox, pruritis ani and other symptoms, which pointed to the fact that his relations with women were still unstable and disturbed. After breaking contact with his pauperized family and his psychopathic elder brother, he married a foreign woman.
In Frank’s case, too, it is very striking how the little drama accompanying the development of the transference neurosis forms the kernel of therapy. Before it and after it, with the exception of insights mentioned above, little of any real importance can be said to have happened. Following the transference drama, Frank also ceased concentrating on his relation to the therapist and merged with the group. At this point he talked about his pregenital inclinations and became clearly involved with the mother figure, but was unable to relive the situation because of the presence of too many “siblings” with whom he had to share the attention of the therapist.
Therefore, with sibling rivalry predominating, the transference became loosened, and it was possible to terminate the therapeutic relationship with the knowledge that an analysis might go further and ameliorate the pregenital disturbances as well. Those ideas about Frank were confirmed when I met him by chance a few years later. He was very thankful indeed; his life had changed thoroughly. He had a very good job and social adjustment but complained about his relationship with his wife, which was unsatisfactory. He expressed an uncontrollable urge for sexual relations with other women, for whom he felt no love. Moreover, this urge toward them was marked by a “queer kind of aggression,” to use his own words.
In the second stage of therapy, which has received most attention in the data of these examples, a few remarkable factors may be discerned. First is the concentration on the relationship with the therapist, with all the implications of the development of a transference neurosis and its influence upon the relations of the group members toward each other. It is evident that the therapy chooses its own terms at this point and that all energy is absorbed by adjustment to the ensuing tensions.
A second striking feature is the fact that all transferences in the group setting show, especially, aspects of relationships that originated at puberty or shortly before. Perhaps this throws light on the origins of transference in group therapy. The general opinion is that transference always has to originate from relationships of the period which is lost in infantile amnesia. I believe one can say transference always has an unconscious source, but I received the impression that in a group the transference neurosis turns on a repeated relationship stemming from traumatic experiences shortly before or during puberty. Simultaneously, however, I also saw experiences from preoedipal and oedipal sources of which the pubertal relationship is a “second edition.” In any case, the repetition in a transference neurosis of the vicissitudes of these rather recent relationships was striking to me. My experience with groups of men struggling to begin adult adaptation might show a unique accent on these problems which arise in communication with peers who feel the same conflicts. The relations with each other are filled with authority conflicts and frictions brought about by styles of living and community codes. Parental images seem to take two forms. In the development of a dyad transference relationship, the therapist represents an individual person with aspects of the early father or mother. However, when the patient interacts with the other group members, the therapist becomes the parent or parent substitute of adolescence, the leader, the representative of morals, style, and code, or the, figure against whom one rebels. These images are of an outspoken post-oedipal character, originating in the stage when the child loosens its dependent, anaclytic ties to the parent and grows toward the group or the gang and its leader.
It is evident that the problems spoken about in the foregoing examples are of a prepubertal nature. In case A, the symptoms were initiated by the divorce of the parents and developed afterward during puberty and adolescence with the mother. The conflicts appeared again in the transference neurosis, with a clear reference to analogous conflicts in the pre-oedipal and oedipal periods. However, the accent remained on the post-oedipal period, and therapy would not advance beyond this point; the group setting seems to be insufficient for the development of intimacy on a true oedipal or pre-oedipal level.
In case B, material from the pre-oedipal period was undoubtedly presented, but was not really part of the transference neurosis. Indications of original conflicts from the oedipal stage were also evident and could be partially analyzed. However, the most important experiences in the therapy originated from the severe trauma in pre-puberty, the father’s suicide and its consequences.
Thirdly, it is obvious how dependent this therapy is on the tensions that arise within the situation. Here lies the importance of the composition of the group. The leader is relatively powerless to do much with a poorly selected group in which the deeper needs of the members are too similar. But he is also paralyzed by a too-disparate group.
If, for instance, a member who is cognizant of group processes dominates from the beginning to such an extent that others cannot develop their own vision, there is little the therapist can do. The therapist is dependent on relations within the group itself and may be effective only by using the shock of opinions to split subgroups. Tension between members is very important, but so is the possibility of eliminating tension when necessary. Naturally, it is the therapist who defines the nature of this communication and gives shape to the contrast between the contents of the individual superegos and the general code. He cannot, however, influence these matters without a sufficient amount of divergence and support among group members.
To summarize, it is sufficient for my purposes in this paper to discern three stages in the course of group therapy in which one centers on transference neurosis toward the therapist.
First, a stage in which the new environment and its therapeutic goal defines the tension and contrast whereby orientation and subsequent adaptation will take place. I hope it has been made clear from both case reports how this adaptation furthered the communication of defended feelings and the development of the transference neurosis, which leads to the second stage wherein the dyad relationship with the therapist develops. The author supposes that this development is more outspoken in groups of less than six members.
The third period is one in which the tension lessens. Members lose interest in the group and do not experience from it what they did at an earlier stage. Regression stops; the transference neurosis, in the limited form it can develop in the group setting, has been analyzed and worked through. The group becomes more rigid, governed by its “tacit agreement,” its “code,” and only a change in its composition or the breaking of existing resistances, frequently unsuccessful, brings progress. Therefore, it is evident how dependent the therapist is on the existing situation in the group. However, he is also continuously the focal point of the situation because of his constant leadership and authority, which induces identification in the members. Especially with relatively young members, he will be the center of a pedagogical influence. Such influence is less with older people of more settled opinions. It was my experience with both these groups that the first, which started with younger men, was more molding in terms of the therapist’s model than was the second, which started with older men.
In this connection it is important to discern two predominating influences exerted by group therapy. (Spanjaard, 1959). First the pedagogical influence that molds the content of the superego and the ego-ideals through identification with the therapist and with the “tacit agreement” or “code” of the group, which is the common denominator of all inducing forces. This factor is effective throughout all phases of group psychotherapy. In the first stage weakening the resistances, in the second furthering urges and feelings of a very intimate nature, and in the third, especially, inducing adaptation to reality and growing to the termination of the therapy.
The second influence results from a working through of the transference neurosis in its structural sequences, the problem to which I have given emphasis in this paper, since I consider it the more important of the two. I was constantly aware of my own structuring of the situation in an attempt to influence common themes and to break resistances and loosen ties between the members. Every structure in the group was considered as a hindrance; only an involvement with the therapist may give true analytic therapy, even if one cannot work without the factor of the group as a whole. The latter factor is continuously appearing in the “tacit agreement,” in which one finds expressed aU the directing forces of personality, psychoanalytically defined as superego and ego-ideal. Its determining influence in favor of, as well as against, the course of therapy, is discussed above.
In conclusion one may say that grouping remains the predominating dynamism in this therapy. A good group composition is difficult, but a prerequisite. The grouping relationships between the members and the “tacit agreement” determine the influence of the therapist as well as that of the members upon each other. The group remains throughout the vicissitudes of the therapy something to fan back upon as a regressive situation, a source of dependency and protection perhaps comparable to a mother. But certainly in little groups as described here, every member will emerge from it into the dyad relationship with the therapist and find there the tensions of transference neurosis, the working through of which may bring him real structural improvement.
Analyzing my own function in this process, I considered my main task as group therapist to be the undermining of individual and general resistances, thereby furthering the exposition of repressed material and the development of the transference neurosis.
These points of view do not differ from the common theoretical and technical basis of psychoanalysis proper. However, the possible danger of a mere suggestive influence by identification rather than a real working through of the transferences probably is a greater pitfall in group therapy than in individual psychotherapy.
However, the psychoanalyst who uses group psychotherapy will meet some facts new to him. He will get an increasing interest in post-oedipal experiences and traumata of puberty and adolescence. Perhaps his idea about the origins of transference will become less certain. Must transference always be a repetition of relations and feelings from the period of infantile amnesia? Perhaps much later events playa role, at least when they are warded off and unconscious.
There exists another problem that has to be solved by ‘group psychotherapy: Are there traumata that could be called “group traumata,” such as with children badly prepared to begin school or adolescents suddenly exposed to much more adult mates? Naturally, their unprepared disposition originated in their families, especially their parents. Does the group therapy situation exert a beneficial influence on these patients? In individual analysis, too, I believe every therapist who is acquainted with group psychotherapy recognizes instances that make him wonder if there are “group traumata” that could be better treated in group rather than individual therapy. I do not think here of a “corrective emotional experience” but of the possibilities of reliving in transference and of working through. Perhaps this will be one of the most interesting questions to which psychoanalytic group therapy will add some entirely new observations and data to psychoanalysis.
Spanjaard. J. (1959). Transference neurosis and psychoanalytic group psychotherapy. Internat. J. Group Psychother. 9:31