TOTAL GROUP INTERVENTIONS:
Reprinted from 4th edition (1995) of The Theory and Practice of Group Psychotherapy
In past decades, there was much debate around the issue of mass group commentary. Many group leaders took a very different position from mine. Rather than view mass group interventions as a mode of removing obstacles to the work of the group, they considered commentary on mass group process as the chief, or even the sole, procedural task of the therapist. Wilfred Bion, a British Kleinian analyst, was one of the key theorists and developed a mode of group therapy, commonly referred to as Tavistock group therapy, which was used by many group therapists both in Britain and the United States during the 1960s and 1970s. It was always my belief that, for reasons I shall mention shortly, the Tavistock group approach was not only ineffective but often countertherapeutic.
Accordingly, in previous editions of this book, I devoted considerable space to a description and a critique of this approach to therapy. That debate seems to have ended. No longer (not even at the Tavistock Clinic) is the classical Tavistock method used as a therapy approach. (Some group dynamists find Tavistock techniques as presented in A. K. Rice experiential institutes to be a useful mode of teaching group dynamics and often offer experimental workshops for students.) Therefore I shall abbreviate my descriptions of this approach and refer interested readers to primary sources.
Wilfred Bion and the Tavistock Approach
Bion studied his groups through holistic spectacles. Searching for total group currents, he noted that at times the group appeared to be pursuing its primary task* in a rational, effective fashion. Bion called this group culture the work group culture. At other times he noted that the group no longer seemed to be pursuing its primary task but, instead, appeared to be dominated by certain massive emotional states which resulted in behavior incompatible with the primary task. He described three types of central, recurring emotional states (a constellation of discrete feelings that permeate all the group's interactions): (1) aggressiveness, hostility, and fear; (2) optimism and hopeful anticipation; (3) helplessness or awe.
From these primary observations, Bion postulated that in each of these emotional states the group was acting as if the members shared some common belief from which their affect stemmed. For example, while in an optimistic or hopefully anticipatory state, the group acts as if its aim is to preserve itself by finding strength or a new leader from its peer membership. When it is in a helpless or awed state, it acts as if its aim is to obtain support, nurturance, strength from something outside the group — generally the designated leader. When it is in an aggressive or fearful state, it acts as if its aim is to avoid something by fighting or running away from it. Bion termed each of these three emotional states basic assumption cultures and thus spoke of three types of basic assumption group: basic assumption pairing, basic assumption dependency, and basic assumption flight-fight, respectively. Thus, at any given time a group may be described as either a work group, or as one of the three basic assumption groups, or in some transitional phase.
Bion's focus on the individual group member centered on that member's relationship to the group culture. The concept of valency was developed to describe an individual's attraction to a particular group culture. This attraction, analogous to tropism in plants, is a force that leads a member into being the chief spokesman or a participant or a major rebel in one of the basic assumption cultures.
One other important aspect of Bion's view of groups is that it is leader-centered. All three basic assumption states are oriented around the issue of leadership. Each type of group searches for a leader — one who will meet its needs: the basic assumption dependency group attempts in various ways to coax or coerce the professional leader to guide them; the flight-fight group searches for a member who will lead them in this direction; the pairing group optimistically pairs and waits, hopeful that a leader will emerge from the offspring of the pair.
Bion's goal in group therapy was to help patients achieve the ability to become effective members of work groups. Thus, he made only mass group interpretations which repeatedly confronted the group with its basic assumption behavior, especially insofar as that behavior related to the therapist. By confronting the group repeatedly in this manner, Bion attempted to reinstate the work group culture. He hoped that patients, as they became aware of the nature and unrealizability of their demands, would gradually learn more realistic and adaptive methods of group functioning.
Bion described three specific types of conflict that complicate group function, and suggested that it is the task of the therapist and the work group to expose, clarify, and work through these conflicts: (1) a desire on the part of the individual for a sense of vitality by total submergence in the group, which exists alongside a desire for a sense of individual independence by total repudiation of the group; (2) the conflict between the group and the patient whose desires are often at cross-purposes to the needs of the group; and (3) the conflict between the problem-oriented work group and the basic assumption group.
My objection to the Tavistock approach is based on the limited role of the Tavistock group leader. Bion prescribed a role that was entirely limited to interpretation — and impersonal mass group interpretation at that. The leader remained impersonal: he or she did not interact with the group members and did not engage in many of the other functions of the leader I have described in this book — such functions as modeling, norm setting, activating the here-and-now, and support. Outcome research in psychotherapy presents extremely convincing evidence against a limited, distant, therapist role: a positive, accepting, warm patient-therapist relationship is essential to good therapeutic outcome. An outcome study by Malan indicated that patients treated in Tavistock groups had extremely poor outcome, experienced their group therapy as a depriving and frustrating experience, and resented the impersonal, cold, aloof stance of their group therapist. Other researchers have demonstrated that therapists who limit their observations to mass group comments are ineffectual; interventions made to the group as a whole are far less likely to instigate self or interpersonal interaction than are interventions made to an individual member or a dyad.
Whitaker and Lieberman
Whitaker and Lieberman have described a very different approach to mass group process. They state their position in a series of propositions.
Successive individual behaviors are linked associatively and refer to a common underlying concern about the here-and-now situation. The comments and activities of a group therapy session are not diverse; they all hang together in relationship to some underlying issue. Seemingly unrelated acts gain coherence if one assumes that there is some concern which is shared by the members of the group
The sequence of diverse events which occur in a group can be conceptualized as a common, covert conflict (the group focal conflict) which consists of an impulse or wish (the disturbing motive) opposed by an associated fear (the reactive motive). Both aspects of the group focal conflict refer to the current setting. For example, the members of a group may share a common wish to be singled out by the therapist for special attention (the disturbing motive), and yet they fear that such a wish will result in disapproval from the therapist and from other patients (reactive motive). The interaction between the wish and the fear is the group focal conflict.
When confronted with a group focal conflict, the patients direct efforts toward establishing a solution which will reduce anxiety by alleviating the reactive fears and, at the same time, satisfy the disturbing impulse. In the group described in proposition 2, the members may arrive at the solution of searching for similarities among themselves; it is as if each were saying, “We are all alike, no one is asking for special favors.” Note, however, that this solution, though it temporarily relieves tension, is by no means productive of growth; instead, the disturbing wish (to be unique and be singled out by the therapist for special gratification) is merely suppressed in the service of comfort. Other solutions, however, may be more enabling of group and personal growth.
Successful solutions have two properties. First, they are shared; the behavior of all members is consistent with or bound by the solution. Second, successful solutions reduce reactive fears; individuals experience greater anxiety prior to the establishment of a successful solution, less anxiety after the solution is established.
Solutions may be restrictive or enabling in character. A restrictive solution is directed primarily to alleviating fears and does so at the expense of satisfying or expressing the disturbing motive. An enabling solution is directed toward alleviating fears and, at the same time, allows for some satisfaction or expression of the disturbing motive. For example, the disturbing motive in one group was the wish to express angry destructive feelings toward the therapist. The reactive motive (fear) was that the therapist would punish or abandon the group members. The group solution (an enabling solution) was to band together to express anger toward the therapist. Thus, following one meeting the members discussed the matter and found strength in an implicit agreement that each would express his or her anger toward the therapist.
Keep in mind that the specific group focal conflict is not within the conscious awareness of the group members who are most involved, and the solution is not deliberately planned but is a vector, a course of action which clicks with the unconscious wishes and fears of each member. Should the solution be clearly unsatisfactory to one of the members, a new group conflict is created which culminates in a modified group solution. In this instance, the reactive fear was alleviated by the mutual support of the group members, and the disturbing wish was therefore expressed. Such a solution will, over the long term, be enabling for the patients since only by gradual exposure and expression of their disturbing wishes can the necessary reality testing occur.
In their therapeutic approach, Whitaker and Lieberman are most concerned with the nature of the group solution. Therapeutic intervention is required when a group arrives at a solution that is restrictive to the group and to the members. Furthermore, an interpretation that elucidates the total group configuration is only one of a number of mechanisms that may be employed to influence the group. These researchers suggest, for example, that the therapist may, with efficacy, deal with a restrictive solution by modeling for the patients a different form of behavior. Thus, the role of the therapist is flexible: the therapist may ask questions, report on his or her personal reactions, focus on an individual's idiosyncratic mode of operating within the group, or — as we have seen — focus on total group process.
Whitaker and Lieberman do not lose sight of the fact that their tripartite system (disturbing motive, reactive motive, and solution) is but an abstraction rather than an entity in the animistic sense. Its purpose is to clarify the meaning and origin of behavior patterns that are restrictive for the group. Thus, in their views about total group phenomena and in their application of this information to the therapy process, Whitaker and Lieberman's approach, despite a semantic difference, overlaps significantly with the approach presented in this chapter.
To summarize, the group-as-a-whole orientation in therapy has both strengths and deficiencies. Without question powerful mass group forces occur in groups. Without question the therapist must learn to identify and to harness them in the service of therapy. However it does not follow that therapists must narrow their focus, must assume an impersonal stance or restrict their comments to mass group interpretation. Though interpretation, as I have indicated, plays an important role in therapy, it is only one of many ingredients in successful therapy. No theoretical interpretive position should take precedence over the importance of the therapist-patient relationship — this requires that the therapist attend, deeply and authentically, to the patient, not to the group, not to a system or subgroup of patients. Although early group leaders such as Bion, and Ezriel offered a conceptual framework that enables group therapists to identify and clarify mass group phenomena they also offered restrictive models of therapist behavior. Later-day group-as-a-whole revisionists such as Lieberman and Whitaker, Ganzarin and Agazarian have attempted to combine the mass group orientation with a more flexible therapist role definition.
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