By Judy O’Hanlon & Kay Ferriter
This article outlines group therapy from an integrative and humanistic perspective. Briefly, we trace its origins in the human potential movement of T-groups and Encounter groups, and consider the influence of third force psychology. Next we discuss the issue of who is suitable for group therapy, consider some of its key themes and what is distinctive about its potential. Finally, we explore some processes in the therapist’s role.
Group experience is an integral part of human culture. “Because of the sheer scope and mass of human experience, group relationships are vital in the birth, nurturing, and maturing of the individual’s sense of self.” (Benson 1987) The individual is formed in relationship to others and his experience of himself is defined and developed through his interactions with others. Benson defined group work practice as the “conscious, disciplined, and systematic use of knowledge about the processes of collective human interaction, in order to intervene in an informed way, or promote some desired objective in a group setting … groupwork practice is a helping process designed to correspond to specific instances of individual and group need based on a view of man as in constant interaction and relationship with others.” (p11)
For the purpose of this article we call such practice group therapy when a group is facilitated from a psychotherapeutic perspective and the agreed focus of the endeavour is the personal growth of the members in relationship to each other and to the group itself. This does not imply that other types of groups are not therapeutic. An outstanding example of therapeutic groups, experienced by millions here in Ireland and worldwide, is the Self-Help programme of AA, Al-anon, Over Eaters and Narcotics Anonymous and Adult Children Of Alcoholics.
Humanistic group therapy as we know it to-day has its roots in three areas: the human potential movement, third force psychology known as the Humanistic school and a move to greater use of group therapy in the psychodynamic and psychoanalytic schools after the Second World War.
A major development in the field of group therapy here and elsewhere, is the widening out of the client base. The development of group workshops facilitated by psychotherapists around diverse themes and issues attract people who do not necessarily see themselves as having serious problems. Rather, they seek to enhance their personal growth in line with the general cultural expectation of “getting more out of life.” The process of de-stigmatising the client role is a major contribution of the humanistic school and a part of a historical process that has its roots in the T-Group and Encounter group movement.
T-Groups, training in human relationships started in the fifties in the US. The first one run by social psychologist Kurt Lewin was in response to a specific social need. The state of Connecticut had passed a fair Employment Practices Act and needed to train leaders who could deal effectively with tensions in and among groups and thus help to change racial attitudes. According to Yalom experiential learning was discovered by accident when participants and leaders gathered informally in the evenings to evaluate behaviour in these groups. Through stumbling upon this process it was realised that “Group members learn most effectively by studying the very interactional network in which they themselves are enmeshed.” (p490) One of the distinguishing features of T-groups was a built-in research component and this according to Yalom is what distinguished them from group therapy.
Many different types of experiential groups evolved in the sixties. Yalom maintains that the popularity of such groups was due to forces in American society which led to people feeling increasingly alienated and disconnected. When some T-groups began to change their emphasis from group dynamics to personal dynamics, a shift to personal growth work took place. T-groups evolved into the Encounter groups, a term coined by Rogers, and the boundaries between education and therapy began to blur. People began to speak of therapy for normals, (c.f.Yalom)
At around the same time theoretical developments were taking place in what is now called the third force in psychology. Led by Maslow, Allport, Fromm, Pearls and Rogers these practitioners rebelled against the mechanistic approach of behavioural theory and the reductionism of analytic theory. One of their important contributions was to return to the concept of the whole person, emphasising a holistic, humanistic approach to the individual. These concepts were adopted by the encounter group and provided impetus and form to their methods. Members were now encouraged to give voice to their many false selves and to explore their long buried parts.
In the mental health field group therapy has a separate history and up to the 1940s it was not considered a very effective therapy. This changed after the Second World War when the huge numbers of casualties with psychological trauma led to an acceleration of the application of group work for practical and economic reasons. The large numbers of patient’s and insufficient numbers of trained personnel made the use of groups a necessity. However the main application in the 1950s was toward the use of different therapeutic approaches to cope with different types of clinical problems. The theoretical models used were mainly from the schools of Freud, Sullivan, Horney and Rogers.( c.f.Yalom). The rigid boundaries between the mental health field and the training/therapy field began to soften as trainees began to experience encounter groups and T-Groups as part of their training, became influenced by their ideas and returned with new methods to their clinical areas.
Humanistic Group Therapy as we know it to-day has emerged, not without struggle from the flow and interchange between these three strands, that is the Human Potential movement, third force psychology and psychoanalytic and psychodynamic group therapy.
SOME KEY ISSUES IN GROUP THERAPY
Group and individual therapy have different potential. A group by its nature has the possibility of offering a wide range of interactions and evoking a rich range of responses in the individual, allowing the group member an expanded experience of herself. This remains the consistent background as themes move into the foreground displacing each other depending on who in the group is working on what. We will discuss four themes that we see as highlighting what is distinctive in group therapy’s potential for personal growth and development. These are as follows:
1. Equality of status. 2. Isolation and aloneness versus feeling part of and belonging. 3. Experience of self as determined and fixed, versus experience of self as responsive and capable of change. 4. Personal worth and integrity versus neediness.
Equality of status
Whatever the therapist’s efforts to be real in her individual relationships with her clients some will have difficulty experiencing her response and feedback as such. Thus they may push away or dismiss support and acceptance with phrases such as, “but that’s your job, I’d expect a therapist to say that.” In the group context it’s not possible to dismiss members’ feedback in those terms.
Isolation versus belongingness
As we have seen, many people come to therapy feeling isolated and different as a result of their past experiences. One of the strongest experiences as people begin in a group is the realisation that others feel as they do and have the same fears and anxieties. This reduces feelings of isolation. As the group develops a major task of belonging is to feel part of the group while maintaining one’s individuality. People experiencing a strong sense of isolation may be stuck in either trying to hide their differences from others or fear of losing their individuality, as they seek to belong in groups. Every entry into the group system by members is an attempt to meet their needs.
By attending to the process by which each member does this the therapist can highlight whether she moves towards isolation or towards contact/belonging. Encouraging feedback from others as to how they experience her entry heightens and expands the individual’s discoveries of her impact on others. The variety of the people in the group expands the possibilities for identifications and differentiations, in contrast to individual therapy where issues of isolation and contact are also addressed.
Experience of self as fixed and determined versus experience of self as responsive and capable of change
One of the ways we experience difficulties in relating is in having overly rigid expectations of ourselves and of others. This rigidity is maintained on the one hand by keeping out of awareness divergences from our fixed perceptions of our own behaviour and on the other hand, ignoring responses that don’t conform to our expectations. For example, a group member repeatedly says, “I am not a warm person” yet the therapist notices warmth in her face as she responds to others. Another example is the person who repeatedly says, “No-body listens to me” as she looks up at the ceiling and therefore does not see members paying attention to her. The possibilities for bringing these experiences into awareness are more direct, immediate, varied and powerful in a group.
Theme of personal worth and integrity versus neediness
By the very fact of presenting ourselves as clients for therapy we experience ourselves as having problems and this may be associated with feelings of worthlessness. While we experience ourselves as being needy we may ignore the value of what we have to offer. When we are encouraged to enter the group and respond to others we begin to experience our impact on others and consider ourselves as having something worthwhile to offer.
WHO IS SUITABLE FOR GROUP THERAPY?
Therapists differ in their practice in determining the appropriateness of individual or group therapy for their clients. Much has been written on the suitability of clients for group therapy. (c.f.Yalom) Some practitioners will only allow clients who have done individual work to join their groups. Many of the organisations that provide trauma survivor counselling, e.g, rape crisis centres, first offer individual processing of their experiences to their clients followed by group experience to widen the bases of support and recovery. In many situations the impact of trauma and of chronically damaging experience on individuals leaves them feeling isolated and different. Individual therapy can subtly reinforce this feeling. Group experience on the other hand may provide exactly the support and opportunity that is needed to reduce the sense of differentness and isolation.
The limited research available on the suitability of clients for group therapy does not add much to our knowledge. It appears to be easier to develop criteria for eliminating rather than selecting types of clients for whom group therapy is suitable. (c.f.Yalom). In practice, skilled therapists will use their experience and knowledge of what their particular group has to offer in determining whom they will accept in their groups. In our practice we explore our clients’ needs and preferences for individual or group therapy or some combination of both. We are increasingly excited however by the possibilities of the group experience over individual therapy. At the moment, while only a small number of clients at any one time avail of the opportunity for group work there are very few of our clients whom we would not like to see in a group.
There will always be a small number of people whose current need for individual support to survive in relation to others is too great for any group.
THE ROLE OF THERAPIST
In a short article like this we could not presume to cover in any comprehensive way the role of the therapist in group therapy. Instead we have selected some key elements of the role that we consider are important. Training and philosophy tend to determine the balance of attention which therapists give to individual and group process. At one end of the spectrum are methods that focus on individual work, with the group as the backdrop which intensifies the experience. At the other end of the spectrum are approaches where the attention is almost entirely on group processes.
In our work we give equal weight to three processes: what is going on in ourselves – therapist’s process; what is going on in each individual client’s process; what is going on in the group – group process. Our role is to stay in touch with all three processes as they are occurring and to work with what is figural and strongest at any one time. As we pay attention to what is figural in these three processes the task becomes maintaining a balance between risk, support and contact.
The inclusion of therapist’s process and giving it equal importance to the other processes may seem unusual. From our perspective as facilitators we are part of the group. Therefore what is going on in us is part of what is happening in the here and now. If what is happening for us is out of awareness it is difficult for us to support ourselves as we come into the group. The more supported we are the more support we can offer. Also and importantly as group members see us pay attention to what we need, it supports and encourages them to do likewise.
CREATING SAFETY FOR RISK TO CONTACT
In general people come to group therapy because their way of being in the world and meeting their needs is not satisfactory. More specifically this manifests itself in difficulties feeling authentically themselves as they relate to others. The goal of group therapy is to create an environment which provides enough safety for people to discover what they are doing as they try to relate to others and to begin to risk experimenting with new ways of being with others. The importance of safety to risk is vital. In this regard it is interesting to note the findings of Yalom and Lieberman’s study of the outcomes of encounter groups. They noted that groups where the leadership style was aggressively confrontational, pushing members to be open, are the ones most highly associated with adverse reactions in members. (Kovel)
Attention to support in the individual and in the group is one aspect of creating safety. Individuals are not encouraged to open themselves without paying attention to both the support within themselves for risk taking and the support in the group for what they are doing in the moment. For example as someone enters the group the therapist notices her sitting on the edge of her chair or speaking very fast.
She draws attention to this and asks what is happening. She begins to become aware that she is worrying about taking up time i.e., that she is unsupported in herself for the risk of coming in. The therapist can support her, help her to find her support within herself, or look to the group for support. Without this attention to support there is no real basis for therapeutic risk taking i.e. risk that can be successfully integrated and thus no satisfactory contact can be made.
Support and competing needs
Another aspect of creating support for risk to participate is to ensure there is some sense of limits and boundaries to the time and attention given to members’ needs. Groups differ in how they handle this process. Some groups give equal time to members. However, much of the task of living is to be able to take enough space to meet our needs. The therapist’s role is to support the individual to discover how they are looking or not looking for this space and to risk to find more effective ways of doing this. Thus a group member remarks that she has been used to working in a group where the therapist regulated the time evenly and she is now finding it difficult to judge how much to look for. She then adds, “Sure that’s my problem out there in the world all the time, how much to look for and when.”
Another aspect of creating a sense of safety to risk in the group is to attend to issues of closure, that is to ensure there is reasonable completion of one phase of work for all members before moving on to the next, or before finishing a session. Where a strong reaction is evoked in individuals by another’s material it is all too easy to follow a chain reaction and fail to complete the work of the first individual. Closure is of course achieved at different levels. In the group as in life not all of our needs can be met and sometimes closure can simply consist of acknowledgement of the lack of time to respond.
In a brief article like this we could not hope to cover the range of methodologies and variety of styles which exist under the heading of integrative and humanistic group therapy. We have chosen aspects of group process that are figural for us as therapists as a result of our own experience in groups as members and as facilitators.
Benson, J.F.: Working More Effectively with Groups. Penguin 1987.
Davies, B.: The Use of Groups in Social Work Practice. Routledge. Kegan Paul 1987.
Kovel, J.: A Complete Guide to Therapy. Penguin 1976.
Yalom, I.D.: The Theory and Practice of Group Psychotherapy. Basic Books 1985.