Group Psycho Therapy? Theory and Practice
- Type:
Reviews
- Author:
klapman, M.D. Hememan. 21s.
Emotional disorders have been well described as disturbed adjustments of internal relations to external relations. In their treatment, much consideration has been given to the internal life of the individual, and the science of psycho-pathology making huge strides towards an understanding of the complex life of the internal world has provided important pointers for basic individual therapy. It has, of course, long been recognized that manipulation i.of the external environment to suit the particular needs and limitations of an individual may also be an effective step in therapy, but modification of the material environment can rarely be effective enough, for the external world is a world not only of things, but of people and, in the world of feeling, it is the people who matter most. Relations to people cannot be modified on demand; they are not one-way but are inter-reactive, not simple but complex, not fixed but dynamic, and fruitful now of great rewards but then of painful frustrations.
The study and treatment of inter-personal relations are, therefore, proper activities for those concerned with emotional disorders in the individual and it is not strange that in recent years, with the growth of the regard for man as a social creature, therapy of groups or, a different thing, of individuals in groups, has been attempted. Workers with groups are agreed that difficulties abound and that much experiment is needed to answer even the most elementary questions. What is a group ? How many people should make up a group ? What kind of problems respond to group treatment ? Is mass therapy effective group therapy ? Is the aim, treatment of the individual by the group, or of the group by one or all participants, or of the group by the group ? What is the role of the group therapist ? What procedures are useful in group therapy ? What is known of the dynamicsof group formation and activity ?
This book is less concerned with the delineation of a theory and the description of a practice than with an uncritical survey of some current theories and practices considered to be relevant to group psycho-therapy. It is, therefore, unprovocative and unchallenging and also unpatterned.
Because of the stress on description and review rather than elucidation and definition, group therapy is given the vaguest terms of reference and one is left to believe that any earnest attempt at therapy of more than one patient at a time may be dignified by the term. A crowd, a number of individuals listening to a lecture, an association of people met for a common function?any, or all of these by the author’s standards can be a group. Procedure can be empiric, or rational, analytic, didactic, pedagogic, hortative, but it is apparently psycho-therapy “so long as it restores a desirable (sic) state of intrapsychic equilibrium”. The book must disappoint those seeking knowledge of the dynamics of group behaviour and a rational science of group therapy. It is a further disappointment that the reader is asked to accept the most questionable a priori statements as basic material for working hypotheses and to view group behaviour and individual illness in the light of concepts which, to say the least, are suspiciously like personal beliefs.
The book appears to have been written for psychiatric ” hill-billies” and contains a good short American isolationist history of group therapy. There are useful short accounts of the practices of Marsh, Schilder, Wender, Slavson, Redl, Moreno, Lazell and some others, but the reader may be astonished in the second chapter by the short anthropological survey of the origins of social needs. After an account of invertebrates emerging from primaeval slime, it tells of apes ” subsisting on tender shoots, nuts and fruits, although not above sucking the eggs found in nests and, on occasions, catching some small bird or lizard ” whereas the homonidae went on to carnivorous life on the ground. Thereafter male competition for females is said to have produced sexual taboos and it is quickly concluded that early social organization occurred round a patriarch. This speciosity paves the way for a closed mind on group formations which the author regards as dependent on early mechanisms and for further beliefs that the group therapist must occupy an archaic, immature central position, that his role is that of leader and that the relations to him can be properly described as ” transference In his easy use of psycho-pathological terms, the author is of course following the practice of some group therapists but his wisdom may be doubted. It is true that the mental mechanisms of individuals in the group are sometimes apparent but it is massively assumptive to describe complex group phenomena by unmodified terms borrowed from the study of individual psychopathology.
Groups are not individuals. Group hostility is something more than “resistance”, something more than the sum of individual transference-relationships to the therapist, and surely involves, as do all group phenomena, something of the complex of interpersonal relations between members. In group therapy, a knowledge of individual psycho-pathology is a sine qua non but, like patriotism, is not enough. Perhaps the dangers of thinking by analogy and using second-hand terms give warning enough that for a full regarding of group events we are in great need of fresh concepts, clear vision and, as important, a new descriptive language. The author has not yet attempted a study of group behaviour; rather, as his case histories show, he seems to be interested in the individual and effect of the group only insofar as it affects individual treatment. He does not attempt to analyse and treat relations within the group but is concerned mainly with the mass application of therapy, treatment by the therapist of a number of individuals collected together for convenience. Group discussions are well described. Spontaneity is not allowed to shape them and patients are encouraged to discuss in order that the therapist may seize further openings for individual therapy. Treatment is, therefore, by the therapist of the individual set in a group rather than of the individual by the social forces within the group.
Several procedures are held to be helpful. A course of lectures on physiology of the nervous system or on mental illness (such as a P.S.W. has experienced) is held to be therapeutic ” affective re-education Class discussion of a case history by other patients is recommended and class dissemination and discussion of the principles of mental hygiene is regarded as valuable; for the author has a vigorous acceptance of the value of effecting emotional release by intellectual channels.
Now didacticism and pedagogy are well known to have far-reaching effects, and collective explanation and persuasion is surely a useful procedure; class discussions have an educative and socially liberating effect and have behind them authority of centuries of human practice; and the account of their use in psychiatric practice is interesting and informative; but it would be unnecessarily disappointing if group psycho-therapy could offer nothing more. The term Group psycho-therapy is too vague. It may mean psycho-therapy (and that has meanings enough!) in, of, by, or through groups. All these possibilities have some value but this book is concerned only with the first. T.F.M.
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