Transcript Group Psychotherapy - The Cambridge MRCPsych Course

Group Psychotherapy
Furhan Iqbal
Cambridge
[email protected]
Brief History (1)
First recorded use of groups in therapeutic settings in 1905
by Joseph Pratt a physician in the USA
Group of patients with TB who took turns in presenting how
they had successfully struggled with the illness
What followed was immense interest on both sides of the
Atlantic resulting in theoretical and practical
advancements in the field of group psychotherapy
History (2)
During the 1920s-1930s there was a shift from the study of
the individual to the study of interpersonal relationships
and their influence on personality
Freud himself took an interest
‘Group psychology and Analysis of the ego’ (1921)
The exodus of many Jewish Psychoanalysts leaving
mainland Europe for the UK and the USA also had a
profound influence on the development of its theory and
practice
History (3)
In the UK Melanie Klein developed a following including
influential followers like Bion
Foulkes a German psychiatrist and psychoanalyst from
Frankfurt was greatly influenced by the work of the
sociologist Norbert Elias and developed an interest in
group work
Bion and Foulkes in the second world war were involved in
the Northfield Experiments. Work from the Northfield
experiments was to have a huge impact on the
therapeutic use of groups in the UK
History (4)
During WWII Bion and Rickman from the Tavistock
successfully assisted the military in selection of officers
Following this success they were asked to help with the
rehabilitation of the ever increasing numbers of
psychologically traumatised men returning from the front
In 1942 at the Northfield Military Neurosis Centre near
Birmingham Bion and colleagues started work on
rehabilitating these men, which was to be later known as
‘The Northfield Experiments’
First Northfield Experiment
Bion was in charge of the military training and rehabilitating
wing
200 men suffering from neurotic disorders
Bion considered the role of the leader to make members
aware of what they were doing and considered that it
was not helpful to provide solutions
A leaderless ward system was established
First Northfield Experiment
The principles were to study the internal tension of the
group in this real life situation
Problems in the group could only be tackled if the majority
understood its nature and a solution accepted after
careful scrutiny by the group. The aim was to let the
patients learn a way of managing the tensions within the
group
Patients improved but Bion after 6 weeks or so was
removed as his work challenged the military structure
Second Northfield Experiment
In 1943 Foulkes along with Bridger, Main and Brier took
over the work at Northfield
There work was equally successful though slower but did
not challenge the military structure
Foulkes viewed the wards, different groups, staff and
individual patients as interrelated groups with a common
aim
Post war work
Bion ,Sutherland and Bridger went back to the Tavistock
where they were later joined by Ezriel and contributed
significantly to the understanding of groups
Foulkes became a consultant at the Maudsley and
developed his ideas of ‘group analysis’
Main at the Cassell set up an analytically oriented
therapeutic community
Brier set up the Marlborough day hospital
Group Analysis
In Group Analysis man is viewed as a social animal born
and brought up in a social situation in the context of
which the development of the individual’s personality
takes place.
The individual is considered as a nodal point in a network
of relationships in the group (the matrix). Attention is
given to the individual’s current life situation more
directly than in individual analytic therapy, emphasising
the ‘here and now’ and focussing less on the individual’s
developmental history.
Communications within the group are considered to be
central and the group focuses not only on what is said
but also when, how and why. This allows for a deeper
and richer understanding of the hidden communication
Bion’s theorising on groups
Bion described the work group and the basic assumptions
group hindering the work group.
He conceptualised basic assumptions as primitive states of
mind automatically generated when people combine in a
group. The basic assumptions include pairing (the hope
that coupling of individuals could lead to the birth of an
individual or idea providing salvation), dependence
(expecting the leader to provide solutions) and fight/flight
(fleeing or engaging in a battle with others).
He suggested that fantasies and emotional drives
associated with the basic assumptions interfere with the
explicit work task preventing change and development
Therapuetic factors in group
Yalom (1995) described 11 therapeutic factors in group
therapy;
instillation of hope, universality, imparting information,
altruism, corrective recapitulation of the primary family
group, development of socialising techniques, imitative
behaviours, interpersonal learning, group cohesiveness,
catharsis and existential factors.
Skills based groups tend to focus more on imparting
information to its members
Therapeutic communities
The phrase was first coined by Tom Main (1946) though
treatments using similar methods had existed for a long
time before
He developed his ideas of the hospital as a community
based on his experience of work on the Northfield
Experiment in WWII
Other people such as Maxwell Jones independently
developed similar ideas and were closely involved in the
development of therapeutic communities in the UK
Characteristics
Generally speaking four themes characterise therapeutic
communities;
‘Democratisation’ (equal sharing of power of decision
making in the community), ‘Permissiveness’ (the
tolerance among community members of behaviours that
outside the setting may be viewed as deviant according
to ‘norms’), ‘Reality confrontation’ (the belief that patients
should be continuously be presented with how their
behaviours is viewed by others) and ‘Communalism’
(refers to the informality, relationships and sharing of
amenities).
Staff in therapeutic communities
In a therapeutic community staff members are also
members of the therapeutic community.
They participate in informal social activities and
relationships e.g. preparing meals etc. This helps break
down the patient-staff barriers.
However, such democratisation has its limits and it is
important to remember that the staff are there for the
therapeutic benefit of patients and not for the gratification
of their own personal needs
References
• Barnes, B., Ernst, S and Hyde, K. (1999). An Introduction to
GroupWork. A Group-Analytic Perspective. Palgrave
Macmillan.Basingstoke, UK
• Brown, D and Pedder, J (1991) Introduction to Psychotherapy: An
Outline of Pscyhodynamic Principles and Practice. 2nd edition.
London. Routledge
• Hyde, K. (1988). ‘Analytic Group Psychotherapies’ in Group Therapy
in Britain. Ed. Aveline, M. and Dryden, W. Open University Press,
Milton Keynes, UK.
• Kennard, D. (1988). ‘The Therapeutic Community’ in Group Therapy
in Britain. Ed. Aveline, M. and Dryden, W. Open University Press,
Milton Keynes, UK.
• Yalom, I.(1995). The theory and practice of group psychotherapy