The Challenge for Group Psychotherapy

Psychoanalysis in Groups, Part 4

How can that search be kept alive? By communication, by learning to know what makes us tick, what makes the other fellow tick, and how he affects us and we him. And the more “other fellows” we know and who know us, the more we will communicate and, hopefully, the more we will understand. Group psychoanalysis of the future will try to understand and treat the individual and will direct its efforts to the end that he be able to adapt to the world in which he lives and also to change it, and to the end that he be able to communicate with and respond constructively to others by word and action. The standard for mental health will be in terms of the widening of the boundaries of one’s active and interactive life rather than simply the solution of personal problems.

Considering the situation in the world today, in this context alone, psychoanalysis in groups cannot wait. It must become psychoanalysis for today, or there will be no future. Patients must get off their couches between sessions and analysts must get out from behind their couches between sessions and join people everywhere, especially when national and international crises are to be faced. Why, for example, should we all not be doing something, committing ourselves in some way or other, on the question of atomic testing and atomic bombing? If we do not, there will be no life with which to pursue liberty and· no happiness to be sought with the help of psychoanalytic means. And those of us who are too persistently dedicated to the couch may, one day before long, find there is a sudden and dreadful peace from which no human being will escape.

It is part of the analyst’s credo to be committed to the value of reason and against unreason; to consciousness, not unconsciousness; to reality, not unreality; to sanity, not insanity. How realistic, sane, conscious, and reasonable is he, pursuing the subtleties of repressed conflict in the individual patient over long years, when hovering over him and all of us is the possibility of sudden and total extinction? His dedication to mental health is an illusory pursuit, unless he also does all he can to mobilize himself and others into effective relationships and activity in the world about him with its demands, its problems, and its responsibilities. To pursue mental health, we need first to be certain that we keep our bodies and brains very much alive. Of course, to avert something like atomic catastrophe, analysts and their patients are not enough.

Only all of mankind will do. But we must make a start—by coming out from behind our soundproof doors and joining with others, emerging out of bomb shelters, out of hiding, out of the passivity that waits to see what may happen and try to do something about it no matter how small.

Scientists are often too neutral. Atomic physicists have, with some notable exceptions, devoted themselves to the discovery and uses and misuses of atomic energy with an alarming neutrality with regard to its application. Psychoanalysts also suspend judgment in dealing, let us say, with a patient. They do this in order to allow the repressed to emerge during the course of treatment. But this suspension of judgment is sometimes unreasonably applied—just as it is by parents who yield to every whim of their children or make their children yield to every whim of theirs or by people who feel they must yield to the impulses or misjudgments of their leaders.

I do not mean to say that psychoanalysis can solve the problems of the world. I happen to be interested in psychoanalysis in groups as a method of treatment, but I do not join those therapists who would like to bring the blessings of group therapy or of individual or group analysis, to solve mass conflict on a national or international basis. Nor do I agree with those who feel that all government leaders should be analyzed as an answer to the problems we are facing.

Still, the theories of Freud and those psychoanalysts who followed him have affected our society profoundly. Extensions of psychoanalytic thinking are evident everywhere: in the study of psychosomatic medicine, anthropology, sociology, philosophy; in literature, theater, painting, and criticism. Psychoanalysis in groups is a technical extension of those theories, particularly suited to the needs of our times. And it, in turn, will create its own extensions in our professional, creative, and personal lives.

I wish to underline the trend in group therapy away from the concept that the patient can be helped by only one person—God, the father, the mother, the analyst—or by only one kind of analysis. This is especially important for us today, when paternalism on the one hand is being fostered and encouraged by the “organization man” structure and on the other is being violently rebelled against by a large part of the world. Analysis in group directs the patient away from the idea that there is only one source of help, only one omnipotent source for sustenance and development.

Some people have already learned this lesson, whether through experience in groups or not, I do not know; but somewhere, somehow the idea has caught on. Some years ago, a letter written by a psychologist in Stockbridge, Mass., was passed on to me, and I am going to present parts of it here, because it is such a splendid and moving example of how people’s getting together in groups can be extended beyond the treatment of mental illness.

The letter begins by describing concern about the world crisis, with its threat to all of us. It describes the personal and long-unexpressed fears of the writer and his feelings of utter helplessness. Then he goes on to say:

We have discovered the beginnings of hope—a hope born of desperation and of a stubborn belief that it is better to do than not to do—that it is better to face the awesome enormity of our peril than to comfort ourselves by denying that peril and all its implications. We have begun to share our loneliness, our fears, our anguish and our sense of helplessness about the perilous world situation. …. At first we were afraid to let each other know of the dread we have had locked in our hearts …. But then one of us timidly and tentatively let escape a hint of our deeply buried sense of burden and anguish …. And then the other of us, somewhat less timidly but still with much discomfort and embarrassment allowed himself to say he, too, had been similarly burdened. And subsequently these two spoke to a third and a fourth and each time the effect was the same. We began to share our deep distress. We began to say so more openly. We began to discover that to talk and to share feelings and concerns that even the sheer act of doing something, even if it was only talking, somehow was helping us.

We began in a clumsy way—awkward in our self-consciousness. None of us knew any answers, least of all to the question—what can we do? Then we began one by one to talk and to ventilate our thoughts and feelings. And as we listened to each in his turn, we saw ourselves. His words may have been different, and perhaps his thoughts and the course of action he advocated also were different—even alien. But in his sense of common peril, he was all of us.

The letter goes on to say that as this small social group continued to meet, they began soon to speak of specific things: some argued for shelters, some against, others wondered how medical supplies and uncontaminated water could be provided let alone distributed. And, to quote the letter again:

“A strange thing happened. We started to feel less alone. We began to feel better. The sheer fact of talking to each other, and sharing loneliness with each other was helping us.”

I wish I could present the whole letter, but space forces me to summarize. The original group split off into sections, each to form its own groups, oriented to the same purpose, until most of the town was included and every shade of opinion was being aired. Later there was communication on a wider level, through newspapers, radio, and television. So grass-root movements have been started before and so may this become one.

But to get back to our point. This letter describes very well one level of experience in psychoanalysis in groups. It is not easy to describe. Some people are afraid it might smack of Buchmanism, of the public confessional, the revival meeting, but it is not that at all. Psychoanalysis in group or out, past, present, or future, has always tried to get the patient to know himself, to look his true thoughts and feelings in the face and thereby improve his attitude toward himself and his relations with others.

Malraux is reported to have said that portraiture in modern art is practically nonexistent, because mankind has committed so many crimes in our era, it dares not look itself in the face. Group interaction is usually effective in trying to bring that very thing about. It is not easy for analyst or patient. It is only human nature for all of us to resist those who insist we put the mirror up to ourselves. In other interaction we usually employ face-saving devices. To keep social interaction going we are apt, more often than not, to conceal the truth of our judgments and feelings. But for psychoanalysis to work, these face-saving devices need to be exposed and then analyzed. One of the things the analyst tries to show the patient is that it is possible to have a good relationship with him, at least, even if the truth is revealed. And he keeps trying, no matter how the patient resists, ambivalates, projects, and distorts in his struggle against knowing the reality.

In group, this situation is heightened and dramatized, because a member may refuse a relationship with fellow members who challenge him by letting down their face-saving masks. He may even vilify the analyst for allowing it. There are some who cannot tolerate the truth about themselves and who insist that others remain bound by the same chains. But there are others who take heart from seeing the struggle to ferret out the real from the illusory and who gain courage thereby to continue their own fight for mental health. I think the letter I just cited proves one thing, at least, that this level of interaction happens, that it is good to have happen, and that it makes the specific analytic treatment of the individual less isolated, less self-absorbed, and more in contact with humanity—and therefore all the more clearly experienced.

The reader may ask why, if groups can take care of so many more patients, if such treatment is less expensive, if there is a shortage of analysts, and if analysis in groups can be so effective, why are so many analysts resistive to it?
I believe one reason is that they have not had the experience of analysis in groups themselves. Another possibility is that analysis in groups can be hard on the analyst, who has been trained to sit with one patient at a time and usually behind the patient, where the analyst’s actions and reactions are not under such scrutiny, and where he is in less danger of being challenged for his interpretations and reactions. The analyst in a group is called on by others, if not by himself, to examine his own reactions.

More and more analysts are, however, welcoming this trend toward examining their own reactions, not only because it is in tune with the positive trends of our time, but also because giving up their godlike role spares them much of the iconoclastic malice they are subjected to in the popular press and humor magazines. Not that we do not deserve some of it or that we should not be able to take a little ribbing now and then. But there are enough pitfalls to being an analyst without having people demand that he always be perfectly healthy with a perfectly healthy wife and children, that he be omniscient, all-powerful, and magically able to solve all difficulties.

It is true that some few analysts believe their own publicity and try earnestly to live out their patient’s image of them. But most of us understand that these jokes and attacks have a deeper origin in resentment that the analyst does not live up to these demands of perfection, that he does, indeed, have feet of clay.
Well, in a group, the analyst who does understand has a chance to practice what he preaches: to show in his own conduct of the group and his own interaction with its members, that he is not a god or a miracle worker but a human being with certain skills and certain professional training, and human enough to make some mistakes and as capable of learning something new as any other person. What is more, such a situation is healthy, for how else are we to get new insights into human problems and behavior?

I will say more of psychoanalysis in groups, because in the immediate future, at least, psychoanalysis is moving in that direction. Perhaps analysis may, one day, be incorporated, like Newton’s theory, into a much larger and more appropriate theory. Today we have moved from Newtonian to Einsteinian physics, from earth space to outer space science. Perhaps one day, psychoanalysis will move to a larger view of the minds of men, in a grander, more realistic understanding. Perhaps one area of research will be the question of why we are so fearful of knowing ourselves and of being seen and how to deal with our need to hide. The analyst needs to know that himself as well as the patient. There would not be so many schools of psychoanalysis and so much acrimonious debate about different methods if analysts themselves were readier to welcome knowledge from outside their particular spheres and biases.

I am reminded of a symposium of analysts from a certain school we call, for want of a better name, “orthodox.” They had invited a lecturer from another school, who spoke fervently of the need to revive, in our professional vocabulary, such words as “faith,” “hope,” “ideals,” etc., as positive facets of an integrated human being.

His audience was polite but, over coffee in the cafeteria later, faintly derisive. What kind of nonsense was he talking, it was asked? Did he really ~hink you could apply those words to science?

Nevertheless, one of them continued to press for some kind of integration, some meeting ground where the guest and they could join and understand each other. And suddenly he had it! “I know,” he exclaimed, “you can hope you’ll kill your father! You can have faith you’ll sleep with your mother!” and so on.

Broader Training Needs
Well, unorthodoxy is like the weather. We all talk about it, but very few of us do anything about it—in the sense of fostering and welcoming it (unorthodoxy, not the weather). What we badly need in analysis is a United Methods Institute, a UM of Psychoanalysis, evolving from the many dissident groups existing today, where unorthodoxy and flexibility will be seen as desirable and as a healthy manifestation of mature minds engaged in a mutual search, rather than as an excuse for flight, splinterings, and introversion. Psychoanalysis needs new ideas. The world needs new ideas. New ideas arise out of conflict—conflict within one’s own group, with other groups, and within oneself when old patterns have ceased to function well. New ideas arise also when theories, hypotheses and experiences are communicated and shared in an atmosphere of cooperating and harmony, with the privilege to criticize and disagree. Discord and harmony coexist in nature. They are part of the reality of man. And it is with the complexity of that reality—intrapsychic, interpersonal, and interactive—with which psychoanalysis has chosen to deal as a science and as an art. By its very nature psychoanalysis must deal with the basic themes of human life, love and hate, money and power, birth and death, and sex. This calls on all the resources of the patient and of the analyst, as a human being as well as a scientist.

This is why the training of the future analyst in groups will be much broader in scope than it is today and will include many disciplines only skimmed through in training today. With this background, the group analyst of the future will listen carefully to the experience of his elders but be less fearful himself of trying the new and the different. He will be less apt to stick rigidly to prescribed schools of thought, more tolerant of the right to dissent, less afraid of the danger of taking calculated risks, of examining the skeptical and heretical position. He will, in the future, value more and more his freedom to explore the prescribed, even as his knowledge and experience increase. He will learn with his patients that none of us is absolutely unique, but are, at the same time, homogeneous and heterogeneous. That we do not live alone or apart, a fact which makes it impossible to conceive of a one-person psychology. That not only authorities but peers are important and that help can come from them, that even his patients being together without him in alternate meetings can be reconstructive. In this future time, “socialization” will no longer be a dirty word in analysis whose only meaning is resistance. It will be acknowledged that socialization can be, at times, therapeutic. If it takes two to tango and at least two to tangle, just think of the possibilities that are opened up when there are eight or ten people in a therapeutic group.

This method of expanding boundaries of communication will also call for expanding boundaries of training for the group analyst himself, who will not only be a psychiatrist, a psychologist, or psychiatric social worker. He may also come from other ranks: sociologists, anthropologists, and humanistic discipline, just so long as he has demonstrated a genuine will to train further along group analytic lines.

It will not be demanded that he be a scholar so much as that he be endowed with horse sense, with reasonableness, a combination of common sense, intuition, training, and wisdom. And he will retain that essence of childhood, so dearly clung to by creative scientists and artists, the sense of wonder, which enables one to see freshly again and again, to question, to accept, and to renew.

The group analyst of the future will have a certain kind of knowledge and a love of that knowledge, not confined to neurology or statistics or research but including as much as possible: history, philosophy, education, anthropology, comparative literature, mythology, the arts and sciences as they pertain to as many facets of human relatedness as possible.

And he will be a doer. He will have demonstrated in his own life that his own creative impulses and powers have areas in which to breathe outside his chosen profession. Can he sculpture, paint, write, garden, or have a family? Each will find his own room and way of expression, but in order to help his patients find theirs, somewhere, somehow, it needs to be part of his own creative experience, so that we and he know he functions as a total person, with a combination of head, hand, and heart. The kind of person he is will rank high in the table of standards for selection, because, above all, we would wish the group analyst of the future to be a humanizing force, and for that he himself needs to be a broad human being who has given up his own isolation even as he strives to bring his patients out of theirs. He lets himself see and be seen outside his office hours. And he finds the community and the outside world eager to meet him, eager to implement and expand their own boundaries on the community level as well as the personal.

This does not mean that we are advocating or recommending analysis in groups for everyone. That would be impractical and unnecessary. There are, however, good grounds for supposing that psychoanalysis in groups will not only be a setting for the treatment of neurotic illness or the training of the well-rounded analyst.

One day, surely, group psychotherapy or some version of it will be exploited for its preventive possibilities and will be made available to adolescents in high school and even to children in elementary school. A school psychologist, trained in group therapy techniques, for example, would be in a position to counsel and guide teachers in dealing with less serious problems in day-to-day contact with students. It may be possible to catch some neurotic tendencies in children before they get too firm a foothold in the personality, and we may be able to uncover the secret, positive yearnings of the child and help to encourage them. I hope that more and more teachers and parents will elect to have a subjective experience in a therapeutic group, not only to stabilize themselves in their chosen professional work and in their social lives, but also to enable them to apply preventive mental health hygiene principles in their dealings with students and children.

With these innovations, public interest in group therapy is likely to grow, if only for the opportunity it offers for escape from isolation, the plague of modern man, into a kind of communication that is encouraged to be free and honest. All of us have disturbances and gripes on one level or another, and an opportunity to ventilate them can be beneficial, especially if, at the same time, the other fellow is encouraged to communicate his response. Trade unions, parent-teacher associations, and other professional groups, sharing common interests, may approach (some have already done so) insurance companies with a view to making psychoanalytic group therapy available at a lesser cost. And these companies, finding that analysis in groups is just as effective as individual analysis and less costly besides, may well take the initiative in supporting psychoanalytic treatment in a group.

While I was writing parts of this paper, I happened to hear a rebroadcast of one of John F. Kennedy’s press conferences. He said at one point: “We happen to live, because of the ingenuity of science and man’s inability to control his relationships one with another, we happen to live in the most dangerous time in the history of the human race.” Analysis in groups is one attempt to deal directly with this problem of man’s disturbed relationship with his fellow man.

In group the patient is asked to give up his isolation in therapy, the analyst is asked to give up his omnipotent position which puts him into a kind of isolation. We hope the increasing ability of the individual to control his relationship one with another and one with the group will spread to the community and from the community to the state, the nation, and the world, though we know that to this end analysis itself can play only a small part.

I am reminded, as I bring this paper to a close, of a sign in the subway some months ago. It read: “PEACE by 1969!” Underneath someone had written: “With or without people?” The answer to that question must, somewhere or other, lie in our individual hands. We have to be the first to realize that analysis, individual or group, is not the be-all and end-all of the problem of human existence. Some people of the world are hungry and medically uncared for and need life first. Some have life and need liberty. Some have life and liberty and need happiness. In some societies children do not have much of a chance to live beyond five. Life, liberty, and the pursuit of happiness are, in that order, as much our concern as anyone else’s. What is more, as we have often seen in groups and as we are witnessing in the world today, sometimes all these three are being fought for at one and the same time.

How are we to meet these chaotic emergencies? By remembering that the search is greater than anyone given answer and that if an answer is found, it proves itself true by opening the way to a greater search. It is a truism that the revolutionist of today is the archconservative of tomorrow. That need not be if we resolve never to abandon the search.

Let us, in the future, find the courage to be pliant, to accept authority without ever relinquishing the right to question and criticize that authority. To think of possible differences without fear of retaliation and then to try the different. We want the courage to be adventurous, to take chances without being foolhardy. Today’s spaceman was, according to some psychiatric thought, yesterday’s schizophrenic. It took courage to be the first man in space, but it also took careful planning. It is this courage of the consciously aware, objectively prepared, that group psychoanalysis of the future will strive to foster. For that we will need to work together. If we are to meet the future face to face, it is better done hand in hand. From now on let it be said that group psychoanalysis is still dedicated to treating the emotional and mental disturbances of the individual; the future trend will be in the direction of decreasing his separateness and bringing him more and more into contact with his fellow human beings. Perhaps that way we will be able to answer partially the age-old questions propounded by a Talmudic scholar (Rabbi Hillel) “If I am not for myself who will be? If I am not for others, what am I? If not now, when?”