Group Psychotherapy Derived from Psychoanalysis

ego in each patient and the working through of

B.1 Psychoanalysis in Groups individual resistances and transferences. An ap-
propriate regard for each other can follow only
Irwin L. Kutash, Ph.D. after a member has realistic self-regard. With the
Alexander Wolf, M.D. emphasis on the primacy of the individual patient
in psychoanalysis in groups, it is, therefore, not
the aim to lead the group into the chaos of
INTRODUCTION everyone for himself or herself.
Psychoanalysis in groups emphasizes harmony
The thrust of psychoanalysis in groups is that growing out of disharmony, reciprocity growing
the creative growth of the individual ego is pri- out of antagonism, ego growth through persistent
mary (Wolf, Kutash, Nattland, 1993). Group emphasis on supporting the suppressed ego, self-
psychotherapy is a misnomer for a technique respect and respect for others in the course of the
that, although conducted in a group, is designed struggle, the appreciation of differences, and a
to aid an individual patient; it is a treatment of sense of mutual regard as treatment goes on.
ailing individual patients in a group setting, not a Until now, psychoanalysis in groups has been
treatment of ailing groups, since only individual the recipient, the student of individual analysis.
patients have intrapsychic dynamics. Further- Analysts in groups have tried to bring to their
more, the treatment both enhances individual work the knowledge and the technique that the
analysis arid provides some benefits impossible in individual therapy analyst has had to offer. In-
dyadic treatment. sights, experience, and understanding derived
All group therapies share three fundamental from psychoanalysis done in groups may well
ingredients: (1) a group therapist and at least two improve, intensify, and enrich the character of
patients, (2) multiple interaction among the individual analytic therapy. If analysts were to
group members, and (3) limits on what takes become aware of the value of forced interaction,
place. Psychoanalysis in groups, a form of group of socializing, of becoming involved with other
therapy that was pioneered in 1937 by Alexander people, of resolving hierarchical and horizontal
Wolf, shares those three ingredients. However, vectors, of dealing with status problems, and of
psychoanalysis in groups has an additional basic the value to intrapsychic change of multiple inter-
ingredient: the exploration and working through personal experiences, those areas would not be
of unconscious processes. neglected in individual treatment.
Indeed, psychoanalysis in groups, with its em-
phasis on protecting and promoting the whole-
THEORY some uniqueness of the individual patient, is
perhaps more relevant in contemporary society
Therapists who emphasize group process and than it has ever been.
group dynamics and those who emphasize the
psychoanalytic treatment of individual patients in Exploration of Latent Material
interaction and their intrapsychic lives wish to
create a climate that supports the progressive Group therapy that introduces psychoanalytic
evolution of each patient in a therapeutic group. means is concerned not only with the manifest
The current emphasis on group process and but also with the latent in patient interaction and
group dynamics not only fosters resistance but functioning. The analyst takes the lead in the
also creates a di-egophrenogenic effect (a sub- search for unconscious processes by promoting
merging of each member's personality) (Wolf, free association and the analysis of dreams, resis-
Kutash, 1991) and provides a pseudocohesion to tance, and transference. The search for uncon-
which each participant submits. A genuine cohe- scious motivation and processes leads patients
sion follows after the liberation of the suppressed away from the here and now and into the there
B. 1. PSYCHOANALYSIS IN GROUPS I I 127

and then, into historical determinants, and back they are afraid of tapping. H e r e , too, the by-
to the here and now with a less distorted view passed patients, like the monopolistic patient,
than in the past. Group therapy is ; converted into may have any one of a series of unconscious
psychoanalysis in groups only when that ele- determinants that require exploration in depth.
ment—the investigation of intrapsychic mate- In group psychotherapy with the principle of
rial—is introduced. alternating roles, members are sometimes asking
U n d e r such circumstances, the other parame- for help, sometimes giving it. In psychoanalysis in
ters take on new depth and meaning. Hierarchi- groups, some members use the role of the helper
cal and horizontal vectors cease to be merely as a way of resisting treatment. The same is true
current experiences with authority and peers but, of those who are always helplessly demanding.
instead, acquire parental and sibling transferen- The analytic group searches for the historical
tial qualities that are reexperienced, and con- determinants that have imposed that particular
scious plans are then introduced to work through r e p e t i t i o n c o m p u l s i o n in o r d e r to w o r k it
those distortions. through.
The intercommunication characteristic of mul- The psychoanalyst in groups introduces an
tiple reactivities is no longer promoted simply for activity not generally available in other group
cohesive socialization, which admittedly has its therapies: interpreting the nature of unconscious
psychotherapeutic benefits. Interaction is also processes in the interaction among the patients
used to proceed from the interpersonal to the and between the patients and the therapist. T h e
intrapsychic, from the manifest to the latent and patients in time learn how to understand the
back to the interpersonal. The pursuit of the latent meaning of their contributions and make
intrapsychic in the interpersonal stresses self- significant interpretations as well; their impres-
knowledge that can lead to personal integration. sions are sometimes appropriate, sometimes not.
That personal integration can lead to wholesome Unconscious material is worked out and worked
social integration. through. The patients develop insight, which
Nonanalytic group therapy frequently im- helps them to understand their disabilities. They
poses a superficial social interaction that can are thereby able, with the support of the analyst
disregard the personal psychodynamics of the and the other patients, to struggle to resolve their
individual patient. In nonanalytic group therapy difficulties.
:he patient may be either well-served or victim- Nonanalytic group psychotherapists may use
ized by the principle of shifting attention. The many of the means of the psychoanalyst. But
patient overly concentrated on may welcome a unless they emphasize and explore latent con-
respite from group examination. Other members tent, they are not practicing psychoanalysis in
may find themselves too frequently bypassed, groups. Psychoanalysts leading groups do not
little if any time is spent in a study of each limit themselves exclusively to the search for
member's psychodynamics in provoking the re- unconscious manifestations. If they entirely ne-
sponses received and the latent nature of those glect manifest behavior, they are practicing indi-
reactions. T h e contrast when psychoanalytic vidual analysis in a group setting. Analysis in a
n e a n s are introduced is striking. The patient who group requires attention to horizontal and peer
focused on may be masochistically provoking vectors, to multiple reactivities, and to uncon-
»hatever latent sadism exists in the other mem- scious processes, with special emphasis on the
:ers. Manifestly, the patient who is focused on is last. But individual similarities, manifest behav-
i monopolist, but on a deeper level the patient ior, and group dynamics are neither neglected
may be trying to exclude younger siblings from nor denied.
letting parental attention. The patient may be Interpretation. The analyst guides the group
remanding attention in an oral-incorporative way members from multiple interaction to the search
: r could be receiving much attention because of for unconscious motivation, f r o m the manifest to
the patient's narcissism, exhibitionism, or phallic the latent. By that means the historical bases for
rverbearance. There are multiple possibilities. the activity are brought into consciousness. Pa-
The bypassed members may be latently the good tients who object to the movement f r o m manifest
inildren, quietly waiting their turn—hurt, disap- behavior to unconscious motivation and persist
pointed, and enraged at being neglected. They merely in catharsis or verbal acting out of affec-
ziay be frightening to the other patients, who tive interaction are in resistance. When they
aguely sense in the silence an enormous hostility accept the idea of the relevance of the latent
128 • Area B. SPECIALIZED GROUP PSYCHOTHER APY TECHNIQUES

material, they begin to offer interpretations of In dyadic analysis the therapist interprets the
their own. Some of those interpretations are free association of the analysand, whose associa-
valuable. In the main, however, they are not tions are free to the extent that the patient is
systematically timed. An analyst may carefully unaware of them. In analysis in a group, the
consider when to introduce an interpretation, but patient not only freely associates but is required
a patient reacting spontaneously is liable to be to operate with an awareness of the others. Al-
impulsive, and a poorly timed interpretation is though that obligation may appear to limit the
only partially heard or not heard at all. f r e e d o m of the patient's stream of consciousness,
Intrapsychic and interpersonal. A consider- the d e m a n d for mutual awareness promotes good
ation that bears on relatedness and reality is health. Unrestrained free association without the
concerned with intrapsychic versus interpersonal checking of feedback in reality leads to disequili-
emphasis. O n e central therapeutic factor intro- bration and derangement.
duced by psychoanalysis in groups, sometimes G r o u p analysts' preoccupation with interrup-
neglected in individual analysis, is the social ne- tions of free association may represent their wish
cessity, while expressing one's own thoughts and to conduct individual analysis in the group set-
feelings, to consider also the ideas and the emo- ting. But such a commitment prevents the leader
tions of other people, an interactive process that f r o m using the resources of the assembled pa-
demands reality-boundness. That socializing ex- tients and interferes with proper treatment of
perience does not permit a dangerous regression them. T h e interruptive contributions of fellow
into autism. It calls attention to the speaker's patients not only clarify the presentation of a
provocative role. It makes possible the explora- given patient but may be used as f r e e associations
tion not only of the internal consequences but in themselves. In a discussion of a d r e a m , for
also of the external consequences of behavior, example, the f r e e associations of various mem-
without denying the speaker the freedom to asso- bers stir the f u r t h e r exposure of the dreamer's
ciate. unconscious material. They also give the analyst
In individual analysis—by virtue of the illusion additional hints for understanding the dream and
created by the therapist, who does not generally clues to the psychodynamics and the psychopa-
respond with subjective feeling to the patient's thology of the others, which can be multilaterally
communications—the analysand has little experi- interpreted.
ential opportunity to develop a sensitivity to the T h e analyst's conception of fellow patients
needs of others. O n e of the outcomes of a good communications as interruptive denies to the
analysis should be not only self-awareness but group the value of multilateral analysis. Instead,
also awareness of others. That experience is it imposes individual treatment in the group set-
largely rejected by the nature of the individual ting and encourages a rivalry among the patients
analytic orientation, which implies that almost to interrupt one another, which becomes a com-
anything the patient says to the therapist is inap- petition to be heard by the analyst.
plicable to the therapist. That is a kind of grand Encouraging patients to enter in with their
illusion the therapist creates, and it is frequently own free associations, which are also acknowl-
a self-protective mechanism. As a result, the edged and examined, promotes the feeling that
patient tends to become rather isolated and self- all are in analysis, rather than just a single mem-
involved. ber at a time in rotation. T h e r e f o r e , the analyst
Free association. Analytically trained thera- must deal with any presented material as interac-
pists are often doubtful about whether patients tional, so that the n u m b e r of patient interrela-
can associate as freely in a group as in a dyad. tionships is enhanced. In so doing, the analys:
True, there are more interruptions of f r e e associ- a u g m e n t s , r a t h e r t h a n circumscribes, all the
ation in a group than in a dyad. But to look on streams of consciousness in the group. T h e ana-
unrestrained, u n b o u n d e d , and indefinite free as- lyst's aim to give space to each patient in which to
sociation as fitting is to misunderstand the func- associate freely is commendable. But by limiting
tion of free association and the nature of analytic the free play of the others, the analyst real/,
treatment. It is better to use free association hinders the achievement of the goal. In analysis
selectively, with recognition of when it is expedi- in a group, all the analysands should be encour-
ent. It is neither possible nor advisable to associ- aged to be collaborative and active participants.
ate freely at all times. Discontinuity and bounda- Dreams and fantasies. In psychoanalysis in
ries are essential in treatment, as they are in life. groups, dreams and fantasies are of the utmos:
B. 1. PSYCHOANALYSIS IN GROUPS I I 129

importance, as they are in individual psychoanal- richer and more rewarding to the patient than
ysis. In groups, dreams can have even more was illusion.
usefulness than in individual analysis in one Analysis of resistance. Resistance in groups
sense. Dreams can elicit unconscious free associa- manifests itself in the forms encountered in indi-
tions not only from the dreamer but also from vidual analysis, but the group setting provides a
o t h e r g r o u p m e m b e r s . I n psychoanalysis i n special environment that lends itself to the elabo-
groups, patients are asked to recount recent ration of resistive forms peculiar to it.
dreams, recurrent dreams, and old nightmares. For the patient "in love with" the analyst,
They are asked to free-associate around the being in the group is enlightening. The patient
dream content and to speculate about and inter- may become as emotionally attached to another
pret the dream. In lieu of dreams, the therapist group member as to the analyst. That "unfaith-
encourages the group to present fantasies, rever- fulness," the rapidity and the completeness with
ies, and daydreams. The therapist asks the group which the patient moves f r o m one person to
members to avoid the censorship of fanciful spec- another, confronts the patient with the irrational
ulation about one another's productions. In that and compulsive character of the behavior, and
way the dynamics of the dreamer and of those the nature of the activity becomes obvious as
who associate to the dream are analyzed. transference.
The essential difference between the analysis A n o t h e r manifestation of resistance is the
of dreams in individual therapy and the analysis compulsive missionary spirit. H e r e the provider
of dreams in psychoanalysis in groups is that in persists in looking after group members in a
groups the members can associate to others' supportive, parental way, using that device to
unconscious productions, as well as to their own. subtly dominate and attack the other members
It is the analyst's job to translate their associa- and to repress basic pathology. The group mem-
tions in regard to the associators' dynamics and bers resent that false charity and demand and
only secondarily to those to whose dream they evoke spontaneous participation by rewarding
associate. The therapist takes another road to the messianic for unguarded slips of feeling and
each member's unconscious through associations by rejecting dogmatic helpfulness. Doing so does
to the unconscious productions of others. not imply that warm and spontaneous offers of
For the dreamer, dreams are discussed be- assistance are rejected; rather, as long as suppor-
cause they reveal essential unconscious data reli- tiveness is not compulsive but thoughtfully sym-
ably and with a demonstrative and liberating pathetic, it is welcomed as a sign of good health.
effect. The analyst must ask for the data in detail. Voyeurism is resistance that is more general in
Dreams are also valuable therapeutic adjuncts psychoanalysis in groups than in individual psy-
in the clarification of transference. A member choanalysis. Some patients try to escape personal
may, for example, project an associated woman examination and engagement by retreating; they
patient in a dream in a dual role, both as a seem willing and even eager to allow others full
menacing figure and as a lovable person. The interaction, but they assign to themselves a trem-
patient may do that before free association or ulous watchfulness. The group members, how-
biographical acknowledgment has given any indi- ever, have little tolerance for nonparticipants.
cation of the mother's ambivalent attitude toward They engage the voyeur by their welcoming self-
the patient. Interpretation of the dream enables exposure. They move the nonparticipant by in-
the patient and the group to discover a destruc- viting and provoking the m e m b e r to become
tive mother image with which the patient compul- involved in the warm emotional life of the new
sively invests the woman. As the patient recog- family. The voyeur's resistance begins to melt
nizes the transference features of the vision of her when the sideshow to which the m e m b e r was
and sees her, in fact, as a friendly associate, the drawn by dubious motives becomes a wholesome
patient is able to divest her of her threatening drama in which the m e m b e r is impelled to take a
aspect; she becomes more lovable than in the legitimate part.
past. As the patient progressively analyzes the Hiding oneself behind the analysis of others is
compulsive character of the attachment to her, also a common form of resistance in psychoanaly-
the patient dispels even that maternal hold, and sis in groups. That resistance is characterized by a
she becomes simply an engaging friend, stripped concentration on the neurotic behavior of other
of maternal qualities but with an attractiveness of patients, and it is accompanied by an evasion of
her own. In those instances, reality proves much analysis directed toward oneself. Such patients
130 • Area B. SPECIALIZED GROUP PSYCHOTHERA PY TECHNIQUES

cleverly shift attention from themselves to the the patient was ambivalently and affectiveh
associator to defend themselves against disturb- bound. Peripheral and penumbral transferences,
ing examination. They manage to redirect the which, in comparison with the central transfer-
group's attention to any m e m b e r who dares to ence, appear with more subtlety and are o f t e r
analyze them. They handle what is said of them, altogether neglected in individual analysis, repro-
for example, by remarking that the critic had an duce more conflicting but less painfully traumatic
interesting overtone in speech that they ought to relationships with the less significant parent anc
examine. By endless devices, they deflect what with siblings. T h e multiplicity of ways in which a
could add up to deep insight, tackling their exam- patient dresses up the other members accurate/
iners. The other patients, however, gradually reanimates the original family, disclosing in the
dissolve the resistance by expressing their appre- action both the patient's history and the rich/
ciation for their incisiveness and by simultane- divergent facets of the patient's personality. The
ously demonstrating to them that, behind their analyst may grant the tenability of the transfer-
emphatic lecturing, they make themselves inac- ences but has great difficulty in persuading the
cessible to the helping hands of the group for fear patient that they are also an attempt to maintain
of humiliation. It is pointed out that fear of archaic familial constellations. The patient's ob-
vulnerability to parental substitutes in the group stinacy melts more easily when faced with diver-
is forcing them into that compulsive role. To the gent impressions of the same person that are
extent that the members understand the frantic projected by many members. Patients are force/
insecurity that underlies the bravado, they extend to reexamine their perceptive faculties. They can-
a reassuring friendliness that enables hiding not maintain their critical obstinacy that the ana-
m e m b e r s to relinquish their insistent critical lyst is brilliant, strong, and all-providing wher
study of others for self-examination. another patient asserts just as insistently that the
analyst is stupid, weak, and unreliable. Patients
Transference. O n e of the most important
are obliged to reconsider their original invest-
aspects of psychoanalysis in groups is the identifi-
ments of the therapist for possible misrepresenta-
cation a n d the resolution of transferences. U n d e r
tion. A n d in their reactions to other patient;
the therapist's leadership, patients discover the
they are also forced to reinvestigate their projec-
extent to which they invest one another with early
tive devices.
familial qualities. When a group member not only
projects a significant historical figure onto the A n o t h e r element in the group setting is conc _-
analyst but also singles out members of the group cive to the evocation of transference possibilities
for the same purpose, the field for transference is the variously provocative characteristics of t r ;
appreciably extended. Some members, in fact, multiple personalities in the group. The dispars":
immediately re-create their original families in personalities in the group furnish a large n u m r ; -
any small cluster of strangers. of agents, whose particular differences elic
The discovery and the analysis of transference wider and more subtle facets of transference thc/
is the most important work of psychoanalysis in are attainable by the analyst alone. With lir_;
groups, since it repeatedly interferes with the effort, save mere attention, the therapist car
patient's true estimate of reality. Transference discern how naturally one patient animates br-
prevents each member's being able to accept other into revealing the peripheral side of .
others by conferring traits on them that originally neurotic investment that would otherwise fc
stood in the way of a full relationship to members missed. Each patient's provocative role shoi. c
of the patient's original family. Accordingly, pa- also be explored in terms of the healthy r e s p o n d
tients need to be made aware of the derivation, and the neurotic responses elicited. Members ar:
the qualities, and the purpose of transference. asked to assist in discovering one another's ir-
In individual psychoanalysis a patient may flammatory tactics, so that the therapist can :
project onto the therapist at different times fa- tinguish between what is truly provocative, o r :
ther, mother, and sibling images, but the analyst nating in the provocateur, and what is neu-
is less likely to spontaneously arouse those multi- rotically derived f r o m the reactor.
ple investments than are a group of people with Analyst's transference. Many think t r c :
variously stimulating personality peculiarities. countertransference is in the analyst's transi -
The central or thematic transference reaction ence. The distortion is perceiving the patients /
that is most generally elicited appears as a repro- a group as though they were members of trt;
duction of a relationship with a parent with whom analyst's original family. A distinction need;
B. 1. PSYCHOANALYSIS IN GROUPS I I 131

be made between the therapist's transference and the patient. Countertransference results in an
the therapist's countertransference. W h o the an- oscillation between gratifying and frustrating the
alyst represents to the patient is the patient's patient. Although countertransference is proba-
transference; who the patient represents to the bly present to a degree in all therapy, some
analyst is the analyst's transference. It is not patients elicit more and some less countertrans-
sufficient knowing who the analyst is to the pa- ference.
tient or the patient to the analyst; the connection
between the two must also be known. If the
analyst is to the patient a mother and if the Working Through
patient is to the analyst a child whose archaic
needs the analyst gratifies, that is countertransfer- The necessity for working through is often
ence in the analyst. If, however, the analyst is to neglected in treatment, particularly by group
the patient a mother and if the patient is to the therapists, probably because many of them
analyst a mother whose archaic needs the analyst repudiate psychoanalysis or are inadequately an-
frustrates, that is cross-transference, not counter- alyzed themselves. As a result, they are confused
transference. about the analytic process and are unable to
Irwin Kutash has coined the following termi- formulate a unified theory of analysis for mem-
nology to cover some important types of analyst's bers of a group. Their perplexity is evinced in the
transferences: direct transference, projected in- multiplicity of group therapies reported in the
dentification transference, projective transfer- literature. The enormous volume of material
ence, and introjective transference. In direct made available by interpersonal reaction in group
transference the analyst or the group therapist therapy may be disequilibrating to some group
invests the patient or the group members with leaders and may make them feel that working
qualities linked with early familial figures f r o m through is not achievable.
the therapist's original family. In projected identi- Clinical experience indicates that working
fication transference the analyst or the group through can be effected in a group. T h e profusion
therapist identifies with the patient and projects of material can make it easy to discover the
the therapist's own early feelings f r o m the origi- repetitive core of the psychopathology, even the
nal family onto the patient, thereby getting vicari- transference neurosis, and can facilitate working
ous transference satisfaction through seeing that through. Recurrence is characteristic not only of
person gratified. In projective transference, the psychopathology but also of treatment. A f t e r
therapist is transferring the early parent outward ventilation and insight into the psychodynamics
to a patient. In introjective transference, thera- and the psychopathology, the therapist and the
pists take on the role of their own parents, having patient again and again suggest reasonable alter-
transferred the early parent inward, and that is native choices. Only in the group is it possible to
reflected in the manner in which they minister to work through the bilateral and the multilateral—
the patient or the group (Kutash, Wolf, 1983). the entwined neurotic manipulations involving
They act as their own parents might, as leaders of two or more patients. T h e resolution of various
a re-created original family, submerging their facets of the members' disorders at different
own personalities (Wolf, Kutash, 1991). phases in their treatment is useful in making clear
Countertransference. C o u n t e r t r a n s f e r e n c e the analyst's recurrent preference for reality over
is the activity of the analyst in response to the illusion. That reiteration promotes the working
ratient's transference, which the analyst fulfills. through of compulsive and archaic yearnings to-
Countertransference is behavior induced in the ward the final choice of reasonable alternatives.
:nerapist that is responsive to transference and A good many patients come to psychoanalysis
ihat provides patient satisfaction. In every trans- in groups after a failure to respond to individual
ference of a patient, there is an implicit demand treatment. Frequently, they have an increasing
that the analyst fulfill or satisfy some aspect of the dependence on the therapist, with a deeply en-
transference. That is transference expectation. trenched transference neurosis or psychosis.
Ijuntertransference is the therapist's uncon- Such patients often demand concurrent individ-
^r.ous, involuntary, inappropriate, and tempo- ual sessions immediately after their transfer to a
rarily gratifying response to the patient's transfer- group. They do so out of anxiety about breaking
t a : e demands; however, it is irrational and the symbiotic tie to the mother surrogate. T h e
•Mmately disagreeable to both the analyst and group analyst must resist those maneuvers. In-
132 • Area B. SPECIALIZED GROUP PSYCHOTHERAPY TECHNIQUES

stead, the analyst must help such patients develop group disequilibrium, group equilibrium, and
some independence, strong egos, and responsi- group malequilibrium (Kutash, 1980; Kutash,
bility for themselves. If group members insist that Wolf, 1989). Group disequilibrium takes the
such patients fuction with them and if the thera- form of a transferential, pathogenic, uncomfort-
pist resists the wish for exclusive individual sup- able, re-created family; group equilibrium takes
port, the patients become securely involved with the form of a comfortable transferential family
their peers, removed from the mother tie, in- with a new look; and group malequilibrium takes
creasingly independent of the therapist, and self- the form of a pathogenic but comfortable family.
reliant. They become less needful of the therapist Group disequilibrium. Just as individual pa-
in an infantile way than they were in the past and tients may re-create their pathogenic families, the
more relaxed with the group members and in group, functioning as a re-created family, may
social s i t u a t i o n s a p a r t f r o m t h e t h e r a p e u t i c become pathogenic as a family. Without adroit
group. A significant derivative of the group ana- management, some groups end up that way. The
lytic experience is that each patient becomes therapist must watch for the elaboration of self-
more ego-oriented than in the past. sufficient, inbred, and incestuous trends that
bind the members together as neurotically as in
their original families.
Vertical and Horizontal Dimensions
A recovering patient, for example, may be at-
The presence of authority (in the person of the tacked as unready for discharge by a compulsively
therapist) and of peers (in the persons of patient overprotective member who is parentally antagonis-
group members) provides for an interplay of tic. If a man and a woman gravitate toward each
vertical and horizontal interactions that elicits other with erotic interest, they may be invested with
father and mother roles, and the other patients may
parental and sibling transferences. The distor-
react to them with detached respect, voyeuristic and
tions projected onto the peers are often diluted
aggressive interest, or moralistic disapproval that
versions of intense projections onto the therapist. corresponds to early ambivalent curiosity and con-
The claim is sometimes made that those dilutions demnation with regard to intimacy between the
interfere with the emergence of intense transfer- parents.
ences to the therapist and, therefore, promote Occasionally, a member or two exhibit some
resistance. However, when transferences to peers reluctance to permit a patient who has recovered to
as parental figures are worked through, patients leave the group. They show the same kind of envy or
are sooner or later confronted with their projec- jealousy that was earlier directed toward a sibling or
tions onto the therapist. Having worked through, a parent, and they feel that the family group or the
if only in part, the nonthreatening aspects of parental therapist is favoring the cured member in a
parental transference onto their peers, the pa- way that their own performances do not deserve.
tients are able to face the authority of the parent Another unfavorable situation that may arise in a
group is the development of intense neurotic resis-
invested in the therapist. On occasions, a peer,
tance, accompanied by hostile bilateral transfer-
because of a particular character structure, elicits ences and the formation of allies in subgroups of two
a more threatening transference than does the or three, leaving some members isolated except for
therapist, but that kind of distortion is diluted by a relatively warm relationship with the analyst.
reality. T h e peer is, in fact, only a peer and, Sometimes even that association with the therapist
therefore, more devoid of parental authority than becomes strained because the isolated patients
the peer seemed at first. blame the therapist for their having been exposed to
an antagonistic environment. Such forms of resis-
tance need to be analyzed; otherwise, the group may
Disequilibrium, Equilibrium, fall apart. Attendance may become low and may
demoralize those present. The therapist, while tak-
and Malequilibrium
ing an analytic view of absenteeism, confronts those
who stay away repeatedly with attempts to under-
The interpersonal environment of the contem- stand their flight. The therapist explores transfer-
porary group can fall into a generally destructive ences that force aggressors into belligerent roles and
balance or pattern of interaction, a generally points out their illusory character. The therapist is
constructive balance or pattern of interaction, or, equally vigilant with regard to projective devices
perhaps most insidious, a generally comfortable that impel the compulsively withdrawn to retreat
but stultifying balance or pattern of interaction. further or to submit to the domination of other
Those three group situations have been termed members. The therapist seeks to uncover the causes
B. 1. PSYCHOANALYSIS IN GROUPS I I 133

for the resistance to participation on deep levels, positive feeling that he would like to help him feel
explicitly pointing out the destructive character of free to be less controlling (a feeling he felt for his
particular defenses and encouraging free emotional father). A younger female group member saw the
ventilation. person as manipulative and subtly controlling (like
If all else fails, the analyst may be obliged to both her parents). Another female group member
remove a patient here and there, one at a time, at saw him as a warm, good father (the father she never
varying intervals, introducing each retired member had). After those four members described their
into a more constructive group than the one left. views of the member in question, all the members
Such a crisis can usually be avoided by not organiz- began to express their feelings to the member who
ing a group with a majority of strongly sadomaso- was the recipient of so much transference. They told
chistic patients or with consciously or unconsciously him how he should behave; as a group, they thus
closed and rejective patients. Too many such mem- became transferentially his mother, who always con-
bers in the same milieu provide an unfavorable trolled him and told him how to act. The member
climate for the evocation of the positive resources vehemently resisted their efforts. Only after each
that need to be expressed if the group is to proceed father transference was explored, one by one, and
efficiently. the group came to see the defensive nature of the
man's controlling behavior—warding off his own
Group equilibrium. G r o u p equilibrium is mother, which his transference to the group clari-
a c h i e v e d w h e n t h e g r o u p c o n s t r u c t i v e l y re- fied—did many group members make progress.
creates the family but with a new look. In a Many members came to see how they related to
present-day figures as people from the past.
permissive atmosphere in which mutual tolerance
and regard can flourish, the prohibitive character The group setting thus facilitated the emergence
of the original family is projected with less inten- and the acceptance of insight by confronting each
member with the disparate investments of the other
sity and is more easily dispersed than it was
patients and the therapist.
originally. Furthermore, the general acceptance
and the sense of belonging that follows make it
possible to achieve a similarly easy transition to When patients join a group, they find that all
correspondingly untroubled social relations be- patients unconsciously warp their perceptions of
yond the confines of the group. T h e other pa- the therapist and of the other patients. They
tients, because of their numbers, provide more begin to question the reality of their views of
familial surrogates for transference evocation people in the group; as they discover and study
than does the therapist alone. T h e members their transferences, they also become aware of
realize the extent to which they re-create their their provocative role.
own childhood families in every social setting and Resistance. Resistance seems to melt easily
the extent to which they invest others with inap- in the potentiating, catalytic atmosphere of mu-
propriate familial-substitute qualities. T h e group tual revelation in the group. The necessity of
participants also clarify the variety and the multi- exposing oneself to another person without a
plicity of central and penumbral transferences. In corresponding disclosure by the therapist makes
individual analysis, therapists try to see clearly some patients self-conscious; however, members
what perceptual distortions patients make of are stimulated by the partial but always increas-
outer reality and what internal factors contribute ing self-revelations of others to expose more and
to their social disfigurements, but the analysts are more of themselves. The discovery that the other
often misled, because they do not see patients in members not only come to no h a r m in showing
action. In psychoanalysis in groups, therapists are themselves but win social approval encourages
also interested in what is happening at the mo- one to uncover as well. T h e general feeling of
ment, so the patients' unconscious warping of shared divestment in a benevolent atmosphere
facts can be observed in motion. Patients can then enables patients to show themselves freely. That
be confronted with their projective trends and with experience is confirmed by the psychic climate of
the inciting role they play in precipitating the an ongoing group; after three or four months,
environmental disturbances that they resent. each new m e m b e r becomes part of the operation.
Dependence. A n o t h e r constructive advan-
A male group member was transferentially tage offered by a group in equilibrium is that it
viewed by a younger male member of the group as removes the patient f r o m the danger of pro-
an immovable, controlling figure (his father). An- longed dependence on the therapist. In the isola-
other younger male group member also viewed him tion of private treatment, the analyst can encour-
as controlling and irritating but also experienced a age patients to pursue their deepest personal
134 • Area B. SPECIALIZED GROUP PSYCHOTHERAPY TECHNIQUES

longings. Those aspirations may be egocentric, cated safety of an unreal laboratory. He found the
and indulging them may lead to detached, antiso- group warmer and safer than most associations on
cial self-assertion. The gratification of particular the outside. He needed to be instructed on how to
yearnings can amount to being allowed to exploit carry the affective closeness he had in the group to
larger segments of society, beyond the confines of
familial substitutes for neurotically satisfying
his fellow members.
ends. Humoring those impulses is bound to bring
patients into provocative, neurotic conflict with H o w can one transpose the good fellowship of
their associates, who will not tolerate such infan- the group to areas outside it? G r o u p analytic
tile actions. T h e group process encourages the technique offers patients a means of making
reliance of one person on the next; it quickly conscious those trends that stand in the way of
demands and gets an abandonment of prolonged, their vigorous effective contact with others,
possessive, and parasitic attachment that ex- whether loving or hating—hating, because some
cludes the possibility of mature kinship. psychopathic influences in the world can appro-
Therapist ideal. One of the most valuable priately be hated.
aspects of psychoanalysis in groups that are in
equilibrium is that it facilitates giving up the ideal A woman patient was placed in a group and
of having a relationship with the single-parent arrived at her first meeting with a long cigarette
holder and a theatrical air and dress. After attending
analyst. Instead of offering the questionable shel-
the session, she told the therapist, "This is not my
ter of a private relationship with one omniscient
kind of people; haven't you a group of people who
ego-ideal, the group in equilibrium presents the have more in common with me?" The therapist, who
patient with a group of persons making a com- was seeing a number of artists and theater people,
mon effort. Whereas a private relationship may was about to start a new group. He invited the
well evade social reality and create an aura of woman and several other patients who seemed to be
isolation, the group serves in just the opposite compatible into the group. Everyone immediately
way. Instead of enhancing the patients' tenden- hit it off, laughed, joked, and had a marvelous time.
cies to neurotic isolation and their anarchic wish No one talked about themselves, their feelings, their
to act out their pathology, psychoanalysis in associations, or their dreams.
groups may help patients realize their full poten- The group was eventually disbanded, and its
tial as social beings. That is an added bridge to members were placed in heterogeneous groups. In
the establishment of healthy social relationships those groups the cultivation of each group came
through the promotion of differentiated, comple-
outside analysis. Rather than strengthening the
mentary and uncomplementary, agnostic and antiag-
egocentric idea—typified in the neurotic's mind nostic, conflictual and nonconflictual personalities.
by the notion of the omnipotent therapist— The members, through their growing individuality,
psychoanalysis in groups helps resolve the false learned—through differences in realistic perception
antithesis of the individual versus the group by and unrealistic misperception—to appreciate one
giving patients the conscious experience that another's mutually proffered gifts of vision and the
their fulfillment can be realized in a social or treasures of each other's perceptions.
interpersonal setting without their losing their
individuality.
CLINICAL ISSUES
Group malequilibrium. G r o u p malequili-
brium occurs when the group members are all
comfortable with each other but do not in any Group Size
way challenge each other's defenses. The group
itself is an unhealthy or stultifying balance. Con- Eight to 10 members are today considered the
flict-laden topics are avoided, and everyone, in ideal number for psychoanalysis in groups. Since
unconscious collusion, avoids stressful but poten- most families consist of between three and eigh:
tially growth-inducing material. members, with the majority of families toda;.
consisting of four or five members, a group of 8 to
A patient, whose love of the emotional climate of 10 provides transferential room for the nuclear
the group bordered on the ecstatic, reveled in the
family and for some extrafamilial significant oth-
luxury of what he considered an absolutely honest
relationship. He was in a "family" whose projec- ers. With fewer than eight m e m b e r s , a group
tions, having become at last analyzable and under- does not have enough interpersonal provocation
standable, no longer alarmed or hurt him. The and activity, leading to dead spots in spontaneous
danger was that he ran from real life to the fabri- interaction. With more than 10 members in a
B. 1. PSYCHOANALYSIS IN GROUPS I I 135

group, patients and group therapist alike have regular session, with patients' speculating about
difficulty in keeping up with what is happening. each other and the absent therapist.
However, some people feel lost even in a group One purpose of the alternate session is to
as small as eight because they were neglected in a facilitate interaction in the absence of the thera-
family that may have numbered as few as three; pist. Members learn that they can disagree and still
an experience in a group setting in which the be friends without the continuous guidance of an
leader can assure them a prominent role can authority figure. Many patients seem freer to inter-
provide a new constructive experience. act at alternate meetings, when transferences to
the therapist are less threatening than in the regu-
Several people who had previously found them- lar meetings. Projections that develop at the alter-
selves overwhelmed in large groups were placed in a nate sessions are attenuated by peer realities.
group with three or four members, a minigroup
Kutash, 1988b). The small size of the group was the The alternate sessions provide an opportunity
reason for the invitation to those groups. The pa- for the patients to be helped by their peers and to
tients found themselves participating more than in exercise a constructive role as helpers. In that
large groups and feeling a unique freedom. They respect and in other ways, too, the alternate
were at last in a setting without overpowering meeting comes closer than a regular meeting to
mother, father, or sibling figures; but they did not an experience in life, in which each patient plays
feel lost in the crowd. Later, additional members a great variety of roles—husband or wife, parent
were added, including active potential transferential and child, employer and employee, ally and an-
mothers or fathers. At that point, the original pa- tagonist, giver and taker, and helper and helped.
tients' egos were secure from their previous experi-
ences with the leader as a good parent. They felt the Together, the climates of the two types of
leader's respect for their participation, and they felt meetings represent a field that cannot be experi-
the regard of siblings who were not perceived as enced in one or the other group atmosphere
overpowering or parental favorites. The enlarged alone. By comparing differences in conduct and
group then became the arena for their further analyzing the transferences involved, the patient
growth. is able to work through more completely in both
settings than in either setting alone.

Time

Group meetings are most effective if they last

Principle of Shifting Attention
between IV2 and 2V2 hours. Just as the regular
In the therapeutic group the focus of attention
session should be limited in time, so should the
moves from one patient to another. That is the
alternate session (described below). Although a
principle of shifting attention. No one patient has
group may have an alternate session that lasts
the exclusive attention of the therapist. T h e more
longer than usual, the members inevitably resist
patients there are, the greater is the diffusion of
unduly prolonged sessions.
attention f r o m the therapist and from individual
patients. For many, the shifting of attention gives
Alternate Session them time to assimilate and to work through
whatever insights they have obtained. For others,
The alternate session is a scheduled meeting of the shifting of attention represents some f r e e d o m
the members of a psychoanalytic group without from continuous scrutiny, which in individual
the therapist's presence. Such sessions are sched- treatment can be experienced as immobilizing.
uled to alternate with regular meetings, when the For still others, the shifting becomes a form of
therapist is present. The therapist asks the group resistance, a way of avoiding the examination of
to meet without a therapist once or twice a week, their intrapsychic distortions.
usually in the homes of the patients. In that way, Shifting attention can be a means of working
an atmosphere is provided in which free interac- through the demand that one be the only child in
tion and participation are stimulated. The mem- the family, a problem that is sometimes not
bers are not restricted to carry on the analytic adequately challenged in the dyadic therapeutic
process in the alternate sessions; nevertheless, relationship. G r o u p therapy, with its insistence
the alternate session frequently becomes an ex- that there are others besides oneself, provides a
tension of the regular session and tends to pre- medium for working through the irrational trans-
serve the atmosphere and the interaction of the ferential demand that no one else be heard.
136 • Area B. SPECIALIZED GROUP PSYCHOTHERAPY TECHNIQUES

Alternating Roles eager to share an emotion, their companions are

just as eager for some private introspection; tha:
A n o t h e r consequence of group structure is the just when they want to entertain their neighbors,
p h e n o m e n o n of alternating roles. Each patient is the recipients of that goodwill are about to punish
required by the presence of others to listen and to them for real or imagined hurts at a prior meet-
try to understand them. New kinds of activity, ing. Many instances of mutually responsive inter-
feelings, and responsiveness are induced. Pa- actions also occur.
tients do not necessarily experience those reac-
tions if they are in individual therapy. In the
group, all the members listen, give counsel, try to
Heterogeneity aind Cohesion
understand, react, feel empathic, become an-
noyed, and elicit reasonable and irrational re- Since treatment, in large part, consists of the
sponses. They seek help and offer help. They analysis of transference, it is advantageous to
experience interactions on a peer level, experi- place patients in a group setting in which they can
ences that are not available to them alone with a project father, m o t h e r , and siblings. That can
therapist. In individual treatment the difference best b e a c c o m p l i s h e d i n t h e h e t e r o g e n e o u s
in status and in activity between the patient and group. Furthermore, heterogeneous groups re-
the therapist is so marked and the roles of helper flect a microcosm of society, and they tend to
and helped are so clearly defined that patients reproduce the family. Since the family probab!;.
have little chance to alter both their role and their ushered in the patient's neurosis, it is the logical
activity. As soon as other patients enter the agency for checking it. Despite the fact that, at
treatment structure, the role limits and the di- first, many patients do not cope successfully with
mensions are enlarged by new kinds of activities. dissimilar character structures, the battle can bes:
be won where it was apparently lost. In psycho-
analysis in groups, the early precipitation and
Multiple Reactivities
recognition of multiple transferences are facili-
The phenomenon of multiple reactivity is tated by the presence of a n u m b e r of provocative
characteristic of the group setting and is facili- familial figures in the persons of various mem-
tated by a heterogeneous group, rather than a bers.
homogeneous group. Multiple reactivity is not Once having assembled a heterogeneous
available in individual analysis except insofar as group, however, the therapist finds that the task
the therapist elicits varied responses. Of course, is not yet over. A homogeneous structure or a
multiple reactivity is available off target or indi- heterogeneous structure can be a consequence of
rectly for analysis in terms of patients' responses the position taken by the therapist. The imposi-
to people outside the therapeutic situation that tion of a make-believe unity is a projection of the
they bring to the analysis in their descriptions of therapist. When therapists turn the group as a
outside experiences. But here the therapist's skill whole into an earlier familial figure of their own.
is called on to perceive through the patients' it may be termed the leader's group-as-a-whole
distortions in their reports of what occurs on the transference.
outside. The therapist is able to witness how What often passes for concurrence in the
patients in a group respond to different kinds of group is itself the expression not so much o:
situations and persons. The group provokes, constructive cohesion as of submerged personali-
through the diversity of its stimuli, a large canvas ties (Wolf, Kutash, 1991). The introjected pseu-
of the patient's pathology at the same time as it doego is so characteristic of the present time tha:
requires a challenging and comprehensive adjust- many patients passively follow assertive leaders,
ment in health toward a wide variety of realistic lending to the group the appearance of cohesion.
and unrealistic demands. That manifest agreement, which is liable to be
G r o u p members learn valuable lessons in in- sponsored by the therapist as a saluatary group
terpersonal relations that are not easily acquired climate, needs to be analyzed as it shows itself in
in individual analysis. They learn that identical each dominant-submissive relationship. Each
feelings do not rise up as responses in all people group may have one or two m e m b e r s whose
at the same time to the same provocation. They personalities strongly sway the others. T h e strong
discover that, when they are in one mood, their members are frequently the most verbal and the
friends are in another mood; that when they are most active, but they are not necessarily repara-
B. 1. PSYCHOANALYSIS IN GROUPS I I 137

nve in their insensitivity to others. To support leader may not be as aware as are the members of
weakened egos, the therapist must not be misled the patient's considerable improvement. What
by an apparent appearance of uniformity but requires resolution in such a case is the patient's
—ust analyze any compulsive passivity or leader- hesitation to show effectiveness in the presence of
ship. Individuality can lead to greater group co- the group leader.
hesiveness than can efforts toward homogeneity, Resistance to ending treatment may be a prob-
since people need to appreciate themselves be- lem not only for the patient but for the therapist
fcre they can truly appreciate others. as well. T h e observing group members can help
reduce both the patient's and the analyst's resis-
tance to termination. That validation by the
Closed versus Open-Ended Groups group does not depreciate the competence of the
analyst; it simply offers another impression on
Psychoanalysis in groups is a totally open-ended
which to base an estimate and an assessment. In
-Dproach, unlike a laboratory or time-limited
dyadic treatment the material is always derived
zroup. People join and leave as they are ready, not
from the analysand, except in the relationship to
ii part of a whole-group readiness phenonmenon.
the analyst. The patient is a partial and one-sided
If individual patients go through stages in the
source of enlightenment. G r o u p members offer
croup by the nature of their individuality, those
evidence and reasoning for reaching a conclusion
stages occur for the patients at different times,
as to the propriety of ending at any given time.
rased on when they joined, how strong their egos
The patient considering termination usually seeks
» e r e to begin with, and what their personal rates of
the opinion of the analyst. If the patient's wish to
rrogress are. Furthermore, as in individual psycho-
leave is resistive, the patient commonly looks to
analysis, those phases of therapy are based on
the other group members for allies who will
individual dynamics, ego strength, and individual
support the inappropriate flight f r o m treatment.
rites of growth. It is like an answer that is often
e v e n to patients at the beginning of treatment The recovery of one patient heartens other
~tien they ask how long the therapy will take: "If members with the hope that one day they, too,
>cmeone asked me how long it would take to get to will be well. The release of one m e m b e r is a
any location in the city, I would say, 'It depends on stimulus and a promise to the others. Such an
~here you want to go and how fast a walker you experience is not available to the patient in indi-
ere.' " For an entire group to go through therapy vidual treatment. Only the members of a thera-
at the same pace, some would have to walk too fast peutic group can observe another patient's get-
ad some too slow; where they would all end up ting well. T h e improvement of one induces the
m :uld be a compromise. rest to try harder to attain similar well-being. The
departure of a recovered patient may remotivate
In psychoanalysis in groups, the group is self-
other members at a time when they are feeling
rerpetuating. Although new patients join and old
despondent. The disconsolate are stimulated by
rattents graduate, the group does not entirely
being witnesses to another's restoration. They
rtsband.
become inquiring and searching about how that
particular patient managed to get well in order to
Termination achieve the same for themselves. They may be-
come rivalrous with the departing or remaining
The successful conclusion of treatment is more members in the competition for a return to
riiilv attained in the group than in individual health. That competition may have its resistive
trerapy because the group fills the therapeutic aspects. If one m e m b e r is discharged as healthy,
- sed for interaction and engagement apart from other members may insist that they, too, have
die analyst. The judgment of the therapist gener- been cured when they are still ill. It takes little
lily determines when a patient is ready to end examination by the group and the analyst to
treatment. But, on occasion, the leader may not expose that resistive maneuver.
re fully aware of the extent to which a member
has improved. Then other patients may call the
therapist's attention to the fact that a progressing SUGGESTED CROSS-REFERENCES
n e m b e r has made substantial gains. A patient
may feel freer to show good resources at alternate Countertransference and transference in
sessions than at regular meetings, and so the groups are discussed in Section A . 9 , working