GROUP-ANALYTIC CLINICAL MINDLINES An Interview …repository.essex.ac.uk/17175/1/PDF Thesis copy 4...

GROUP-ANALYTICCLINICALMINDLINES

AnInterviewStudyoftheWorkingTheoriesofGroup-Analytic

Psychotherapists

DavidVincent

AThesisSubmittedfortheDegreeofProfessionalDoctorate

CentreforPsychoanalyticStudies

UniversityofEssex

September2015

Contents

p2.Contents

p3.Summary

p5.Introduction

p7.Chapter1:GroupAnalysis,GroupPsychotherapyandtheChangeProcess:

thehistorical,theoreticalandresearchbackground

p32.Chapter2:ClinicalWorkingTheories:Procedural,ImplicitandTacit

KnowledgeandClinicalMind-lines

p48.Chapter3:Methodology

p67.Chapter4:Findings

p120.Chapter5:Discussion

p148.Conclusions

p150.AppendixA:ExtractfromCodedInterview

p154.AppendixB:CodesandThemes

p169.References

Summary

TheIntroductionlaysouttheproblemthatthisresearchprojectattemptedto

examine:theimportanceofthe‘therapistfactors’intherapyoutcome,andthe

difficultyofascertainingtheworkingtheoriesofFoulksiangroupanalysts,

which,itissuggested,areheldinthegroupanalyst’smindasimplicit,pre-

conscious,proceduralortacitknowledge.Theconceptoftheclinicalmind-line

isthensuggestedasausefulwayofdescribingandstructuringthemannerin

whichclinicalworkingtheoriesareheld,reached,whenrequired,andthen

usedbythegroup-analyst.

Chapter1reviewstherelevantliteratureaboutthedevelopment,theoryand

practiceofgrouppsychotherapy.Chapter2reviewssomerelevantphilosophical

andpsychologicalworkaboutknowledgeandtheory.Chapter3describesthe

chosenmethodology:interviewsofexperiencedgroup-analysts,whichwere

recorded,transcribedandanalysedusingathematicanalysis.

Chapter4laysoutthefindingsfromtheinterviews,givinganarrativeaccount

followedbythethematicanalysis.Chapter5discussesthesefindingsindetailin

thelightofthegrouppsychotherapyliteratureandtheconceptsoftacit

knowledgeandtheclinicalmind-lines.Itissuggestedherethatthetwothemes

andfoursub-themesthatwererevealedbythethematicanalysisusefully

formedabasisforatentativeformulationofthegroup-analyticclinicalmind-

linesasconsistinginamentalstructureofinter-connectingclustersandnodes.

Thisstructureenablesthegroup-analyst,pre-consciously,toorganisetheirtacit,

implicitknowledge,andtointegrateitintotheirconsciousexplicitknowledge,

atanyonemoment-of-time-in-the-group,intoaclinicaldecisionand

therapeuticaction.

Theconclusionthendescribesthelimitations,usefulnessandpossiblefuture

developmentofthisstudy.Thereare,finally,twoappendices,whichprovidean

extractfromacodedinterview,andlistofallthethemesandcodesfromthe

thematicanalysis.

Introduction

Thisresearchprojectisconcernedwiththeworkingtheoriesofgroupanalysts.

Groupanalysisisasuccessfulandwidespreadmethodofpsychoanalyticgroup

psychotherapy,developedintheUnitedKingdomaftertheSecondWorldWar

byS.H.Foulkesandhiscolleaguesandfollowers,andextensivelyusedtodate

throughouttheNationalHealthServiceandinprivatepractice.Ithassome

theoriesandworkingpracticesthatareuniquetogroupanalysis,andothersin

commonwithindividualpsychoanalyticpsychotherapy,psychoanalysisand

psychodynamicandpsychoanalyticgrouppsychotherapyintheUnited

Kingdom,EuropeandtheUnitedStates.Overthelastfiftyyearsgroupanalysis

hasdevelopedanextensiveanddevelopingliteratureandrobusttheoriesof

practiceandtechnique.

Atthesametimetherehasbeenlittleresearchintoeitheroutcomeorprocess

ingrouppsychotherapyintheUnitedKingdom,butagreatdealintheUnited

StatesandCanada.TheareasthatgroupanalysishasincommonwithNorth

Americanmethodsofgrouppsychotherapyallowthisliteraturetoberelevant

togroupanalysis,andthisisreviewedinChapter1.Thisliteraturetendsto

showthatgrouppsychotherapy,includinggroupanalysis,likeindividual

psychotherapy,isgenerallyaneffectiveformofpsychologicaltreatment.

Burlingame,aseniorresearcheringrouppsychotherapyintheUnitedStates

reviewedtheresearchin1994:“Grouptherapydemonstratedsignificant

improvementoverinertcomparisongroups…andprovedcomparableor

superiortootheractivetreatmentconditions”(Fuhriman&Burlingame,1994,p

15).WampoldandImelreviewingmeta-analysisofallpsychotherapy

treatmentsin2015foundamoreorlessagreedlargeeffectsizeofbetween

0.75and0.85(Wampold&Imel,2015,pp70-71,94-5).Ofthemanyfactorsthat

contributetoeffectiveness,orthe‘changeprocess’,theleastunderstoodare

thetherapistfactorsandtheindividualpatientfactors.Thisstudyisconcerned

withoneaspectoftherapistfactors,theworkingtheoriesofthetherapist:the

ideas,knowledgeandexpectationsthattheybringintothesession.Itisthefirst

hypothesisofthisstudythatFoulksiangroupanalystscarrywiththemintothe

groupasetofdistinctive,sharedworkingtheories.Thesecondhypothesisis

thattheseworkingtheoriesarelargelyheldaspre-conscious,implicit,

proceduralknowledge.ThephilosopherMichaelPolanyicallsthis‘tacit

knowledge’:“weknowmorethanwecantell”(Polanyi,1966,p4).Thethird

hypothesisisthatthissortofknowledgemightbeaccessedthroughan

interviewstudyofexperiencedgroupanalysts,whichconcentratesontheir

viewsandthoughtsaboutthechangeprocessingroupanalysis.Thenatureof

thechangeprocess,andthereforetheeffectivenessofthemethod,isassumed

tobecentraltoboththeprofessionalidentityandformationofthegroup

analyst,andadiscussionofitismostlikelytorevealworkingknowledge.The

fourthhypothesisisthatthissortofworkingtheoryandtacitknowledgecanbe

usefullydescribedasa‘group-analyticclinicalmind-line’,followingthemodelof

theresearchofGabbayandLeMayintotheclinicaldecision-makingofGP’sand

hospitalphysicians(Gabbay&LeMay,2011).

Chapter1

GROUPANALYSIS,GROUPPSYCHOTHERAPYANDTHECHANGEPROCESS:THE

HISTORICALTHEORETICALANDRESEARCHBACKGROUND

Introduction

Thischapterisasurveyofthetheoreticalandresearchliteratureconcerned

withgroupanalysisandthewiderfieldofgrouppsychotherapy,particularlyin

relationtothechangeprocess.Grouppsychotherapy,whichincludesgroup

analysis,isanextensivefield,encompassingawiderangeofviews,aswideas

psychoanalysisanddynamicpsychotherapy.Inanattempttoreducethe

potentialcomplexityandrangeofviewsinthisresearch,alloftheinterview

subjectsweretrainedinthesameorganisation,theInstituteofGroupAnalysis,

andinthetraditionofS.H.Foulkes,thefounderofgroupanalysis.

Thischapterthereforecoversinsomedepththehistoricalandtheoretical

backgroundofgroupanalysisanditscomplexrelationshipwithothertypesof

grouppsychotherapy,andwithindividualpsychoanalysis.Groupanalysts,like

otherschoolsinthepsychoanalyticworld,tendtohaveastrongsenseofthe

historicaldevelopmentoftheirparticulardiscipline,andidentifythemselves

withtheirownhistory.Onepartoftheresearchwastoseewheregroup

analystsplacedthemselvesinrelationtoFoulkesandtheFoulksiantradition.At

thesametime,grouppsychotherapyisacomplexandwide-rangingareaof

theoryandpracticeandthevariousdifferentschoolsinfluenceandcompete

withoneanother,andadaptbothtochangingcircumstancesinclinicalpractice

andtonewdevelopmentsintheoryandresearch.Ingeneral,thegroup

psychotherapyliteratureissyncretistic,fluidandchangeable.However,the

researchinterviewwasorganisedaroundtheideaofthechangeprocessinthe

groupinordertofocusonwhatwasthemostimportantquestionaboutthe

groupanalyst’sworkingpractice:howdoesgroupanalysis,intheirview,bring

aboutpositivechange?Thesurveythereforecoverscontemporarytheoryand

researchaboutthechangeprocessinindividualandgrouppsychotherapy.

S.H.FoulkesandtheHistoryandDevelopmentofGroupAnalysis

Inordertohavesomeconsistencyinbothexperienceandtheoretical

backgroundtheresearchinterviewsubjectswere,asalreadystated,limitedto

experiencedgroupanalysts,whohadtrainedinthesameorganisation,oneof

thequalifyingtrainingsprovidedbytheInstituteofGroupAnalysis.Thisisa

recognisedandwell-establishedtrainingorganisation,withasubstantial

membershipandalonghistory.Foulkesandthehistoryofgroupanalysisare

importantinthetrainingandon-goingexperienceofgroupanalysts,andform

thebasisfortheirintellectualandclinicalformation.Theintellectualand

theoreticaloriginsanddevelopmentofgroupanalysishavebeendescribedwell

byPines(Pines,1983),andsetinthecontextofpsychoanalysisandother

approachesinthevolumeeditedbyOakley(Oakley,1999).Thefounderof

groupanalysis,S.H.Foulkes,wasaprofoundinfluenceontheformationand

developmentofgroupanalysis.HewasaGermanpsychoanalystwhocameasa

refugeetoBritainin1933.Thereisabriefbiographicalessaybyhiswifeina

collectionofhispapers(Foulkes,1990a).HetrainedasadoctorinHeidelberg,

MunichandFrankfurtandthenspecialisedinneurologyworkingasanassistant

totheinfluentialneurologistKurtGoldsteininFrankfurt(Foulkes,1939).He

thentrainedasapsychiatristandasapsychoanalystinVienna,whereHelene

Deutschwashistraininganalyst,andmovedbacktoFrankfurttorunthe

psychoanalyticclinic.Thepsychoanalystsattheclinicdevelopedclosetieswith

thesociologistsfromtheFrankfurtSchoolforSocialResearch.The

psychoanalysts,likeErichFromm(Fromm,1970)becameinterestedinsociology

whilethesociologists,likeTheodoreAdornoandHerbertMarcuse,became

interestedinpsychoanalysis(Marcuse,1962&1970,FrankfurtInstitutefor

SocialResearch,1972).Thislivelycross-fertilisationofideascontinueduntilthe

riseofNazismandstafffrombothorganisationsbegantoleaveGermany.

AsarefugeeinGreatBritain,Foulkestookmedicalqualificationsagainand

joinedtheBritishSocietyforPsychoanalysis.Hebecameamemberofthegroup

aroundAnnaFreud,andatraininganalyst.DuringtheSecondWorldWarhe

workedforawhileinExeterandexperimentedforthefirsttimewithaclinical

groupofpatients.HethenjoinedtheBritishArmyMedicalCorpsasaasa

militarypsychiatristatNorthfieldHospitalinBirminghamandfurtherdeveloped

hispracticeofgroupanalysisthere.Thiswasaninfluentialhospital:W.R.Bion,

ThomasRickman,HaroldBridger,TomMainandPatdeMarealsoworkedat

Northfield,andthetherapeuticworkthereisdescribedbyFoulkesinhisfirst

book(Foulkes,1948);byBioninhisearlypapersongroups(Bion,1961),by

HaroldBridger(Bridger,1990),byPatdeMare(deMare,1985),andasa

historicalstudybyHarrison(Harrison2000).AfterthewarFoulkesworkedasa

psychiatristattheMaudsleyHospitalandwenton,withcolleagues,tostartthe

GroupAnalyticPractice,theGroupAnalyticSociety,andfinallytheInstituteof

GroupAnalysis(Foulkes,1990).

Whatisimportantaboutthishistoryisthatherepresentedandbrought

togetherawiderangeofdifferentinfluenceswhichthendeveloped,through

thegrowthontheonehandofpsychoanalysisandpsychotherapy,andonthe

otherhand,oftheNationalHealthService.Theexperienceofdealingwith

‘battleneurosis’(PostTraumaticStressDisorder)atNorthfieldHospitalledto

furthertherapeuticworkwithrefugees,returningprisonersofwarand

‘displacedpersons’(Wilson,1990)Afterthewarthisthenledontothe

expansionofgrouptreatmentsandthegradualdevelopmentofthetherapeutic

communitymovement,inwhichgroupanalysisandothergrouptreatments

formedavitalandincreasingpart(Manning,1989).Theconnectionbackto

NorthfieldcanbeseeninBion’scareer,developinggrouptherapyatthe

TavistockClinic(Bion,1960),andbyTomMain,whosetuptheCasselHospital,

coiningtheconceptof‘thehospitalasatherapeuticinstitution’(Main,1946;

Barnes,1968).AttheMaudsleyHospital,Foulkesinfluencedalongstanding

interestinthepsychotherapyclinicingrouppsychotherapy.MaxwellJones,

whofoundedtheHendersonHospital,animportanttherapeuticcommunityfor

sociopathicpatients,startedhispsychiatriccareeratDartford,whichwasa

post-warrehabilitationhospital.TheHendersonwasformanyyearscompletely

committedtoagrouppsychotherapeuticapproachinthecontextofthe

therapeuticcommunity,andmuchstudiedandresearchedintheearlyyears

(Rapoport,1960),andthenagainmuchlater(Dolan,1996).Withthefurther

developmentoftheNationalHealthServiceandadvancesinpsychiatric

treatment,groupanalysisexpandedanddeveloped.

GroupAnalysis,PsychoanalysisandTheoreticalDevelopments

Therangeoftheoreticalworkexpandedalongsidethedevelopmentsinthe

NationalHealthServiceandprivatepractice,andoverthelasttwentyyearsin

particulartherehasbeenasubstantialdevelopmentoftheory,muchofwhich

hasbeenconcernedwiththerelationshipbetweenpsychoanalysisandgroup

analysis.Thisiscomplexandoftencontentious,andhasstrongimplicationsfor

techniqueandforanytheoryoftherapeuticactionandchange.Onequestion

thatisoftenaskediswhethergroupanalysisisadevelopmentoutof

psychoanalysis,orisitaseparateentity?FarhadDalalarguesvigorouslythat

theyareseparateandthatFoulkeswasheldbackinbringinggroupanalysison

bytooloyalanadherencetopsychoanalysis(Dalal,1998).EarlHopperarguesto

thecontrarythatgroupanalysisisandshouldbeanessentialpartof

psychoanalysis(Hopper,2003b)andinparticularhasemphasisedtheunique

groupanalyticconceptofthesocialunconscious(Hopper,2003a).ForDennis

Brown,himselfbothapsychoanalystandgroupanalyst,Foulkes’“genius”was

hisabilitytoholdinmindboththecentraltenetsofpsychoanalysisandthe

“understandingofhowprofoundlysocialhumannatureis”(Brown,1986,p83).

Othergroupanalystshavemovedinthedirectionofattachmenttheoryandits

relationshiptopsychoanalysis(Marrone,1998)andfurtherawayfrom

psychoanalysistowardscomplexitytheory(Stacey,2003).Alargergrouphave

stayedwithintheboundariesofFoulksiangroupanalysis,withaclinical

emphasis,andthemostimportantsummariesofthispositionarebyBehrand

Hearst(2005)andBarnesetal(1999).Therehavealsobeenvariousstudiesof

thespecialapplicationofgroupanalyticmethodstoparticularpatient

populations.BarbaraElliotdescribeddayhospitalgrouptherapywithalcoholics

(Elliot,2003),MartinWeegmanwithdrugaddicts(WeegmanandCohen,2002)

andDickBlackwellwithrefugees(Blackwell,2005).LionelKreegereditedatext

ontherapeuticworkwithlargegroups(Kreeger,1975)andPatdeMarewrote

aboutdialogueinwhathecalled‘median’groups(deMare,1991).BothKreeger

andDeMarealsohadworkedattheHalliwickHospital,anearlyandinfluential

therapeuticcommunity,deMarehavingalsopreviouslyworkedatNorthfield.

Thiscomplexnetworkoforganisations,methodsandtheoriesslowlydeveloped

outofthematrixofinfluencesbroughttogetherinthepersonofFoulkes.Itmay

bethecasethatgroupanalysts’identificationwiththeFoulksianapproach,

throughtraining,supervisionandpersonalexperienceofintensivegroup

analytictherapy,reinforcesthistendencytowardsaneclectic,many-stranded,

‘matricial’castofmind.Therearedifferentstrandsingroupanalysisandthis

makesitmoredifficulttodescribeindetailwhatisdistinctiveanduniqueabout

thegroup-analyticmethodofgrouppsychotherapy,inallitsforms,and

thereforetoidentifyacharacteristictheoryoftherapeuticchange.Thecomplex

historicalbackgroundandthewiderangeofinfluencesinthedevelopmentof

group-analysisaretaughtinthetrainingandarewithinthegroup-analyst’s

frameofreference,formingabackgroundtothegroupanalyst’sclinicalmind-

lines.

W.R.BionandHenryEzriel

Afurthercomplicationistherelationshipofgroupanalysistootherkindsof

Britishgrouppsychotherapy,inparticularBionandEzriel.Groupanalysisissaid

tobedistinctfrom‘psychoanalyticgrouppsychotherapy’,whichisusually

identifiedwiththeapproachofBionandEzriel,andtheirfollowersatthe

TavistockClinic(Garland,2011).Inthisgroup,thecritiqueofgroupanalysis

wouldbeoppositetothatofDalal(opcit),thatthereisnotenough

psychoanalysisingroupanalysis,ratherthantoomuch.TheworkofBionhas

beenextremelyinfluentialparticularlyinthefieldofhumanrelations

conferences,largegroups,organisationalstudies,andtherapeuticcommunities,

butgenerallyseemstohavehadlessinfluenceinclinicalsmallgroup

psychotherapy(Bion,1960;Hinshelwood,1987).Biontrainedinmedicineafter

theFirstWorldWar,developedaninterestinpsychotherapyandworkedfor

severalyearsattheTavistockClinic,(Miller,2013).Afterwarserviceinthe

SecondWorldWar,intheArmyMedicalCorps,asapsychiatristatNorthfield

HospitalandfortheWarOfficeSelectionBoards(Murray1990),here-joined

theTavistockClinicwherehebegantoleadpsychotherapygroupswhichhe

studiedwithgreatcare.Hedevelopedwhatcametobecalledhis‘Basic

AssumptionTheory’andthiswaspublishedinitsfirstforminanimportant

paperinthejournal,‘HumanRelations’,andthendevelopedfurtherandrefined

initsfinalforminhisbook,‘ExperiencesinGroups’,whichbecameextremely

influentialthroughoutEuropeandNorthandSouthAmericainlateryears(Bion,

1960).Inthebook,theessay,inanexpandedform,isthelastchapter,called

‘GroupDynamics:areview’.Itwasthelastessaythathewroteaboutgroups.

TheBasicAssumptionTheory,whichhasbeensoinfluential,isinsomewaysa

straightforwardidea.Bionsuggeststhatthegrouphasacentral‘workgroup

function’.Thegroupistheretodoajob:dopsychotherapy,makeadecisionor

carryoutatask,forexample.Somethinggetsinthewayofthework,akindof

compellingsharedanxiouspreoccupationwiththenatureofthegroup,rather

thanthetask.Thisdestabilisinganxietyadoptedbythegroupdependedonthat

group’sparticulartendencyatthatmomenttoheadtowardsoneofthethree

basicassumptions:pairing,fight/flightordependency.Thisverysimple

theoreticalschemehasbeenfoundtobeveryrobustinexaminingorganisations

andinstitutionallife(Sutherland,1990;Miller,1990).Inspiteofthefactthat

BionisoftenseeninoppositiontoFoulkes,mostgroupanalystsarealso

influencedbyBion’sformulations,andhisworkistaughtinthegroup-analytic

training(Garland,2011,Hinshelwood,1987).

AnotherimportantinfluencewasfromHenryEzriel,whoislessnoticednow,

butwhowasalsotaughtformanyyearsonthegroup-analytictraining.He

workedattheTavistockClinicwithBion.Hedevelopedhisownrather

idiosyncraticmethodbasedontheideaofthe‘commongrouptension’,which

developedinthegroupasaresultofadeniedwish.Thisresultedinwhathe

calledthe‘requiredrelationship’.Thisunconscious‘requiredrelationship’wasa

falsestateofmindthatthegroupunconsciouslyforceditselfintotopreventthe

emergenceofthe‘avoidedrelationship’,thesecretwish,which,ifitwere

revealed,wouldresultinthe‘calamitousrelationship’,whichwouldbetheend

ofthegroup(Ezriel,1950).Thisstructurewasadoptedforsometimeasa

methodofsmallgrouppsychotherapy,particularlyattheTavistockClinic,in

preferencetothemethodsofBion,accordingtoSutherland,whowasformany

yearstheDirector(Sutherland,1990)and,famously,alsointheNHSatthe

PaddingtonDayHospital,withmixedresults(Baron,1987).Influencesfrom

bothBionandEzrielthereforeformanotherpossiblestrandinthegroup-

analyticclinicalmind-line.

GroupPsychotherapyintheUnitedStates

Anothersubstantial,complexinfluenceongroupanalysiscomesfromthe

UnitedStates.Therewasaninterchangeformanyyearsbetweengroup

psychotherapistsfromtheUnitedStatesandBritishgroupanalysts.BothBritish

psychoanalyticgrouppsychotherapy(Bion)andgroupanalysis(Foulkes)are

differentagainfromthevariousapproachestogrouppsychotherapyinthe

UnitedStates.Thesearethe‘interpersonal’school,bestrepresentedbyYalom

(1975),the‘modernanalytic’approach(Ormont1992,2001;Rosenthal,1987)

andthe‘relational’approach(Billow,2003).Thereisalsoarangeof

independentgrouppsychotherapistswhoaremorefranklypsychoanalyticin

theirapproach.AgoodandinfluentialexampleisLeonardHorwitz,whotrained

andworkedattheMenningerClinic,whowasinturnveryinfluencedbyJ.D.

SutherlandfromtheTavistockClinic,whovisitedandworkedattheMenninger

formanyyears(Horwitz,2014).Horwitz,forexample,explicitlyidentifiesmuch

morecloselywiththemethodsandtheoriesofBionandEzrielthanhedoes

withFoulkes(ibid,pp39-40).Moreimportantly,themajorityofresearchinto

bothprocessandoutcomeofbothindividualandgrouppsychotherapyhas

beencarriedoutintheUnitedStatesandCanadaratherthanBritain(Piperet

al,2002;Burlingameatal,2011,2013;Fuhriman&Burlingame,1994).An

importantexampleofthiswouldbeIrvingYalom,whoseinfluentialtext-book

hasalwaysbeenusedinthegroup-analytictrainingintheUnitedKingdom.

(Yalom,1975)

OutcomeandProcessResearchinGrouppsychotherapyandGroupAnalysis

Thisresearch,mainlyintheUnitedStates,asstatedearlier,indicatesthatgroup

psychotherapyisaneffectiveformofpsychologicaltreatment(Burlingameop

cit).Itis,likeallotherpsychodynamicmethodsoftreatment,significantlybetter

thannotreatmentatall.IntheUnitedStatestherehasbeenagreatdealof

intensiveresearch,formanyyears,intobothoutcomeandprocessingroup

psychotherapy,largelybytheresearchersconnectedtoBrighamYoung

University(Burlingameetalopcit),andinCanadabythegroupofresearchers

connectedtotheUniversitiesofAlbertaandBritishColumbia(Piper,2002).In

BritainandEuropethecontemporaryevidencebaseforallanalytic

psychotherapyisdescribedbyRichardsonandHobson,bothofthem

psychotherapycliniciansandresearchers,inanimaginedconversationbetween

ascepticalinquirerandapsychotherapist(RichardsonandHobson,2003),and

theseparatebutrelatedissueofevidence-basedpractice,RCT’sand

psychotherapyisalsoaddressedbyRichardson(Richardson,2003).Inthe

UnitedKingdomtheUniversityofSheffieldcarriedoutasubstantialmeta-

review,lookingatalltheavailablemethodologicallyacceptableoutcomestudies

ingrouppsychotherapyandgroupanalysis,fortheGroupAnalyticSocietyand

theInstituteofGroupAnalysis.Thisshowedmodestproofofefficacyand

effectiveness(CentreforPsychologicalServicesResearch,2009).Morerecently,

SteinarLorentzen,agroupanalystandresearcherfromNorwayandhisgroup

completedalongandcarefulcomparisonstudybetweenshortandlongterm

groupanalyticpsychotherapylookingatpotentialdifferentialoutcome

(Lorentzen,2014).Thiswasarandomisedcontrolledtrialcomparingthetwo

modesofshortandlongtermgroup-analytictherapy:SALT-GAP(ibidpxv).All

ofthesestudiesshowthatgrouppsychotherapyisaneffectivepsychological

treatment.Themuchmoredifficultquestiontoanswernowisnotwhether

grouptherapyworks,but,ifitdoes:whyandhowdoesitwork?Some

researchersinthefieldnowclaimthatlittlemorecanbediscoveredabout

outcomethroughresearch,exceptfordifferentialoutcomeeffectsfordifferent

kindsofpsychologicalconditionsandpopulations,untilmoreisknownabout

process(Greene,2004).Thereforeresearchintoprocessinallthe

psychotherapiesisincreasinglyimportant.Thesituationwithgroup

psychotherapy,whichincludesgroupanalysis,thesubjectofthisstudy,is

perhapsnodifferentfromthesituationwithindividualpsychoanalytic

psychotherapy,althoughtherehavebeenmoretheoreticaldevelopmentsand

moreresearch,particularlyintoindividualpsychoanalysis,andpsychoanalytic

psychotherapy,mostnotablyintheUnitedStates,withtheBostonChange

ProcessStudyGroup(2010)andinGermanyandinSweden(Richardsonetal

2004).Processresearchisofcoursedifficult,anditpresentsresearchers

workinginthepsychoanalyticfieldwithparticularethicalandmethodological

problems.Outcomeresearch,however,canbedonewithawiderangeof

outcomemeasures,giventopatientsbeforeandaftertreatment.Forgroup

psychotherapygoodexamplesareprovidedbytheCOREBattery,drawnupby

theTaskForcefromtheAmericanGroupPsychotherapyAssociation,(Core-R

TaskForce,2006).Examplesofvariousdifferentapproachestoprocessresearch

aredescribedlaterinthischapter.

TherapistFactorsinGroupAnalysisandGroupPsychotherapy

Arecentsurveyoftheevidencebaseforpsychotherapyaffirmstheimportance

ofthe‘therapistfactors’inbothprocessandoutcome.WampoldandImel

proposewhattheycalla“contextualmodel”forexaminingpsychotherapy,

ratherthana“medicalmodel”andclaimthat:“Acentralcomponentofthe

ContextualModelistherelationshipbetweenthetherapistandtheclient.”

Wampold&Imel,2015,p80)Anotherresearcher,Norcross,statesthatthe

evidenceshowsthatthatdifferencesinoutcomethatarenottodowiththe

patientareassociatedwiththeindividualtherapistdifferencesandthenature

ofthetherapeuticrelationship(Norcross,2011,p7).The“personofthe

therapistisinextricablyintertwinedwiththeoutcomeofthepsychotherapy”

andthiseffectisvariously,acrossstudies,responsiblefor5%to9%ofoutcome

variation(ibidp7).Norcrossthenshowsananalysisofvarianceinoutcome

whichshowsthecontributionofthetherapistas7%,thetreatmentmethodas

8%,thetherapyrelationshipat12%,thepatientat30%andunexplainedfactors

at40%(Norcross,2011p13)Whatthetherapistactuallydoeswithgoodeffect

inthetreatmentisconnectedmoretowhotheyare,andwhatsortof

relationshiptheyhavewiththeirpatients,thanwhattheyknow.Ingroup

analysisthiswouldincludethegroupanalyst’sabilitytofostergood

relationshipswithin,aswellaswith,thegroup.Thisraisessomecomplexissues.

Forgroupanalysts,howmuchoftheirapproachtogroupanalysisistodowith

beingagroupanalystandhowmuchofitistodowiththeirindividualnature

andviewofgroupsandpsychotherapy?Thisthenraisesthecomplexquestion

ofidentification.Howpersonalandinternalisedistheidentificationwithbeinga

psychotherapistandgroupanalyst,andhowmuchofthataffectstheworkona

moment-by-momentbasis?Itisassumedinthisstudythatexperiencedgroup

analystsdobecomeidentifiedtoaconsiderabledegreewiththegroupanalytic

method,whatevertheirownindividualconstructiononthatis.

Ifitisthegrouppsychotherapist’sroletoguidethegroup,whetherby

interpretation,analysis,education,encouragementorconfrontation,then

grouppsychotherapistsmustthereforeregardtheirworkandtheir

interventionsascontributinglargelytothechangeprocessinthegroup.What

sortofworkingmodeldotheythenholdwhichhelpsthemtodecidethenature

ofanyinterventionatanypointinthegroup?Areallinterventionsdesignedto

effectchange?Whatistherelationshipbetweentheotherelements,thenature

andconditionofthegroup,theunconsciousgroupdynamicsandthetherapist’s

work?Oneattempttoresearchthisisthebook,AWorkbookofGroup-Analytic

Interventions,byDavidKennard,JeffRobertsandDavidWinter.Inthisstudy

theauthorspresentedanumberofgroupanalystswitheightdifferent

problematicsmallscenarios,ofvaryingdifficulty,askingthegroupanalyststo

describewhattheywoulddo(Kennardetal,1993).Theresultsshowedthat

mostoftheimaginedinterventionsweremodestandbrief:“Groupanalysts

placeconsiderableconfidenceinthecapacityofgroupmemberstoworkthings

outforthemselves”(ibid,p147)Thissuggeststhatgroupanalystsframetheir

interventionssubstantiallyinthelightofwhatBlochandCrouchcall“the

conditionsofchange”(BlochandCrouch,1985).Inareviewofstudiesinto

grouptherapistsDiesfoundthatsixtherapistvariablesemergedintreatment:

theco-therapistrelationship,thefocusofintervention,personalstyle,

skill/expertise,techniquesandmanuals,andthat“thecontributionsofthe

cliniciantoeffectivegrouptreatmentareimportant,butoutcomeisalso

influencedbyahostofotherconsiderations”Fortheclient/therapistcategory,

thethreevariableswerethequalityoftherelationship,therestructuringof

goalsandtransference(Dies,1994,pp144-5).

Thisindicatestwoimportantlinkedelements,bothofwhichhavestrong

implicationsforthegroupanalyst’sworkingtheories:thecomplexnatureof

transferenceinthegroupandtheconsequentroleofinterpretation.

Interpretationisthebasisoftherapeuticactioninpsychoanalytic

psychotherapy,makingtheunconsciousconscious:“whereidwas,thereshall

egobe”(Freud,1933).ForFoulkes,however,interpretationisaslowand

modestprocessthatarisesfromlisteningtothegroupoveraperiodoftime.

Theinterpretationshouldalwaysbemadeinthelightofthegroup-as-a-whole,

itarisesoutofthegroupanalyst’spassive,receptivestance,anditisa

“perceptiveandcreativeact”(Foulkes,1968).MalcolmPinestakesaslightly

differentstance.Forhim:“theprimarytaskofthetherapististofacilitatethe

communicativecapacityofthegroupmembers”andtheinterpretationarises

outofthatasan“actoffreedom…ofliberationfromtheroleofcontainer”

(Pines,1993,p141)Thisisaninterestingwayoflookingatthedynamicsofthe

connectionbetweentheconditionsofchangeandtherapeutictechnique,in

BlochandCrouch’sterms,andimplicitlyjoinsupwithBion’sconceptsofthe

containerandthecontained(Bion,1970,pp77-82).

Binder,inhisstudyofmanualisedbrieftherapy,whiledistinguishingbetween

‘procedural’and‘declarative’knowledgeinhisstudy,alsoemphasisedthat,in

spiteofincreasingresearch:“thepreciseagentsorprocessesoftherapeutic

changeremainlargelyspeculative”(Binder,2004,p46).Healsopointedout

thateachtheorywilltendtoclaimchangeprocessesthatwillfitwiththat

theory.Thisseemstobeacommonproblem,aretrospectiveascriptionof

agencyforchange,probablyinvolvingconsciousandnon-consciousre-writing,

ofpresenteventstofitpasttheory.Inhisstudy,whichislargelyoftheuseof

manualsinshort-termtherapy,Binderidentifiestwosetsofelementsinthe

changeprocess,whichheclaimsaregenerictoarangeoftherapies.First,he

picksoutfourconditionsnecessaryforthepatienttochange:cognitiveinsight,

practice(ofwhatislearnedfromtheinsight),creatingnewbehaviourand

internalisation;andsecond,hedescribesthegenericskillsthatneedtobe

acquiredinordertomakeuseofthepotentialchangeprocess:interpersonal

patternrecognition,self-reflection,self-monitoring,reflection-on-action,

reflection-in-action,andimprovisation(Binder,2004,pp46-54).Thisisavery

helpfulandproductivewayofbreakingdowntheideaofthechangeprocessin

amanageableway:first,whathastobehappeninginorderforhelpfulchange

totakeplace,and,second,whatdothetherapistandthepatientsorgroup

needtodoinordertoenablethechangeprocesstocontinueanddevelop.

Group-analytictheoriesofthechangeprocess

Thisraisesthequestionastowhetherthereisaspecificgroup-analytictheory

ofthechangeprocess?ForFoulkeshimself,changederivedfrominsight,ina

conventionalpsychoanalyticunderstandingofmakingtheunconscious

conscious.Thefree-associativeprocessofgroupanalysis,whathelatercalled

the“free-floatingconversation”,whichisenabledbytheinterventionsofthe

groupanalyst,ratherthanmakinginterpretations,leadstowards“enlargingthe

areaofcommunicationindepth”,and“thisprocess…produceschangeaswellas

insight”(Foulkes,1990,p141).“Enlargingtheareaofcommunication”iswhat

Kutterdescribesastheincreaseinopenness(Kutter,1982),andthismustbean

importantelementinthechangeprocess,but,again,whyandhowdoesthe

acquisitionofinsightinthegroupleadtochange?“Weareinterestedinchange

andinthestudyofchange….thestudyofchangeinoperation,thestudyof

changeinalivingsituation”,claimedFoulkesinanotherpaper,asthoughhe

knewthatitwasnotenoughjusttonoticeit,itneededtobestudied(Foulkes,

1990,pp206-7).AndinapaperwrittenfiveyearslaterFoulkesreturnstothis

problem,andhehasclearlybeenworryingatitintheinterveningyears.Henow

sawitdifferently,inalessconventionallypsychoanalyticway:“Change,

however,resultsfromtheinteractingprocessesthemselvesevenbeforethey

aremadeconscious.Inthisviewchangeis,therefore,thecauseofinsightand

notitsconsequence”(Foulkes,1990,p291).Foulkes,however,presentedhis

viewsofgroupprocessandchange,ingraduallymorecomplexwaysandthese

ideaswerethentakenup,developedandchallengedbyotherresearchersand

grouptherapists.DennisBrown,forexample,emphasisestheimportanceof

‘dialogue’,“intimatereciprocalcommunicationatmanylevels”,forchangein

groupanalysis(Brown,1986,p91).InanotherpaperBrownexplainsthat“in

groupanalysisweseeinsightandchangeasinteracting”(Brown,1987,p104).

RobinSkynner,agroupanalystandfamilytherapistilluminatesthisby

describinghoweachgroupmemberbringstothegroupa“familypattern”,and

then“projects”thisintothegroup,manipulatingitunconsciouslytokeepitin

operation(Skynner,1985,p105).This‘pattern’isgraduallydismantled,because

theothergroupmembersincreasinglydonotcooperatewithitandthegroup

changeprocessgetsunderway.

TheoriesofConditionsforChange:theGroup-specific,Therapeuticand

CurativefactorsinGroupPsychotherapyandGroupAnalysis

Thenextimportantquestionis:whatarethepre-conditionsforthechange

processingroupanalysisandgrouppsychotherapy?Thereisnowasetof

establishedandgenerallywell-acceptedconceptsofwhatmakeschange

possibleingrouppsychotherapy.Thesearenotallspecificallygroupanalytic,

exceptfortheconceptsofFoulkesandAnthony,butapplytoallanalyticgroup

psychotherapy.Theseworkingmodelsofgrouppsychotherapyprocessthat

attempttoexplainthelikelyconditionsinthegroupfortherapeuticchangeare

usuallydescribedasthe‘group-specificfactors’byFoulkes(FoulkesandAntony,

1957),asthe‘therapeuticfactors’byBlochandCrouch(1985)andasthe

‘curativefactors’byYalom(1975).Thesetermsareusedquitelooselyattimes

andcanbeinterchangeable,buttherearesomedistinctdifferencesin

emphasis.Waltonhasausefullistof‘phenomenaspecifictogroups’,whichis

anattempttoseparateoutwhatisuniqueaboutgroupasopposedtoindividual

therapy(Walton,1971).HereferstoWhitakerandLieberman(1964),stating

that:“Thegoalinatherapeuticgroupistoprovidepatientswithasettingin

whichchangecanoccur.Toachievethisitisnecessarytogenerateagroup

environmentconducivetoopennessandmutualtrust”(Walton,1971,p37).

Thisisausefulandcleardescriptionofthebasicrequirementingrouptherapy

forchangetotakeplace.Thisiswithinthesettingofthefivegroupspecific

phenomena,whicharethegroup’s“capacity”for:consensus,mutualpressure,

rewardandpunishmentbyinclusionandexclusion,sharedfeelingsand

collaboration.Hestatesthatthespecialskillrequiredofthegroup

psychotherapististhatofa“monitorandmanagerofgroupforces”(ibid,p38).

Oneofthebasicrequirements,therefore,forchangetotakeplaceinthegroup

isthatthegrouppsychotherapistisalwaysawareof,andenabling,ofthegroup-

specificphenomena.

FoulkesandAnthonyseeitslightlydifferentlyintheirclassicdescriptionofthe

group-specificfactors(FoulkesandAnthony,1957).Theydifferentiatebetween

group-specificfactors,whicharethenecessaryconditionsinthegroupfor

therapy,andthereforechange,totakeplaceinthegroup,andgroup-specific

phenomena,“whichresultfromtheworkingsofthetherapeuticprocess”(ibidp

149).Therearefivegroup-specificfactors:socialisation,the‘mirror’

phenomena,the‘condenser’,the‘chain’and‘resonance’.Thisamorecomplex

ideathanitfirstseemsbecausetheimplicationisthatthesefactorsaretherein

allgroupsaspathwaysforgroupcommunicationandcloseness,butatthesame

timetheyarealsothemeanswherebythegroupbecomescloserandmore

communicative.Itcouldalsobesaidthatthesefactorsarenormalinteractive

patterns,indicatorsofgoodmentalhealth.Thegroupphenomenaare

describedvariouslyasthethingsthathappeningroups,forgoodorill,oncethe

groupisunderway;therolesthatindividualmembersmaytakeoninthe

courseofthegroup;andaswaysoflookingat,analysingordescribingwhatis

happening.Theylisttheorising,support,sub-grouping,silences,scapegoats,the

stranger,thehistorian,andrhythmandtensions(ibidpp149-162).Although

theydescribeeachoftheseinsomedetail,withclinicalillustrations,itisstill

unclearhowusefulthesefactorsandphenomenaareindescribingthe

necessaryconditionsfortherapeuticchangeinthegroup.Theyarerather

arbitrary,andhaveaslightlytaken-for-grantedquality.

The‘therapeuticfactors’aremostcloselyassociatedwiththedetailedresearch

ofBlochandCrouch(1985).Again,however,theproblemisthedefinitionofa

necessarilycomplexandhard-to-graspidea.Greene,inausefulquotation,says

thatthetherapeuticfactors:“isanambiguouslydefinedconceptthatseemsto

representthecrystallisationorcondensation...oftheon-goingflowof

behaviourswithinthegroupthatpurportedlycontributetotherapeuticgain”

(Greene,2000,p28).Thisishelpfulbecausehedescribesthecomplexityofthe

subject,butgivesitashape.Thegroupisobviouslyan“on-goingflowof

behaviours”,consciousandunconscious,someofwhichpromoteandmaintain

therapeuticchangeinindividualgroupmembersandinthegroup-as-a-whole.

IntheirresearchBlochandCrouchidentifiedthreelargesetsofvariableswhich

mightaffecttreatmentoutcome.First,therearetheconditionsforchange,

whichmustbepresentinthegroupfortheretobechange,butwhichdonotin

themselveshaveatherapeuticeffect.Second,therapisttechnique,whatthe

therapistdoesandsaysisasubstantialvariable.Third,theylisttentherapeutic

factors,whichareessentialpartsofthegroupprocess,andwhichhavea

beneficialeffect.Theseare:acceptance,universality,altruism,instillationof

hope,guidance,vicariouslearning,self-understanding,learningfrom

interpersonalaction,self-disclosureandcatharsis(BlochandCrouch,1985).

Manyoftheseconceptsareinterchangeablebetweendifferentresearchersand

clinicians,andBlochandCrouch’slistwasinfluencedby,andoverlapswith,the

better-knownformulationsofYalom,whoseinfluentialtext-book,‘TheTheory

andPracticeofGroupPsychotherapy’hasbeencontinuouslyinprintthrough

severaleditionssince1970(Yalom,1970).Thisisaveryfirmandconfident

statementoftheinterpersonalapproachtogrouppsychotherapy,whichisvery

muchcentredontherapeuticworkinthehereandnow.WhatBlochandCrouch

callthe‘therapeuticfactors’,Yalomcallsthe‘curativefactors’,andhelists

eleven:instillationofhope,universality,impartingofinformation,altruism,the

correctiverecapitulationoftheprimaryfamilygroup,developmentof

socialisingtechniques,imitativebehaviour,interpersonallearning,group

cohesiveness,catharsis,andexistentialfactors.Ofthese,Yalomregardsgroup

cohesivenessandinterpersonallearningasbyfarthemostimportantfactors

(Yalom,1975,p3-4).Inparticular,thesetwofactorsareessential,inhisview,for

grouptherapythataimsfor“characterologicchange”(ibid,pxi).Hemakesa

distinctionbetween“front”and“core”,takingthesetermsfromErving

Goffman,tomean,roughlyspeaking,theoryandpractice,orpossibly

declarativeandproceduralknowledge(Binder,2004).Hisviewisthat:“Therapy

groupswhichappeartotallydifferentinformmayrelyonidenticalmechanisms

ofchange”(Yalom,pxi).Theproblem,ofcourse,ishowtoidentifythecentral

mechanisms.Heemphasisesaparticularaspectofthecomplexity:“therapeutic

changeisanenormouslycomplexprocess…itoccursthroughanintricate

interplayofvariousguidedhumanexperiences”(ibid,p3).Theseexperiences,

the“ongoingflowofbehaviourswithinthegroup”thatGreenedescribes(2000,

p38)arepartly“guided”(therapeutictechnique)andpartlyariseoutofwhat

BlochandCrouchcallthetherapeuticfactorsandtheconditionsofchange(op

cit).Anexamplewouldbetheirclaim,inanotherreviewofresearch,thatgroup

psychotherapistscanincrease‘interpersonallearning’byactivelyhelpingthe

grouptoworkwithoneanother,and,morestrikingly:“groupleaderscan

enhancecohesionthroughvariousmeanslikereinforcement,adoptinga

moderatelyself-expressiveandcaringstyle,andorganisingthegroupinspecific

ways”(Crouchetal,1994).Thisleadsontothenextimportantquestion:what

shouldthegroupanalystdotomovethegroupintoaneffectivechange

process,ifallthepre-conditionsforchangearereasonablywellinplace?

TheGroupAnalyst’sTherapeuticWorktoPromotetheChangeProcess

Thenextimportantmatteristhenatureoftheinteractionbetweentheactions

ofthetherapistandtheprocessofthegroup.Greeneputsitwell:“Withoutan

understandingofthespecificinnerprocessesofpsychotherapy,arangeof

problemsensues”(Greene,2000,p24).Nottheleastoftheseishowto

generaliseexperimentalfindingsofgoodoutcomeintoeverydayclinical

practice.Whatsortofbehaviourbythegroupanalystmovesthegroupfromthe

pre-conditionsforchangetotheactualchangeprocess?Onewaytolookatthis

isthroughprocessanalysisofgroupsessions.Afairlyrecentexampleofthis

kindofthrough-goingprocessanalysisispresentedinthebookeditedbyBeck

andLewis.(BeckandLewis,2000).Theyexamineninedifferentsystemsof

processanalysis,usingeachsystemtoanalysethesamesetofrecorded

materialfromapsychotherapygroup.Theyareveryinfluencedthemselvesby

generalsystemtheory,andthereforeveryawareofthecomplexityofsmall

therapygroupsovertime,andintheirintroductiontothebooktheyemphasise

thisstrongly:“…itisclearthatlivingsystemsarebasicallyinprocessatalltimes.

Thereforeprocessanalysisofdataovertimeisoneusefulmethodologyfor

understandingspecificlevelsofinteractionandchangeinatherapygroup”

(Beck&Lewis,2000,p7).Thisemphasisonprocessovertime,where

interactionleadstochangerecallsGreene’sphrase:“theongoingflowof

behaviours”(opcit).TheAmericangrouppsychotherapist,LouisOrmont,a

foundermemberoftheModernAnalyticschooldescribesitinasimilarway.In

thegroup,hesays:“Lifeisunfoldinginfrontofus”(Ormont,2001,p40).

Psychotherapyprocessresearchwastakenupanddescribedinasystematic

waybyGreenburgandPinsofinawell-knowntextbook:‘The

PsychotherapeuticProcess:aResearchHandbook’.Theirviewoftheworkis

clear:“Processresearchisthestudyoftheinteractionbetweenthepatientand

therapistsystems”(GreenbergandPinsof,1986,p18).BeckandLewissetthis

concernwithinteractioninthecontextofstudyinggroupprocess,theyare

concernedwiththefactthatinthegroup:“…simultaneousinfluentialevents

canbeoccurringattheindividual,dyadic,sub-groupandgroup-as-a-whole

levels”,emphasisingthecomplexityandmulti-layerednatureofgroup

psychotherapy(BeckandLewis,2000,p9).Ofthenineprocessresearch

systemsthattheydescribe,mostareinfluenced,tosomedegreeby

psychoanalysis.SigmundKarterudhasdevelopedthe‘Groupemotionalityrating

system’,whichattemptstoratebasicassumptionfunctioningfromrecordings

ofsmallgrouppsychotherapy(Karterud,2000).Asdescribedabove,thebasic

assumptionsareacentralpartofBion’stheoriesaboutsmallgroupbehaviour

(Bion,1952,1961).InKarterud’ssystemfivecategoriesofemotionalityare

independentlyratedaccordingtoascale:fight,flight,dependency,pairingand

neutral(Karterud,2000,pp119-120)WhatBioncalled“valence”,whichisthe

groupmembers’willingnesstojoininwiththegroup’smovementintobasic

assumptionactivity,wasalsomeasured,inthesensethatcertaindiagnostic

categoriesamongthegroupmemberswerefoundtobemorelikelytoengage

inonebasicassumptionratherthananother.Forexample,groupmemberswith

schizotypal,narcissisticorborderlinepersonalitydisordersweremorelikelyto

fallintofight/flightbasicassumptions,anddepressedmemberstofallinto

dependencybasicassumptions(ibid,p125).TheHillInteractionMatrix,was

alsoinfluencedbyBion’sbasicassumptiontheory,andKurtLewin’sgroup

dynamics.Itisacomplexmeasurebutithastheadvantageofrepresenting

complexityandtherelationshipbetweenthevariouspartsoftheinteractive

process(FuhrimanandBurlingame,2000).InMann’s‘Member-leaderscoring

system’,whichwaspartlyinfluencedbyKleiniantheory:“…therelationshipto

authorityorthemember-leaderrelationshipisconsideredthecentralaspectof

grouplifeandthatwhichaffectsprocessanddevelopmentthemost”

(Cytrynbaum,2000,p176).The‘Groupdevelopmentprocessanalysismeasures’

aremoreinfluencedbysocialpsychologysmallgroupstudiesandsystemtheory

thanbypsychoanalysis(Beckatal,2000).Howevertheycanbeusedtostudy

groupsruninavarietyofdifferentways,allofwhichwillbesubjecttoan

observableandmeasurabledevelopmentalprocess,whichwillaffectthe

growthandtherapeuticoutcomeofthegroup.Aninterestinggroupresearch

systemisthe‘Psychodynamicworkandobjectratingsystem’influencedby

psychodynamictheory,objectrelationsandsystemstheory.Theworkinthe

groupistheactivityinthegroupof:“oneormorepatients(eg.apairorsub-

group),thetherapist,orthegroupasawhole”andtheobjectsarewhatare

continuallyreferredtointhecourseofthepsychodynamicworkofthegroup

(PiperandMcCallum,2000,p264).

Summary

Itisclearthatthereareanumberofdifficultiesinthewayofprocessanalysisof

grouppsychotherapy,andthereforeinthewayofunderstandingthechange

process.Thegenerallyaccepted,andthereforerathertaken-for-granted,wayof

offeringabasisforunderstandingthechangeprocessingrouppsychotherapyis

theconceptofthetherapeuticorcurativefactors,andthecloselyassociated

group-specificfactorsofFoulksiangroupanalysis.Theproblemwiththesethree

waysoflookingatthechangeprocessisthattheyarenecessaryconditionsfor

change,perhaps,ratherthanspecificagentsoftherapeuticdevelopment.It

couldalsobesaidthattheyarestandardaspectsofnormalgoodemotionallife

andrelationstoothers.Whatisitabouteffectivegrouppsychotherapythat

makesforpositivechangeingroupmembers,andwhatisitthatisineffectiveor

obstructivetochange?Partoftheanswermaybeavailableinprocessgroup

research,butastheliteratureindicates,thisisdifficultandlaboriouswork.The

processanalysishastotakeaccountofthecomplexityofthegroupprocess:the

multi-layeredinteractionbetweentheindividualpatient,thetherapist,pairs,

sub-groups,thegroup-as-a-wholeandtheexternalcontext.Andallthishasto

beseenasaprocessintime,continuouslyunfoldingandchanging.Whatis

thereforeaverystrikingphenomenonistheworkingattitude,andtherefore

whatmightbecalledtheinternalworkingmodelofgrouppsychotherapy,ofthe

grouppsychotherapist,whoappearstoapproachthiswithsomekindof

confidencethatchangewilloccur.Itmightthereforebeusefultostartwith

that,the‘internalworkingmodel’or‘clinicalmind-lines’,ofthegroup

psychotherapist,whichmustbebasedonanideaofpositivetherapeutic

change.Thisthenformsanimportantpartofthegroupanalyst’sclinicalmind-

lines.And,asalreadystated,ofalltheresearchhasbeendoneintofactorsof

change,theleasthasbeenaboutthetherapist.Thisstudywasorganised

aroundtheideaofaskinggroupanalystswhatwasintheirmindswhenthey

wereworkinginthegroup.

Chapter2

CLINICALWORKINGTHEORIES:PROCEDURAL,IMPLICITANDTACIT

KNOWLEDGEANDCLINICALMIND-LINES

Introduction

Thischapterisasurveyofsomeoftherelevanttheoreticalapproachesto,and

researchinto,differenttypesofknowledge,asappliedtoindividualandgroup

psychotherapyandgroupanalysis.Thisnecessarilyintroducessometheories

fromphilosophy,fromthesociologyofknowledgeandsocialpsychology,as

wellaspsychoanalyticandpsychotherapyresearch,abouthowknowledgeis

heldandusedinrelationtoclinicalpractice.Arangeofdifferinghelpful

conceptualisationsarethendescribed:thedifferencebetweenproceduraland

declarativeknowledge,tacitorimplicitknowledge,‘unconsciouscompetence’,

theinternalworkingmodel,the‘analyst’spre-conscious’,andfinally‘clinical

mind-lines’.Theprincipalaimoftheresearchwastodiscoverwhatsortof

workingtheoriesandclinicalknowledgewerelikelytobeinthemindofthe

groupanalystwhentheywereworkinginthegroup,andwhatsortof

knowledgewasthis?ThissurveylooksatBinder’sresearchaboutdeclarative

andproceduralknowledge(Binder,2004),andatVictoriaHamilton’sinterview

studyofthe‘analyst’spreconscious’(Hamilton,1996).Itthenconsiders

Canestri’sworkabouttheoryandpracticeinpsychoanalysis(Canestried.,

2012);someaspectsofthephilosophicalbaseinGilbertRyle(Ryle,1949)and

MichaelPolanyi(Polanyi,1958,1966).Finally,thesurveylooksinmoredetailat

GabbayandLeMay’simportantworkonclinicalmind-lines,andattemptsto

applythistotheconceptoftheimplicitandexplicit,proceduralanddeclarative

workingtheoriesofgroupanalysts(Gabbay&LeMay,2011).Istheclinical

mind-lineausefulconceptualtoolforexaminingthegroupanalystinthegroup?

DeclarativeandProceduralKnowledgeandtheChangeProcessinGroup

Analysis

Itmightalsobeusefulatthispointtoemphasisethedistinction,madeby

Binder,betweendifferentkindsofpracticeknowledge.Binder’sresearchwas

intomanualisedshort-termpsychotherapy,andheusefullyemployedthis

distinctionbetweentwodifferentkindsofknowledge,‘declarative’and

‘procedural’(Binder,2004).Thisdistinction,whichhedrawsfromcognitive

science,particularlythestudyofmemory,isbetweenthekindofknowledge

thatweknowwehave,thinkwehave,orsaywehave,andwhichwewere

probablytaughtandreadabout,andwhichweteachothers,whichis

‘declarative’,andthekindofknowledgethatinformswhatwedowithoutus

knowingnecessarilyconsciously,momentbymoment,whatitis,orwhereit

comesfromandthisis‘procedural’.Thisissometimesalsoknownas

‘unconsciouscompetence’.Oneexampleofthis,whichBinderexplainsisthe

mostimportantandunifyingfactorinexpertiseinallprofessionalfields,isthe

abilitytoimprovise(Binder,2004).Theinterestingexamplethathegivesofthis

fromthepsychotherapyfieldistheresearchintoexpertswhowritetherapy

manuals,who,whentheyarefilmedworkingoftendonotfollowtheirown

manual’sinstructions(ibid,pp8-14).Itseemspossible,therefore,thatwhat

informsthegroupanalyst,strugglingtounderstandandformulate,ona

moment-by-momentbasis,theon-goinglifeofthegroup,isexactlythis

complexkindof‘procedural’knowledge,anon-conscioussetoftherapeutic

assumptions,skillsandtechniques.Itislikelythattheseinteractandoverlap

withuptoapoint,butarenevercompletelyidenticalto,thepsychotherapist’s

‘declarative’knowledge,acquiredthroughtraining,supervision,readingand

membershipofagroupororganisationofcolleagues,andwiththeirown

personalityandinterests.

Whatthisresearchprojectisaimingtodiscoveriswhatmightbealsocalledthe

groupanalyst’sinternalworkingmodel(Bowlby,1988;Holmes,1993)or,‘group

analyticclinicalmind-lines’(GabbayandLeMay,2011).Onepossibility,of

course,isthatthesetwokindsofknowledgeeitheractuallyoverlapatpoints,

or,moreaccurately,thatthereisathirdareaofknowledgecombiningpartsof

thetwokinds,thatisinoperationonamomentbymomentbasisinthecourse

offollowingandbeingpartoftheinteractioninthegroup.Thisisprobably

involvedinthefrequentassertioningroupanalysisthatthegroupanalystis

bothamemberofthegroupandatthesametimeoutsideit(Foulkes,1957,p

Thereseemstobeawiderangeofdifferenceinallschoolsofindividualand

grouppsychotherapybetweenindividualpsychotherapists,differenceswhich

oftenseemgreaterthanthedifferencesbetweenestablishedapproaches.Itis

possiblethatdeclarative,explicitknowledgeismuchmorevariousand

conflictedthanprocedural,implicitknowledge(Binder,2004).Whattherapists

actuallydo,therefore,maybemoresimilarthanwhattheysaytheydo.

However,whatisnotclearlystatedinanyapproachisaspecificclearly

delineatedtheoryofthechangeprocessingrouppsychotherapy,andyetit

mustbethecasethatgrouppsychotherapistshaveaworkingmodelofwhat

promotesandbringsaboutchangeingrouptherapythatinformsboththeir

understandingandtheirmoment-by-momentactivityinthegroup.One

possibleexplanationisthattheactualproceduralworkingmodel,thepractice

wisdom,islargelynon-consciousandtacitandnotimmediatelyavailablefor

consciousandrationaldescriptionandexplanation,andthatitcomesintoplay,

intoaction,onlyinthecourseofthespontaneousmoment-by-moment

interactioninthegroup.

TheAnalyst’sPre-conscious

ThepsychoanalystandresearcherVictoriaHamiltonidentifiedaparticular

problemwiththeoryandpracticeinherseriesofresearchinterviewswith

psychoanalysts,whereshetriedtoelicitwhatshecalled‘theanalyst’spre-

conscious’,inotherwords,whatthepsychoanalystbroughtintothesession,

andmightuse.Oneproblem,whichBinderisalsoawareofinhisstudy,isa

possibletendencytore-labelpresentclinicalexperienceretrospectivelytofitin

withtherequirementsoftheacceptedtheory(Hamilton,1996).Hamilton

showedthat“Whentheorisingaboutpsychicchange,psychoanalystsmight

attempttodefinethecriteriafordelineatingthekindofchangethatissought”,

andforexample,Freudiangoalsforchangewillbedefinedintermsofthe

Oedipuscomplex,Kleinianintermsofthedepressiveposition,andWinnicottian

intermsofplayingor‘goingonbeing’(ibid,p225).Butallthesediffering

explanationsofchange:“…reflectanalysts’beliefsinthecentralityofaffectas

anagentofpsychicchange”(ibid,p227).Presumablysomethingsimilar

happensingroupanalysis,andgroupanalystswoulddefinetheconditionsof

changeintermsofFoulksianideasabouttheprimacyofthegroupoverthe

individual,thecentralaffectbeingthegroupmembers’growingemotionalties

tooneanother.Whatisclearisthatingrouppsychotherapygroupanalystsdo

seemtoknowverywellwhenchangehashappened,orishappening,butthey

knowmuchlessaboutexactlyhowthishashappened.Agoodexampleisfrom

anearlybookbyPeterKutter,aGermangroupanalystandpsychoanalyst.He

wroteabouttheendingofagroup,andhowmuchthemembersofthegroup

hadbenefitted,howtherewaslessresistance,andamuchgreateropenness

andacapacitytomourn:“Thejoyderivedfromthesuccesswehaveattained,

however,outweighedfarthepainofseparation”(Kutter,1982,p110).This

wouldnotbeanunusualstatementformostgroupanalysts,attheendofan

apparentlysuccessfulgroup,althoughothersmightemphasisethequalitiesof

thechangedaffectandbehaviourdifferently(Rosenthal,1987,p96).Kutter’s

movinguseoftheword“joy”inthisquotationshowshowstrongtheaffect

ofteniswhenthegroupanalystisconvincedthattherehasbeengreatpositive

change.Thisleavestheenormousandimportantquestion:howdidthechange

comeabout?Andisitpossibletoinvestigatethechangeprocessinauseful

way?Hamilton’suseofthetermpre-conscioustodescribewhatisinthe

analyst’smindinthesession,ablendoftheories,influences,allegiances,

experiencesandaffects,isalsousefulasawayofthinkingaboutwhatisinthe

groupanalyst’smindwhenworkinginthegroup.

TheoryandPracticeinPsychoanalysis:PrivateTheoryasanInternalObject

TheEuropeanPsychoanalyticFederationproducedacarefulstudyofhow

theoriesareactuallyusedinpractice(Canestried.2012)andinhisintroduction

Canestriemphasisessomethingsimilartothedeclarativeandprocedural

distinctionmadebyBinder(opcit):“Webelievethattherehasnotbeenas

muchdiligenceinconfrontingtherealityofourclinicalpractice,thatis,whatit

reallyisandnotwhatwesayitisorwhatwewouldlikeittobe”(Canestri,ed.

2012,pxx).Heclaimstheimportanceofexploringclinicalwork“fromthe

inside”(ibidpxx),andusefullydescribestheprocessofclinicalwork,whereby

theanalystandthepatient,orinthisresearchthegroupanalystandthegroup,

togethercreateaspecific“sharednarrative”,inwhichthetheory,theresulting

clinicalhypothesisandthepersonal,clinicalsituationallcometogether(ibid,p

xxi).Healsotalksaboutthreesimilarwordsforthiskindofknowledgethatthey

usethroughoutthestudy:private,implicitandpre-conscious.Theorycomesto

haveaparticularplaceintheanalyst’smind,andCanestrimentionsthe

importanceofthetriangularrelationshipbetweentheanalyst,thepatientand

theanalyticcommunityorgrouptowhichtheanalystbelongs.HequotesCaper

totheeffectthattheorycanfunctionintheanalyst’smindlikeagoodinternal

objectandParson’sideathatitistheclinicalsituationitself,inthemoment,

thatcreatesthenecessarytheorythatthengetscalledupintheanalyst’smind

(ibid,p3-4).IntheconclusionstothestudyCanestridrawsupahelpfulscheme,

whichallowsforwhatwas,inthepreviouschapter,describedasthepartial

overlapbetweendeclarativeandproceduralclinicalknowledgeinpractice.He

claimsthattheirstudyshowedthatanalystsworkednotwith“officialtheories,

butwithacombinationthatwehavedefinedasthesumofpublictheorybased

thinking+privatetheoreticalthinking+interactionofprivateandexplicit

thinking(implicituseofexplicittheory)”(ibid,p163).Itisnoticeablethat

Canestriandhiscolleaguesattempttokeeptheoryastheory,whereveritisin

theanalyst’smind,andlikeHamilton(1996)usestheterm‘pre-conscious’to

describethepositionoftheoryinthemindwhenitisnotexplicitorconscious.A

differentwayofthinkingaboutthisquestionofwhethertheoryisstillsome

particularkindoftheorywhenitisnotimmediatelyinconsciousawarenessis

offeredbythephilosopherGilbertRyle.

GilbertRyle:KnowingHowandKnowingThat

Theanalyticphilosopher,GilbertRyle,inthecourseofacomplexargument

againsttheassumptionsofCartesiandualism,whichhecalled“theghostinthe

machine”and“theCartesiancategorymistake”(Ryle,1949,p20),drewa

stronglyargueddistinctionbetweentwoimportanthumanactivitieswhichhe

called“Knowinghowandknowingthat”(ibid,p26).Thefirst,‘knowinghow’,is

asimilarconcepttoproceduralknowledge,and‘knowingthat’issimilarto

declarativeknowledge.Inpsychotherapythedistinctionwouldbebetween,for

example,knowingthatananalyticinterpretationisanattempttomakethe

patient’sunconsciousbecomeconsciousbymeansofaverbalcommunication,

usuallylinkingpresentandpastthroughthetransference,whichis‘knowing

that’anddeclarative,andactuallymakinganinterpretativeremarktoa

particularpatient,ataparticularmomentinthetreatment,whichrevealedto

thepatientwhattheydidnotknowtheyknew,whichis‘knowinghow’.Ingroup

analysis,thegroupanalyst’sknowledge,forexample,thatgroupsfeeldeprived

andangrytowardstheirgroupanalystafteraholidaybreak,is‘knowingthat’,

declarativeandexplicit.However,thegroupanalyst’sabilitytounderstand,at

oneparticularmoment,thataparticulargroupwereangryordepressed,by

observingtheirmoodandposture,andhearingtheirverbalcommunications,

andthenmakingthiscleartothemembersofthegroupwhomightbeignoring,

hidingordenyingtothemselvesthegroup’sstateofmind,isprocedural,

implicitand‘knowinghow’.Inthecourseofacomplexargumentaboutthe

relationoftheorisingand“intellectualoperations”tootherhumanactivities,

Ryleclaims:“Intelligentpracticeisnotastep-childoftheory.Onthecontrary

theorisingisonepracticeamongstothersandisitselfintelligentlyorstupidly

conducted”(ibidp27).Thisisaverydifferentdescriptionfromthatofferedby

Canestri.ForRyletheorisingisonethinganddoinganother.Theyarenotthe

samethinggoingonindifferentpartsoftheanalyst’smind,whichisCanestri’s

view.Oneimplicationofthislineofthoughtforthisstudyisthatdeclarative

knowledge,‘knowingthat’,hasahigherassumedvalue,thatoftheorising,of

observingrulesandapplyingcriteria,asRyleputsit,whichimpliesaCartesian

separationofthoughtandaction,orinpsychotherapy,oftheoryandpractice.

But,claimsRyle:“Inordinarylife…wearemuchmoreconcernedwithpeople’s

competencesthanwiththeircognitiverepertoires”(ibidp29).Rylegivesthe

exampleofapersonwhotellsgoodjokesbutwhocannotexplainhowitisthat

theyarefunnyorwhatrulestheyapplyinordertotellthemsuccessfully.In

groupanalysis,similarly,itmaybepossibletointervenehelpfullyinagroup,

drawingmeaningfromaninteraction,withoutbeingabletoexplainhow,and

accordingtowhatprinciples,itwasdone.Ryleputsthisanotherway,whichis

alsoveryimportantforthisstudy,andforthinkingaboutpsychotherapy

generally,whenhesays:“Efficientpracticeprecedesthetheoryofit,

methodologiespre-supposetheapplicationofthemethods”(Ibid,p31).This

ideafurtherconnectswiththemovementinpsychotherapy,psychologyandin

medicinetowards‘Practice-basedevidence’,asadevelopmentonwardsfrom

theideologyof‘Evidence-basedpractice’,andthisisexactlythedrivingforce

behindtheresearchofGabbayandLeMayingeneralpracticeandhospital

medicine,thatledthemtodiscoverandusetheconceptofclinicalmind-lines

(Gabbay&LeMay,2011).ThisalsorecallsthepointmadebyParsons

mentionedearlierinthischapterthatthenecessaryandhelpfultheoryiscalled

upintheanalyst’smindbytheindividualclinicalsituationbetweenanalystand

patientinthemoment(Parsons,opcit).Ryle’slargerargumentinthebookis

againsttheCartesianposition,andheisthoroughlyopposedtotheconceptof

separatingmindandbody,intelligenceandaction,theoryandpractice,and

therebyprivilegingthefirstofthese.“WhenIdosomethingintelligently,ie

thinkingwhatIamdoing,Iamdoingonethingandnottwo.Myperformance

hasaspecialprocedureormanner,notspecialantecedents”(Ryle,1949,p32).

Because‘knowinghow’iswhatRylecallsa‘disposition’,thenexpertorefficient

practice,becauseitisnotdependenton,orconsequentialtoaseriesof

separateintellectual(theoretical)operations,butis“onething”(opcit),itis

opentowhathecalls‘innovation’,thecapacitytoadapttothechanging

situation.ThisiswhatBinderclaimsforexpertsinanyfield,theabilityto

improvise,andinfacthisexampleofthemanualwritersnotfollowingtheirown

manualintherapyisagoodexampleofwhatRyleisattemptingtoexplain

(Binder2004,pp,9&53).Forthisstudy,thesignificanceofRyle’sargumentis

theimportanceof‘knowinghow’inthinkingabouthowknowledgeisheldin

thegroupanalyst’smindasaworkingtheory,asaclinicalmind-line.‘Knowing

that’,declarativeandexplicitknowledge,canbeover-valued,idealisedand

‘split-off’,touseanalyticterminology,andmoresoif,usingRyle’sanalysis,

therapeuticactionisseenastwothings,andnotone.

TacitKnowledge:MichaelPolanyi

MichaelPolanyi,thescientistandphilosopher,developedinmoredepth,and

withadifferentemphasis,theconnectedconceptof‘tacitknowledge’.He

acknowledgesRyle’sconceptofthedifferencebetween‘knowinghow’and

‘knowingthat’,butarguesadistinctionofemphasis,inthatheisinterestedin

thewaythatbothhavea“similarstructure”andbotharealwaysrepresentedin

theactofknowing:“Ishallalwaysspeakof‘knowing’,therefore,tocoverboth

practicalandtheoreticalknowledge”(Polanyi,1966,p7),andhearguesfurther

againstRyle,describingRyle’sthoughtas“logicalbehaviourism”(Polanyi,1958,

pp98&372).Hewasmoreconcernedwithboththedifference,andthe

connectedness,betweenwhathecalled‘tacitknowledge’and‘explicit

knowledge’.Hegivesanumberofexamplesoftacitknowledgeineverydaylife:

ridingabicycle,stayingafloatwhileswimming(Polanyi,1958,pp49-50)and

recognisingfaces(Polanyi,1966p5).Hesummarisesthis:“…theaimofaskilful

performanceisachievedbytheobservanceofasetofruleswhicharenot

knownassuchtothepersonfollowingthem”(Polanyi,1958,p49).Thisis

importantforthisresearchasitoffersawayofconceptualisingthecomplexity

ofwhatexactlyisinforming,orin,themindofthegroup-analyst-in-the-group

onamoment-by-momentbasis,andwhyitisneitherimmediatelyavailablefor

examinationandscrutiny,noridenticalwithreceivedoracceptedtheory.Inhis

laterbook,‘TheTacitDimension’,Polanyisummedthisupinwhatisnowknown

ashismaxim:“…wecanknowmorethanwecantell”(Polanyi,1966,p4).

GascoigneandThornton,inadevelopmentofPolanyi’swork,emphasisethat

tacitknowledgeis“whatisnottellable”andproposewhattheycallthe

“principleofinarticulacy”todescribetacitknowledge,whichtheysetin

contrasttotwootherprinciples:articulacyandcodifiability(Gascoigneand

Thornton,2013,pp3-5).Theprincipleofcodifiabilitysuggeststhat:“all

knowledgecanbefullyarticulated,orcodified,incontextdependentterms”

andtheprincipleofarticulacythatallknowledgecanbearticulatedin:“context-

dependent…orincontext-independentterms”(ibidpp4-5).Forthegroup-

analyst-in-the-groupthelastofthesewouldimplythatalltheknowledgeheld

bythegroupanalystandappliedinthemomentisopentoscrutinyand

consciousthought,whichisacompletelycognitive,rationalistposition.The

principleofcodifiabilitywouldimplythatthepartofthatknowledgethatis

“context-dependent”,perhapsknowledgeofgroup-analytictheory,ormental

illness,couldbeatleastpartiallyarticulatedanddescribedinaspecificgroup-

analyticcontext,aseminarperhaps,andthereforeheldontoinconsciousnessin

themoment.ThisseemstobewhatCanestriandhiscolleagues,asabove,are

workingwith,totheeffectthat,incertaincontextsatleast,theory,althoughit

takesdifferentshapes,iscompletelyknowable.Finally,Gascoigneand

Thornton’s“PrincipleofInarticulacy”statesthat“Therecanbeknowledgethat

cannotbearticulated”(ibidp5).Theyalsoemphasisethattacitknowledgeis

“practicalknowledgeorknow-how”,whichechoesRyle’sinsistenceonthe

differencebetweenknowingthatandknowinghow,andthattheonlypossible

accesstothissortofknowledgeisthrough“practicaldemonstration”(ibidp

191).TousePolanyi’sfamousexample,apersonmaybeabletodemonstrate

theirabilitytorideabicyclebyridingit,althoughtheymightneverbeableto

describeoranalysehowtheydoit.InRyle’sexamplethepersonwhotellsvery

funnyjokesmayneverbeabletoexplainhowtheyareabletobeamusing,but

candemonstrateitbytellinganotherjoke.Forthisresearchitmaybe

understoodthatgroup-analyticknowledgecanbedemonstratedinthecourse

ofworkingclinicallyinthegroup,andbygivingaccountsofworkinthegroup,

butmaynotbeavailableforimmediateanalysisorscrutiny,particularlyinthe

presentmoment,andleastofallbythegroupanalyst.

Collins,buildingonPolanyi’swork,particularlyonhisclaimthat“allknowledge

iseithertacitorrootedintacitknowledge”(Polanyi,1966,p195),attemptsto

universalisethisclaim:“Thereis,then,nothingstrangeaboutthingsbeingdone

butnotbeingtold-itisnormallife.Whatisstrangeisthatanythingcanbetold

(Collins,2013,p7).Healsoemphasisestheimportanceoftheword“can”inthe

famousaphorism:“wecanknowmorethanwecantell”(Polanyi,opcit),asfor

Polanyitacitknowledgeisknowledgethat“cannot”betoldormadeexplicit

(Collins,2010,p4).PolanyiwasalsoinfluencedbythesameGermanGestalt

psychologists,whomadesuchanimpressiononFoulkes,andwhohelpedhim

todevelopthecentralgroup-analyticideaof‘figure-and-ground’.Hestatesthat

Gestaltpsychologistsstudyingperceptionshowedthatrecognitionofaface

occurredby“integratingourawarenessofitsparticularswithoutbeingableto

identifytheseparticulars”andhecomparedthisprocesstohisowntheoryof

knowledge(Polanyi,1966,p6).Theprocessisan“activeshapingofexperience

performedinthepursuitofknowledge…thegreatandindispensabletacitpower

bywhichallknowledgeisdiscovered”(ibid,p6).Hehadalsoshowninhis

earlierbook,PersonalKnowledge,theimportanceof“senseperceptiontothe

tacitcomponentsofarticulateknowledge”inthecourseof“makingsenseof

ourexperience”(Polanyi,1958,p98).Inhischapterinthesamebookon

‘conviviality’hemakesitclearthathebelievesintheimportanceofemotional

andinter-relationallifeintheprocess:“Theinterpersonalcoincidenceoftacit

judgementsisprimordiallycontinuouswiththemuteinteractionofpowerful

emotions”(ibid,p205).Collinslaterdevelopsthisasrelationaltacitknowledge

inthecourseofhisbreakdownoftacitknowledgeintothreecategories:

relational,somaticandcollective(Collins,2010).

Theimplicationoftheseconceptsforthisstudyisthattacitknowledge,what

wedon’tknowthatweknow,canbeactedupon,demonstratedthroughaction,

communicatedinterpersonallythoughemotionandwhatPolanyicalls

“conviviality”andyetcannotbearticulated.Theargumentofthisstudyisthat

moment-by-momenttherapeuticactioninthegroupisdrivenprimarilybytacit

knowledge,andthatthemoment-by-momenttacitknowledgeofthegroup-

analyst-in-the-groupwhichdrivesthistherapeuticaction,can,atleastpartially,

bereachedinanindirectway,andbyimplication,throughanintensive

interviewstudyandasubsequentthematicanalysis.GascoigneandThornton

describethisprocesswell:“Whatoneknows,whenoneknowshowtogoon,

canbearticulated,demonstratedandthusseenandheardinthemovesone

makesandthewordsoneutters.Nothingneedbesilentorhiddeninthesense

ofinexpressible.”(GascoigneandThornton,2013,p192).Group-analytictacit

knowledgeisthereforeavailableforobservationbyothers,watchingor

listeningasthegroupanalystgoesondoingwhatitistheydowhentheyknow

“howtogoon”.

ClinicalMind-lines

Theconceptofthe‘clinicalmind-line’emergedfromtheresearchofGabbay

andLeMayintheirbookpublishedin2011.Theywerelookingatthepossible

reasonsfortheapparentreluctanceofclinicians,inthiscaseGP’sandhospital

doctors,toapplytheresultsofnewresearchintoillnessandrecommended

treatments.Theystudiedatlengththeactual,everydaycollegialpractices

includingconsultationsandexaminations,conferencesandwork-based

conversationandinteractionsbetweenfellowclinicians.Theydescribedtherise

of‘evidence-basedpractice’inmodernmedicineand,then,usingethnographic

methodsofinvestigationinto,principally,alargeandsuccessfulGPpractice,

attemptedtoestablishhowclinicaldecisionswereactuallymadeinthereal

worldofpractice.Whatemergedwasaconfirmationoftheneedfor‘practice-

basedevidence’ratherthan‘evidence-basedpractise’,andthiswasthen

reflectedinthetitleoftheirbook:Practice-basedEvidenceforHealthcare:

ClinicalMind-lines(Gabbay&LeMay,2011).Outoftheobservational

ethnographicresearchthenemergedtheconceptofthe‘clinicalmind-line’,an

attempttodelineatethecomplexinternalmentalprocessesandstructuresof

sorting,collatinganddecision-makinginvolvedinaclinicalassessment.They

sumupthereasonsforthedifficultyinrigorouslyapplyingevidencetopractice

asaresultof:“theunderestimationoftheimpactofcontextontheknowledge

thatisneededtomakepracticework”(ibid,pxvi).Onecontextisthelarger

oneofsocialchange:“…theclinicalknowledgebaseisbeingdemocratised”(ibid

p2)andanotheristhe“persistentmismatch”betweenthedemandsof

researchevidenceandwhattheycall“themessyworldofpractice”(ibidp5).In

Ryle’stermsthiswouldbethedifferencebetween“knowingthat”and

“knowinghow”.Inthisrealworldof“messy”clinicalpractice,theirresearch

showedthattheideaoftheclinicalmind-linewasanaccurateandpragmatic

wayofdescribingtheinternalmentalprocessesthatledtoclinicaldecisions:

“…clinician’sinternalisedguidelines,whichwecallmind-lines”(ibidp18).They

goontodemonstratethe“inconsistentgoals”,“complexsubjective

judgements”and”fuzzylogic”involvedinclinicaldecisions(ibid,pp39,43,44).

ThisthenconnectswithPolanyi’sconcepts,astheymakeclearthatthese

“internalisedguidelines”arealso“oftentacit”(ibid,p44).Whattheygoonto

emphasiseisthecollective,socialreinforcementoftheclinicalmind-lines.Inthe

caseofgroupanalyststhiswouldbesupervision,professionalcollegialityand

interactionandtrainingandreading,allofwhichblendwiththeotherelements

inthemind-linetoinformthetacitknowledgeandtheconsequentmoment-by-

momenttherapeuticactioninthegroup.ThisiswhatGabbayandLeMaysum

upas:“…internalisedknowledge-in-practice-in-context”,withinthe:“…bounded

rationalityofturbulentpractice”(ibid,p202).

Summary

Thisconceptoftheclinicalmind-lineisausefuldeviceforlookingatgroup-

analyticclinicalpracticeingeneral,andmoment-by-momenttherapeutic

decision-makinginparticular.Groupanalyticpracticeis“messy”and

“turbulent”,andgroupanalystsintheclinicalmomentcancallonalargerange

ofideas,concepts,andtechniques,mostofwhichareheldatthatpoint-of-time

–in-the-groupastacit,pre-conscious,implicitorproceduralknowledge.The

ideaoftheclinicalmind-lineisahelpfulwayofmappingtheinternalised

structuresofthoughtthatorganisethiswiderangeofknowledgeandholditin

thegroupanalyst’smindinaformthatmakesitavailableforinstantaneous

therapeuticaction:group-analyticknowledge-in-clinical-practice-in-the-

moment-in-the-context-ofthegroup.

Chapter3

METHODOLOGY

Introduction

Thisstudywasconcernedwiththegroupanalyst’s‘clinicalmind-line’,the

consciousandnon-conscious,explicitandimplicit,declarativeandprocedural,

tacitknowledgethatinformedthemoment-by-momentinteractionalworkby

thegroupanalystinthegroup.Itwasanattempttofindoutonepartofwhat

actuallygoesoningrouppsychotherapysessions,thegroupanalyst’sworking

theoriesormind-lines,thatpromotechangeandthereforeimprovethemental

healthandwell-beingofthegroupmembers,andwhatgoesonthateitherdoes

nothelp,ormakesthingsworse.Giventheimportanceoftheindividual

therapistfactorsingoodoutcomeitwasimportanttofindoutwhatitwasthat

thetherapistbroughtintothesession.Whatwasinthegroupanalyst’smind

beforethegroupstarts,oratimportantjuncturesinthesession,thatwaslikely

toaffectthecourseofthesession?Thismaybeanimportantelementinwhatit

isthathelpspatientsinpsychoanalyticgrouptherapytochange,anditwould

behelpfultoidentifyexactlywhatitis.Thisstudyapproachedthisproblemby

askinggroupanalystswhattheythoughtwerethemainelementsinthechange

process.Whatworkingconceptsdidtheyuseandhowdidtheythinkthatthese

relatedtoacceptedtheoryandclinicaltechnique?Whatideasorassumptions

didtheyhaveincommonwithoneanother,andhowbigwerethedifferences

betweenthemandothergroupanalystsandwhatsortofknowledgewasthis?

TheChangeprocessinGroupPsychotherapyandGroupAnalysis

Thereis,ashasbeenindicatedinChapter1,thiscontinuingproblemingroup

analysisandgrouppsychotherapyabouthowtounderstandtheprocessof

changeingrouppsychotherapy.Thereissomegoodenoughevidencefrom

outcomeresearchthatgrouppsychotherapyishelpful,butmuchlessevidence

astowhatthehelpingprocessesare(BeckandLewis,2000).Infact,forsome

researchersthisisnowthemostimportantissue,andasLesGreenehasstated

itmustbethecasethatoutcomeresearchwillnotprovideanymorehelpful

informationunlesstherearesubstantialadvancesinthefieldofprocess

research(Greene,2000,p24).Processresearchinallpsychotherapyis

extremelydifficult,buttheproblemingrouppsychotherapyismuchgreater,of

course,becauseofthecomplexandmulti-factorialnatureofgroup

psychotherapytreatment.Thereareuptoeightgroupmembers,oneor

possiblytwopsychotherapistsandsessionsthatareonaverageninetyminutes.

Agreatdealhappensbetweennineortenpeopleinanhourandahalf,and

researcherscangetoverwhelmedbythequantityofevents,interactionsand

levelsofdiscourse.Howisitpossibletoselectandorganisetheinformationto

makeitopenforresearch,withoutlosingwhatismostimportantorsignificant?

Onepointofthisresearchprojectwasthatonemodestwayforwardwasto

startwiththegrouppsychotherapist.Thecontributionofthepsychotherapistto

thequalityandoutcomeofthesessionisnowwellestablishedataround30%.

Thedeclarativepartofthepsychotherapist’sknowledgeisprobablytherefore

significantlylessimportantthanotheraspects.Theseotheraspectsofthe

psychotherapistmightincludepersonality,personalhabits,attitudetothe

patient,behaviourinthesessionandindividualtheoreticalposition,andmany

otherfactors.

Whatmustalsobeincludedforgrouppsychotherapistsistheirownparticular,

whatmightbecalled‘group-relatedness’.Whatpersonalviewsandtheories

aboutgroupinteractionandthepotentialforgroupchangedotheybringwith

themintothesession?Inotherwords,therearetwoaspectstothis,towhat

thegroupanalystbringsintothesession.Oneisthedeeplyheld,non-conscious,

mentalsetabouttheuse,potentialandvalueofgroupanalysis.Theother,

moreeasyofaccess,istheabilitytoholdthegroupinmindandtobeabletobe

selectiveandnottobeconfusedbytheimmediaterichnessandcomplexityof

thegroupexperience.Bothofthesetypesofknowledgeareclosertothearea

oftacit,pre-conscious,proceduralandimplicitknowledgethantodeclarative,

explicitknowledge.Astothissecondaspect,theoverallassumptionofthis

studyisthatgrouppsychotherapists,byacombinationoftraining,experience

andcontinuingsupervisionandlearning,doacquireanunusualabilitytodeal

withtheproblemthatisalwayspresentforresearchers.Howisitpossibleto

havesomeunderstandingandgraspofwhatishappeningmomentbymoment

inthegroup,tosuchanextentthataworkinghypothesiscanbeformed,not

onlyaboutanindividual,butalsoaboutthesub-groups(AgazarianandPeters,

1981)andthegroup-as-a-whole(Bion,1961)?Themoment-by-moment

hypothesesformedbythegrouppsychotherapistarethenorganised,

formulatedandconvertedintotherapeuticaction,whichofcoursemayinclude

in-action,aswellasarangeofverbalornon-verbalinterventionsincluding

interpretation.

Thepsychoanalyst,KevinHealy,talkingaboutindividualpsychotherapy,

discussesthevariouscomplexfactorsthataffecttheconstructionofthe

psychotherapist’sworkinghypothesisinthesession,boththosebroughtbythe

patientandbythepsychotherapist:personality,professionalbackgroundand

personalinterests(Healy,2001).Itisimportanttorecognisetheinfluenceofall

ofthesefactors,andinaddition,thepsychotherapist’sconsciousand

unconsciousassumptions,practicalandtheoreticalorproceduraland

declarative,aboutthenatureoftherapeuticwork.Althoughtheseare

influencedbyandinteractwiththeotherbasicfactors,theseworking

assumptionsarenotnecessarilythesameasthosefromtheirprofessional

background.

TheResearchQuestion

Theresearchquestionwasthereforeaboutthegrouppsychotherapist’s

workingtheoriesandhowthisconnectedwithandenrichedtheirexplanationof

individualpsychicchangeforthemembersofthegroupandthegroup-as-a-

whole.Oneassumptionofthiswasthatthegrouppsychotherapist’sworking

modelwouldbeorientedtowardsapositivechangeprocess,andthatthe

psychotherapist’sbehaviourandthinkinginthegroupwasdrivenbyawishto

cure,eventhoughthisinitselfcouldbeformulatedinanumberofwaysona

continuum,fromthesearchforpsychictruthtobasicsymptomrelief.The

researchquestionthereforereliesonthreeassumptions:first,thatthegroup

psychotherapist’sworkingmodel,orclinicalmind-lines,includesamodelofthe

changeprocess:whatitisandhowitcomesabout.Asecondassumptionisthat

theworkingmodel,particularlythepartconcernedwiththechangeprocess,is

largelynon-conscious,implicit,tacitand‘procedural’,atleastonamoment-by-

momentbasis.Andthethirdassumptionisthatthesenon-consciousand

proceduralelementsoftheworkingmodelwillemergefromaclosediscussion

ofthechangeprocess.Theresearchquestionistherefore:whatconsciousand

non-consciousknowledgeinformsgroupanalysts,momentbymomentinthe

group,aboutthechangeprocessinpsychoanalyticgrouppsychotherapy?

Therearethreefurtherworkingassumptionsunderlyingthisresearchquestion.

Thefirstisthatingrouppsychotherapythereisagapbetweenthegroup

psychotherapist’sdeclarativeandproceduralknowledge.Theknowledgethat

grouppsychotherapistsaretaught,teachothers,andthink,consciously,that

theypracticeisprobablydifferentinsomeimportantrespectsfromwhatthey

actuallydo,particularlymoment-by-momentintheon-goinglifeofthegroup.

Becausethisknowledgeisbyitsnaturenon-consciousorpre-consciousand

implicit,itisnotimmediatelyavailablefordiscussionandintrospection.The

secondworkingassumptionisthatthiskindofproceduralpracticewisdomis

actuallyoneofthemostimportantenginesforthegroupchangeprocessand

facilitatesandenablesboththeindividualsandthegroup-as-wholetolearn

fromandusethegrouptherapeuticprocesstotheiradvantage.Thethird,less

importantandmoretentative,workingassumptionisthattheapparent

difficultyinrecognising,accessingandtalkingaboutimplicit,procedural

knowledgeforgrouppsychotherapistsmayinitselfbeunconsciously

determined,byaprocessofshameandguiltatnotobservingandfollowingthe

establishedorimaginedparentalrules.

TheInterviews

Thesearecomplexmatterstoresearch,andthisstudywasbasedarounda

seriesofopen-ended,semi-structuredinterviewswithexperiencedgroup

psychotherapists,focussingtheareaofdiscussionintheinterviewonthe

changeprocess.Thisisthemethodforthisresearch,asetoflengthyinterviews

withgroupanalysts,whichwererecordedandtranscribed.Therecordingswere

thenexaminedandresearchedintwoways.Thetranscribedinterviewswere

researchedusingathematicanalysis,lookingforcodes,themesand

connectionswhichmightrevealtheprocedural,implicitandtacitaspectsofthe

workingmodel.Therecordingswerefirstlistenedtocarefully,bythe

researcher,usingapsychoanalytic,free-associativestance,withthe

understandingthatthefindingsfromthiscouldthenbecheckedagainst,and

comparedto,theresultsofthequalitativeanalysis.Thisassociativelistening

wasthenfollowedbyacloseexaminationandanalysisofthecourseand

argumentsoftheinterviews.Theinteractionbetweenthisandthethematic

analysiswasthenusedinthediscussionoftheinterviewfindings.

TheParticipants

Grouppsychotherapyisalargeandwide-rangingfieldoftherapeuticwork.The

relationshipandconnectionsbetweenthevariousschoolsofgrouptherapyis

actuallyquitecomplexandoftencontentious,asinindividualpsychotherapy,as

wasdiscussedinChapter1.Althoughthevariousschoolsofgroup

psychotherapyhavemuchincommon,therearealsosubstantialdifferences.It

maybethecasethatthegapbetweendeclarativeandprocedural,explicitand

implicitknowledgemaymeanthatthevariousschoolshavemuchmorein

commonthantheywouldeversayorthinkthattheydo,buttherealsomightbe

smallbutsignificantdifferences,thatarenotimmediatelyavailablefor

inspection.Thesedifferencesmightofcoursealsobedifferentfromthe

declaredandobviousdifferences.Forthisresearchprojectallofthe

participants,asstated,weredrawnfromthesametrainingorganisation,and

werealsoallofatleastfiveyearspost-qualificationexperience.Theobjectof

thisresearchprojectwastodiscovertheinternalworkingmodelofthechange

processingroupanalysisandtocompareit,implicitlyandexplicitly,to

establishedtheoryandtechnique.Itwasthereforebehelpfultoreducethe

numberofvariablesanddifferencesbylimitingtheparticipantstothosewho

are,onthesurfaceatleast,reasonablysimilarintrainingandexperience.

Asalreadydescribed,intheUnitedKingdomtherearebasicallytwoapproaches

togrouppsychotherapy,mosteasilycharacterisedasgroupanalysisand

psychoanalyticgrouppsychotherapy.Thefirst,groupanalysis,arosefromthe

workofS.H.FoulkesandhiscolleaguesintheGroupAnalyticSocietyandthe

InstituteofGroupAnalysis(Foulkes,1964).Astrongaccountofthisapproachis

therecentbookbyBehrandHearst(2005).Thesecondapproacharosefrom

theworkofW.R.Bionandismostcloselyrepresentedbytheworkofhis

followersandformercolleaguesattheTavistockClinic.Astrongmodern

statementofthisapproachisbyCarolineGarland(2010).Thisishoweveran

over-simplifiedaccountofthefield,and,forexample,oneinfluentialgroup

psychotherapistwhoreachesintobothapproachesisthepsychoanalystand

groupanalyst,EarlHopper(2003).Theotherstrandsareallimportantinvarious

ways,fromthetherapeuticcommunityanddayhospitalmovementtoAmerican

grouppsychotherapy,particularlytheinterpersonalandmodernanalytic

schools(Yalom,1975).Thereisalotofinterchangeandindeedallofthe

participantsarelikelytohavebeenconsciouslyandnon-consciouslyinfluenced

byalloranyoftheseotherapproaches.However,itseemedthebestand

simplestapproachwastocontroltherangeofparticipantsbylimitingthemto

experiencedgroupanalystsallofwhotrainedattheInstituteofGroupAnalysis

andallofwhomwouldagreetoseethemselves,amongotherthings,as

‘Foulksian’groupanalysts.Thisshouldmakeintra-groupcomparisoneasierand

moreuseful,andforthisreasontheparticipantswereallFoulksiangroup

analysts,whohadtrainedattheInstituteofGroupAnalysisandwhoallhadall

beenqualifiedforatleastfiveyears.Allfourweresenior,threeweretraining

groupanalysts,twowerealsoqualifiedinindividualpsychotherapy,andtwo

workedasConsultantAdultPsychotherapistsintheNationalHealthService.The

reasonforthiswasthatexperiencedgroupanalystshaveseenalotofgroups

andpatients,andtheirproceduralknowledge,andtheirgeneralunconscious

competence,is,itisassumed,verywell-developedandfirmlyinplace.Also,

experiencedgroupanalystsalsousuallyhavebeeninvolvedinteaching,training

andsupervision,allactivitieswhichcallurgentlyonintuitiveandprocedural,as

wellasdeclarative,knowledge.Somewerealsotraininggroupanalysts.More

newlyqualifiedandmorejuniortherapiststendtobeself-consciousand

anxiousabouttheireverydaytechnique,andwhattheresearchlookedforwere

themoretaken-for-granted,well-usedpracticesthatweremorelikelytoreveal

theshapeofthenon-consciousworkingmodelandtoformasignificantpartof

theclinicalmind-lines.

ConfidentialityandEthics

Theinterviewswererecordedonanunobtrusivedigitaldeviceandtransferred

withacodednumberasreferencetoacomputerfileonadedicatedlaptop

whichisusedonlyfortheresearchandwhichiskeptlockedinacupboard.The

recordingswerepersonallytranscribedbytheresearcherandallidentifying

detailschangedatthepointoftranscription.Thetranscribedinterviewswere

thengiventhesamecodenumberasinthecomputerfile,andthecodewas

knownonlytotheresearcher.Alltheparticipantsweregivenaletter

guaranteeingconfidentialityandanonymity,anddescribingthesesecure

arrangements.Theparticipantswereallexperiencedandmaturegroupanalysts

whoonlytookpartbecausetheyagreedwiththeaimandmethodsofthe

research,andpreliminarydiscussionsindicatedthatthisresearchwasfelttobe

acceptable,interestingandtimely,giventhedifficultsituationfor

psychoanalyticpsychotherapynow,particularlyinthepublicservices,which

emergedclearlyinoneoftheinterviews.Becauseofthesemi-structured,free-

associativenatureoftheinterviewsthenparticipantsdidneedtofeelsecure

aboutconfidentiality.

Psychotherapiststendtofeeltenderandvulnerableabouttheireveryday

clinicalpracticesandtherapeuticstyle,andgenerallytendtobemore

comfortablearguingabouttheoryortechniqueinanabstractway,or

presentingcarefullyselectedclinicalworktosupportatheoreticalortechnical

point.Talkingaboutthecentralassumptionsbehindtheirworkingpracticeswas

notsomethingthattheywereusedto,andthisaspectoftheresearchtherefore

requiredextrathoughtandcareaboutconfidentiality.Oncetheinterviewswere

transcribedthenthematerialwasresearchedintwoways,asabove,both

lookingtoamalgamateandgeneralise.Isthereanidentifiablegroup-analytic

mind-set,andisitpossibletodescribeagroupanalyticinternalworkingmodel,

aclinicalmind-line,inawaythatmakessense,andpermitscomparisonin

generalfromacceptedopinionandpractice?Thefirstmethod,thematic

analysis,lookedforthemesacrossresearchdataandcodesthesethemesfor

analysis.Thesecondmethod,afree-associativepsychoanalyticlisteningtothe

recordingsfollowedbyacarefulanalysisoftheinterviewresponses,lookedalso

forgeneralandsharedthemes,throughcarefulattentiontothefeelingtone,

flowofassociationsandimageryoftheinterview.Althoughtheconceptof

proceduralorpre-consciousknowledgemustallowforasignificantelementof

individualvariation,becauseofindividualdifferencesbetweenincharacter,

experienceandconviction,theresearchwasnotprimarilylookingforindividual

differencesbutforgeneralisedideas,attitudesandpracticesheldincommon.

Theparticipantswerealsoassuredintheletterthattheyweregiventhatthe

materialoftheinterviewswouldbedestroyedonthecompletionofthe

researchproject.Therewerenoothersignificantethicalissuesthataroseoutof

thisresearch.

Theinterviews

Theinterviewslastedanhour,withoneresearcher,whowasalsoaseniorgroup

analyst.Asdescribedabove,thematerial,whichwastheobjectoftheresearch,

wasbyitsnaturedifficulttoreach,eveniftheinterviewsubjectwaswillingand

interested.Whatisitthatworkinggroupanalystsdointhegroupwithout

thinkingaboutitatthemomentthattheydoit?Howisitpossibletothink

aboutwhatisbyitsnaturenotthoughtaboutinthemoment,thetacit,

procedural,implicit,non-conscious,orunconsciousactsandthoughts,without

contaminatingitbyrecallingitanddiscussingitinaconscious,cognitive

manner?Theassumptionofthisstudyisthattalkingaboutitinthatwaymakes

itimmediatelysubjecttoconsciousandunconsciousrevision,censorship,

elisionandre-shaping.Thisiswhyaquestionnaireoraverydetailedinterview

schedulewouldnothavehelpedtorevealwhattheresearchwaslookingfor.

Theinterviewwasthereforeopen-endedandpartlyfree-associativeinstyle,in

theformthatKvalecalls‘asemi-structuredlife-worldinterview’(Kvale,2007).

Therewere6questions,with7sub-questionsenlargingonthemainquestions.

Theinterviewstartedwithaspokenintroduction:“Iwanttofindouttheviews

ofexperiencedgroupanalystsaboutthechangeprocessingroupanalysis.What

isitthathastohappeninthegrouptomakeadifferencetotheindividual

patientsinthegroup?Whatisthechangeprocessingroupanalysisbothforthe

groupasawholeandfortheindividualmembers?And,whatideasand

therapeuticmethodsdoyouhaveinmindinthecourseofagroup,about

advancingorpromotingtheprocessofchange?Iamgoingtoaskyouafew

open-endedquestions,andIhopethatwecanhaveafree-rangingdiscussion.

Thanks.”

1.“Iwillstartbyaskingyou,therefore,averygeneralquestion:whatforyou

arethethreemostimportantthingsaboutgroupanalysis,orgroup

psychotherapygenerally,that,inyourviewhelpgroupmemberstochangeover

thecourseoftheirtimeinthegroup?

1.1.“Whichofthethreeismostimportanttoyou,andwhy?”

1.2.“Howdoyouthinkthatrelatestowhatyouunderstandisthegeneralor

acceptedviewingroupanalysis?”

1.3.“Whatabouttheothertwo?”

2.“Foryou,whatisspecialordistinctiveaboutgroupanalysiscomparedto

othermethodsofpsychotherapy?”

2.1.“Isitthosethingsthatareparticularlyimportantinthechangeprocess?

Andifso,which,foryoupersonally,isthemostspecial,distinctiveanduseful?”

2.2.“Whatismostdifficulttodo,ortounderstand,ingroupanalysis,

particularlyinrespecttothechangeprocess?”

3.“Whattheoreticalconceptsandideasaremostusefultoyoupersonallyas

agroupanalystyouthinkaboutyourclinicalgrouppractice?

3.1.“Whenyouareworkinginagroup,whichworkingconceptscomemost

oftentomind,andwhicharemosthelpfultoyou

3.2“Canyougivearecentexample?”

4.“Canyouthinkofcommentsthatyourpatientshavemadeinthegroup,

particularlyattheendofthesession,orattheendoftreatment,aboutthe

waysinwhichthegroupexperiencewashelpfultothem?”

5.“Whatusefulmetaphorsorimagescometomindwhenthinkingaboutthe

changeprocessingroupanalysis?”

6.“So,finally,whatisthechangeprocessingroupanalysis?Howdoesgroup

analysishelpthemembersofthetherapygroup?”

Attheendoftheinterviewtheresearcherwillagainthanktheparticipantand

repeattheassurancesaboutconfidentialityandaboutwhathappenstothe

material.

Theexpectationwasthatbyaskingoverlapping,andslightlyrepetitive

questionsitwouldbecomeeasier,inthecourseoftheinterview,toapproach

themorecomplexandinternalisedviewsofthepersonalworkingassumptions

alittleatatime,andtobegintogetaglimpseofthenon-conscious,procedural

workingmodelandtheclinicalmind-lines.

AnalysisoftheInterviews

Theresearcherlistenedtotheinterviewsandthentranscribedthem.The

transcriptionwasdetailedandaccuratebecauseoftherichnessanddensityof

theinterviewmaterial.Thematerialwasthenanalysedintwoways,asabove,

objectivelyandsubjectively.Thesubjectiveanalysisconsistedsimplyofthe

researcherattemptingtolistentotherecordedinterviewsinapsychoanalytic

stateofmind.ThisiswhatthepsychoanalystTheodoreReikcalled‘listening

withthethirdear’(Reik,1956).Thisinvolvedadoptingafree-associative,free-

floatingattentiontothematerialoftheinterview,listeningforthefeelingtone,

theassociativeleaps,ambivalence,unconsciouslapses,denials,connections

andelisions.Theaimofthisstageoftheresearchwasnotbetomake

observationsaboutindividualinterviewees,butmoretothrowsomelighton

thoseaspectsofthegroup-analyticworkingmodelthataredifficulttodescribe

consciouslyandcognitivelyandwhichtheintervieweeshaveincommon.The

researcherlistenedandmadenotes,lookingforsharedpreoccupation,and

anxieties.Theinterviewrecordingswerethentranscribedbytheresearcher.

Thefirststageofpsychoanalyticlisteningprovidedaguidetoboththe

conscious,availableand‘declarative’themes,aswellaswhichofthenon-

conscious,unconsciousand‘procedural’materialoftheinterviewsneededto

bepursuedintheformal,objectiveinvestigationthroughthematicanalysis.The

materialwassodenseandvariousthatalltheinterviewsneededtobecarefully

transcribedforfurtheranalysis,andthechosenmethodofresearchforthe

second,objectivestageofinvestigationwasthematicanalysis.

ThematicAnalysis

Thematicanalysisisabroadrangingmethodofexaminingandcodifyingdata.It

isusuallyusedtoresearchwrittenmaterial,interviewandgroupconversational

transcripts.Itcanalsobeusedtoresearchprintedmaterial,newspaperarticles,

soundandvideorecordings,andnow,alltheversionsofthenewmedia.Gibbs

describestheprocessneatly:itis“howyoudefinewhatthedatayouare

analysingareabout”(Gibbs2007,p38).Thereisabasisofagreementasto

whatthematicanalysisactuallyis,butthereissomedisagreementabout

whetheritisaseparaterecognisabletheoreticallybasedmethodinitsown

right,orwhetheritisjustatechniquewhichcanbeusedtoinvestigatedata

fromanothermorestronglystatedtheoreticalposition,suchas,forexample,

groundedtheoryorconversationanalysis.BraunandClark,inaninfluentialand

widelyquotedarticleaboutthematicanalysis,describeitasa“foundational

methodforqualitativeanalysis”(BraunandClark,2006,p78;BraunandClark,

2013).Theyalsomakeapointofapplaudingits“theoreticalfreedom”(ibid

p79),andthisfreedomfrombelongingtoafixedtheoreticalpositionmakesit

anopenandflexibletoolforexaminingdata.Thecentralaimofthematic

analysisisthediscoveryandelucidationofcodes,themesandpatternsof

meaningacrossarangeofresearchmaterial.AsBraunandClarkdescribeit:

“Thematicanalysisisamethodforidentifying,analysingandrecordingpatterns

(themes)withindata”(Ibid,p82).The‘themes’,constitute:“somelevelof

patternedresponseormeaningwithinthedataset”(ibidp83).Itisthisaspect

ofthematicanalysisthatmakesitcongenialforpsychoanalyticresearchers,in

thatamajorpartofthepsychotherapist’snormalworkingactivityislistening

carefullyto,andsearchingfor,patternsofmeaning,themesandconnectionsin

thediscourseoftheindividualpatientorgroupwhichrevealdenied,hidden,

unconsciousideasandfeelings.

Infact,RichardBoyatzis,inanimportantbookaboutthematicanalysis,writes

veryclearlyabouttheimportanceofunderstandingtheideaofmanifestand

latentcontent,andusespsychoanalyticdreamanalysisasanexemplarofthe

method,analysingtwodreamsbyJung,andtwobyRobertLouisStevenson

(Boyatzis,1988,pp17-28).Hewritesabouttheneedfortheresearcherto

“capturethecodablemoment”(ibid,p4).Theresearcher’staskisoneof

“patternrecognition”(ibidp7).Saldana,inanotherfrequentlyquotedand

influentialbookaboutthedetailedprocessofcodingandorganisingthe

researchdataexplainsthat“acodeinqualitativeinquiryismostoftenawordor

shortphrasethatsymbolicallyassignsasummative,salient,essence-capturing,

and/orevocativeattributeforaportionoflanguage-basedorvisualdata”

(Saldana,2009,p3)Hegoesontodescribetheprocessoffirstandsecondcycle

coding,wherebythefirst,largerlistofcodesisrefinedandreducedtocreatea

secondlistofwidercategoriesofthemesandmeanings.HelenJofferefersto

“implicittacitthemes”,andputsthisveryhelpfully,forthispresentresearch,in

termsofbeliefsheldingroups:“tacitpreferencesorcommitmentstocertain

kindsofconceptsaresharedingroups,withoutconsciousrecognitionofthem”

(Joffe,2012,p211).Thematicanalysis,asshedescribesit,is:“bestsuitedto

theelucidationofagivengroup’sconceptualisationofthephenomenonunder

study”(ibid,p212).Thismatchestheaimofthepresentresearch,whichisto

elucidatethesharedworkingassumptions,consciousandnon-conscious,of

groupanalysts,particularlyaboutthechangeprocess.Further,shealso

confirmstheneedforthedatatobecollectedwithsemi-structuredinterviews

withamaximumof5to7topicstoallowthissortofmaterialtoemerge(ibid,p

McLeod,helpfully,comparesthethemesthataretheobjectoftheresearchto

themesinmusic,thethemeismorethanthecontent,it:“isarecurringpattern

whichconveyssomethingaboutwhattheworld(ortheparticularaspectofthe

worldbeingdiscussed)meanstoaperson”(MacLeod,2011,p145).Robson,

describingtherelationshipbetweenthemesandcodingishelpfulwiththis.The

numberofthemesissmallerthanthenumberofcodes.Whatheclarifiesisthat

thethemes“capturesomethingofinterestorimportanceinrelationtoyour

researchquestion(s)”(Robson2011).ThisistheprocessthatSaldanarefersto

assecondordercoding(Saldana,2007).Anexampleofthesortofcodesand

themesthatmighthaveemergedintheresearchinterviewswasthosearound

theconceptofgroupcohesiveness.Thereisarecognition,whichisgenerally

shared,thatingroupanalysis,andingrouppsychotherapygenerally,group

cohesivenessisavitalelementinagroupthatisworkingwellandhelpfultoits

members.Yalom,inhisinfluentialtextbook,discussescohesivenessasa“widely

researched,poorlyunderstood,basicpropertyofgroups”andwhichisalsoa

‘therapeuticfactor’(Yalom,1975,pp46-7).Ifitisgenerallyunderstoodthatthis

isanelementinthechangeprocessthenitwouldemergeintheinterviews,

possiblyinvariousforms:closeness,togetherness,mutuality,forexample.

Theseareslightlydifferent,andmighthaveformeddifferentcodes,butitmight

beputtogetheratthesecondstage,asalargercompositethemeof

cohesiveness.

Summary

Theresearchconsistedofrecordedsemi-structuredinterviews,whichcentred

aroundthetherapist’sviewofthechangeprocessingroupanalysis.The

interviewswerefirstlistenedtocarefullybytheresearcherwhoattemptedto

listeninafree-floating,free-associative,analyticstateofmind,partlyto

discoverwhatthisrevealedforitself,andpartlytobegintheprocessoflooking

forsharedthemeswhichwouldilluminatethegroupanalyticinternalworking

model.Thetranscribedinterviews,andtheirimplicationsforestablishingthe

structureoftheclinicalmind-lines,aredescribedinfullinChapter4and

discussedinChapter5.Thetranscribedinterviewswerethenmadesubjecttoa

formalthematicanalysis,goingthroughtwostages:first,identifyingthesmall

fragmentsofmeaningandcodingthem;andthensecond,reducingand

combiningthesimilarcodesintolargerunitsofmeaning,thethemes.This

methodisfullydescribedaboveinthischapter.Thethemesthenprovideda

basicframeworkfordescribingthesharedgroup-analyticinternalworking

theories,orclinicalmind-lines,ofthechangeprocessingroupanalysis.The

findingsfromthethematicanalysisarealsodescribedinfullinChapter4,and

discussedinfullinChapter5.

Chapter4

FINDINGS

Introduction

Thestructureandaimoftheinterviewsisdescribedfirst,theattempttoelicit

thegroupanalysts’clinicalmind-lines,andtheconnectionswithestablished

theoryandpractice.Whatthenfollowsisthemainpartofthischapter.Thisisa

closeaccountofthedetailedprocessoftheinterviewsinthelightofwhat

appearedtobethemaintheoreticalandclinicalpreoccupationsofthe

intervieweesandtheoriginalresearchquestion.Thisincludes,wherenecessary,

notonlytheconsciousand‘pre-conscious’referencestoparticulartheoriesand

theorists,butalsoamoregeneral,subjective,‘counter-transferential’response

tothelanguage,toneandqualityoftheresponsesintheinterviews(Hollwey&

Jefferson,2000).Thisisfollowedbyadetailedaccountofthefindingsofthe

thematicanalysis.

Thestructureoftheinterviews

AsdescribedaboveinChapter3,theinterviewswere“semi-structuredlife-

worldinterviews”,whichattempt“tounderstandthemesoftheliveddaily

worldfromthesubject’sownperspectives”(Kvale,2007,p10).Theyconsisted

ofsixquestions.Thefirstthreequestionseachhadeithertwoorthreesub-

questions(seeappendixA).Thecentralaimoftheresearchinterviewswasto

discover,ifpossible,asstatedaboveinChapter2,thegroupanalysts’clinical

mind-lines(GabbayandLeMay,2011),thatis,thebasicworkingtheoriesor

principlesofexperiencedandseniorgroupanalysts.Ashasalreadybeen

discussed,therearenumberofotherwaysofdescribingthesekindsofworking

theories:asproceduralknowledge(Binder,2004),asthegroupanalyst’spre-

conscious(Hamilton,1996),astacitknowledge(Polanyi,1966)orasthegroup

analyst’sclinicalmind-lines(Gabbay&LeMay,2011).

Theprimaryfocusoftheresearchwastodiscoverwhattheseworkingtheories

were,onamoment-by-momentbasis,forthegroupanalyst.Whatweretheir

clinicalmind-lines?Whatwasintheirmindaboutgroupanalysisandthechange

processjustbeforeandduringthegroupsession?Whatworkingtheoriesand

principlesinformedtheirtherapeuticactionsinthecourseoftreatmentand

what,intheirview,whentheyreflectedonthis,werethedriversforchangein

thegroupprocess?Inordertohelptheintervieweestogainaccesstotheirown

workingtheories,manyofwhichwereprobablyheldintheirminds,notas

consciousworkingthoughts,butaspre-conscious,non-consciousor

unconsciousthoughts,inthecourseoftheinterviews,thequestionswere

focussedaroundthechangeprocess.Howdothesegroupanalyststhinkthat

groupanalysishelpedgroupmemberstochangeforthebetter?Inotherwords,

whatwastheirviewofhowgroupanalysisworks?Thequestionswere,asa

result,designedtoelicitthemind-lines,orworkingtheories,inaroundabout

andindirectway,throughrepetitionwithvariationsandonlyinthelast

questionweretheintervieweesaskeddirectlyabouttheirviewofthechange

processingroupanalysis.Alloftheintervieweesreportedthattheyrarely,if

ever,spokethiswayabouttheirwork,andtheyallparticipatedwithenthusiasm

andinterestintheanswerstotheinterviewquestions.

TheClinicalMind-linesinRelationtoGroup-AnalyticTheoryandPractice

Anadditionalfocusoftheinterviewwastoexaminetherelationshipofthese

deeplyheldpersonalworkingtheoriestoestablishedandacceptedtheory,in

particulartogroupanalytictheoryandprinciples.Itmustbethecasethat,as

wasarguedearlier,thatthedivisionbetweenproceduralanddeclarative

knowledge,appliestogroupanalysis,andtoallotherpsychotherapies.The

clinicalmind-lines,whatthegroupanalysttakesintothegroupsession,may

haveacomplexordistantrelationshipwithwhatwasgenerallytaught,

theorisedandtakenforgrantedinthegroupanalyticliteratureandtraining

materials.Whatemergedfromtheinterviewswasthattheseveryseniorand

experiencedgroupanalystsgenerallyreferredexplicitlytotheoryonly

occasionally,unlessdeliberatelypromptedbytheinterviewquestions.The

explicittheoreticalandtechnicalreferencesthattheydidmakeweremodest

andtendedtobeshared,invariouswordings,byalloftheinterviewees.Many

basicandcommontheorieswerenevermentioned,andveryfewauthorsinthe

field,withtheexceptionofFoulkes,werespontaneouslymentioned.There

werehoweveroccasionalimplicitreferencestoparticularwell-known

authorities,mostnotablyWinnicottandBion,butthesereferencesoften

appearintheinterviewees’responsesonlyasechoesoftheories,oftenthrough

aspecialuseofordinarylanguage.Thisisexaminedinmoredetaillaterinthis

chapter,inthenarrativeaccountofhowtheinterviewsproceededand,froma

differentpointofview,inthethematicanalysis.

THEINTERVIEWPROCESS

Introduction

Eachinterviewbeganwithabriefstatementfromtheintervieweroutliningthe

shapeandprocessoftheinterview.Itwasdesignedtofocustheinterviewee’s

mindaroundthechangeprocessingroup-analysis,bothforindividualgroup

membersandforthegroup-as-whole,andemphasisedthesemi-structured,

free-associativeanddialogicstructureoftheinterview:

“Iwanttofindouttheviewsofexperiencedgroupanalystsaboutthechange

processingroupanalysis.Whatisitthathastohappeninthegrouptomakea

differencetotheindividualpatientsinthegroup?Whatisthechangeprocessin

group-analysisbothforthegroup-as-a-wholeandfortheindividualmembers?

And,whatideasandtherapeuticmethodsdoyouhaveinmindinthecourseof

agroup,aboutadvancingorpromotingtheprocessofchange?Iamgoingtoask

youafewopen-endedquestions,andIhopethatwecanhaveafree-ranging

discussion.Thanks.”

Question1

Thefirstquestion,whichhadthreesub-questionsattachedwas:‘Iwillstartby

askingyou,therefore,averygeneralquestion.Whatforyouarethethreemost

importantthingsaboutgroupanalysis,orgrouppsychotherapygenerally,that,

inyourview,helpgroupmemberstochangeoverthecourseoftheirtimeinthe

group?”Thisquestionwasintendedtoimmediatelyhelptheintervieweesto

focusandselecttheirviewsonthechangeprocessbyaskingforthe“threemost

importantthings”.Itwasexpectedthattherequesttochoosethreethingsin

thefirstquestionwouldhelptheintervieweetobepersonalandspontaneous

fromthestart.Hopefully,therefore,theresponsesfromthebeginningofthe

interviewonwardswouldnotbetoothoughtout,andtherewouldbemore

opportunitiestorevealanddiscusstheimplicit,proceduralandpreconscious

workingtheoriesandclinicalmind-lines.

Thefirstfourintervieweesallgavequickandspontaneouslistsofthethree

factorsthattheythoughtweremostimportant.Therewaslittleoverlapin

specificterms,butagreatdealincommoningeneral,mainlytodowithtrust

andcontainment.Thechoice,therefore,andthelanguageusedtodescribe

them,wasapparentlyquitepersonalandtherewaslittleuseoftechnicalor

specialisedterms.

Interviewee1(I.1):

1) Thecompositionofthegroup

2) Asafeenoughsetting

3) Theconductor

Interviewee2(I.2):

1) Containment

2) Trustandbuildingtrust

3) Tospeakfreelywhatisonyourmind

Interviewee3(I.3):

1) Asenseofbelonging

2) Partsoftheselfreflectedinothers

3) Bearingwitnessandrepetition

Interviewee4(I.4):

1) Internalisingthegroupasawholeandindividualmembers

2) Trustingthegroupovertime

3) Routineandritual

Theintervieweesthenelaboratedatsomelengthonthechoicesthatthey

made.Tosomeextentitwasclearthattheirindividualchoicesofthethree

mostimportantfactorsdependednotonlyontheirinterestsandindividual

viewsaboutgroupanalysisbutontheirmainplaceofwork.SoI.1.,who

workedfulltimeinanNHSClinic,wasveryconcernedabouthavingsomechoice

inthecompositionofthegroupandthesafetyofthesetting,reflectingthe

clinicalprioritiesandmanagementmethodsinthepublicservices,whereasI.2.,

I.3.andI.4.workedalmostentirelyinprivateandtrainingpsychotherapy,and

theirconcernsweredifferent,althoughrelatedinageneralway.

I.1spokeatsomelengthaboutherfirstchoice,thecompositionofthegroup,

andlikealltheinterviewees,becameincreasinglyinterestedinherown

processesofthought.Atfirst,reflectingtheinstitutionallybasedanxietyabout

clinicalfreedom,shesaidthattheimportantthingwasthatshehad“enough

choice”ofmembersforthegroup.Shethenwentontomusealittleonthis

basicprocessofchoosingsuitablemembersforagroup.Itwasa“subjective

process”andcouldthereforebe“contaminatedbymyown

psychopathology…myownstateofmindatthetime”.Itwas“notaparticularly

objectiveorscientificprocess”,andmightnotcomeupwiththebestresultand

itwas,instead,“anintuitiveprocess”.Thisratherself-criticalandapologetic

wayofthinkingabouttheirworkcameupinvariouswaysthroughoutallthe

interviews,andmayreflect,ratherdistantly,theconventionalFreudian,

psychoanalyticemphasis,particularlyinthestructuralmodelofthepsyche,on

guiltandthestructureandfunctionofthesuper-ego.Thismaymake

psychotherapistsevenmorevulnerabletoanxietythattheyarenot‘scientific’

enough,inthecontextofthedifficultcontemporarydebateaboutevidence

basedmedicine(Fonagy2004,Shedler2010,NICE).I.1thenwentontotalk

abouttherelatedmatter,forhersecondchoice,ofa“safeenoughsetting”

whereshewouldfeel“contained…soIdon’thavetobethinkingaboutwhatis

goingonoutsideandwhetheritisgoingtointerfereorimpingeonthegroup

sessionsandwhetherwhatIdoisvaluedandunderstoodbythecentreorplace

whereIam”.Thiscomplexstatementreflectstheparticularproblemofthe

traumatisingrecentchangesinthepublicservicesandtheassociatedanxiety

abouttheeffectofinstitutionaldevelopmentsonclinicalwork.Italsorefers

verystronglytotheneedforcontainmentforbothgroupanalystandgroup,

whichisaconstantthemethroughalltheinterviews.Thisstatementisalsoa

goodexampleofhowtheoriesandauthoritiesappearmoreasechoesthan

directreferenceswhenthegroupanalystsaretalkingabouttheirwork.I.1

implicitlyreferstoBioninemphasisingtheimportanceofcontainment,andhis

theoryof‘container/contained’(Bion,1959and1970),andtoWinnicottbyher

useoftheword‘impinge’(Winnicott,1947,p.183).‘Impingement’isan

importantclinicalwordforWinnicott,concernedwithoutsideinterferencein

therelationshipbetweenmotherandchild:“…thatwhichinterruptstheinfant’s

continuityofbeing”(Abram,1996,p.163).

Thisimportantconcept,whichsuggeststheimportanceofthegroupboundary,

thereforealsodrawsintoviewanothertaken-for-grantedassumption,that

appearsthroughouttheinterviews,oftheparallelconnectionofthe

psychotherapyrelationshipwiththatofthemotherandbaby.Thisisoften

takenforgrantedwithindividualpsychotherapy,butislesscommonlylinked

withgrouppsychotherapybecauseoftheconceptualdifficultyofequatingthe

group-as-a-wholewiththeinfant.Nevertheless,bythispre-consciousreference

toWinnicottandthemother-babypairI.1maystillhavehintedatoneofthe

moreimportantnon-consciouslyheldworkingassumptionsofgroupanalysts.

I.1’sthirdchoicewastheconductor,whichistheconventionalgroup-analytic

wordfortheleaderortherapist,thetermfavouredbyFoulkes(Foulkes,1948,

p.69).Aftersomehesitationshewentontolistwhatshethoughtwerethe

importantqualitiesforaconductortohaveinordertofacilitatechange:

interest,curiosityand“excitementwhenthinkingaboutconductingagroup.

Thatneverislost”.Shethenmadeaverycomplexstatementaboutthe

conductor,whichisquotedatlengthbecauseitraisesmanyissuesthatemerge

inthelaterinterviews.Shesaysthattheconductormustbeableto

“engage…andthatiswhatImeanbytheotherthings,thatheisablegive

himselforherself,tobepreparedtousehimselforherselfasatoolforthe

group,sothatitisavailable,tothemembersofthegroupandtothegroup

process,sothatheisnotafraidofbecomingoverwhelmedbythefeelingsand

theemotionsthatareverbalisedinthegroup,orexpressedinthegroup

sometimesinanon-verbalway”.Theseideas,aboutengagement,beingused,

beingavailable,thedistinctionbetweengroupmembersandgroupprocess,

beingafraidofbeingoverwhelmedandverbalandnon-verbalexpressionall

occuragainandagaininvariousformsintheinterviewresponses.Thereisalso

hereanotherechoofWinnicott,wherebeingusedasatoolseemstorefer

indirectlytohispaperabouttheuseofanobject(Winnicott,1971,pp.101-

I.2confidentlychose“containment…everythingthatbelongstoitlike…the

rhythmandtheclearboundariesofthesessions”.Thisincludespractical

containmentintermsofwhatgroupanalystscall‘dynamicadministration’,

whichistheproperarrangementandcareofthephysicalandorganisational

settingofthegroup(Foulkes,1975,pp.99-108),andcontainmentonan

“emotional,psychologicallevel”todowiththeinterpersonalmanagementof

thesession.SothisalsohastheconnectionwithBion,foremotional

containment,againwiththedistantreferencetothemother/babyrelationship

impliedintheideaof‘container/contained’,combinedwiththeveryspecific

Foulksianreferenceto‘dynamicadministration’.(Bion,opcit;Foulkes,ibid).She

thengoesontodiscusshersecondchoiceof“trustandbuildingtrust”.This

thenbecomesquiteacomplexstatementabouttheassessmentinterviewfor

groupandtheneedtoemphasisetheestablishmentoftrustinher,sothatthey

feel“thattheycantellmethingsthattheymightnothavetoldotherpeople”,

butstillfeelthatshewillsafeguardthisinthegroupuntiltheyarereadytotalk

themselves.Itmightthenbeeasierforthemtotalkinthegroupbecausethey

knowthatsheknows.Shethendevelopsthis:itisnotjusttrust,but“the

establishmentofarelationshipwithme…Iamakindoftransitionfortheirtrust

tobeinvestedinthegroup”.Shespecificallysays,however,thatsheisnota

‘transitionalobject’,referringtoWinnicott’sdevelopmentalformulation

(Winnicott,1974,pp.1-30).Whilethinkingaboutherthirdchoiceshethen

arguedthatthefirsttwochoices,containmentandtrustappliedtoboththe

relationshipwithherand“therelationshipwiththegroupasawhole”,

exemplifyingthisconstantpreoccupationofgroupanalystswiththe

relationshipandtensionbetweenthegroup-as-a-wholeandtheindividual

groupmembers.Thisbroughtherontoherthirdchoice,tospeakfreely,and

again,acomplexargumentfollowsabout“thecapacitytowhatIreallythink

enableschangeistodaretosaywhatisonyourmind,tospeakfreely…to

actuallydaretosaywhatisonmymindandseewhathappenswiththat,how

othershearit,ifothershearit,ishowIfeel,iftheydohearit,don’thearit…”

This,sheaddedlater,is“themostimportantcurativefactorintermsofgroup

analysis”.Itwasalsoveryconfidentlyandexcitedlystated,givinganindication

ofhowimportantthisparticularfactorisformanygroupanalysts.Interestingly,

thisoneoftheveryfewoccasionswhenoneoftheintervieweesactuallyused

thephrase‘curativefactor’(Yalom,1975)

I.3.answeredthefirstquestionslightlydifferentlyfromtheotherthree

intervieweesandgaveallthreeofherchoicesinaonesentencereply:“having

asenseofbelonging,beingpartofsomething…seeingpartsoftheselfreflected

inothers…bearingwitness”andthenadded“…too,havingtheexperienceof

feelingthatyouare…inyourfamilyoforigin,somerepetition”.Sheclarifiedthat

thatwaswhatshemeantby“bearingwitness”.Shethenexplainedthatshefelt

veryanxiousaboutbeingrecorded,butthenrelaxedandmadeclearerwhatshe

meant.Shedescribedaprocesswherebyagroupmember“getsintouchwitha

feeling”and,throughafamilytransference,theyexpectthattheothergroup

memberwillbehaveexactlylikethepersonfromtheirfamilyoforiginwho

occasionedthefeeling,butasitbecomeclearthatthegroupisa“separate

entity”thenchangeoccurs,“whenanexperienceisrepeatedinthegroup”and

thereis”differentiationbetweenthefeeling(inthepresent)andthepast”,asit

isrecognisedthatthemembersofthegroupare“notthatoriginalfamily”.This

complexargumentabouttheengineforchangeinthegroupwasrushedatthe

startoftheinterviewandslightlyunclear,butherworkingtheoriesbecame

clearerandmoreextensiveintherestoftheinterview.Atthispointitisobvious

thatthisintervieweeisexplicitlyandimplicitlyquitepsychoanalyticinher

views,andisalsoindividuallytrained.Theargumentaboveisontheonehand

straightforwardlyaboutmakingtheunconsciousconscious,throughworkingin

thetransference,butontheotheralsoconnectsup,throughtherecognitionof

complexityofthegroup,withmorecontemporaryideasfrominter-subjective

andrelationalpsychoanalysis.(Natterson&Friedman,1995)

I.4.alsoansweredquitequicklyandconfidently,andshesaidstraightawaythat

onethingthatwasreallyimportantwas”whentheygetinterestedinother

groupmembersandstartwantingtoengagewiththemandtakeonsortof

rememberingaboutthem”.Thisgetsthegroupstarted,asitwere,becauseif

theyrememberthingsaboutothermembersthentheycanbringthingsbackto

thegroupandtakethemfurther.Itisatthispoint,sheexplains,thatthegroup

membersbeginto“internaliseotherpeopleabit,orthegroupitself,abit,asa

whole”andtheythenbecomelessfocussedonthegroupanalyst.Hersecond

choicewas“trustingthegroup”,whichleadstothenformingrelationshipsand

“makingsomekindofconnection”,andthisledhertothethirdchoice,which

wastheroutineorritualofgrouptherapy:comingregularly,everyweek,

allowingthejourneyandthetimingtobecomeroutine,evenaritual,andthis

thenestablisheditasanimportantpartofthegroupmembers’dailylives,

presumablythenreinforcingtheothertwochosenfactorsofinternalisationand

trust.Thisintervieweetookaveryclinical,experientiallinethroughoutthe

interview,andillustratedmostofherideaswithrichclinicalexamples,which

expandedonhercomplexandwell-establishedviewofgroupprocess.

Theintervieweeswerethenaskedasub-question:“Whichofthethreeismost

importanttoyouandwhy?”I.1saidthatthiswasaverydifficultdecisionand

thenimmediatelyreferredtoFoulkes.ShethoughtthatFoulkeswouldsaythat

theconductoristhemostimportantfactor,butthat“othergroupanalysts

mightthinkthatitis…thesettingyouknow,whatisgoingonaround”.This

questionthenseemedtostartaninternaldebate,withfirstastatementofthe

difficultyofthechoice,thenadeferraltoauthority,intheformofFoulkes,and

thentocustomandpractice,wonderingaboutwhatothergroupanalystsmight

think.Shethencontinuedtothinkthisthrough,sayingagainhowdifficultitwas

toseparatethemasallthreewere“equallyimportant”andthenbegantotalk

atlengthabouttheroleoftheconductorintermsofthemother/child

relationshipandthecontainmentofanxiety.Thecontainingpresenceofthe

mother,in“asituationoftrauma”protectsthechild,andintheeventofthe

mother’sabsence,thechildwill“suffer”.SheisreferringtoFoulkes’

psychoanalyticbackground,andnottohisgroup-analyticformulations(Foulkes,

1990;Dalal,1998).Thisimplicitlyusestheextendedmetaphorofthemother

andchildrelationshipforthecontainingrelationshipbetweentheconductor

andthegroup.Thisthoughtthenseemstohelpherdecidewhichismore

importantforher:“IthinkIwouldputmyselfmoreonthesideofthesetting”,

andthen,inastrongstatement,explainsthereasonforherchoice:“Ican’t

conceiveofmyselfasseparatefromwhatisgoingonaroundme…whateveris

goingonaroundmewillinfluencethewayIfeelandthewayIconductagroup,

thereforethatwillbepresentinthematrixofthegroup”.Thisisnowmuch

moreclearlyagroupanalytic,Foulksianwayofthinkinginthattheconductoris

verymuchpartofthegroup,andaffectedbythegroup,andeventsaround

themall(Foulkes,1957).Shealsorefersdirectlytothegroup‘matrix’,whichisa

central,thoughrathertaken-for-grantedgroup-analyticconcept(Foulkes,1970,

p131).I.1addedthatthe“good-enough”groupanalystwillmakeuseofthefact

thatexternaltraumaappearsinthematrixofthegroupasawhole:“Ifthatis

presentinthegroupanalystthenitwillalsobepresentinthemembersofthe

group”andthegroupanalystcanhelpthegrouptobecomeawareand

consciousofthisprocessand“workwithit”.Thisisimportant.Itseemstobea

statementabouthowthegroupcanpromotechange.Thegroupanalystuses

theirself-knowledgeandunderstandingofthesharednatureofthetraumatic

experiencetohelpthegrouptounderstandwhatishappeningandtolearn

fromit.Thetraumaisexperiencedthereforeinthematrix.Thisisamore

complexthought,onabackgroundofimplicitstraightforwardpsychoanalytic

ideasabouttheneedtounderstandthecounter-transference,‘working-

through’(“workwithit”)andthebasicprocessinpsychotherapyofmakingthe

unconsciousconscious.ThereisanotherquietechoofWinnicottagain,inthe

ideaofthe“good-enoughgroupanalyst”(Abram,1996,pp.193-6).I.1then

wonderedabouttheopposite,the“negativesituation”,andrelatedthis

particularlytothestageofdevelopmentofthegroup.Ifthegroupwas

“immatureanddependent”thenitmightbe“overwhelmed”andthen“notable

toprocessthosefeelings”,andmightcometoanend.Sheisverycentredon

difficultiesinthesetting,which,again,mayreflectherinstitutionalexperience,

andsherepeatsherviewthatthemostimportantthingisthesettingbecause“I

didn’tthinkthattheanalystcould…escaperespondingtotheuncontained

setting”,butatthesametime“whateverisgoingonwiththegroupasawhole”

mightmakeitpossibleforthegrouptocontinuetoworkinahelpfulway,and

to“growandchange”.

I.2madeherchoiceimmediately,butshehadinfactalreadyidentified

‘speakingfreely’as“themostimportantcurativefactor”,because,shesaid,itis

“sosimple”.I.2wasalsoacommittedindividualpsychotherapist,and

throughouttheinterviewmadethoughtfulcomparisonsbetweenindividualand

group.Atthispointsheexplainedwhatshethoughtwasthedifference

between‘freeassociation’andspeakingfreelyinthegroup.Sayingwhatwason

yourmindtoagroupwas“adifferentprocessbecauseyousaythisintoagroup

ofpeoplewho…dosomethingwithit,whichissomehowmuchmoredaring,

muchmorescaryandmuchmorefrighteningthanthefreeassociationinaone

toone”.Shewentontosaythatanindividualpatientgetstoknowthe

psychotherapistinawaythatisnotpossiblewithallthemembersofagroup

andthereforemuchmore“risky”.But,ifgroupmemberscanpersevere,

“withoutcensoringandwithouthesitating,andwithacuriosity”thenthis,she

said,canpromotechange,becauseinitselfitimpliestrustandcontainment.

Thechangeprocessthenleadsto,asaresultofthisfreedomtospeak:

“…allowingthingstochangefrommomenttomomentinthatprojectofsaying

what’sonyourmind,noticingwhat’sonyourmindwhensomeonesays

somethingintheroom.It’sselfawareness”.Shethenexplainsthisprocess

further.Thefirststepistobeawareofwhat’sonyourmind,thesecondstepis

tosayit:“…youneedtocatchitandthenspeakit”.Thecouragetospeakand

curiosityaboutselfandothersiscombinedinthegroupwith“…anawareness

thatyoucannotcontrolothers”butthat“…youareactuallyinanaliveexchange

withothers”.Whatisinterestingaboutthisintervieweeistheconfidentway

thatsheassertedherviewofthebasisofthechangeprocessingroup-analysis.

Thisprocessstartswiththeviewthatthegroupsettingisinitselffrightening

anddangerousandthattheprocessofovercomingthefear,ontheonehand

drivenbycuriosityandcourage,andontheothersupportedbyafeelingof

containmentandtrust,withanincreasingawarenessthattheothermembersof

thegroupcannotbecontrolled,leadstoan“aliveexchange”,whichinitself

promoteschange.Thisisrichandinteresting,butinevitablyonlyapartial

descriptionofacomplexprocess.

I.3alsoquicklychoseherthirdfactor,‘repetitionanddifferentiation’asthe

mostimportant.WhereasI.2usedthephrase‘curativefactor’,I.3referredto

‘therapeuticpotential’.Thisisavailablewhen“…pastandpresentcome

together”andtime“collapses”inthegroup.Herclinicalexperiencereinforced

thisideawhenshesaidthatitwaswhenthishappenedthatpatientsfeellike

leavingthegroup,asthoughtthisiswhentheyfeelmostvulnerable.Whenshe

wasaskedtoexplainwhythiswassotherapeuticshesaidthatitis:“Becauseit

getsreconstructed,somethinggetsdeconstructedandthenreconstructed

throughthatexperience”.Thehelpfulchangeisthattheexperiencecanthenbe

“translated”intoothergroupsituations,andtheunhelpfulresponsewill

thereforenotberepeated.I.3wasalsoanindividualpsychotherapist,andthere

isasuggestionhereofre-enactmentandre-castinginthepresent,inthe

transference,ofdisablingoldwaysofrelatingtoothers.

I.4.chose‘trustingthegroupovertime’,andemphasised“…theimportanceof

therelationshipsinthegroup”andtheideathattimehaspassedwhilethey

havebeentogetherinthegroup,andthatthegroupis“theplacewherethey

havelearnedtotalkaboutthings”.Thepassageoftimetogether“triggersa

deeperlevelofconnecting”.Shethentold,asanillustration,astoryfroma

group,aboutaveryisolatedpatient,forwhomtheattentionofthegroup

becameincreasinglyvital.Shethenaddedthatthegroup,overtime,becomes

moreimportantthanthegroupanalyst,andthereforeinitselftheprimary

agentofchange:“…itwasnolongerme,itwasthewholeexperienceofthe

group”.

Thesecondsub-questionwasspecificallyabouttheinterviewees’theoretical

views,inparticulartherelationshipbetweentheirviewofwhatwasmost

importantandconventionalgroupanalysis:“howdoyouthinkthatrelatesto

thegenerallyacceptedviewingroupanalysis?”I.1.wasreluctanttocommit

herselftothis,claimingthatshecouldnotknowtheacceptedFoulksianview,

feelingthattherewasno“acceptedwisdom”intheIGA.TheIGAwas“catholic”,

andthenmoreconfidentlyassertedthat“difference”wasthe“essence”of

groupanalysis:“differentopinionsanddifferentapproachesanddifferentways

ofunderstanding”.Shethenspeculatedaboutwhatbecameanimportant

considerationthroughoutalltheinterviews,therelationshipbetweenindividual

andgrouppsychotherapy,feelingthatgroupanalystswithanindividualtraining

wouldemphasisetheimportanceoftheconductor,andfeltthatthisappliedto

Foulkeshimself.Shealsothenmadeacomplexpointaboutgroupanalystswho

hadnothadanindividualtrainingwhomightthenalso,inreaction,“over-

emphasise”individualdynamicsandtheimportanceoftheconductor:“...we

trytodenyourorigins,besomethingelseinordertocompensate”.I.2also

founditdifficulttoacknowledgethattherewasanacceptedviewingroup

analysis,andthoughtthathermostimportantelement,ofspeakingfreelyinthe

groupandsayingwhatwasonone’smind,wasnot“necessarilytheaccepted

view”.Somegroupanalystswouldsaythesamething,butotherswouldnot.

Othergroupanalystsmightregardthemostimportantthingasbeingto

“promoteself-reflection”,orto“adapttheirbehavior”,whereasotherswitha

morepurelypsychoanalyticorientationmightregarditasmostusefultomake

interpretations.Shethenwentonenthusiasticallytoemphasisewhatwasmost

importanttoher:“freeexchangeinwhicheverybodyhassomethingtoputin”.

Groupmembersshouldnot“monologue”,thechangeprocessarosefrom

”interaction”,“engagement”andthe“interpersonalelement”.Itwasnotabout

“theanalystknowingitall,it’saboutthematrix”,or“theexchangeinthe

matrix”.I.3.thoughtthat“repetitionanddifferentiation”wasthemost

importantofthethree,andexpectedthatothergroupanalystsmightagree.

Shefeltthatherindividualtrainingledhertoexpect“psychicchange”,or

“internalchange”,asanoutcome,whichshethoughtsomegroupanalysts

wouldnotexpect,beingpossiblymoreconcernedwithsocialfunctioning.For

her,internalchangeinthegroupmembersarosefromtheprocessof

understandingwhatwasbeingrepeatedfortheminthecourseofthegroup.

Shethenclarifiedthis,sayingthatachangeinsocialfunctioning,inthegroup,

camefirstandwasthenfollowedbyunderstanding,whicharosefrom“insight”,

whichshespeculatedwasnotreallyagroup-analyticterm.Shefeltthatan

individualanalyticviewor“yourowncuriosity”helpedwiththisprocess,

wherebythegroupfirstofallopenedupthedifferentiationprocess,andthis

couldthencouldleadtosomething“deeper”.I.4answeredthissub-question

quitedecisively.Forherwhatwasmostimportantwastheexperienceofthe

groupovertime,andthenexpandedthistomakeastrongstatementofhow

groupanalysisworks:“thecommitmenttothefactthatordinarypeople,for

me,ordinarypeoplecanhelpeachotherasmuchastheconductorcan”.The

groupmemberswere“morebroad-mindedthanconductors”,andshefeltthat

therewasagroupanalyticconcept“thateverybodycanreallyhelpeachother

intherightsortofenvironment”.Shethengavealongandcomplexclinical

exampleofwhatshewastryingtoexplain.Attheendoftheanecdotethe

groupmemberwasexplaining,towardstheendofalongtreatment,thathe

hadmadesomegainsandsaidthat“whatIhavediscoveredisthatIamreally

interestedinotherpeopleandotherpeoplelikemeandareinterestedinme,

andsoIambeginningtomakefriends”.

Theywerethenaskedinthethirdsub-questionabouttherelationshipbetween

theirothertwochoicesandacceptedtheory.I.1.hadchosencompositionand

theconductorbutarguedthattheformerwasdependentonthelatter,and

bothagain,onthesetting.Thegroupanalystislikelytobe“unconsciously

choosingpeople”,possibly“withthesamesortofpsychopathology”,butalso

thechoiceisconsciouslyorunconsciouslyaffectedbythesetting,thekindof

patientsavailabletotheconductor,ortheconductor’swishtomakea

particulartypeofgroup.Shethenemphasizedagaintheimportanceof

differenceongroupanalysis:“differenttraits,differentages,differentsocial

backgrounds,differentpresentingproblems”.Thisledhertotalkatlength

aboutthechangeprocess:thedifferencesallowthegrouptoexplore

“repressed”or“denied”partsofthemselvesthrougha“mirroringprocess”.

Seeingthenleadstoexploration,understandingandverbalization:“weallhave

thingsincommon,allofus”,and,“It’slikeuniversality,weareallinthesame

soup”.ForI.2.herchoiceofcontainmentwas,inherview,abasicprincipleofall

analyticpsychotherapy,buttrustwasmorecomplex.I.3.feltthatwhatwas

importantandsharedwas“thesenseofbelonging,beingpartofsomething,

beinglessisolated”andthentalkedatsomelengthaboutwhatideaswere

shared.Shetalkedabouthowcommonitisforgroupmemberstofeelthatthe

groupisworkingforthem,butnottounderstandwhy:“thesepeoplemaynot

havethoughtverymuchabouttheirstoriesbutfeelbetterinthepresenceof

others”.ShethenrelatedthisfurthertoFoulkesandthematrix,andagain

emphasizedthecommonpurpose:“you’reallinittogetherandsomehowyou

changesomeindividualthings”.Thiswasagoodexampleofaninterviewee

workingsomethingoutforthemselvesastheyspoke,andgoingontorelatethis

toFoulkes’conceptofthenetwork,the‘group-mind’,andthenagaintoa

descriptionofthechangeprocessasasequenceovertime.Reverieallows

reflectionandmirroring,andthisleadstoverbalizationthroughidentification

withothersinthegroup,whichthenallowsthedifferentiationofexperience.

Thiscomplexlineofthoughtwillbediscussedfurtherinthenextchapter.

Question2

Thisquestionhadonemainquestionandtwosub-questions:“Whatisspecialor

distinctiveaboutgroupanalysiscomparedtootherformsofpsychotherapy,

bothindividualandgroup?”I.1immediatelyreplied,sayingthatitwaswhatshe

alwaysthoughtaboutingrouptherapy:‘figureandground’.Shethenexplained

this,whichisanimportantandcentralgroupanalyticidea,vividlyandatlength,

describingthealwayschanging,“backwardsandforwards”relationship,inthe

groupanalyst’smind,betweentheindividualandthegroup:“changingthe

frame”.Inadditionsheemphasizedthecounter-transferenceandthegroup

analysts’“contribution”tothegroup-as-a-whole,andwentontodescribethe

significantdifferencesbetweenthecounter-transferenceingroupandin

individualtherapy.I.2.firstansweredbysayingthatitisthejobofthegroup

analysttoteachthegrouptoworkinagroup-analyticway,itisa“kindof

investment”,aprocessthatthegroupneedstolearn.Shethenre-thoughtthe

questionandtalkedabouttheimportanceofthe“interaction”andthe

“emergentprocessthatissovisibletomeasthegroupanalyst”,andthenspoke

intenselyabouttheneedforthegrouptohaveafreereintobeabletowork,

andtomoveto“areasandnewexperiencesthathaven’tbeentherebefore”.It

is“multi-faceted”,andthereisapotentialforsomuchdevelopment,whichshe

linkedwithcreativity.Comparingthiswithindividualpsychotherapyshetook

theinterestinglinethatgroupanalysishaschangedherindividual

psychotherapywork,particularlythe“powerrelationship”,andsheisnow

muchmoreofa“partneronanequallevel”withherpatients.Shethendrew

anotherimportantdistinctionaboutthis,sayingthatshewasalwaysinan

“authoritypositionasfarasdynamicadministration”butwas“alongsidethe

patientsintermsoftheanalyticalwork”.Thisthenledhertotalkaboutthe

richnessofthegroupanalyticexperience,the“variouspatterns”anddrewan

analogywithJung’sideaofcircumambulation(Jungref…):“Youhavetowalk

arounditsothatyoulookattheissues,ortheproblem,fromallthedifferent

sidesthatissues,aproblem,has.Inagroupyouhavealreadygotthatthrough

thesetting”.Whatemergedasmostimportantforher,mostdistinctiveabout

groupanalysis,wastheclinicalexperienceoffeelingfreetoletthegroupwork,

andof“usingthegroup”.Sheputthisintwosimilarways,firstthattheideaof

usingthegroup“takesaburdenoffme,Idon’tneedtoknowitall,youdon’t

needtodirecttheprocess”;andsecond,that“groupanalyticalthinkinghas

freedmefromfeelingthatIneedtoknowitall”.I.3.wasconfidentthatwhat

wasmostdistinctiveforheraboutgroupanalysiswas“thegroupbeingthe

therapeuticagent…buildingagroupandthateverybodyispartofthatprocess”,

includingtheconductor.ThisisofcoursecloselyrelatedtoI.3’sview.Each

memberofthegroupis“contributingtotherapy”,and“theanswerlieswithin

thegroup,thatitisnotalwaysinthetherapist”.“Everybody’svoicecounts”in

thisprocessofunderstanding.I.4.talkedatlengthaboutherownexperiencesin

groupandindividualtherapytoillustrateherviewthatwhatismostimportant

fortheindividualgroupmemberistheinvolvementwiththeotherpeoplein

thegroup,thiswasforherthedistinctive“therapeuticfactor”ingroupanalysis.

Thefirstsub-question,followingonfromquestiontwo,was:“Isitthosethings

thatareparticularlyimportantinthechangeprocess?And,ifso,which,foryou

personally,isthemostspecial,distinctiveanduseful?”I.1firstworriedabout

themeaningof‘change’inrelationtothetherapeuticfactors.Didchangemean

thelossofsymptoms,orthattheproblemswerelessened,orbecameless

distressing,orthattherewasachangeinhowthesymptomswereexperienced

orunderstood?Shethenwentontotalkaboutthestagesofgroup

developmentinrelationtochange.Asthegroupbecomesmorematureand

settled:“itcantakemoreemotionallydemandingexplorationofdisturbance”.

Shethentalkedaboutthegroupandtheindividualmemberschanging

differently,implyingthatearlydeparturefromthegroupmayresultfrombeing

leftbehindbythedevelopmentofthegroupasawhole,which“willcontinue

changingandmaturing”.Shethenstatedherstronglyheldviewthat“changeis

moretodowiththecapacityforflexibility,thecapacitytowithstandquite

disturbingemotions”.Thisthenledontoherviewoftheroleofthegroup

analyst,whenthisisatrisk,from,forexample,atraumatisedpatientwhois

distressed,andpossiblyexhibitionisticinthegroup:“Thatiswherethe

conductingtakesplace”,andthegroupanalysthastointervene,andamature

groupthegroupcanworkwiththepatientatthispoint.I.2.alsospokeatlength

inresponsetothisquestion.Herviewwasthatgroupanalysisworkswell

becauseitoffers“akindofrelationshiponanequalsiblinglevel,itisnotan

authoritymodel,parent-child”.Iffullyengagedthismakesa“different

developmentalprocessavailable”.Then,whilethinkingabouttheimplications

forbothherindividualandgrouppsychotherapypractice,shesummedupby

sayingthat:“Idon’tthinkthatwehavequitefullyunderstoodgroupanalysis”.

Shethenusedananalogyfromeducation.Ateacherhadsaidtoher:“wedon’t

learnfromourteacherswelearnfromourpeers”,andthiswasforherinthe

“group-analyticparadigm”.Itmeantthatthegroupanalystwasnotdirecting

theprocess,butwas“intheproblemlikeeverybodyelse”.Again,inteaching,

sheadded:”ifonechildlearnsitthentheotherchildrenlearnitslightly

quicker”,andtheninthegroup:“onepersonmakesashiftothersaredrawnon,

drawnintothattoo”.Thismightbeconnected,shethought,withtheneuro-

scienceconceptofthemirrorneurons.Thissub-questionalsoledI.3totalk

enthusiasticallyaboutwhatwasmostimportantforher.Shefirstdescribedthis

asaprocessof“takingbackprojections”,throughaprocessofunderstanding

thatwhattheindividualhatesinanothergroupmemberis“partofyourselfthat

youseeinothers”.Itis“thehallofmirrors…avarietyofmirrorsbackabout

yourselfandwhatyou,youaredenyinginyourselfandseeinothers”.The

groupprocessensuresthattheindividualtakesitbackandbecomesmore

understandingand“morefullyhuman”.Sheenlargedonthis:“morefully

developedinallaspectsofyouremotionallife”.Thedifferentviewsinthegroup

makethegroup“moreexpansiveinitspossibilities”,becausethereare“more

voicesinagroup,andmoredirectnessandfrankness”,andthisagainforcesthe

individualto“confrontdifferentaspectsofyourself”.I.3.alsoimmediately

answeredatlength,givingacomplexresponse.Theindividualgroupmembers

needtoknowthat“theirtherapistisontheirside”,thattheyhavea“special

relationshipwiththeconductor…apersonalindividualrelationship...asortof

connection…theyknowyouunderstandsomethingaboutthemasapersonin

theirownright”.Atthesametimeshestatedthat“themostimportantthingin

agroupistheothergroupmembers”.Whatthegroupandtheindividual

membersneedis“thetherapist’smind…anemotionalmind”.Allthevarious

theoriesofthetransference,counter-transferenceandinter-subjectivityall

meanaprocessliketheFoulksianideaof‘translation’,whichshedescribedas

givingit“somekindoflanguage”.Theninastrongstatementofherclinical

mind-lineshesaid“…soIuseallsortsoftheories,Idon’treallycare,ifIthinkit

ishelpfultothepatient,Ijustuseit”.Shefurtherexplainedthatthegroup

analysthadto“allowyourselfemotionallyandactuallyjusttogetlostbecause

youknowthatyouaregoingtobeabletouseyourmindtorecoveryourself”.

Thisprocessthenled,throughtranslation,tothegroupmemberfeeling

recognisedorunderstood.

Thenextsub-questionwas:“Whatismostdifficulttodo,ortounderstand,in

groupanalysis,particularlyinrespecttothechangeprocess?”I.1.answered

straightawaywithacomplexstatementaboutthedifficultyofgroupanalyst

beingthat“theanalystisinthegroup,isanothermemberofthegroup”andis

thereforesubjecttothedynamicsandforcesofthegroup,anditisthendifficult

to“disengage…andknowwhatisreallygoingoninthegroup”.Whenagroup

“losetheirwayorbecomestuck”thenmanygroupanalysts,shethought,have

said“Idon’thaveacluewhatisgoingoninthatgroup”.Sheexpandedonthis:

“youdon’tknowwhatisgoingon…youcan’tunderstandthegroupasa

whole…whatisitthatisgoingon?”Groupanalysisishardbecauseitgets

“amplified”bythesevenoreightgroupmembersandthegroupanalysthasto

“contain”andthinkaboutalltheindividualsandthegroup-as-a-whole,and

“sometimesisitnotthesamething”.I.2startedbysayingthatthemostdifficult

thingwasknowinghowto“provoke’theprocessofdevelopmenttomaturity.

Howdothegrouplearn.Shegaveanexampleofthegroupanalysthavingto

stoponegroupmemberfrom“monologueing”.Thatpersonmayfeelangry,

hurtorrejectedanditthenbecomesimportanttoworkwiththenegative

transference.Shethendrewaninterestingdistinctionbetweenunderstanding

groupanalysis,whichshesawasintellectual,andcomprehending,whichwas

“muchmoreholdingthewholething”.LikeI.1.shemadealongspontaneous

statementaboutthegroupanalystfeelinglost:“forlong,longtimesIhaven’t

hadaclueaboutwhatwasgoingonandIfoundthatalwaysreallyawful,sothat

isterribletotolerate,thatasagroupanalystIshouldknowwhatisgoingon,I

shouldbeabletohelpthegroupdevelopthiscapacityforchangeandIdon’t

knowhowtodoit”.

Theresultwasafeelingof“beingoverwhelmedbyeverythingthathappensin

thegroup”.Thisfeelingwasstrongestinanewgroupwhenshehadnotyetgot

her“bearings”.Theprocesswasquitecomplex.Themostdifficultthingwasher

stateofmindwhenshethenfelt“notgoodenoughatthisjob”,anddidnot

knowwhatshewasdoinganddidnotunderstandthegroup.Thewaythrough

wasremindingherselfthatshedidnothavetounderstandit,itis“reallyjust

holdingitandlettingitfinditsowndevelopment”.Thismadeherthinkfirstof

Foulkes,and‘trustingthegroup’,andthenKeats’sideaof‘negativecapability’,

andtherefore,byimplication,Bion(Bion,1970,p.125;Williams&Waddell,

1991,p.119).

I.3.tookadifferentdirectionatthebeginning,andfeltthatthegroup’s

resistancewasthemostdifficultthing,andgavetheexampleofagroupthat

shehadtakenoverfromanothergroupanalystandaforayearhada“terrible

time”,notgettingdownto“whatIthinkhappensingrouptherapy”.The

resistancewasto”workinginthegroup”,toopeningup,andbyunconscious

attacksonherandbyalwaystalkingofleavingthegroup,whichshethought

mightbeabouttestingherresilience.Thisresistancewasfrustratingforher,

andshehadtoleantotoleratethis.Thisledhertotalkaboutthe

psychoanalyticconceptsthatshecalledon,indifficultclinicalsituations,aspart

ofherclinicalmind-line,likeWinnicott’sconceptofthedestructionandsurvival

oftheobject(Winnicott,1974,p.105).I.4inheransweralsoemphasizedthe

importanceanddifficultyof“holdingback”,beingpatientand“stayingthere

withit”.Sheadded:“IfIgiveagrouptimetoexploreitthemselvestheyreally

dochangealotmore”.Shealsotalkedabouttheneedtoadapttechniqueto

individualpatientsandtoldastoryaboutaverydifficultpatientwhoneeded

hertochangesomeaspectsofthewaythatsheworked.Whatwasalsovery

hardforherwasagroupmemberleavingbeforeshethoughttheywereready.

Shegaveanexampleofapatientwhowantedtoleave,“gooutintotheworld”

andalsothoughtthiswasamistake,shefeltsheshouldsupportherbecause“I

didn’twanthertogooutintotheworldfeelingthatshehaddonethewrong

thingforherself”.

Question3

Thisquestionwasintendedtoexplorethepersonaluseofclinicalconceptsasa

centralpartoftheclinicalmind-line:“Whattheoreticalconceptsandideasare

mostusefultoyoupersonallyasagroupanalystwhenyouthinkaboutyour

clinicalgrouppractice?”I.1gaveafullandconfidentresponsetothequestion,

listingthebasicpsychoanalyticconceptslike“tryingtomaketheunconscious

conscious”,whichledtotheneedtohelppeopleinthegroup“verbalise”and

exploretheir“unconsciousprocesses”andthegroup-as-a-whole,whichshe

connectedwithBion.Sheaddedthe“Foulksianapproach”of“allthetime

changingthelens”:“lookingattheindividual,lookingatthegroup,lookingat

yourself”.Shehadalsotriedtousetheconceptofthesocialunconscious

(Hopper,1999)thinkingabouthowthegroupwasaffectedbysocialand

politicaltraumaintheoutsideworld,andhowthismightcontributetoshared

paranoidanddissociativedefences.I.2alsoansweredstraightawaywithmatrix

andtranslation.Shefeltthattheconceptoftranslationwas“totally

undervalued”inbothindividualandgroupanalysis.Itisoneofthe“major

piecesofwork”forpsychotherapists.Sheaddedthatmirroringisalso

important.Shefeltthat“manypeopleinthefielddon’tquiteknowhowtowork

withthenegativetransference’,itistoofrightening.Butforherthematrixwas

the“mainidea”itwasa“complexandrich”concept.Sheaddedthe

‘condenser’,alesscommonFoulksiannotion.Aftertalkingabouthoweasyit

wastoforgetalltheotherFoulksianconceptssheremembered“malignant

mirroring”(Zinkin,1983),whichagainwentback,inherview,tothenegative

transference.I.3.alsowentstraightto‘translation’andthenthegeneral

importanceofbeingpatientandwaiting”forsomethingtounfold…tobeput

intowords”,the“processofsomethinggettingtobearticulate”.Sheadded

metaphorsingroups,andthiswaslinkedtotranslationasthemetaphoris

discussedinthegroup.Theimportanceofmetaphorswastodowiththe“group

becoming,attemptingtocohere,tofindasharedwayofdescribing…what

couldbeastruggleinthegroupatthattime”ora“morepalatablewayof

bearingverydifficultfeelings”.Thematrixwasalsoimportant,andtrustingthe

group,andfinally,theimportanceofthesetting,thecircleofchairs,andthe

dynamicadministration.I.4beganwithmirroring,whichshesometimesusedin

thegroup,butinterestinglyshesaidthatshedidnotrallyunderstandwhat

Foulkesmeantbythematrix,andpreferredherselftotalkabout“thebuilding

ofawebofrelationships”,whereby“relationshipsbecomefamiliar”intheway

thatbabiesbecomefamiliarwiththeirmother’ssmell,andthenthesmellofthe

restofthefamily.Thegroup“buildupaplacewheretheyfeelcomfortable”.

The“comfortableroutine”thenwasforher,a“kindofmatrix”.Shealsofelt

thattransferenceandcounter-transferencewereimportant,andtheassociated

“familyresonance”.Sheaddedanotherconcept,forwhichshefelttherewasa

notagroupanalyticterm,whichwasthewaythatgroupmembers“borrow

eachother’spathologyandtheyrehearsetheirunderstandingofitthrough

otherpeople”.Thegroupmembers“canhelpotherswithproblemsthatthey

themselveshave,buttheycan’thelpthemselves”.

Thefirstsub-questionwasdesignedtobuildontheresponsestothemain

question:“Whenyouareworkinginagroup,whichworkingconceptscome

mostoftentomind,andwhicharemosthelpfultoyou?”I.1gaveaninteresting

firstresponsetothis,indicatingwhatshefeltwasanimportantpartofgroup-

analytictechnique.Whatshetriedtogetholdofwas“unconscious

communication”:“whatisthispersonsayingand…howcanIfacilitatethegroup

torespondtothatpersoninawaythatishelpful,thatisnotgoingtoalienate

thispersonfromthegroup”.Ifagroupmemberwascommunicatingbybeing

provocative,forexample,thegroupanalystmustfindawayto“pre-empt”the

group’spossibleattackonthatmember,andtohelpthegrouptoexploreand

tothinkaboutwhatwashappeningratherthanreact.Sherelatedthisto

mentalisation(Bateman&Fonagy,2006).Whatwasalsoimportantwas“notto

presentyourselfasifyouknow”buttohelpthegrouptoexploreandreach

theirownconclusions,oratleast,to“arousetheircuriosity”.Interestingly,she

alsofeltthattheimportanceofnotbeingtheexpertwasconceptualizedin

groupanalysisbytheuseofthewordsconductororfacilitator.I.2.went

immediatelytoprojectionandprojectiveidentification,butapologisedforthese

notbeingpurelygroupanalyticconcepts,andthenemphasisedthatshewould

neverusethesetermsinaclinicalgroup,butmight“explainthatpeopletryto

putthingsintoyoutogetridoftheirownstuff”.Denialandtransference,and

theJungianideaoftheshadowwerealsoimportant,and“victim/perpetrator

dynamics”.Whatwashowever,mostusefultoherclinically,particularlywhen

shefeltlostandanxious,andwhenshethoughttoherself“OhmyGod,I’m

supposedtodealwiththis,Ihaven’tgotaclue”,thenshecalledontheideaof

keeping“anopenmind”,andsometimeimaginedthistoherselfas“openingher

headlikethisandseewhatcomesintoit”.Sheexpandedonthisimportantand

verypersonalstatementoftryingtostayopentoexperiencewhenunder

pressureinthegroup:“TheweirdthingformeisthatIdon’tthinkIwillopen

myselftotheunconsciousinthatway,Iamopeningmymind,butitcertainlyis,

IcanrelaxwhenIrememberthat,tokeepanopenmind,tostartrelaxing,and

anotherprocesscanstartbecauseIrelinquishcontrolreally,whichisthe

reverie,sothat’smostusefulforme,Ithink”.I.3.startedwithalongdiscussion

ofcounter-transference,whichshereliedon“allthetime”,andrelatedittothe

differencesbetweengroupandindividualpsychotherapy.I.4.wentstraightto

thecentralideathatthegroupanalyst“shouldletthegroupdoit”,asshe

herselffounditsohardtoholdback,notbecauseshedidnottrustthegroup

butbecausesheherselfbecame“excitedandinvolved”.Anothervery

important,buthardtodefineideaforherwastheneedtohelpthegroupto

keepholdofapieceofwork,“Idosomethingaboutnotlettingitgetlost…Isort

oftryandkeepthelinkalive”.

Thesecondsub-questionbuiltonthepreviousresponse:“Canyougivearecent

example?”I.1startedbytalkingabouttheearlystagesofthegroupandthe

difficultyofthedemandsonthegroupanalystbecauseoftheearlydependent

stageofthegroupandtheirwishforthegroupanalysttohavealltheanswers.

FortheFoulksiangroupanalystitwasimportanttoresistthetemptationand

possiblytointerpretthedependence,atthesametime“encouragingthemto

thinkabouttheirpredicament”.Shethengavetheexampleoftakingovera

groupfromanunwellgroupanalyst.Thegroupweredependent,believingthey

couldnotfunctionwithouttheiroldgroupanalystandnotacceptingand

attackingtheirnewtherapist.Thenewgroupanalysthadtopworktogetthe

grouptoseethattheywereallstillhereandhowimportantthegrouphad

been,notjustthetherapist.Thisthenenabledthemtomournforthelost

therapistandreturntothetherapeuticwork.Thegroupanalystwastherefore

onemorememberofthegroup.Shethendevelopedthisintoawideraccount

oftheimportanceofconceptsaboutmourningandtheiruseineverydaygroup

analysis:lossofself,denial,anger,blameandevenadelusionalstage.She

added:“Thegroupmournsallthelosses”.I.2.wentstraightintoanexampleof

agroupmembersayingthatshewantedtotalkaboutsexuality,andthen

insteadtalkingatgreatlengthabouthermother.Shefeltangrywiththis

patient,whohadatendencyto“gooffinherownmind…aroundincircles…and

sheisnotactuallytalkingtotheroom”,andsointerruptedherandsaidthiswas

notaboutsexuality.Interestingly,atthatpointanothergroupmembersaidthat

whentheygotanxiousabouttalkingaboutrelationships,theyinsteadtalked

abouttheirfamily.

Shefeltthatthiswasabadexample,asitwasnotanalyticalenough,althoughit

hadbeenveryhelpful,butinfactitwasagoodexampleofthegroupanalyst

feelingopenenoughtosaywhatwasontheirmind,andthisthenmovingthe

groupforward.I.3.alsomovedimmediatelyintoanexampleofalong-term

groupmemberwhowastalkinginaveryencapsulatedwayabouteverything

beingmuchbetter,butmentionedinpassingthatherpartnerdidnotwant

childrenThegroupanalyst,thinkingaboutafamilyconnectionandherown

workwithmothersandbabies,usedhercounter-transferenceperceptionto

pointoutwhatwasmissingfromthepatient’saccountwasherownwishfora

child.Thegroupbecameinvolvedwithherthen,andonegroupmembershared

theirowninabilitytoconceive,whichgaverisetoanemotionalsilenceasthe

patient“feltmuchmorepartofthings”.Thiswasthenagoodexampleof

trustingandfollowinghercounter-transferencefeelingsandthoughts.I.4’s

examplewasaboutagrouppatientwhowasalwaysverysilentinthegroup,

andwas“preoccupiedwithallthetimethingsthatcouldn’tbeputintowords”.

Helpinghertofindwordsinthegroupforherdespaircouldbeachievedby

helpinghertomakecontact,perhapsinasibling-likerelationshipinthegroup.

Thisisaversionoftranslation,“thesymptombeginstospeak”aspartofthe

processof‘findingalanguage”.

Question4

Thisquestionwasalsoclinicallyoriented:“Canyouthinkofcommentsthatyour

patientshavemadeinthegroup,particularlyattheendofthesession,oratthe

endoftreatment,aboutthewaysinwhichthegroupexperiencewashelpfulto

them?”I.1.hesitatedandthensaidthatworkingwithborderlinepatients,one

ofthemhadsaidthat:“itisthegrouphaskeptmealiveandIcouldn’thave

survivedwithoutcomingtothisgroup.Iwouldhavekilledmyselfalongtime

ago”.Anotherpatient,whowasinbothindividualandgrouppsychotherapyhad

startedby“denigrating”thegroupbutthenrealisedthatbothwerehelpful.Her

individualtherapistwouldmakeacommentwhichshedeniedbutwhenallthe

othermembersofthegroupsaidthesamething,thenshelistened,“it

clicked…thisiswhatIdo”.Eveninthegroup,thegroupanalystcanbedismissed

moreeasilythantheothermembers,“whoarethemselvessufferers”.When

thegroupmembersareworkingastherapistsinthegroup:“thatisanotherone

ofthemostextraordinarythingsaboutgroupanalysis”.Shethengaveanother

exampleofagroupmemberwhowasalwaysveryhelpfultoalltheothers,and

theypointedouttohimthatheavoidedhisownneedforhelpbyhelpingothers

andsaid:“itisalmostlikeyouareatseaandthesepeoplearelikethesepieces

ofwoodthatyoucangrabholdoftokeepyourselfafloat”.I.2.saidthatagroup

member,onfinishingtherapy,saidthatshe“hadneverworkedatsuchadeep

level…wenttoplacesthatshenevergotintobefore”.Thisreferredto

“infantile”,borderlinematerial,whichinterestedherbecauseofherbeliefin

Winnicott,andparticularly‘FearofBreakdown’(Winnicott,1963).Shewenton

tosaythatsomegroupmembersthankherandthegroup,butgenerallyshe

stopsthesessionexactlyontime,ofteninthemiddleofsomething,anditis

hardtorecallactualcommentsbythegroup.I.3.hesitatedandthengavesome

examples:“Idon’tfeelsoalonewiththings…Idon’tfeelsoalien…Idon’tfeelso

mad,actually,sometimes…andallthosethingsareusuallylinkedup.Idon’tfeel

somadbecauseIhaverealisedthatIamnottheonlyonewhofeelslikethis”.

Shethenaddedthattherearedifferentkindsofthank-you:“verywarm,well

that’sarelief,youunderstandme…thanksforrecognizingme,howIfeel,what

happens,orelsethanks,thankgodthat’sover”.Themorenegativeremarks

wouldbe:“youknowitisjustoneandahalfhoursnowIhavegottherestof

theweekandnowIhavejustgottoleave”.Theproblemhereisgroupmembers

whodon’tfeelsafe“lefttotheirowndevices”,andwhocannotyetthinkof

“takingtheexperienceintomylifeoutside”.ForI.4.whatcametomindfirst

wasagroupmemberwhohadexperiencedagreatdealoflossandwhofound

the“on-goingmetaphors”wonderfulinthegroupasawayofbeginningtotalk

aboutdifficultmatters.Butthispatienthadalsodiscoveredinthegroupthat

otherpeoplefoundherfunnyandentertainingandenjoyedhercompany.This

was“somethingaboutalife-force,aboutbringingheraliveinthegroup”.

Anothergroupmembertalkedabouthisdreamsintowhichmuchofhis

imaginativeemotionallifehadgone.Whenhetalkedaboutthedreamsandthe

groupmemberswereinterestedhebegantotakemoreinterestinother

people.Inanothergroupfourpeoplewithverylonelylivesbecamevery

involvedwithoneanotherinthegroup,a“connectionwitheachotherthatitis

sortoflikehavingbrothersandsisterstogrowupwith,thatonlytheycould

recognizedsomethingthattheyhadallbeenthroughtogetherthatnobodyelse

could”.

Question5

Thisquestionwasdesignedtohelptheintervieweesthinkinaslightlydifferent

wayaboutthechangeprocessitself:“Whatusefulmetaphorsorimagescome

tomindwhenthinkingaboutthechangeprocessingroupanalysis?”ForI.1.the

rulingmetaphorwasthefamily,morethanmotherandchild.Shethoughtthat

thegroupassignedeachmembera“particularrole”whichwasconnectedwith

theirroleintheirfamilyoforigin,andthatifthisrolewasassociatedwitha

“disturbanceataparticularstageofdevelopment”thenthatwouldberepeated

inthegroup.Shethengavetheexampleofagroupmemberwhowasalways

treatedas“thecleverone”intheirfamilyoforigin,andthenthegroup

“unconsciously”expectthismembertorepeatthis;orthe“stupidone”,whodid

notfeelthattheirviewsmatteredinthegroup.Thechangeprocessisthen

drivenbythegroupanalystandthegroup“helpingthemnottogetstuckinthat

role”.I.2.talkedatlengthinresponsetothisandimmediatelythoughtofthe

Jungianconceptsderivedfromalchemy,thepotoralembic,inwhichalchemical

transformationtakesplace.Thecircleofthegroupwasa“container”,likean

alembic,andgroupmemberswouldsaythingslike“Ineedtoputthisintothe

middle...orputthisinthepot”,andinthealchemicalmetaphor,thedistillation,

whichwascloselyconnectedforI.2.withtheFoulksianconceptofthe

“condenser”.Further,shesaid,groupscanbedepressed,andthiswas

connectedwiththealchemicalstageofthe“nigredo”,thedarkstage

(Papadopoulos,2006,p100).Shethenaddedthatforherthematrixcouldbe

imaginedasaphysicalnetwork,andthatgroupmemberscouldfalloutofit,or

notconnecttoit.Shethenbroughtthesetwosetsofmetaphorstogetherby

imaginingtheabsenceofthetableinthemiddleofthecircleofchairsasa

“crater”,“plug-hole”or“blackhole”downwhichthedisconnectedgroupmight

fall,ifitisnotheldtogetherbythenetworkofthematrix.Thetabletherefore

alsowasareceptacleandametaphorforthemealthatthegroupcooks

together;thecontainingandholdingfunctionofthematrix.I.3.alsotalkedat

lengthaboutwhatwasforhertheveryimportantgroupofmetaphorstodo

withwater:thesea,diving,drowningandre-emerging.Theimagewasofdiving

intothegroup,goingdowntothebottomandfindingawayto“swimtothe

surface”andbreatheagain.Forherthiswasconnectedwiththeunconscious,

withthewomb,birthandrebirthandthenfurtherwiththesubjective

experienceforindividualgroupmembersoffeeling“terriblyoverwhelmedand

claustrophobic”,andsheaddedthatindreamsaboutdeaththerewereoften

imagesofwater.Thisthenledtomuseaboutthegroupanalyst’ssubjectivityin

thegroup,andbeing“tunedinatsomedeeplevel”,andgavetheexampleofa

grouptalkingatlengthaboutpetswhenherpetwasunwell.Wasthisbecause

thegroupanalystunconsciouslycommunicatedinterestorlackofinterestina

topic,bysmilingornodding,orbychangingbodyposture?ForI.3.cinemawas

important,andsheusedanimagefromafilmofawomanattemptingsuicideby

drowning,butthen“choosinglife”andcomingback“uptothesurface”,to

illustrateagroupandindividualprocessof“plummetingtothedepthsofyour

ownunconscious”.Thiswasanexampleofherownpreoccupations

“resonating”withthoseofthegroup:“atemplateof…co-constructionbetween

groupconductorandgroupmembers…theco-constructionofnarrativeand

constructionofidentity”.Shethenfurtherconnectedthisimageofthegroup

andthegroupanalystconstructing“somethingtogether”withmotherand

infant,andwithPines’paperon“mirroring”(Pines,1982),andthemythof

NarcissusandEcho.Shealsosaidthatinshorttermfocusedgroupstherewas

oftenimageryaboutwater,andgavetheexampleofagroupforcompulsive

eatersspeakingabouttheirfearoftheboatcapsizing.Shefinishedheranswer

bysaying:“Andwefeelatseaquiteoftenasgroupanalysts,withoutdrowning

butwithoutkindofgettingoutofthewater”.I.4,anexperiencedtraininggroup

analyst,feltthatshehadtoseparateouttraineesfrompatientstoanswerthis

question.Fortraineesthemetaphorinhermindwas”completecollapseand

madness”.Theimpactofthegroup“triggersthemadnessthattheycameinto

therapytodealwith”,andthereisprocessof“fragmentationand

madness…havingtofragmentandpulltogetheragain”.Butinalong-termgroup

thenthegroupgraduallybecame“moreunderstandingabouttheprocess

themselves,andmorealongsideme…becausetheyarekindofcelebratingan

understandingofthemselves”.

Question6

Thelastquestionwasdesignedtohelptheintervieweessummarise:“So,finally,

whatisthechangeprocessingroupanalysis?Howdoesgroupanalysishelpthe

membersofthetherapygroup?”I.1.feltthatshehadansweredthisquestionin

theprocessofrespondingtothepreviousquestion.Theprocessofgivingupa

familyrole,whichwasre-experiencedinthepresentinthegroupalongwiththe

developmentaldisturbanceassociatedwithit,wastheprincipalagentof

change.The“developmentaltask”iscompleted,andthegroupmemberscan

then“putinplace”whatwas“missing”,andare“abletobemorerobustand

withstandwhateveristhrownatthem”.I.2.gavetwoexamplesofchangeina

group,emphasisingthatthetwopatientshadchangedalotalongsidethe

changesinthegroup.Onegroupmemberhadlearnedto“listenandtalkwith

lessanxiety”,had“learnedtrust…lessfearoftalkingtoothers…andspeakingher

mind”,andfoundthat“itcanbeenjoyabletoconnect…orconverse…the

pleasureoftalkingtoanotherhumanbeing”.Theothergroupmember,who

wasanxiousandreluctanttojoinagroup,andtalkedabout“hatinghuman

beingsandnotbeinginterestedinthem”,hadalsochangedandwasnow

interestedinothers.Shefeltthathehadchangedlargelybecausewhenhetold

thegroupthathehatedeverybodyandwasveryprovocativethegroupdidnot

retaliate,butaskedhimwhyhethoughtthatway.Thegroup,inotherwords

wasinterestedand”notjudgmental”.I.3.answeredwithadescriptionofthe

generalprocessofchangeasshesawit:“fundamentallyovercomeisolation,to

bepartofsomethingshared…findingyourselfinagroup,differentiating…finding

yourownindividualityandvoice”.

Sheadded,thinkingitthroughasshespoke,thatthegroupprocesshelps

“regulateeverybody,arebalancing…thegroupitselfbeingtheway,asabody

thatregulatesorsomeobjectthatregulates,calmsthemdown”andthatthis

processis“afunctionofmothering”.I.4.drewadistinctionbetweenshortand

long-termgroups.Intheshort-termgroupsthemostimportantpartofthe

changeprocesswasthe“feelingthatthesymptomstheyhadweresharedby

others,theywerenotalone,Iamnottheonlyone”.Inthelonger-termgroupsit

wasthe“senseofgoingthroughthingsoveraperiodoftimeandseeinghow

differentlytheytelltheirstory,likewhentheycomebacktoit,andnew

membersjoin”.Sogroupmembersbecomemoreawareof“whattheyknow

andwhattheyunderstand”.Whatisalsoimportantisthe”feelingthatthe

groupwillbealongside”thegroupmemberovertime.Forsomegroup

memberswithsevereproblemsthegroup“sufficientlysustained

them…becausetheyhadenoughofarelationshipthattheycouldmanageand

thatstoppedthemfromfeelingsoaloneandsoisolatedandsodifferentfrom

everyoneelse”

THEMATICANALYSIS

TheInterviews

AsdescribedinChapters3andabove,theinterviewswererecordedandthen

transcribedbytheresearcher.Thetranscribedmaterialwasthensubjectedto

thefirststageofathematicanalysis(Boyatzis,1988;Braun&Clark,2006,

2013).Thisinvolvedacarefulscrutinyoftheinterviewmaterial,lookingfor

single‘unitsofmeaning’(Braun&Clark,2013;Saldana,2009).Thesewere

wordsorphrasesthatappearedtocarrysignificantmeaningorexplanatory

valuefortheinterviewee,forminganimportantpartofanargument,

explanation,clinicalstoryorstatementofbeliefaboutthegrouptherapy

process.Theseformedthecodes,thebasisforthefirstlevelofthethematic

analysis.(SeeAppendixCforanexcerptfromacodedinterview).

Codes,secondarycodesandthemes

Overalloftheinterviewstherewereatotalof340individualcodes(theseare

listedinfullinAppendixB).Theseincludedsinglewordsforfeelings(for

example:excitement,gratitude,anger);forsymptoms(depression,anxiety,loss,

trauma);waysofrelating(interaction,support,belonging)andtechnicalterms

(projection,resonance,matrix).Thereweremanycodesconsistingalsooftwo-

wordandlongerphrases(beingoverwhelmed,projectiveidentification,finding

yourselfinthegroup).Mostofthewordsandphraseswereinordinary

language,asweretheinterviewresponsesasawhole.Notonlywastherean

apparentreluctancetorefertoauthorities,butalsoasparinguseofjargonand

technicalterms.

Thecodeswereinitiallysortedintosevensecondarycodinggroupsasfollows:

1. Cohesion,belonging

2. Mirroring,repetition,reflection

3. Thegroupanalyst

4. Theories

5. Thechangeprocess

6. Groupprocessandexperience

7. Thegroupunconscious

Afterfurtherstudyitbecameclearthattherewasoverlapandconfusionin

thesesevencategories,andthereweretoomanytoallowmorethrough-going

analysis.

However,thesevencategoriesprovedausefulbasisfornarrowingdown.The

firstsecondarycodeof‘cohesionandbelonging’,andthesecond,‘mirroring,

repetitionandreflection’,clearlycouldhavebeenjoinedinonecategory.

Togethertheyclearlyreflectedasharedviewonthegroupprocess:whatwas,

intheopinionoftheinterviewees,mostvaluabletothegroupchangeprocess

andmosthelpfultothegroupmembers.Thesethentogetherconstituteda

revisedfirstsecondarycoding:‘thegroupspecificfactors’,inwhichtherewere

eightyinitialcodes.Thenexttwosecondarycodings,‘thegroupanalyst’and

‘theories’,thenfelltogetherintoarevisedsecondarycodingcategory‘group

analysisandthegroupanalyst’.Talkingabouttheirworkinthegroup,the

intervieweesdidnotmakeaseparationbetweenthemselves,asindividual

groupanalysts,andwhattheypersonallydidorthought.Inthisnewcategory

therewereseventy-fivecodes.Thefifthoriginalcategoryofthechangeprocess,

the‘changeprocess’remainedasanewthirdsecondarysub-theme,ofsixty-

fourcodes,andthelasttwo,‘groupprocessandexperience’and‘thegroup

unconscious’alsofellnaturallytogetherasafourthrevisedsecondarycodeof

‘groupprocess’,containingonehundredandtwentyonecodes.

Thecodeswerethenresortedandre-themedinthelightoftherevised

secondarycodes.Thisallowedmoreinterestingmaterialtoemerge.Within

eachnewsecondarycodetheindividualcodesfellintoseveraldifferentsub-

sections.Itthenbecameclearthatthefournewsecondarycodescouldbe

furtherbroughttogetherintotwoover-archingthemesof‘thegroupanalystin

thegroup’and‘thegroupchangeprocess’.BraunandClarke,intheir

authoritativestudyofthematicanalysis,describethisprocessofthethemes

narrowingdownastheanalysisproceedsovertime(BraunandClarke,2006,

2013).Thefinalstructureofthethematicanalysiswasthereforeasfollows:

THEME1.TheGroupAnalystintheGroup

A. GroupSpecificFactors

B. GroupAnalysisandtheGroupAnalyst

THEME2.TheGroupChangeProcess

C.TheChangeProcess

D. GroupProcess

Thefindingsofthecodingprocesswillnowbedescribedinmoredetail.

A.Group-specificfactors

Theeightyseparatecodesofthisfirstsectionwereorganizedintoeight

categories:

1. GeneralFeaturesofGroupAnalysis

2. Groupdifficulties

3. Theworkofthegroup

4. Thesetting

5. Thetherapeuticfactors(Foulkes)

6. Mirroring/reflection/self

7. Cohesion/sharing

8. Family/motherandchild

Inthefirstcategorythereweresevencodes,allrathergeneralized,andmostly

concernedwithlinkedpairsofconcepts:individual/group,subject/object,

past/present,inside/outside.Eachoftheseappearedonce,alongwithother

generalideasoftheimportance,andworkofthegroup.Onecode,

complexity/multi-facetedappearedtwice.Inthesecond,concernedinageneral

waywithgroupdifficulties,therewereeightindividualcodesliketrauma,loss

andidealization.Thethirdcategoryalsocontainedrathergeneralconceptslike

safety,understandingandinteraction,concernedwiththeworkofthegroup.

Threecodeshowever,stoodout.Equalityandgroup-asa-wholewereeach

mentionedtwice,andtrustfourtimes.

Inthefourthcategory,ofthreecodes,therewasastrongeragreementabout

somecentralgroupmatters.Settingappearedseventimes,thecircleas

containertwice,andthegroup-roomtablealsotwice.Thefifthcategoryofthe

therapeuticfactors(Foulkes)containedtwelvecodes.Thematrixappeared

seventimes,containmentfourtimes,translation(aFoulksianterm)threetimes

andthecondenser,exchangeanddynamicadministrationeachtwice.The

patternofcentralpre-occupationsandmattersofagreementseemedtobe

emergingearlyinthefindingsfromthethematicanalysis.Thiswasconfirmedin

thenexttwocategories.InMirroring/Reflection/Self,witheightcodes,there

wassubstantialconfirmationofaninterestinself/deniedpartsoraspectsofself

seenorreflectedinothers.Thiscomplexcodeappearedninetimes,andthe

relatedcode,mirroring/hallofmirrors,fivetimes.Thecode

understanding/differentiationofexperienceappearedfourtimes,sotherewas

agreatdealofrepeatedagreementbetweentheintervieweesinthiscategory.

Theotherfivecodesinthiscategorywereallrelatedtotheabovecodes:mirror

neurons,bearingwitness,reflectiveaboutothers,experiencerepeatedin

group,groupasseparatefromfamily,buttheywererecordedasseparatecodes

astheindividualintervieweesattachedaparticularmeaningtothem.Inan

overallanalysis,thewholecategoryconstitutesoneimportantsetofideas

abouttheworkofthegroupandthisisarguedinChapter4.Thenextcategory

ofCohesion/Sharing,witheighteencodes,isimportantforthesamereasons.

Themostsignificantwasthecode,partofsomething/sharing,withseven

mentions,andthenthecloselyrelatedcodesofpartinstory,cohesion/cohere,

thingsincommon,belonging,notalone/alienandlearningfromeachotherin

thegroup/peerlearning,eachmentionedtwice.Inthelastcategoryof

Family/MotherandChild,withfivecodes,therewassomeoverlapbetween

threementionsofparent/motherandchild,andthreeofthereflectionof

family/childinfamilyinthegroup/familytransference,andtwomentionsof

siblings.Itwasclearatthisearlystageoftheanalysisthatcertainsignificant

conceptswerestronglyshared,andthiswillbediscussedfurtherinChapter4.

B.GroupAnalysisandtheGroupAnalyst

Theseventy-fivecodesinthesecondsub-themefellintosixcategories:

1. References

2. Generalfactorsofgroupanalysis

3. Thegroupanalyst’squalities

4. Difficultiesinconductingagroup

5. Thegroupanalyst

6. Theoreticalconcepts

Thereweresixcodesinthefirstcategory,sixteenofwhichwereFoulkes,which

isverynotable,twoforBion,twoforNitsunandoneeachforPines,Jungand

Garland.Inthesecondcategorytherewereeighteenseparatereferencesto

differencesbetweenindividualandgrouptherapy,whichisalsonotable.Allthe

restweresinglereferences.Inthethird,theGroupAnalyst’sQualities,among

singlecodesaboutwhatthegroupanalystshoulddo,likeexcitement,

commitmentandengagementtherewerefourmentionsofcuriosity,fourof

notknowing/notbeingtheonewhoknowsandtwoofpatience.Thefourth

category,withninecodesaboutdifficultiesinrunningagroupwasamixtureof

singlecodesaboutproblematicmattersinthegroup,likesexandpolitics;

difficultfeelingsfeltbythegroupanalyst,likebeingoverwhelmedortrappedby

despair;anddifficultbehaviourinthegroup,likeavoidanceandborderline

symptoms,or,mostnotably,unconsciousattackson/testingtheGAwithtwo

mentions.Thefifthsection,abouttheGroupAnalyst,withfourteencodes,

overlappedtosomedegreewiththesectionabouttheGroupAnalyst’s

Qualities,buttherewasagreateremphasisintheseresponsesaboutthegroup

analyst’sworkinthegroup,liketheuseofself,andresultingproblematic

behaviorandattitudes,liketheGA’sblindspots,ortheGA’svulnerability.One

importantfactwastheninementionsforthetermconductor,whichisthe

centralFoulksiantermforthegrouptherapist.Therewerefivementionsforthe

GAin/partofthegroup,anothersignificanttheoreticalcommitment,andtwo

fortheGA’smind.

Inthesixthcategory,TheoreticalConcepts,thereweretwenty-onecodes,

mostlysinglereferencestothesortoftheoreticalideasthatcametothe

interviewees’mindinthegroup,oftenfromoutsideGroupAnalysis,like

reverie,projectiveidentification,fearofbreakdown,theshadow,andfrom

within,likeresonanceandfigure/ground.Themostsignificantcodewasthe

matrix,withfourmentions,whichisacentralFoulksianconcept.Nextwas

counter-transference,withthreementions,andtransference,projection,

transitionalobjectappearingtwiceeach.

C.TheChangeProcess

Thereweresixty-fourcodesinthissection,andtheyfellintofourcategories.

1. TheGroupChangeProcess

2. TheGroupasaWhole

3. TheGroupAnalystintheChangeProcess

4. GroupChangeFactors

Allofthecategoriesinthissectiontendedtoshowlargenumbersofsingle

referencecodes,whichmayreflectthedifficultyinconceptualizingthe

dynamicsofthechangeprocess.ButinthefirstcategoryoftheGroupChange

Process,withtwenty-fivecodes,therewerethreementionsofspeakfreely/say

what’sonmind/telling/speakingmind,andtwoeachofconnecting,puttinginto

words,thegroupontheirside,andthevalueofordinarypeople.Inthesecond

category,ofTheGroupasaWhole,witheighteencodes,thereweretwoeach

forhuman,narrativeandfamilyrepetition,buttherewasalsosomepossible

overlapbetweenothersinglecodes,whichaddressedimportantmattersin

slightlydifferentways.Beingalive,aliveexchangewithothers,thegroupkept

mealiveandthelife-forceofthegroupareallstrugglingtogetholdofdifferent

aspectsofanideathatisbothverygeneralandquitespecific,whichalsofurther

overlapswithbeinghuman.

ThethirdcategoryoftheGroupAnalystintheChangeProcesshadfourcodes,

butthiswasclearlysignificant,withtrustingthegroupinfourmentionsandnot

knowinginthree.Thesewerealsoveryclosetotheothertwocodesofletting

thegroupdoitandbeingalongsidethegroup.Thefourthcategory,ofthe

GroupChangeFactors,withseventeencodesalsocontainedalotofsingle

codes.However,understanding/insight/meaninghadfourmentions,

connecting/deeperlevel/engagementhadthreeandgrowthandchangetwo.

D.GroupProcess

Thefourthsub-themeoftheGroupProcesshadatotalofonehundredand

twentyonecodes,whichfellintofourcategories.

1. GroupProcess:NegativeFactors

2. GroupProcess:PositiveFactors

3. GroupProcess:Generalfeatures

4. GroupProcessMetaphors

Asinsomeoftheearliersections,therewerealargenumberofsinglecodesin

thesecategories,againpossiblyreflectingthedifficultyinconceptualizingthe

process.InthefirstcategoryoftheNegativeFactors,therewereforty-one

codes,coveringawidevarietyoftheoriesandgroupandindividualproblems.

Themostagreementwasoveranxiety/fear/danger,withsevenmentions;

gettinglost/lossofself/losingway/notfoundwithsix;

collapse/madness/breakdown/fragmentation,withfive;depressionandnot

understanding,withfour;andanger,holdingback/hesitation,isolationand

negativetransferencewiththreeeach.Beingoverwhelmed,beingvulnerable,

stuckness,denial,illnessandrejection/beinglefteachhadtwo.Manyofthe

singlecodes,likenotconnecting,andnowayin,werealsoonlyslightlydifferent

fromsomeoftheothermorefrequentlymentionedproblemsinthegroup.It

strikingthatthereweresomany,andsuchvivid,codesfordifficultiesand

dangersinthegroupprocessandpossiblereasonsforarethisdiscussedfurther

inChapter4.

Therewerethirty-twocodesforthepositivefactorsinthegroup,andthemost

frequentweretodowiththegroupbehavior,withsevenmentionsof

interaction/involvement/engagement/investment,fourforexploration,three

fortherelatedinterestingroup/otherpeopleandforawareness/self-

awareness.Thereweretwoeachforenjoymentofothers,reflection/self-

reflection,freedom,relaxing/comfort,understanding,processing

feelings/working-through,listeningandhearingandjoining/beingpartofthings.

Inthethirdcategoryorthegeneralfeaturesofthegroupprocesstherewere

forty-twocodes,andtherewereeightmentionsofthecentralityofgroup

developmentandchange,andsixofthegroupchangeprocess,andthreeeach

formetaphors,trauma,allowing/capacityforchange,thewebofrelationships

anddefences.ThereweretwoeachoffocusonGA,groupmaterial,groupasa

whole,symptomaticchange,resonance,interpretation,dreams,verbalization,

sharingtimeandexpectations.Finally,inthelastsection,GroupProcess

Metaphors,thereweresixslightlyoverlappingcodes,withthreementionsof

water/boats/seaandtwoofdrowningandremerging,withothersinglecodes

fordiving,surfaceandthedepthoftheunconscious.

Theme1:theGroupAnalystintheGroup

Thisfirstthemearosefromthecombinationofthetwomajorsub-themesof

‘GroupSpecificFactors’and‘GroupAnalysisandtheGroupAnalyst’.Inthefirst

ofthosesub-themes,themostfrequentcode,mentionedninetimes,was

self/deniedpartsoraspectsofselfseenorreflectedinothers.Thiscomplex

code,containingreferencestoanumberofimportantandrelatedideas,was

clearlycentraltotheinterviewees’understandingandconceptualizationof

whatwasspecifictogroupanalysis.Thenextmostimportant,withseven

mentions,werepartofsomething/sharing,setting,andmatrix,followedby

mirroring/hallofmirrorswithfivereferences,whichisinitselfveryclearly

relatedtothefirstandmostfrequentcodethroughtheobviousconnectionof

reflectionandmirroring.Thenextimportantcodesforthegroup-specific

factors,eachwithfourmentionsweretrust,containment,

understanding/differentiationofexperience,followed,withthreementions,by

translation,parent/motherandchildandreflectionoffamilyingroup.This

showsthedifficultyoftheinitialcodingprocess,wherebyverysimilar,orat

leastrelated,conceptsaredescribedbythedifferentintervieweesinquite

differentlanguage,arisingperhapsfromtheuseoftheconceptinadifferent

context.

Inthesecondsub-theme,GroupAnalysisandtheGroupAnalyst,themost

frequentcode,witheighteenmentions,wasthedifferencebetweenindividual

andgrouptherapy.Thisisclearlyveryimportant.Itcoversboththetheoretical

differences,astheintervieweessawthem,betweengroupandindividual

therapiesandthedifferencesintheirownpractice,asmostoftheinterviewees

alsodidalotofindividualpsychotherapy.Perhapsitindicatesacontinuing

preoccupationwith,andawarenessof,thespecialnatureofthegroupprocess.

Thesignificanceofthiscodewillbediscussedatgreaterlengthinthenext

chapter.ThisisfollowedbyFoulkeswhichappearssixteentimes,andwhichis

perhapsanindicatorofthelivelypresenceofFoulkesandhisconceptsinthe

groupanalyst’smind.Thenextmostfrequentcode,withninementions,is

conductor,whichistheFoulksiantermforthegrouptherapist,andthen,with

fivementions,groupanalystin/partofthegroup,alsoaveryFoulksianidea.

Therearefourmentionsofcuriosity,andagain,matrix,asthemostimportant

theoreticalconceptinthegroupanalyst’smind.Counter-transferenceappears

threetimes.

Theme2:TheGroupChangeProcess

Inthefirstsub-theme,oftheChangeProcess,themostfrequentcodes,withfor

mentionseachweretrustingthegroupandunderstanding/insight/meaning,

followed,withthreementions,byspeakfreely/saywhatisonone’smind,and

notknowing.Itisstrikingthattherewasamajorityofsinglecodesinthethis

sub-theme,perhaps,again,reflectingthedifficultyoftheconceptof,orthe

reluctancetoconceptualise,thechangeprocessingroupanalysis.Inthesecond

sub-themeofGroupprocessgenerally,thereseemedtobemoresharedviews.

Therewasastrongendorsementofthechangepotentialingroupanalysiswith

ninementionsofgroupdevelopmentandchange,andsevenof

interaction/involvement/engagement.Therewasalsoalivelyawarenessofthe

difficultiesofgroupanalysiswithsevencodesforanxiety/fear/dangerandsix

forgettinglost/lossofself/notfound.Therewereatthesametimesixcodesfor

themoreaffirmativegroupchangeprocess.Thecontinuingawarenessofthe

problemsofgroupanalysisappearedinfivementionsof

collapse/madness/breakdown/fragmentation,andfourmentionsofdepression

andnotunderstanding.Exploration,aspartoftheworkofthegroup,appears

fourtimes,andinterestingroup/otherpeople,awareness/self-awareness,

allowing/capacityforchange,webofrelationshipsallhavethreementions,as

dometaphorandwater/boats.Groupproblemsappearthreetimeseach,as

isolation,holdingback/hesitatinganddefences.

Summary

Thischapterhasgivenanaccountofthefindingsoftheresearchinterviews,

whichwereexaminedintwoways:first,throughadescriptive,sequential

accountoftheinterviewprocess;andsecond,throughathematicanalysisof

thetranscripts.AfulllistofthecodesandthemesisinAppendixB,anda

sampleextractfromacodedinterviewisinAppendixC.

Thesignificanceofthesehierarchiesofcodeswithinthesub-themesand

themesisrichandcomplex,andtheimplicationsofthefindings,andhowthe

findingsofthethematicanalysisinterweavewiththeinterviewprocess,inthe

processofbuildingamodelofthegroup-analyticclinicalmind-line,willbe

discussedinfullinthenextchapter.

CHAPTER5

DISCUSSION

Introduction

Inthisfinalchapter,thesignificanceandmeaningofthetranscribedinterviews

andthethematicanalysisisdiscussedindetail.Alloftheintervieweeswere

involvedinacontinuousdebate,consciousandpre-conscious,withtheoretical

influencesandseniorauthoritiesingroupanalysisandpsychoanalysis.Because

ofthis,thediscussionoftheresultsofthethematicanalysisalsoincludes

attempts,whenrequired,tosetthesefindingsintheexplanatorycontextofthe

literatureofboththeoryandpractice,andtherichlinesofthoughtofthe

individualinterviewees,andthecomplextheoreticalinfluencesontheirclinical

decisionmaking.Overallthethematicanalysisseemedtorevealabasic

structuretothesharedclinicalmind-linesofFoulksiangroupanalysts:a

frameworkofideas,conceptsandtheoriesheldmoreorlessincommon

throughouttheinterviews.Thesefindingsandtheircomplexconnectionsare

thenenlargedupon,inanattempttoelucidate,fromdifferentperspectivesthe

sharedgroup-analyticclinicalmind-lines.Intheconclusiontothischapterthere

isatentativeaccountofwhattheclinicalmind-linesofaFoulksiangroup

analystmightbe.Anattempttoshowtheseindiagrammaticformisin

AppendixA.Thethematicanalysisrevealedabasicpossiblestructuretothe

clinicalmind-line.Theanalysisfirstidentifiedandthencollectedthecodesfrom

theinterviews,theindividualsignificantunitsofmeaning.Thesecodeswere

thenputtogetherinvariouswaystodiscoverthemostusefulstructurefor

analysis.Whatfinallyemergedwasasetoffoursub-themesandtwooverall

themes.Thisgaveabackgroundtotheconceptoftheclinicalmind-line.The

codeswerethenreassembledintoclustersandnodesofmeaning,asawayof

takingasecondlook,fromadifferentdirectiontothethematicanalysisproper,

atthemind-line.Thetwonodesweretwoparticularandspecialcollectionsof

conceptsorworkingtheories,whichwereconnectedwithallthesixclusters,

andtherefore,itisargued,werealwaysonthegroupanalyst’smind,knowingly

orunknowingly,intheclinicalsituation.Thesixclusterswereseparategroups

ofconceptually-relatedworkingtheorieswhichcouldbeconnectedatvarious

timesandinvariouswaystooneanother,andwhichwereallconnected,allof

thetime,tothetwocentralnodesinthemind-line.Thisorganisationofthe

researchmaterialarosefromanattempttocreateamoredynamicand

adaptablestructureforthedescriptionofthemind-lineswhichwouldreflect

boththechangeableandunstablenatureofmoment-by-momentclinical

thoughtanddecision-making,andthequalityofthegroupanalyst’spre-

consciousandnon-consciousthinking.

TheThematicAnalysis:theUseofOrdinaryLanguage

Theresultsoftheformalcodingprocesssawtheindividualcodesfallintofour

overallthemes:group-specificfactors;groupanalysisandthegroupanalyst;the

changeprocess;andgroupprocess.Thesewerethengatheredintothetwo

over-archingthemesof‘thegroupanalystinthegroup’and‘thegroupchange

process’.Inotherwordstheintervieweesorganisedtheirresponsestothe

questionsalmostentirelyaroundthesetwounderlyingpreoccupationsabout

thecomplexityoftherelationshipbetweenthegroupandthegroupanalystand

abouttherelationshipbetweengroupprocessandgroupchange.Onegeneral

observation,whichemergedimmediately,wasthatgroup-analystsusedvery

littlejargonorspecialisedtechnicallanguageandtendednottoexplicitlystate

theoreticalconstructsandpositions.Therewereafewimportantexceptionsto

this,whicharoseinthecourseofthedetailedexaminationofthefindings,and

theyareconsideredlaterinthischapter.Afurtherconsequenceofthis

apparentdecisionnottousetheoreticallanguagewasinsteadwhatseemedto

beadeterminationtouseordinarylanguagetoaddressthecomplex

phenomenaofthegroup.Inthisdiscussionitwasimportanttonotethatthese

intervieweesoftenusedordinarylanguagetodescribewhatappearedtobe

similarorrelatedgroup-phenomena,whichcouldhavebeen,andaremore

usually,describedintechnicalortheoreticallanguage.Thismayreflectthe

simpleclinicalneedofgroupanalyststocommunicateclearlywithsevenor

eightpeopleatonceinananalyticgroup.Ananalyticcommentor

interpretationmadetothegroupneedstobemadeinthesharedlanguageof

thegroup,alanguagewhichwillbedependentonboththecapacityandmutual

trustofallthemembersofthegroup.Itmayalsoofcourseariseoutofananti-

theoretical,pragmatic,in-the-present-momentqualitytogroup-analysisasa

whole,andtheassociatedcomplexrelationshipbetweentheoreticaland

common-senseviewsofwhatare,insomesense,profoundlyordinary,universal

group-relations.Inevolutionaryterms,forexample,itiswell-knownthtearly

hominidsemergingfromtheprotectionoftheforeststothedangersofthe

opensavannahcouldonlysurvivebylearningtocooperateandworktogether

insupra-familialgroups.Tobesocialistobehuman.Groupanalysisasa

treatmentformentalandemotionalproblemsispredicatedontheideathat

neurosisarisesfromlossof,ordamageto,theabilitytorelate,andthatthis

loss,ordamage,canbestberepairedbycultivatingandpracticingahighly

specialisedkindofhumanrelationsintheanalyticgroup.Therewasanexample

ofthischoiceofordinarylanguageinthefirstsection,1.A.1-4,whichconsisted

ofthefourfirstgeneralthemesoftheGroup-specificFactors.Theinterviewees

usedamixtureofordinarylanguagewordsandphrasesforcodesdescribing

‘theworkofthegroup’,whichalldescribedsimilarandrelatedphenomenato

dowiththepositiveworkingatmosphereorattitudeofthegroup:trust,safety,

affinity,understanding,andrecognition.Inthesesamesectionstheyalsoused

ordinarylanguageterms,whichhaveagenerallyunderstoodspecialmeaningin

psychoanalyticpsychotherapy:trauma,dependency,loss.Theyalsousedafew

specialisedtermsandphrases:idealisation,role-suction,andfreeassociation,

forexample.

BinaryConcepts

Afurtherimportantaspectofthissectionwasthetendency,reflectedon

occasionsthroughouttheinterviews,todescribepairsoflinked,usually

polarised,concepts.Thisisofcoursenotuncommonthroughoutdepth

psychology,asawayofencapsulatingcomplextheoreticalconcepts,concerned

withinternalconflict,psychicrealityandthedynamicunconscious,asin:ego/id;

self/other;introvert/extravert.Somethingsimilarranallthewaythroughthe

interviewsbutinthissectionitwasverymarked:individual/group;

inside/outside;subject/objectandpast/present.Itcouldbearguedthatthe

mostsignificantofthesewasindividual/group,andlaterinthethematic

analysisitemergedthattherewereeighteenmentionsoftheindividual

therapy/grouptherapycode.Inotherwordstheintervieweeskeptcomingback

tothisbasicbinaryconcept,alinkedpairofopposites,themostimportantof

whichwasgroup/individual.Thesearenotinasimplewayopposed,orset

againstoneanother,butseemtobeinsteadinacontinuousdynamic

relationship,appearingthroughouttheinterviewsinslightlydifferentversions

(asabove).Thismaybedrivenbythenecessaryrestlessnessofgroup-analytic

work,wherethegroupanalyst’sattentioniscontinuallypulledbackandforth

onamoment-by-momentbasisbetweenthetwosidesofthesebinary

concepts:group/individual;self/other;transference/counter-transference;

here-and-now/there-and-then.Thisisanimportantobservationandislinked

withabasicFoulksianconcept,mentionedtwiceintheinterviews,of‘figureand

ground’.AsalreadydescribedinChapter1,thisconceptaroseingroup-analysis

astheresultoftheinfluenceoftheGermanGestaltPsychologists’studiesofthe

psychologicalmechanismsofperceptiononFoulkes,whenhewastrainingasa

neurologist,beforethesecondworldwar.Inthosestudiesthefigure,the

foregroundedprimaryobjectofperception,wasalwaysunderstoodtobeseen

onlyinrelationtotheground,orbackground,andthereforethegroundonlyin

relationtothefigure,movingbackandforthintheprocessofperception.

Foulkesthenappliedthis,later,totheprocessofthegroup,wherebyeach

member,andthegroupanalyst,sawtheindividual(thefigure)inrelationtothe

group(theground),andviceversa,inacontinualdynamicprocess(Foulkes,

1990;FoulkesandAnthony,1957;BehrandHearst,2005).Whatisimportant

aboutthisconceptisthatitseemstobepartofanimportantsetofconnections

inthegroupanalyst’sclinicalmind-lines.Itbringstogethertheselinkedcodes:

individual/group,individualtherapy/grouptherapyandfigure/groundandthen

connectsfurtherwithFoulkesandhisintellectualformation.

FoulkesandtheMatrix

Thisdynamicoffigure/groundandtheassociatedbinaryconceptsjoinsupagain

withanothercentralFoulksianconcept,thematrix,whichhas11mentionsin

theinterviews.Foulkeshimselflinkstheseexplicitly:“…everyeventinagroupis

consideredashavingmeaningwithinthetotalcommunicationalnetwork-the

matrix-ofthegroup,thoughmoreoftenparticularlyrelatingtooneorseveral

ofthemembers.Thisconstitutesa‘figure-ground’relationshipwithinthe

group.”(FoulkesandAnthony,1957,p256).Foulkeswasmentioned16timesas

acodeintheinterviews,andtherewasapparentlyaconnectionbetweenthe

threeofthemostfrequentlymentionedcodes:Foulkes(16),individual/group

(18)andthematrix(11).Thesegroupanalystsappearedtobecontinually

processingandworkingwiththissharedsetofideasandinfluences.Foulkes’

describesthematrixasa“totalcommunicationalnetwork”(ibid,p256),andthe

“totalfield”is”…bestunderstoodintermsoffigureandground”,and:“Inorder

toseesomethingwhole…wehave,Ibelieve,toseeitinrelationtoagreater

whole,sothatwecanstepoutsideofthatwhichwewanttosee”(Foulkes,

1973,p230).WhatFoulkesimpliesisthat,clinically,inthegroupthisisa

continuousprocess,andthegroupanalystisalwayshavingto“stepoutside”

theprimaryobjectofattention(usuallyanindividualorapairinthegroup)in

thepresentmomentinordertoseethegroupclearly(ibid,p230).Asimilar

processisalsovividlydescribedbyCarolineGarlandinherpaper,‘Takingthe

Non-ProblemSeriously’(Garland,1982),whichdescribeshow,forexample,one

patientinagroupmaybemakingafuss,gettingattentionandbeing‘the

problem’,whenthegroupanalystshouldinsteadbepayingattentiontothe

‘non-problem’,whichiswhytherestofthegrouparelettingithappen.This

thereforeclearlyhasstrongimplicationsforthenatureofthechange-processin

group-analysis,andforthementalformationofFoulksiangroupanalysts.The

threelinkedcodes,accordingtothethematicanalysis,areoftenintheirminds

whentheyarethinkingabouthowthegroupdevelops.Thereisthereforean

importantbuildingblockherefortheconstructionofthegroup-analyticmind-

lines,acomplextriangleofatleastfourcodes:individual/group,whichalso

takesinfigure/ground,thecloselyrelatedconceptofthematrix,andFoulkesas

analwayspresenttheoreticalinfluence.Interestingly,thereislittleother

explicitmentionofFoulkes’theories,apartfromthematrix,giventheemphasis

onthe‘therapeutic’or‘group-specificfactors’intheliterature(Foulkesand

Anthony,1957,pp149-162).Theimportantconceptoftranslationwas

mentionedfourtimes,andresonance,thecondenserandexchangeeachtwice.

OfallFoulkes’concepts,therefore,itisonlythematrixthatappearstooccupya

strongpositionintheclinicalmind-line.

ReflectionandMirroring

Thenextmostimportantclusterofcodeswas1.A.6,‘Mirroring/reflection/self’.

Thissub-themeincludedeightover-lappingcodeswith,inparticular,nine

mentionsofSelf/deniedpartsoraspectsoftheselfseenorreflectedinothers.

Thiswasthenfollowedninementionsofthecodemirroring/hallofmirrorsand

therelatedcodeunderstanding/differentiationofexperience.Thissectionis

important.Thesetwolastcodesarerelatedthroughacomplexprocessthatall

theintervieweesdescribed,allinslightlydifferentways.Theargumentisthat

thegroupmember’sideaorperceptionoftheself,orpartsoftheself,areseen

moreclearlyormoretruthfullyasaresultofbeingmirroredbackandforth

betweenothermembersofthegroupandthegroup-as-a-whole.Fromthe

beginningofgroup-analysisFoulkesrecognisedthisasacentralelementinthe

changeprocessofgroupanalysisandin1948hecalleditthe“mirrorreaction”

(Foulkes,1948,p167).Helaterelaboratedontheconcept:“Apersonsees

himselforpartofhimself-oftenarepressedpartofhimself-reflectedinthe

interactionsofothergroupmembers…Healsogetstoknowhimself–andthisis

afundamentalprocessinegodevelopment–bytheeffecthehasuponothers

andthepicturetheyformofhim”(Foulkes,1964,p110).Thereisalink,

throughthepsychoanalyticline,backtoFreud.In‘Recommendationson

AnalyticTechnique’headvised:“Thedoctorshouldbeopaquetohispatients

and,likeamirror,shouldshowthemnothingbutwhatisshowntohim”(Freud,

1912,p118).Thisismoreofaone-wayprocessforFreud,andlessdevelopedas

theinteractionalorinter-subjectiveprocessthatitlaterbecame,inFoulkes’

workongroupanalysis.FreudwasHeleneDeutsch’spsychoanalyst,andshe

analysedFoulkesinVienna.HeinturnanalysedMalcolmPines,theBritish

psychoanalystandgroupanalyst,inLondon,andMalcolmPinesisoneauthor

whoismentionedtwiceintheinterviews,particularlyinrespecttothe

influentialFoulkeslecturethathegavein1982:‘ReflectionsonMirroring’

(Pines,1982,Supp.pp.1-32).

Inthislecture,whichtwooftheintervieweesexplicitlyreferredto,Pinesmakes

aninterestingconnectionbetweenthetworelatedmeaningsof‘reflection’:

“…theself,asseeninself-reflectionandhowthemind’smirroriscastinthe

matrixofhumanrelationships…thesameword,reflection,isusedforthemirror

imageandfortheprocessofreflectivethought…”(ibid,Supp.p.5).Whatis

importanthereisalsotheexplicitconnectionoftheconceptofthemirror

reactiontotheconceptofthematrix,whichsuggestsanothercentralpointin

thegroup-analyticclinicalmind-lines.Inthethematicanalysistherewere

clusteredtogetheragroupof17relatedcodes:theprocessesofself/denied

partsoraspectsofselfseenorreflectedinothers(9codes);mirroring/hallof

mirrors(5codes);and3relatedsinglecodes,mirrorneurones,bearingwitness

andreflectiveaboutothers.Whatwerealsoconnectedtothiscluster,whichthe

intervieweestalkedaboutintheinterviews,weretheseothers:

understanding/differentiationofexperience,experiencerepeatedingroupand

groupasseparatefromfamily.Thiswasextremelyimportanttothe

interviewees,andinfactseemedtobecentraltotheirconceptualisationsofthe

changeprocessinthegroup.Itisconcernedwiththeattempttoexplainhow

individualgroupmemberscanseeaspectsofthemselvesinothersinvarious

waysandcanbehelpedtorecognisethisbyothergroupmembers.Theymay

seepartsofthemselvesthattheycannotusuallyrecogniseordenybyseeinga

versionofitinanother,orseeitmirroredbacktothem,orbyhavingother

membersofthegrouphelpthemtoseeitdifferently,orbyrealisingthattheir

customaryfamilyorrelationalrolesdonotworkinthisgroupandtrying

somethingdifferent.Thisfamilyaspectlinksthisfurtherto1.A.8,thesub-theme

of‘Family/motherandchild’.Thesewerenotmentionedfrequently,onlyten

mentionsofsevencodes,buttwoofthemconnecttotheimportanceofthe

reflectingcapacityofthegroup:familyresonanceandreflectionoffamilyin

group/familytransference.Theothersinglecodesaretodowithconnectingthe

relationsinthegrouptofamilyrelationsortomother/parentandchild.

PinesalsomentionsWinnicottinhislecture,whoalsomadeasignificant

contributiontoconceptsofmirroringanddevelopment,comparingitcarefully

totheanalyticrelationship(Pines,1982,Suppp.5).Ashasalreadybeenshown

inChapter4,theintervieweesinthisstudyoftenseemedtoacknowledgesome

analyticinfluencesbyimplication,ratherthandirectly,mostoftenWinnicott

andBion.InHamilton’slanguagethiswouldbe‘preconscious’(Hamilton,1996).

ConnectingupPines,andthroughhimFoulkes,withWinnicott,ishelpfulhere

asitmayilluminatepartofthestrugglethatgroupanalystsapparentlyhaveto

theorisetheconnectionsbetweenmotherandchild,andanalystandpatient,

whichisofcoursethecommonimageryofpsychoanalyticwork,andthefamily,

thegroupandthegroupanalyst.WhatWinnicottsaysis:‘Thisglimpseofthe

baby’sandchild’sfaceseeingtheselfinthemother’sface,andafterwardsina

mirror,givesawayoflookingatanalysisandthepsychotherapeutictask.

Psychotherapyisnotmakingcleverandaptinterpretations;byandlargeitisa

long-termgivingthepatientbackwhatthepatientbrings.Itisacomplex

derivativeofthefacethatreflectswhatistheretobeseen”(Winnicott,1971,p

137).Itseemstobethecasethataspectsofthiscomplexphenomenon,as

describedbyWinnicott,ingroupanalysisareverysignificantinwhatgroup

analyststhinkofasthechangeprocess.Theprocessofcontinuallyreflecting

backandforthinthegroupbetweenthemembers,thegroup-as-a-wholeand

thegroupanalystwasanengineforchangeandinparticularthewaythatthis

processrelatedtomother/childandself/familydynamicsinthegroup,andthis

becameclearerinthenextsectionofthischapterwhentheinterviewees

explainthisinmoredetailinclinicalexamples.Thisisofcourseconnectedto,

butnotidenticalwith,bothageneralisedideaoftheanalytictransference,and

Yalom’sformulationofwhathecalled“Thecorrectiverecapitulationofthe

primaryfamilygroup”(Yalom,1975,pp3&97).

Thisiscomplexofthoughtsandideasisimportantasthebasisforasecond

clusterinthegroup-analyticclinicalmind-lines,whichbringstogetherthese

centralconceptsofreflection,mirroringandthere-enactmentorrecapitulation

ofpastfamilydynamicsinthepresentgroup,asacentralpartofthechange

process.Thefirstcluster,toreturntoit,istheindividual/groupand

figure/groundformulation.ThisrelatesonewaytothenodeofFoulkes,and

anotherwaytothenodeofthematrix,buttheythenconnectbothwithto

another,andthenforwardtothissecondmajorclusterofreflection,mirroring

andfamilyre-enactment.

CohesionandTrust

Thethirdclustercombinesanothersetofcomplexideas,describedbythe

intervieweesindifferingterms.In1.A.4,underthesub-themeof‘theworkof

thegroup’thecodeoftrustismentioned4timesandthisseemstobeclosely

connectedto1.A.7,thesub-themeof‘cohesion/sharing’,althoughthecode

cohesion/cohereisonlymentionedtwice.Therearehoweveranother17codes

inthesamerangeofmeaning.Thereare7mentionsforthetwocodespartof

somethingsharedandpartofsomething/sharing;2forpartinstory;2forthings

incommon;2forbelonging;3fornotaloneandnottheonlyone;2forlearning

fromeachotherinthegroup/peerlearningandoneeachforconnecting,

comingtogether,feelingvalued,somethingtoofferandallinthesamesoup.

Thiswiderangeofsimilarandoverlappingwordsmaybepartlyanexampleof

theideastatedearlierthatimpreciseorflexibleordinarylanguageisafactor

specifictogroupanalystsasawayofensuringgroup-widecomprehension.It

mayalsobeamarkerofthegroupanalyst’smorepersonal,engagedand

importantpre-occupationsaboutgroupanalysis.Itwasnoticeable,forexample,

intheinterviewsthattheintervieweestendedtobecomemoreincoherentand

moreungrammaticalintheirspeech,themorethattheyspokeaboutmatters

towhichtheywereeitherpersonallycommitted,orwhichweremoreexciting

ormorepuzzling.Thisdifficultyincommittingtomoresharedterminology

reflectedbythewiderangeofslightlydifferentcodesmayalsopointtoasimilar

phenomenon.

Cohesionisindeedamoredifficultconceptthanitfirstseems.Theuseofthe

word‘cohesion’todescribeaqualityofthegrouprelationshipthatisnecessary

forgroupanalyticworktoproceedisnotstraightforward.Itisnotusedformally

veryofteninearlierBritishwritingaboutgroupanalysis,andFoulkes,for

example,neverusestheterm.TwoimportantexceptionsareHopperand

Hinshelwood.Hopper,writingmorerecentlyaboutorderanddisorderinsocial

systems,includinggroups,firstofalldistinguishes‘cohesion’from‘adhesion’,

usingtheanalogyofthephysicalsciences,inthatitis“bondingtogetherof

particles…insuchawaythattheparticlesdonotlosetheirindividualidentity”,

andthengoesontodefinecohesioninthisway:“…thecohesionofgroups

referstotheexperienceoftheunityoffeelingsandpurposethatenablesat

leastthreepeopletoworkinharmonywithinsimilarrolestowardsacommon

goal”(Hopper,2003,pp.197-8).Hinshelwood,lookingmainlyattherapeutic

communities,isinterestedinthedifferencebetweenresilient/flexibleand

fragile/rigidcommunities.Oneofthemediatingforcesiscohesion:“cohesionin

agroupisimportantfortwogeneralreasons.Oneisthegroup’srationalpursuit

ofitstask;theotherisadefensiveneed”(Hinshelwood,1987,p192).Thisisan

echoofBion’sideaofthe‘work-groupfunction’anditsobstructionbythebasic

assumptions(Bion,1956).

ThesituationisverydifferentintheUnitedStates.Yalom,forexample,explains

theimportanceofcohesivenessasbeingtheequivalentingrouptherapyofthe

‘relationship’inindividualtherapy,andreviewstheevidenceforcohesiveness

asbeingoneofthecurativefactors,althoughhealsomaintainsthat

cohesivenessisinfactnotonlyacurativefactorbutisa“necessarypre-

conditionforeffectivetherapy”(Yalom,1975,p47).Thisdifficultywiththeterm

mayexplainwhyitisonlymentionedtwiceintheinterviews,butthe

combinationofthe17slightlydifferentcodessuggeststhattheinterviewees

feltstronglythatsomethingverylikecohesionwascentraltotheirviewofwhat

wasneededforthegrouptofunction.Perhapstheproblemisthatwhatis

neededisatermwhichdescribesthesubjectivefeelingofbeingcohesive.

Puttingtheinterviewstogethersuggeststhatthefeeling,inordinarylanguage,

ofthegroupfeeling,allinthesamesoup,belonging,connectingandcoming

together,gotnearertowhatissocentraltothelifeofthegroupandthemove

towardschange.Yalomcallsthis“group-ness”,orthe“attractivenessofthe

groupforitsmembers”andsuggeststhatresearchshowsthat:“groupswitha

greatersenseofsolidarityor“we-ness”valuethegroupmorehighly”(Yalom,

1975,p46).Thisconnectsbackagaintoordinary,common-senseviewsof

relating,andisatthesametimeimportantfortheclinicalmind-line,andlinks

upimmediatelytotheconceptofthematrix,whichcanbeconstrued,inone

way,touseYalom’sword,asthe“group-ness”ofthegroup-as-a-whole.

Anothersub-themewhichisimportanthereisthatofthe‘setting’,1.A.4,in

whichtherewereonly3codes,butsevenmentionsofthesetting,andtwoeach

ofthecircleascontainerandthetable/andlossoftable.Thislastreferstothe

smalltable,whichiscustomarilyinthemiddleoftheroomingroupanalytic

sessions,andthepsychicconsequencesforthegroupifthetableismissing.But

allofthesethreecodesareabouttheanalyticsetting,afamiliarconceptsince

Freud,whichprotectsthesafetyandreliabilityoftheanalyticworkand

thereforefacilitatestheemergenceovertimeofunconsciousmaterialinthe

session.Ingroupanalysis,wherethesettingislargerandmoreopen,and

thereforemoreatrisk,thisiscalled‘dynamicadministration’,andcomprises

thegroupanalyst’sneedtotakecareofalltheadministrativerequirementsof

theworkasanessentialpartofprotectingthesettingandthereforethe

therapeuticwork.ThisiswelldescribedbyBehrandHearst(2005,pp.42-55).

Clearlyintermsoftheclinicalmind-linesthegroupanalystisprotectingthe

‘group-ness’ofthegroup.

Thisbringsthediscussionbacktothecodeoftrustingthegroup,which

appearedfourtimes.Thisnotonlyreferstothecommon-sensenotionofeach

groupmembertrustingalltheothergroupmemberstoberespectful,honest

andconfidential,butalsotothegroupanalyst’sneedtotrustthegrouptodo

theanalyticwork,andtotrusttheindividualmembersofthegrouptobethe

therapistsforoneanother,andforthegroup-as-a-whole.Oneofthepre-

conditionsforcohesionandgroup-nessmustthereforebetrust,whichisthen

furtherrelatedtospeakingopenly.In2.C.1,thesub-themeofthe‘groupchange

process’thereareagainawiderangeofsinglecodeswhichcoversimilar

concerns,whichmaysuggest,asarguedabove,anareaofcomplex

preoccupationandconcern.Thecodeofspeakfreely/saywhat’sonone’s

mind/telling/speakingmindismentionedthreetimes,buttherearealsocodes

forputtingintowordswithtwomentions,andoneeachoflearningtotalk

aboutthings,hearingothers/beingheard,sharingwithothers,individualityand

voice,askingthegroupanddirectnessandfrankness.Thiscentralthemeof

findingavoiceandspeakingoutisconnectedbacktocohesion,inthatthe

grouphastofeelconfidentinits“group-ness”fortrusttoemerge,whichthen

inturnallowsthefreedomandconfidencetospeak,whichthenfacilitatesthe

changeprocess.Therelatedcodeofconnecting,withtwomentions,which

appearsalsoin2.C.1,isalsopartofthisextendedandcentralprocess.The

relatedsinglecodesarenottheonlyone,internalisingthegroup,intense

involvementinothersandovercomingisolation.Thisthenmovesthrough

believingthatothersareinterested,toworkingwitheachother,tofinding

yourselfingroup,toformingrelationshipsandnewexperiences,allwithone

mention,tothegroupontheirsideandthevalueofordinarypeople,both

mentionedtwice.Thislivelysenseoftheinterviewees’trustinthedevelopment

andgrowthoftherapeuticspaceovertimeinthegroupseemstobecentralto

whattheyappeartounderstandaboutthechangeprocess.Thisprocessof

connectingandspeakingisalsocloselyrelatedtothethemesoftrustand

cohesion,andthesetting,andthisthereforetogetherconstitutesthethird

clusterintheclinicalmind-lines,itbeingincreasinglythecasethateachnodeor

clusterseemedtorelate,inbothsimpleandcomplexways,toeachoftheother

nodesandclusters.

TheWorkoftheGroup

Therewerethreeotherpossibleclustersofconceptsfromthethematic

analysis,whichareinsomewaysmorestraightforward.Thefirstincludedthe

changeprocessingroup-analysisandthepositiveworkofthegroup.The

secondwastheopposite,thenegativeaspectofgroupanalysisandthe

obstaclestochange.Thethirdcomprisedtheduties,workandresponsibilities

ofthegroupanalyst,andthedifficultyofthetask.Theintervieweeswereasked

directlyaboutthechangeprocessbuttheirresponsestotheotherquestions

alsorevealedtheirpreoccupationsaboutthiscomplexproblem.Inthesub-

theme2.C.1,‘thechangeprocess’thereweretwentysinglecodes,manyof

themdifferentbutoverlapping,whichmaybeanindicatoragainofanareaof

specialpersonalorindividualdifficultywithunderstandinganddescribingthe

groupchangeprocess.Thesecodesalsoconnectedupandoverlappedwiththe

nodeorclusterofcohesionandtrust,forexamplethetwomentionsofboth

connectingandspeakingfreely.Butthislistofsinglecodescan,ifsequenced,

chart,throughthewordsandphrasesoftheinterviewees,theprogressofa

groupmemberthroughthechangeprocessinthegroup.Thegroupmember

realisesthattheyarenottheonlyone,andthenbyconnectingandbelieving

thatothersareinterested,bylearningtotalkaboutthings,byspeakingfreely,

sharingwithotherswithdirectnessandfranknessandusingthegroupandthen

askingthegroup,theythenbeginformingrelationships,overcomingisolation

andenjoyingnewexperiences.Hearingothersandbeingheardandworking

witheachotheranddevelopinginterestinthegroup,listeningtomorevoicesin

thegrouptheygrowintoanintenseinvolvementwithothers,internalisingthe

group.Thisthenresultsinasenseofindividualityandvoice,increasedego-

strength/internalcapacityandfindingyourselfinthegroup,andfinally,

celebratingtheunderstandingofself.Itisinteresting,inthelightofthiscollage

ofcodesputtogethertocreateassenseofmovementthroughthecourseof

thechangeprocess,thatthefinalstageofcelebratingtheunderstandingofthe

selfisquitecloseasaconcepttothehighestscoringofthe60sortedcategories

inYalom’swell-knownresearchaboutthecurativefactors:“Discoveringand

acceptingpreviouslyunknownorunacceptablepartsofmyself”(Yalom,1975,p

In2.C.2.thesub-themeof‘Thegroupasawhole’thereareagainamajorityof

singlecodes,whichagainprobablyindicatestheintervieweesthinkingthrough

acomplexmatter.Thiswasamuchmorevariousandindividualsetofcodes,

buttheconceptofthegroup-as-a-wholeisdifficultandcontentious,andthisis

reflectedintheanswers.Thetwocodeswithtwomentionswerefamily

repetition,whichcanthereforebeseenasanelementinthegroup-as-a-whole,

andthislinksonfurthertothenodeorclusteraroundreflection,andhuman.

Thisconnectswithothercodesaboutthehumanityandlifeofthegroup-as-a-

whole:beingalive,aliveexchangewithothers,thegroupkeptmealive,thelife-

forceofthegroupandlife-giving.Thegroup-as-a-wholeisseenasagroup

mind/brainbutalsoisthegroupasabodythatcalmsandregulates.Thegroup

proceedsbydeconstructionandreconstruction,byco-construction,by

routine/ritual,bytheuniquenessofeachgroupandthroughthegroup

membersastherapists.Intheendforeachmembertheanswerisinthegroup.

In2.D.2,thesub-themeof‘Groupprocess:positivefactors’someofthese

preoccupationsemerge.Themostsignificant,withsevenmentions,is

interaction/involvement/engagement/investment,andthisisobviouslylinked

withinterestingroup/otherpeople,andjoining/beingpartofthings,listening

andhearingwhichthenmovesontoreflection/self-reflection,andexploration.

Relaxing/comfortandthenprocessingfeelings/workingthroughleadto

understanding.Thiscollagedsequenceseemsagaintobestraightforward,and

consistentwithwhatisusuallyunderstoodaboutthepsychotherapeutic

process:theneedtoconnectwithanotherinordertochangeoneself.In2.D.3.

thesub-themeof‘Groupprocess:generalfeatures’thereareforty-fivecodes,

againalmostallsingle,overlappingcodes,likebuildingagroup,andgroup

becoming,butthereareeightmentionsofgroupdevelopmentandchangeand

sixofgroupchangeprocess,andmorespecifically,threeforthewebof

relationships,whichisagainthematrix,threeformetaphorsandthreefor

allowing/capacityforchange.Withinthisinfluentialclusterornodeofthe

changeprocessandthepositiveworkofthegroupthereseemstobea

continualaffirmativeandforward-movingprocessatworkintheworkingtheory

ormind-lineofthegroupanalysts:the‘life-forceofthegroup’.Thisclusteris

thereforeapparentlyclose,inthegroupanalyst’smind-line,toFoulkes’

idealisticmaxim,whichhecalledthe‘BasicLawofGroupDynamics’tothe

effectthat:“…collectivelytheyconstitutetheverynormfromwhich,

individually,theydeviate”(Foulkes,1948,p29&Foulkes,1964,pp297-8).

Atthesametimethereisanother,morestraightforwardrelatedclusterof45

codes,with74mentions,inthemind-line,whichisconcernedwiththe

difficulties,fearsanddangersofgroupanalysis.Againwiththisclusterthereare

alargenumberofsinglecodes,althoughin2.D.1.‘groupprocess:negative

factors’,therearesevenmentionsofanxiety/fear/danger;sixmentionsof

gettinglost/lossofself/losingway/notfound;fiveof

collapse/madness/breakdown/fragmentation;foureachofdepressionandnot

understanding;andthreeeachofisolation,negativetransference,anger,and

holdingback/hesitation.Toagaincollagethesecodeswouldshowacontinuous

livelyawarenessinthegroupanalyst’smind-lineofthenegativeanddifficult

aspectsoftheworkofgroupanalysis.Itwouldbepossibletoarguethatthis

nodeisnotonlyconnectedto,andstandingincontra-distinctionto,the

precedingcluster,indirectopposition,forexample,toFoulkes’‘BasicLawof

GroupDynamics’(ibid),butalsoisanegativeconfirmationoftheimportanceof

thecohesionclusterandthematrix.Whatthisrecognisesisaparticularanxiety

ofgroupanalysts,thesenseofobligationtoholdthegrouptogether,andto

keepitgoinginthefaceofdifficulties.Withoutcohesionandafunctioning

matrix,thereisagreatfearthat,inthewordsofthepoetYeats:“Thingsfall

apart,thecentrecannothold”(‘TheSecondComing’).

TheGroupAnalyst

Theclusterconcernedwiththedifficulties,isalsocloselyconnectedtothefinal

cluster,concernedwiththepersonandtaskofthegroupanalyst.In1.B.3.,‘The

groupanalyst’squalities’thetwomostsignificantcodes,eachwithfour

mentionseachwerecuriosityandnotknowing/notbeingtheonewhoknows,

thenpatience,withtwo.In1.B.5.,‘Thegroupanalyst’therewereninementions

ofthecodeconductor,whichisimportant,becauseitisthepreferredgroup-

analyticwordforthegrouppsychotherapist,andconfirmsfurtherthe

intervieweescommitmenttoFoulksianthinkingandterminology.Italsolinksin

acomplexwaytothenextmostimportantcodeinthissection,with5

mentions,ofthegroup-analystin/partofthegroup,whichisadifficultand

unresolvedconceptaboutwhatsortofmemberofthegroupisthegroup-

analyst,giventhedifficultyofmaintainingastanceasapuretransference

objectinthegroup,aswouldbethecaseinconventionalpsychoanalytictheory.

Thereweretwomentionofthegroup-analyst’smind,andtherestweresingle

mentionsofarangeofconcepts.Somewerepositiveideaslikethegood

enoughgroupanalyst,withitsechoofWinnicott;thesubjectivityofthegroup

analystandtheuseofself/availability;andadaptingtechniquetothe

group/patient.Therestweremorenegativeandcritical:thegroupanalyst’s

vulnerability,illusions,psychopathologyandblindspots;andthegroupanalyst’s

therapyfromthegroupandtheunconsciouschoicebythegroupanalystofthe

group.Finally,in2.C.3.,‘Thegroupanalyst’,therewerefourmentionsof

trustingthegroupandthetworelatedsinglecodesoflettingthegroupdoit

andalongsidethegroup,andagainanaffirmationofnotbeingtheexpert,

whichisrelatedtotrustingthegroup,with3mentionsofnotknowing.

Nodes,ClustersandThemes

Therewere,therefore,attheendofthisstageofthediscussionoftheresultsof

thethematicanalysis,astructureoftwonodesandsixclustersinthemind-lines

ofthesegroupanalysts.Thetwomediatingnodes,connectedinmultipleways

acrossthenetworkofthemind-linewere:

A)FOULKES

B)THEMATRIX

Thefirstthreemoretheory-basedclusterswere:

1)GROUP/INDIVIDUAL

2)COHESION/TRUST

3)REFLECTION/MIRRORING.

Thethreemorepractice-basedclusterswere:

4)POSITIVEGROUPCHANGE

5)NEGATIVEGROUPFACTORS

6)THEGROUPANALYST.

Thesesixclustersandtwonodeswerealsorelatedtotheinitialsortingofthe

codesintothemesandsub-themes.Thefirsttheme,oftheGroupAnalystinthe

Group,withthetwosub-themesofGroup-SpecificFactors,andGroupAnalysis

andtheGroupAnalystconnectswithallsixclustersandbothnodesindifferent

andcomplexways,withboththetheoryandpractice-based-clusters,butin

particular1,2and6.Thesecondsub-theme,GroupChangeProcess,withits

twosub-themesoftheChangeProcessandGroupProcess,likewiseconnects

withalltheclustersandthetwonodesindifferentways,inparticular2,3and4.

Itthereforeseemsreasonabletoassumethatthetwoclearlyidentifiedmajor

themesofthegroup-analyst’sworkingtheories,theGroupAnalystintheGroup

andtheGroupChangeProcess,whichemergedfromthefirststageofthe

thematicanalysis,doaccuratelyreflectthesameoverallshapeorstructureof

thegroupanalyticclinicalmind-linethatarosefromfurtherexaminationofthe

researchinterviewmaterial.Thiswouldsuggestthat,atanyonemomentin

time,intheanalyticgroup,thegroupanalyst’sconsciousand/orpre-conscious

workingattentionisalwaysmovingbackandforthbetweentwoareasof

thought,oneconcernedwiththegroupanalystinthegroup(self/selfand

self/other)andtheotherwiththegroupprocessandtheworkofchange

(other/otherandother/self).

TheClustersintheInterviewProcess

Asimilarpatterncouldbeseenintheprocessandcontentoftheinterviews.

Thefirstquestion,forexample,wasaboutthe“threemostimportantthings

aboutgroupanalysisthat…helpgroupmemberstochange”.Alltwelveanswers

werestronglyconnectedwiththeclusters.Themajority(eight)wereprimarily

associatedwiththeclusterofCOHESION/TRUST:‘thecompositionofthegroup’,

‘asafeenoughsetting’,‘containment’,‘trustandbuildingtrust’,‘tospeakfreely

whatisonyourmind’,‘asenseofbelonging’,‘trustingthegroupovertime’and

‘routineandritual’(asameansofestablishingmutualtrust).Twoanswerswere

primarilyaboutREFLECTION/MIRRORING:‘partsoftheselfreflectedinothers’

and‘bearingwitnessandrepetition’.OnewasabouttheGROUPANALYST:‘the

conductor’,andone,themostcomplexanswerofthetwelve,wasinthe

GROUP/INDIVIDUALcluster:‘internalisingthegroupasawholeandindividual

members’.Itwasclearthatthese“threeimportantthings”wereveryavailable

totheinterviewees’thoughtprocesseswhentheywereconceptualisingthe

changeprocessingroupanalysis,anditisstrikingthateightoftheanswers

wereintheCOHESION/TRUSTcluster,confirmingthecentrality,forgroup

analystsofthethemes,ideasandconceptsthatclusteraroundandrepresent

the‘group-ness’ofthegroup.Inthebackground,ofcourse,foreachanswer,as

becameclearerinthebodyoftheinterviews,wasalsoacontinual

preoccupationwithboththePOSITIVEGROUPCHANGEandNEGATIVEGROUP

FACTORS,andwiththeGROUPANALYST.Howshouldthegroupanalystactat

anyonemomenttoprogressthegroup,topromotechangeandlimittheeffect

ofnegativefactors?Theintervieweesgavelongandthoughtfulanswerstothe

firstquestion(describedinChapter4)andallansweredthesub-question,asto

whichofthefirstthreechoiceswasthemostimportant,withmoredifficulty,

threechoosing‘thesafeenoughsetting’,‘speakingfreely’and‘trustingthe

groupovertime’,allofwhichbelongtotheCOHESION/TRUSTcluster,andone

choosing‘bearingwitnessandrepetition’,whichbelongstothe

REFLECTION/MIRRORINGcluster.Thisincreasinglycomplexprocesscontinued

throughtheinterviews,butinthecourseofansweringallofthequestionsthe

intervieweesmadechoices,asinthefirstquestion,whichconfirmedthe

prevalenceofthesixclustersintheclinicalmind-line,withmuchgreater

emphasisonCOHESION/TRUSTandREFLECTION/MIRRORING.Atthesametime

alloftheinterviewees,ascanbeseeninChapter4,returnedallofthetimeto

theirowninternaldebatewithFoulkesandGroupAnalysis.Theyfelt,inanswer

tovariousquestions,thattherewas“noacceptedwisdom”or“acceptedview”

inGroupAnalysis:“differencewastheessence”,itwas“catholic”,andtheydid

notthinkatanyonetimethatotherGroupAnalystswouldnecessarilyagree

withthem,orthattheywouldagreewithFoulkes.Atthesametimethe

thematicanalysisshowedthattheyreferredtoFoulkesand,inparticular,tothe

centralFoulkesianconceptofthematrix,morethananyotherauthority.One

explanationofthiswouldbethatgroupanalyststendtobeinacontinuous

livelyexchangewithFoulkesandFoulksiantheory,inalong-running

developmentaldynamicofagreeing/disagreeingandfollowing/rejecting,which

isbothconsciousandpre-conscious,tacitandexplicit,proceduraland

declarative,andwhichformsanessentialstructuringpartofthegroupanalytic

clinicalmind-lines.

Summary

Oneoftheintervieweesmadeastrongclaim:“…soIuseallsortsoftheories,I

don’treallycare,ifIthinkitishelpfultothepatient,Ijustuseit”.Thisisavery

usefulstatementoftheconscious,declarative,explicitpartofthegroup

analyst’sworkingknowledge,thatthereisarangeof,presumably,equally

usefultheoriestobepulleddown,consciously,asneededtosuiteachpatient.It

isarobustandverypatient-centredviewoftheory.Amomentlater,however,

thesameintervieweeemphasisedhowimportantitwasforthegroupanalyst

to:“…allowyourselfemotionallyandactuallyjusttogetlost”,whichisan

equallystrongstatementofthenon-conscious,procedural,tacitworking

theories,lettingsomethingdevelopwithalifeofitsown,ratherthandirectingit

tohappenthroughconsciouschoice.Anotherintervieweeemphasisedtheneed

forthegroupanalysttobeawarethattheyare“inthegroup,anothermember

ofthegroup”,subjecttothesamedynamicsasthepatientsandtorecognise

thatthegroupanalystatthatpointdoesnotknowwhatis“reallygoingonin

thegroup”andcannotunderstand.Foranotherintervieweetheprocessof

whattheycalled“usingthegroup”,wasthemostdistinctiveaspectofgroup

analysisforthem:“…feelingfreetoletthegroupwork…Idon’tneedtoknowit

all”.Groupanalysisisnotan:“authoritymodel,parent-child”,becausethe

groupanalystwasnotdirectingtheprocess,butwas“intheproblemlike

everybodyelse”.

Thesefewquotesfromtheinterviews(alreadyquotedinfullinChapter4)

indicatethatingroupanalysis,accordingtotheseinterviewees,thegroupitself

isalwaysboththepatientandthetherapistandtheprimaryagentofthe

changeprocess,andwhentheyareworkingwellasgroupanalyststheyare

primarilylettingsomethinghappenthatisalwayspotentiallyalreadytherein

thegroup.Theygroupanalystneedsto“trustthegroup”todoitswork.

Althoughinmanywaysdifferent,followingaslightlydifferentemphasisintheir

responses,alloftheintervieweesseemed,accordingtothethematicanalysis,

tosharearichsetofclinicalmind-lines,ofwhichtheywerenotnecessarily

consciouslyaware.Mostimportantlytheyallfollowedthisview,asabove,of

theprimaryimportanceofthegroupitself,whichtheyallreferredtoas

“trustingthegroup”,acentralconceptinFoulksiangroupanalysis,andtheyall

wereinacontinualconsciousandpre-consciousdebatewithFoulkesandhis

ideas,particularlytheconceptofthematrix.Thisisreferredtosooftenand

investedwithsuchimportancethatitrequiredtwoseparatenodesinthemind-

line,oneforFOULKESandonefortheMATRIX,asalmostallofthetheorising,

thinkingandexplainingintheinterviewsrelatedinsomewayoranother

(agree/disagree,reject/accept)tobothnodes.Inadditiontheinterviewees

sharedsixclustersofthoughtinthemind-line,whichallinter-relatedinvarious

waystoeachoftheotherclustersandthetwonodes.

Forexample,thegroupanalystmighthaveapatientwhosays,unexpectedly,in

thegroupthattheywanttoleavegrouptherapyimmediately.Whatdoesthe

analystcallonatthatmoment?Anindividualtherapistwouldlookfirsttothe

transference.Whatdidthatpatientfeelaboutthetherapist,and,whatcanthe

therapistcallon,intheirownsubjectiveexperienceofthepatient,thecounter-

transferenceandreverie,toclarifythatinrelationtothewishtoleave?Inthe

groupthegroupanalystmightthinkaboutbothofthese,butatthesametime,

withbothFOULKESandtheMATRIXinmind,theywouldthinkaboutbothin

relationtothegroupasawhole,andtosub-groupsandothersetsof

relationshipsinthegroup.Isthepatientleavinginresponsetothegroup’s

attitudetothem(GROUP/INDIVIDUAL),whichmaybeimaginedorreal

(NEGATIVEFACTORS)ortooneortwootherpeopleinthegroup

(COHESION/TRUST),ortoattacktheanalyst(GROUPANALYST)orthegroupasa

whole?Cantheanalysthelpthepatientandthegroupunderstandthatthisisa

repetitionofanearliereventinthepatient’slife,oracharacteristictypeof

relationshipfailureforeitherthepatientorthegroup

(REFLECTION/MIRRORING),and,ifso,isitpossibletomakesomething

therapeuticofit(POSITIVEFACTORS)?Thisisanecessarilyover-simpleexample

oftheprocessofinstantaneouspre-consciousinternalscanningthattakesplace

inthegroupanalyst’smindatanymoment-of-time-in-the-group.

Whatthisresearchprojecthasattemptedtodiscoveristhesetoforganising

mentalconstructsthathelpthegroup-analystinthatmomenttofindawayto

themosthelpfultherapeuticactioninthegroup.Theresearchsuggeststhatthe

groupanalystorganisestheirmind,forthepurposeofclinicaldecision-making,

intothisstructureoftheoreticalclustersandnodes,andthatthisstructure

enablesthegroupanalyst,atanyonemoment-of-time-in-the-group,tocallon

boththeirconsciousandpre-conscious,explicitandtacitknowledge.

CONCLUSIONS

ThisresearchprojectattemptedlookintotheworkingtheoriesofFoulksian

groupanalysts.Theresearchdiduncoveracomplexnetworkofinfluences,

theoreticalassumptionsandworkingpracticesthatwerelargelysharedamong

thefourintervieweesandpostulatedawayofdescribingtheorganising

structureforgroup-analyticclinicaldecision-makingthroughasetofmental

clustersandnodes.

Therewerehowevertwolimitationstothisstudy.First,therewerearelatively

smallnumberofinterviewees,allofwhomwereofasimilarageandrangeof

experience.Moresubjects,withagreaterrangeofexperience,wouldbehelpful

ifthestudywascontinued.Second,itwouldbeinteresting,ifthestudywas

extended,tointerviewotherpsychoanalyticpsychotherapists,whowerenot

groupanalysts,inthesameformat,asacomparisongroup.Takingthisinto

account,thereseemstobesufficientusefulnessinthisstudytocontinueitinan

extendedform,butmodifiedinthelightoftwolimitationslistedabove.

Thestudyalsosuggestedthattherewasalwaysamixtureoftacitandexplicit,

consciousandpre-conscioustheoriesinoperationatthesametimeatanyone

moment-of-time-in-the-group,necessarily,giventhecomplexityandconfusion,

ormessinessandturbulence(Gabbay&LeMay,2011),alwayspresentinan

analyticgroup.Theresearchalsoconfirmedthatitispossible,tosomedegree,

toaccesstacitandpre-conscioustheoriesbyaninterviewprocessofindirect,

repetitive,openquestions,followedupbybothacommon-sensedescriptive

account,enabledbypsycho-analyticattentiveness,andamorerigorous

thematicanalysis.

Thereforethefourworkinghypothesesoutlinedatthebeginningofthestudy,

thatunderlaytheresearchquestion,havebeenshowntobeuseful.These

were:first,thereisasetofdistinctivesharedideas;second,thattheseareheld

asbothexplicitandtacitknowledge;third,thatitispossibletoaccessthem

throughaninterviewstudy;and,fourth,thatthesecanbesaid,tentatively,to

constituteagroup-analyticclinicalmind-line.

Thisstudy,andanyfutureextensionofit,mightalsobehelpfulinthinking

aboutclinicaltrainingandteaching,andinparticularforthemanagementof

supervisionandclinicalseminars.

WORDCOUNT:Thesis38046

Appendices&References:3726

AppendixA

EXTRACTFROMCODEDINTERVIEW

Interview2:Question3.1.

(Codesareunderlined)

Interviewer:OK.So…Clinicalagain,so…whenyouareworkinginagroup,which

workingconceptscomemostoftentomind,andwhicharemosthelpfultoyou?

Slightlyoverlapsagain,but…

Subject:Iwasthinkingalreadybefore,youknow,projectionobviouslyis

permanentlytherebetweentwopeople,andsometimesIpointitoutand

sometimesIdon’t,youknow,butthat’snotagroup-analyticconcept,sothat’s

whyIdidn’tsayit.Andprojection,but…

Interviewer:That’swhyIsaidworkingconcepts,anything…thatisaconceptual

toolthatyouusealotinthegroup.

Subject:Andprojectiveidentification.Youknowpeoplecomefullofstuffthat

hashappenedduringthedayorinwork,andthatissomethingtheyhavetaken

infromsomebodyelse,anditneedstobeunpicked,soIwouldn’tnecessarily

usetheterm,projectiveidentification,butIwouldsometimesexplainthat

peopletrytoputthingsintoyoutogetridoftheirownstuff.Yes,soprojection,

projectiveidentification.Denialisquiteimportantandobviouslytransferenceis,

butIthinkthegroupsknowthat,becausetransferencesareevengenerally

talkedaboutthesedays,orshadowistalkedaboutgenerally,youknow,

shadowaspects,soyou,sotheynoticethesethingseven,andwhenItalkabout

denialIdon’tneedto,andanotherthingthatcomesintheonegroupthatis

twiceaweekaweekherenow,victim-perpetratordynamics,actuallytheycame

inmygroupinXaswell,theyareoftentalkedabout.

Interviewer:Whichofthosedoyoufindthemosthelpful?

Subject:Formywork?SoImisunderstoodthequestion?

Interviewer:Noit’sboth.Imean,isthereonethatyoucallon?

Subject:It’swhatcomes.WhatIcallon?

Interviewer:Yeah

Subject:WhatIcallonisnotaclinicalconcept,whenIamsolost,andIdon’t

knowwhat’shappening,yes,andIgetabitanxioussometimes,youknow,I

think,OhMyGod,I’msupposedtodealwiththis,Ihaven’tgotaclue,Ido

somethingwhichisnotaclinicalconceptatall.Idon’tknowifthat’swhatyou

wanttoknow?

Interviewer:Yes,sortof…

Subject:WhatIdothenisIsaykeepanopenmindandIimaginesometimes

whenIrememberit,toopenmyheadlikethis(gestures)andseewhatcomes

intoit.

Interviewer:Right

Subject:Sothat’snotaclinicalconcept

Interviewer:Itisreally,isn’tit?Yes,itisjustthatthereisn’tanameforit.

Exceptthatitissortoftrustingyourreverie.

Subject:Yes,exactly

Interviewer:Soitislikethat.

Subject:Afewminutesorso,buttheinterestingthingforme…

Interviewer:It’stheweirdthoughtthatfallsinisoftenthehelpfulthing.

Subject:Exactly.TheweirdthingformeisthatIdon’tthinkIwillopenmyselfto

theunconsciousthatway,Iamopeningmymind,butitcertainlyis,Icanrelax

whenIrememberthat,tokeepanopenmind,tostartrelaxingandanother

processcanstartbecauseIrelinquishcontrolreally,whichisthereverie,so

that’smostusefulformeIthink.

Comment

Therewereinthisextract28codes:

Projection3,projectiveidentification3,relax3,openmind/openmyself3,

denial2,transference2,shadow2,group-analyticconcept,takeninfrom

someoneelse,victim-perpetratordynamic,beinglost,don’tknowwhatis

happening,anxious,weird,relinquishcontrol,reverie,unconscious

Becauseofthequestionsatthispointintheinterviewthesecodesfellmostly

intoTheme1,theGroupAnalystintheGroup,andthenintosub-theme1.B,

GroupAnalysisandtheGroupAnalyst.Intheclinicalmind-linetheywould

havebeenactivatedintheGroup-analystandNegativeFactorsclusters.

AppendixB

CODESANDTHEMES

1) THEGROUPANALYSTINTHEGROUPA. GROUPSPECIFICFACTORS1. Cohesion,belonging2. Mirroring,repetition,reflection

B. GROUPANALYSISANDTHEGROUPANALYST

3. Thegroupanalyst4. Theories

2)THEGROUPCHANGEPROCESS

C. THECHANGEPROCESS

5. Thechangeprocess

D. GROUPPROCESS

6. Groupprocessandexperience7. Thegroupunconscious1A.GROUPSPECIFICFACTORS

1. Generalfeaturesofgroupanalysis

Individualv.group1

Complexity/multi-faceted2

Inside/outside1

Importanceofgroup1

Workofgroup1

Subject/object1

Past/present1

2. GroupDifficulties

Dependency2

Trauma1

Victim/perpetratordynamics1

Idealisation1

Rolesuction1

Socialclassanddeprivation1

Attacks1

3. TheWorkoftheGroup

Trust4

Equality2

Safety1

Affinity1

Understanding1

Recognition1

Freeassociation1

Interaction1

Difference1

Group’suseofGA’smind1

Groupunconscious1

Group-as-a-whole2

Feeding1

Network1

Symptomspeaking1

Grouproles1

4. TheSetting

Setting7

Circleascontainer2

Table(andloss)2

5. TheTherapeuticFactors(Foulkes)

Therapeutic/curativefactors2

Matrix(container/process)7

Translation3

Condenser2

Exchange2

Support1

Figureandground1

Dynamicadministration2

Socialunconscious1

Malignantmirroring1

Containment4

Boundaries1

6. Mirroring/Reflection/Self

Mirrorneurones1

Bearingwitness1

Self/deniedpartsoraspectsofselfseenorreflectedinothers9

Reflectiveaboutothers1

Mirroring/hallofmirrors5

Experiencerepeatedingroup1

Understanding/differentiationofexperience4

Groupasseparatefromfamily1

7. Cohesion/sharing

Partofsomethingshared3

Partinstory2

Cohesion/cohere2

Partofsomething/sharing4

Thingsincommon2

Belonging2

Inittogether1

Everybodypartofprocess1

Everybody’svoice1

It’syourgrouptoo1

Notalone/alien2

Nottheonlyone1

Connecting1

Comingtogether1

Feelingvalued1

Somethingtooffer1

Allinthesamesoup1

Learningfromeachotherinthegroup/peerlearning2

Isolationinthepresenceofothers1

8. Family/motherandChild

Family/motherandchild1

Parent/motherandchild2

Maternalcontainment1

Familyresonance1

Childinthefamily1

Reflectionoffamilyingroup/familytransference2

Siblings2

1.BGROUPANALYSISANDTHEGROUPANALYST

1. References

Bion(Keats)2

Pines1

Nitsun2

Garland1

Foulkes16

2. Generalfactorsofgroupanalysis

Differencesbetweenindividualandgrouptherapy18

Subjectiveprocess1

Scientific/intuitive1

EssenceofGA1

Acceepted/wisdomofGA1

Catholic1

Frame1

Identification1

Dream1

Stories1

Metaphors1

Startingagroup1

Facilitation1

Process1

3. Thegroupanalysts’qualities

Waiting1

Excitement1

Commitment1

Curiosity4

Patience2

Toleratingfrustration1

Truth1

Engagement1

Trustingthegroup1

Mother/maternal1

Notknowing/notbeingtheonewhoknows4

4. Difficultiesinconductingagroup

Repression1

Politics1

Avoidance/anxiety1

Beingoverwhelmed1

Encapsulation1

Trappedbydespair1

Borderline1

Unconsciousattackson/testingtheGA2

5. TheGroupAnalyst

Goodenoughgroupanalyst1

GAin/partofgroup5

GA’smind2

SubjectivityoftheGA1

UnconsciouschoicebyGAofgroup1

GA’svulnerability1

GA’sillusions1

GA’spsychopathology1

GA’sblindspots1

GA’sselfawareness1

Useofself/availability1

GA’stherapyfromthegroup1

Adaptingtechniquetogp/patient1

Conductor9

6. TheoreticalConcepts

Matrix4

Transference2

Counter-transference3

Circumambulation1

Shadow1

Projection2

Playing1

Transitionalobject2

Socialunconscious1

Projectiveidentification1

Neuro-science1

Holding1

Impingement1

Reverie1

Fearofbreakdown1

Survivaloftheobject1

Psychodrama1

Figureground1

Resonance1

Alchemy1

NarcissusandEcho1

2.CTHECHANGEPROCESS

1. Thegroupchangeprocess

Connecting2

Nottheonlyone1

Internalisingthegroup1

Intenseinvolvementinothers1

Overcomingisolation1

Learningtotalkaboutthings1

Hearingothers/beingheard1

Workingwitheachother1

Interestinthegroup1

Sharingwithothers1

Findingyourselfingroup1

Individualityandvoice1

Egostrength/internalcapacity1

Formingrelationships1

Newexperiences1

Speakfreely/saywhat’sonmind/telling/speakingmind3

Celebratingtheunderstandingofself1

Usingthegroup1

Askingthegroup1

Believingthatothersareinterested1

Morevoicesingroup1

Directnessandfrankness1

Puttingintowords2

Thegroupontheirside2

Thevalueofordinarypeople2

2. TheGroupasaWhole

Groupmind/brain1

Uniquenessofeachgroup1

Groupasabodythatcalmsandregulates1

Deconstructionandreconstruction1

Co-construction1

Routine/ritual1

Groupmembersastherapists1

Foreachmembertheanswerisinthegroup1

Fairytalesandgrouproles1

Familyrepetition2

Maturegroup1

Beingalive1

Aliveexchangewithothers1

Thegroupkeptmealive1

Life-forceofthegroup1

Human2

Life-giving1

Narrative2

3. TheGroupAnalyst

Notknowing3

Trustingthegroup4

Lettingthegroupdoit1

Alongsidethegroup1

4. GroupChangeFactors

Rightsortofenvironment1

Wholeexperienceofgroup1

Immaturity1

Growthandchange2

Therapeuticpotential1

Regulationandrebalancing1

Openingtotheunconscious1

Connecting/deeperlevel/engagement3

Non-verbalcommunication1

Safety/safeplace1

Openmind1

Saying/noticingwhatisonmind1

Understanding/insight/meaning4

Mothering1

Tolerance1

Capacityforflexibility1

Capacitytowithstandstrongfeelings1

2.DGROUPPROCESS

1. GroupProcess:negativefactors

Goingroundincircles1

Goingoffinownmind1

Mindgoingblank(GA)1

Notgoodenough1

Painfulstateifmind1

Negativetransference3

Nottalkingtotheroom1

Nowayin1

Groupresistance1

Gettinglost/lossofself/losingway/notfound6

Collapse/madness/breakdown/fragmentation5

Beingoverwhelmed2

Beingvulnerable2

Isolation3

Uncontained/unstable1

Suicide1

Stuckness2

Notunderstanding4

Exhibitionism1

Helpingothersbutontself1

Delusion1

Vomit1

Paranoia1

Attackingthegp/GA2

Denial2

Anxiety/fear/danger7

Illness2

Depression4

Dissociation1

Bullying1

Doingthewrongthing(GA)1

Anger3

Projectiveidentification1

Aliencation1

Holdingback/hesitation3

Rejection/beingleft2

Notconnecting1

Infantileaspect1

Destructiveprocess1

Leavingtoosoon1

Comingandgoing1

2. Groupprocess:positivefactors

Intouchwithfeelings1

Gratitude1

Familiarityofrelationships1

Makingconnections1

Specialrelationshipwithgp1

Recognition1

Depth1

Daringtotalk1

Interestingroup/otherpeople3

Enjoymentofothers2

Reflection/self-reflection2

Workofgroup1

Adaptbehaviour1

Interaction/involvement/engagement/investment7

Remembering1

Awareness/self-awareness3

Freedom2

Unpicking1

Relaxing/comfort2

Richness1

Groupmovement1

Understanding2

Holding1

Beingseenandheard1

Lifeforce1

Projectionstakenback1

Exploration4

Helpingthegrouptounderstand1

Workinginahealthyway1

Processingfeelings/workingthrough2

Listeningandhearing2

Joining/beingpartofthings2

3. GroupProcess:GeneralFeatures

Whatisgoingon?1

Unconsciouscommunication1

Borrowingpathology1

Network1

Beingpresent1

Groupbecoming1

Buildingagroup1

Waitingforthegroup1

FocusonGA2

Groupmaterial2

Groupdevelopmentandchange8

Groupchangeprocess6

GAingroup1

Groupasawhole2

Symptomaticchange2

Groupsurvival1

Webofrelationships3

Rhythm1

Leaningalanguage1

Pivot1

Lifeanddeath1

Nomonologuing1

Therapeuticfactors1

Inside/outside1

Momenttomoment1

Trauma3

Allowing/capacityforchange3

Emotionalmind1

Accountingtopatient1

Resonance2

Earlyfailure1

Mothersandbabies1

Metaphors3

Counter-transference2

Interpretation2

Sexuality1

Dreams2

Verbalisation2

Sharingtime2

Expectations2

Defences3

Bearingdifficultfeelings1

Courage1

4. GroupProcessMetaphors

Water/boats/sea3

Drowningandre-emerging2

Diving1

Surface1

Depthofunconscious1

Alembicascontainer1

REFERENCES

Abram,J.(1991)TheLanguageofWinnicott:aDictionaryofWinnicott’sUseofWords.London:Karnac

Agazarian,A&Peters,R.(1981)TheVisibleandInvisibleGroup,RKP,London

Barnes,B,Ernst,S.andHyde,K.(1999)AnIntroductiontoGroupWork.London:Macmillan.

Baron,C.(1987).AsylumtoAnarchy.London:FreeAssociations

Bateman,A&Fonagy,P.(2004)PsychotherapyforBorderlinePersonalityDisorder:aMentalisationBasedTreatment.Oxford:OUP

Beck,A.,&Lewis,C.(2000).TheProcessofGroupPsychotherapy:systemsforanalysingchange.Washington:AmericanPsychologicalAssociation.

Behr,H.,&Hearst,L.(2005).Group-analyticpsychotherapy:ameetingofminds.London:Whurr

Billow,R.M.(2003)Relationalgrouppsychotherapy:frombasicassumptionstopassion.London:JessicaKingsley.

Binder,J.(2004).Keycompetenciesinbriefdynamicpsychotherapy:clinicalpracticebeyondthemanual.NewYork:Guilford.

Bion,W.R.(1961).Experiencesingroupsandotherpapers.London:Tavistock

Bion,W.R.(1970)AttentionandInterpretation.London:Tavistock.

Blackwell,D.(2005)CounsellingandPsychotherapywithRefugees.London:JessicaKingsley.

Bloch,S.&Crouch,E.(1985).Therapeuticfactorsingrouppsychotherapy.Oxford:OUP.

BostonChangeProcessStudyGroup(2010)ChangeinPsychotherapy,Norton,NewYork

Boyatzis,R.(1988)TransformingQualitativeInformation:thematicanalysisandcodedevelopmentSage,London

Braun,V.&Clarke,V.(2006)“Usingthematicanalysisinpsychology”,Qual.Res.Psych,3:77-106

Braun,V.&Clarke,V.(2013)SuccessfulQualitativeResearch:aPracticalGuideforBeginners.London:Sage

Bridger,H.(1990)‘Thediscoveryofthetherapeuticcommunity:theNorthfieldexperiments’.inTristandMurray(1990)pp68-87

Brown,JohnSeely&Duguid,Paul.(2000)TheSocialLifeofInformation.HarvardUP,Boston

Budman,S.H.etal.(1989).‘Cohesion,allianceandoutcomeingrouppsychotherapy’.Psychiatry,52.

Burlingame,G.etal(2011)‘CohesioninGroupTherapy’in,Norcross,J.C.(ed)(2011)pp110-131.

Burlingame,G.etal.(2013).‘Changemechanismsandeffectivenessofsmallgrouptreatment’inLambert,M.(ed)(2013)pp640-689.

CentreforPsychologicalServicesResearch,SchoolofHealth,UniversityofSheffield(2009)ASystematicReviewoftheEfficacyandClinicalEffectivenessofGroupAnalysisAnalytic/DynamicGroupPsychotherapy:http//www.groupanalysis.org/uploadedfiles/workshops/IGA_GAS_FINAL_REPORT_UPDATED.pdf

Chazan,R.(1999).‘Thegroupastherapistforpsychoticandborderlinepersonalities’.InV.Schermer&M.Pines(Ed.),Grouppsychotherapyofthepsychoses:conceptsinterventionsandcontexts(pp.200-220).London:JessicaKingsley.

Collins,H.(2013)TacitandExplicitKnowledge.Chicago:UniversityofChicagoPress

CORE-12TaskForce(2006)CoreBattery-Revised:anAssessmentToloKitforPromotingOptimalGroupSelection,ProcessandOutcome.NewYork:AGPA.

Crouch,E.,Bloch,S.&Wanlass,J.(1994).‘Therapeuticfactors:interpersonalandintrapersonalmechanisms.’InA.Fuhriman&G.M.Burlingame(Ed.),Grouppsychotherapy:anempiricalandclinicalsynthesis(pp.269-318).NewYork:Wiley.

Cytrynbaum,S.(2000)Themember-leaderscoringsystem.InA.Beck&C.Lewis(Ed)Theprocessofgrouppsychotherapy:systemsforanalysingchange(pp.175-218).Washington:APA.

Dalal,F.(1998).Takingthegroupseriously.London:JessicaKingsley.

DeMare,P.(1985).‘MajorBion’inPines,M.ed(1985)

Dies,R.(1994)‘Therapistvariablesingrouppsychotherapyresearch’.In:A.FuhrimanandG.M.Burlingame(ed)pp114-154.

Duncan,BarryL.,Miller,ScottD.,Wampold,BruceE.&Hubble,MarkA.(2011).TheHeartandSoulofChange:DeliveringWhatWorksinTherapy(2nded),APA:Washington.

Elliot,B(2003).ContainingtheUncontainable:AlcoholMisuseandthePersonalChoiceCommunityProgramme.London:Whurr

Ezriel.H.(1950)‘Apsychoanalyticapproachtothetreatmentofpatientsingroups’JournalofMentalScience,96,pp774-9.

Fonagy,P.(2004)‘Foreword’,inRichardsonetal(eds)ppxix-xxvii.

Foulkes,E.(1990a).‘S.H.Foulkes:abriefmemoir’.InE.Foulkes(Ed)SelectedpapersofS.H.Foulkes:psychoanalysisandgroupanalysis.(pp3-20)London:Karnac

Foulkes,E.(1990b)(Ed).SelectedpapersofS.H.Foulkes:psychoanalysisandgroupanalysis.London,Karnac.

Foulkes,S.H.(1948).Introductiontogroup-analyticpsychotherapy.London:Heinemann

Foulkes,S.H.&Anthony,E.J.(1957)Grouppsychotherapy:thepsychoanalyticapproach.Harmondsworth:Penguin.

Foulkes,S.H.(1964).Therapeuticgroupanalysis.London:GeorgeAllen&Unwin.

Foulkes,S.H.(1968).‘Oninterpretationingroupanalysis.’InternationalJournalofgroupPsychotherapy,18,432-444.

Foulkes,S.H.(1975).Group-analyticpsychotherapy:methodandprinciples.London:Gordon&Breach.

FrankfurtInstituteforSocialResearch.(1973)AspectsofSociology.London:Heineman.

Fromm,E.(1970)TheCrisisofPsychoanalysis:EssaysonFreud,MarxandSocialPsychology.London:Penguin

Fuhriman,A.&Burlingame,G.M.(1994)Handbookofgrouppsychotherapy:anempiricalandclinicalsynthesis.NewYork:JohnWiley.

Fuhriman,A.&Burlingame,G.M.(2000).‘TheHillinteractionmatrix’.InA.Beck&C.Lewis.(pp135-174)

Gabbay,J.&LeMay,A.(2011).Practice-basedEvidenceforHealthcare:ClinicalMind-lines.Abingdon:Routledge.

Gans,J.(2010)Difficulttopicsingrouppsychotherapy:myjourneyfromshametocourage.London:Karnac.

Garland,C.(1982)‘Takingthenon-problemseriously’,GroupAnalysis,15,1pp4-14

Garland,C.(2011)TheGroupsBook.London:Tavistock

Gascoigne,N.&Thornton,T.(2013).TacitKnowledge.Durham:Acumen.

Gibbs,G.(2007)AnalysingQualitativeData,Sage,London

Greenberg,L&Pinsof,W.M.(1985)Thepsychotherapeuticprocess:aresearchhandbook.NewYork:Guilford.

Greenberg,L.(2000).‘Foreword.’InA.BeckandC.Lewis(ppxxiii-xxvi)

Greene,L.R.(2000)‘Processanalysisofgroupinteractionintherapeuticgroups’.InA,BeckandC.Lewis(pp23-48)

Hamilton,V.(1996)TheAnalyst’sPreconscious.NewJersey:TheAnalyticPress.

Harper,D.&Thompson,G.R.(2012)QualitativeResearchMethodsinMentalHealthandPsychotherapy,WileyBlackwell,London

Healy,K.(2001)“Workinghypothesesinpsychoanalyticpsychotherapy”,inMaceetal(2001)

Harrison,T.(2000)Bion,Rickman,FoulkesandtheNorthfieldexperiment.London:JessicaKingsley.

Hinshelwood,R.D.(1987).Whathappensingroups:psychoanalysis,theindividualandthecommunity.London:FreeAssociationBooks..

Holmes,J.(1993)JohnBowlbyandAttachmentTheory,Routledge,London

Hopper,E.(2003).Traumaticexperienceintheunconsciouslifeofgroups.London:JessicaKingsley.

Hopper,E.(1999).Thesocialunconscious:selectedpapers.London:JessicaKingsley

Horwitz,L.(2014)ListeningwiththeFourthEar:UnconsciousDynamicsinAnalyticGroupPsychotherapy.London:Karnac.

Joffe,H.(2012)‘Thematicanalysis’,inHarleyandThompson(2012)pp209-223

Karterud,S.(2000).Thegroupemotionalityratingsystem’.InA.Beck&C.Lewis(pp113-134)

Kennard,D.,Roberts,J.&Winter,D.(1993)Aworkbookofgroupanalyticinterventions.London,JessicaKingsley.

Kreeger,L.(1975)TheLargeGroup.London:Constable

Kutter,P.(1982)BasicAspectsofPsychoanalyticGroupTherapy.Routledge,London

Kvale,S.(2007)DoingInterviews,Sage,London

Lambert,MichaelJ.(ed)(2013)BerginandGarfield’sHandbookofPsychotherapyandBehaviorChange(6thEd).Wiley,NewJersey

Leiper,R&Maltby,M.(2004)ThePsychodynamicApproachtoTherapeuticChange,Sage,London

Lepper,G.&Riding,N.(2006)ResearchingthePsychotherapyProcess,Palgrave,London

Lewis,C.,Beck,A.,Dugo,J.,&Eng,A.M.(2000)‘Thegroupdevelopmentprocessanalyticalmeasures’.InA.Beck&C.Lewis(pp221-262)

Lieberman,M.(2013):Social:whyourbrainsarewiredtoconnect.Oxford:OUP

Lorentzen,S.(2014)GroupAnalyticPsychotherapy:WorkingwithAffective,AnxietyandPersonalityDisorders.London:Routledge.

Mace,C,Moorey,S.&Roberts,B.(eds)(2001)EvidenceinthePsychologicalTherapies:acriticalguideforpractitioners,BrunnerRoutledge,London

McLeod,J(2011)QualitativeResearchinCounsellingandPsychotherapy,Sage,London

McPherson,S.,Richardson,P.&Leroux,P,(eds)(2003)ClinicalEffectivenessinPsychotherapyandMentalHealth.Karnac,London

Maratos,J.(ed)(2006).ResonanceandReciprocity:SelectedpapersofDennisBrown.Hove:Routledge.

Marcuse,H.(1962).ErosandCivilisation:aPhilosophicalInquiryintoFreud.NewYork:VintageBooks.

Marcuse,H.(1970)FiveLectures.Boston:BeaconPress.

Marrone,M.(1998).Attachmentandinteraction.London:JessicaKingsley.

Murray,H.(1990).‘Thetransformationofselectionprocedures:theWarOfficeselectionboards’.InTristandMurray(eds)(pp45-67)

Norcross,J.C.(ed)(2011).PsychotherapyRelationshipsthatWork:Evidence-basedResponsiveness.NewYork:OUP

Natterson,J.M.&Freidman,R.J.(1995)APrimerofClinicalSubjectivity.NewJersey:JasonAronson

NICE(NationalInstituteforHealthandClinicalExcellence).https:\\www.nice.org.uk

Oakely,C.(1999)(Ed).Whatisagroup?Anewlookattheoryinpractice.London:RebusPress.

Ormont,L.R.(1992)Thegrouptherapyexperience:fromtheorytopractice.NewYork:StMartinsPress.

Ormont,L.R.(2001)Thetechniqueofgrouptreatment.Madison:PsychosocialPress

Papadopoulos,R.(ed)(2006)TheHandbookofJungianPsychology.London:Routledge

Pines,M.(1982)‘ReflectionsonMirroring’GroupAnalysis,Supplement,15,2pp1-26

Pines,M.ed(1983).Theevolutionofgroupanalysis.London:RKP

Pines,M.ed(1985)BionandGroupPsychotherapy.London:RKP.

Piper,W.&McCallum,M.(2000).‘Thepsychodynamicworkandobjectratingsystem’.InA.BeckandC.Lewis(pp263-282)

Piper,W.E.etal(2002)InterpretiveandSupportivePsychotherapy:MatchingTherapyandPatientPersonality.Washington:APA

Polanyi,M.(1958).PersonalKnowledge.Chicago:UniversityofChicagoPress.

Polanyi,M.(1966)TheTacitDimension.Chicago:UniversityofChicagoPress

Richardson,P.(2003)‘Evidence-basedpracticeandthepsychodynamicpsychotherapies’inMcPhersonetal(ed)(2003)pp49-70

Richardson,P.&Hobson,P.(2003).‘InDefenceofNHSPsychotherapy’,inMcPhersonetal(ed)(2003)pp27-42

Richardson,P.,Kachele,H.&Renlund,C.(eds)(2004)ResearchonPsychoanalyticPsychotherapywithAdults,London:Karnac.

Roberts,J&Pines,M.(eds)(1991)ThePracticeofGroupAnalysis.London:Routledge

Robson,C.(2011)RealWorldResearch,Wiley,London

Rosenthal,L.(1987)Resolvingresistanceingrouppsychotherapy.Northvale:JasonAronson.

Ryle,Gilbert(2000)TheConceptofMind,Penguin,London

Saldana,J(2009)TheCodingManualforQualitativeResearchers,Sage,London

Schermer,V.L.,&Pines,M.(1999)Grouppsychotherapyofthepsychoses:concepts,interventionsandcontexts.London:JessicaKingsley.

Shedler,J.(2010)‘Theefficacyofpsychodynamicpsychotherapy’.AmericanPsychologist65(2)pp98-109

Stacey,R.D.(2003).Complexityandgroupprocess:aradicallysocialunderstandingofindividuals.Hove:BrunnerRoutledge.

Sutherland,J.D.(1990).‘Bionrevisited:groupdynamicsandgrouppsychotherapy’InTristandMurray(pp119-140)

Trist,E.&Murray,H.(eds)(1990).TheSocialEngagementofSocialScience.FreeAssociationBooks,London

Walton,H(Ed)(1971)Smallgrouppsychotherapy.Harmondsworth:Penguin

Wampold,B.E.&Imel,Z.(2015)TheGreatPsychotherapyDebate.London:Routledge.

Weegman,M.&Cohen,B.(eds)(2002)ThePsychodynamicsofAddiction.London:Whurr

Williams,M.H.&Waddell,M.(1991)TheChamberofMaidenThought.London:Routledge.

Wilson,A.T.M.,Trist,E.&Curle,A.(1990)‘Transitionalcommunitiesandsocialreconnection:thecivilresettlementofBritishprisonersofwar’.InTristandMurray(eds)pp88-110

Winnicott,C.,Shepherd,R.&Davies,M.(eds)(1989)PsychoanalyticExplorations:D.W.Winnicott.London:Karnac

Winnicott,D.W.(1947)‘Birthmemories,birthtraumaandanxiety’inWinnicott,D.W.(1958)pp174-193.

Winnicott,D.W.(1958)ThroughPaediatricstoPsychoanalysis:CollectedPapers.London:Karnac

Winnicott,D.W.(1963)‘FearofBreakdown’inWinnicott,C.etal(eds)(1989)pp87-95

Winnicott,D.W(1974)PlayingandReality.London:Penguin

Yalom,I.D.(1975).TheTheoryandPracticeofGroupPsychotherapy,BasicBooks,NewYork

Zinkin,L.(1983)‘MalignantMirroring’,GroupAnalysis,16,2pp113-126)

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DIN 17175 - 1979

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FOREST CERTIFICATION AS ENVIRONMENTAL LAW MAKING …web2.law.buffalo.edu/faculty/meidinger/823/Meidlaw.pdf · FOREST CERTIFICATION AS ENVIRONMENTAL LAW MAKING BY ... may usefully

TMA World Mindlines 2012 Some Lessons from the Cirque du Soleil

Bas van Fraassen has usefully contrasted two ways to view the

SVEU ČILIŠTE U ZAGREBU FAKULTET STROJARSTVA I …bib.irb.hr/datoteka/394761.17_12_2008__9913_Novosel_magistarski... · 15Mo3, DIN 17175. The paper also gives an overview of analyses

When redundancy is useful: A Bayesian approach to ...alpslab.stanford.edu/papers/2020_DegenEtAl.pdfRUNNING HEAD: USEFULLY REDUNDANT REFERRING EXPRESSIONS 1 When redundancy is useful:

PROSEDUR OPERASIONAL STANDAR (POS) PENYELENGGARAAN UJIAN NASIONAL TAHUN …repositori.kemdikbud.go.id/17175/1/(0053) POS UN 2019-2020.pdf · Nomor 20 Tahun 2016 tentang Standar Kompetensi

TMA World Mindlines The Borderless Workplace

Bas van Fraassen has usefully contrasted two ways to view ...users.uoa.gr/~psillos/PapersI/van Fraassen-on-Perrin-Psillos.pdf · Bas van Fraassen has usefully contrasted two ways

PANITIA SELEKSI NASIONAL PENGADAAN CPNS 2018 · Jabatan : 1199637 - GURU PRAKARYA DAN KEWIRAUSAHAAN AHLI PERTAMA 123 Kode Jumlah Instansi : 3012 - Kementerian Agama 17175 Lokasi Formasi

SEAMLESS STEEL PIPE - OKorderfile1.okorder.com/cnbmcms/uploadfiles/attach/2011/03/24/c48dac3f... · a192 & a192m, astm a210 & a210m, astm a519, astm a179 & a179m, din 17175, ... cnbm

Conceiving Musical Transdialection - amherst.edu · composer, Michael Finnissy. ... We conclude, among other things, that Finnissy’s transcription is justifiably, and usefully so-called

skoch tip kazan - Wenta · aksamlar DIN 17155 malzemeden imal edilmektedir. Kazan borulartrmz DIN 17175 - 2448 normunda dikissiz çelik çekme yüksek bastnçll kazan borusudur

Afrox Product Reference Manual 12 | Low Alloy Steels · din 17155 17mn4 din 17155 19mn6 din 17155 15mn3 astm a204 a, b, c astm a302 a, b din 17175 17mn4 din 17175 19mn5 bs 3059 243