1

1

GROUP-ANALYTICCLINICALMINDLINES

AnInterviewStudyoftheWorkingTheoriesofGroup-Analytic

Psychotherapists

DavidVincent

AThesisSubmittedfortheDegreeofProfessionalDoctorate

CentreforPsychoanalyticStudies

UniversityofEssex

September2015

2

2

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

3

3

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

4

4

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.

5

5

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

6

6

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

7

7

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

8

8

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

9

9

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

10

10

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,

11

11

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

12

12

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

13

13

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

14

14

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).

15

15

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

16

16

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

17

17

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

18

18

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

19

19

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

20

20

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

21

21

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

22

22

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

23

23

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

24

24

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

25

25

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.

26

26

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

27

27

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

28

28

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

29

29

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

30

30

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).

31

31

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

32

32

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

33

33

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

34

34

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

35

35

offollowingandbeingpartoftheinteractioninthegroup.Thisisprobably

involvedinthefrequentassertioningroupanalysisthatthegroupanalystis

bothamemberofthegroupandatthesametimeoutsideit(Foulkes,1957,p

28).

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

36

36

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

37

37

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

38

38

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

39

39

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

40

40

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

41

41

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

42

42

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-

43

43

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.

44

44

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).

45

45

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

46

46

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

47

47

“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.

48

48

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

49

49

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.

50

50

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

51

51

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

52

52

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

53

53

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

54

54

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

55

55

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

56

56

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

57

57

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

58

58

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,

59

59

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?

AND

1.1.“Whichofthethreeismostimportanttoyou,andwhy?”

60

60

1.2.“Howdoyouthinkthatrelatestowhatyouunderstandisthegeneralor

acceptedviewingroupanalysis?”

1.3.“Whatabouttheothertwo?”

2.“Foryou,whatisspecialordistinctiveaboutgroupanalysiscomparedto

othermethodsofpsychotherapy?”

AND

2.1.“Isitthosethingsthatareparticularlyimportantinthechangeprocess?

Andifso,which,foryoupersonally,isthemostspecial,distinctiveanduseful?”

2.2.“Whatismostdifficulttodo,ortounderstand,ingroupanalysis,

particularlyinrespecttothechangeprocess?”

3.“Whattheoreticalconceptsandideasaremostusefultoyoupersonallyas

agroupanalystyouthinkaboutyourclinicalgrouppractice?

AND

3.1.“Whenyouareworkinginagroup,whichworkingconceptscomemost

oftentomind,andwhicharemosthelpfultoyou

3.2“Canyougivearecentexample?”

4.“Canyouthinkofcommentsthatyourpatientshavemadeinthegroup,

particularlyattheendofthesession,orattheendoftreatment,aboutthe

waysinwhichthegroupexperiencewashelpfultothem?”

61

61

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,

62

62

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

63

63

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.

64

64

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

212).

65

65

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

66

66

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.

67

67

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

68

68

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

69

69

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

70

70

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:

71

71

“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.

72

72

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

73

73

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

74

74

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

75

75

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

76

76

theemotionsthatareverbalisedinthegroup,orexpressedinthegroup

sometimesinanon-verbalway”.Theseideas,aboutengagement,beingused,

beingavailable,thedistinctionbetweengroupmembersandgroupprocess,

beingafraidofbeingoverwhelmedandverbalandnon-verbalexpressionall

occuragainandagaininvariousformsintheinterviewresponses.Thereisalso

hereanotherechoofWinnicott,wherebeingusedasatoolseemstorefer

indirectlytohispaperabouttheuseofanobject(Winnicott,1971,pp.101-

111).

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

77

77

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

78

78

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

79

79

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

80

80

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

81

81

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,

82

82

“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

83

83

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

84

84

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

85

85

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”.

86

86

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

87

87

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

88

88

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

89

89

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

90

90

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

91

91

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

92

92

“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

93

93

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

94

94

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

95

95

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

96

96

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

97

97

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

98

98

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.

99

99

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

100

100

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

101

101

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

102

102

“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

103

103

“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

104

104

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

105

105

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,

106

106

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

107

107

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.

108

108

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.

109

109

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.

110

110

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

111

111

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,

112

112

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.

113

113

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.

114

114

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.

115

115

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,

116

116

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

117

117

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,

118

118

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

119

119

thetranscripts.AfulllistofthecodesandthemesisinAppendixB,anda

sampleextractfromacodedinterviewisinAppendixC.

Thesignificanceofthesehierarchiesofcodeswithinthesub-themesand

themesisrichandcomplex,andtheimplicationsofthefindings,andhowthe

findingsofthethematicanalysisinterweavewiththeinterviewprocess,inthe

processofbuildingamodelofthegroup-analyticclinicalmind-line,willbe

discussedinfullinthenextchapter.

120

120

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

121

121

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.

122

122

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

123

123

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

124

124

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

125

125

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

126

126

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.

127

127

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

128

128

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

129

129

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,

130

130

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

131

131

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

132

132

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).

133

133

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

134

134

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

135

135

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

136

136

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

137

137

ofcodesputtogethertocreateassenseofmovementthroughthecourseof

thechangeprocess,thatthefinalstageofcelebratingtheunderstandingofthe

selfisquitecloseasaconcepttothehighestscoringofthe60sortedcategories

inYalom’swell-knownresearchaboutthecurativefactors:“Discoveringand

acceptingpreviouslyunknownorunacceptablepartsofmyself”(Yalom,1975,p

80).

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

138

138

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

139

139

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-

140

140

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

141

141

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

142

142

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

143

143

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

144

144

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

145

145

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-

146

146

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

147

147

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.

148

148

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

149

149

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.

150

150

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

151

151

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

152

152

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

153

153

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.

154

154

AppendixB

CODESANDTHEMES

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

B. GROUPANALYSISANDTHEGROUPANALYST

3. Thegroupanalyst4. Theories

2)THEGROUPCHANGEPROCESS

C. THECHANGEPROCESS

5. Thechangeprocess

D. GROUPPROCESS

155

155

6. Groupprocessandexperience7. Thegroupunconscious1A.GROUPSPECIFICFACTORS

1. Generalfeaturesofgroupanalysis

Individualv.group1

Complexity/multi-faceted2

Inside/outside1

Importanceofgroup1

Workofgroup1

Subject/object1

Past/present1

2. GroupDifficulties

Dependency2

Trauma1

Loss1

Victim/perpetratordynamics1

Idealisation1

Rolesuction1

Socialclassanddeprivation1

Attacks1

3. TheWorkoftheGroup

Trust4

Equality2

Safety1

Affinity1

156

156

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

157

157

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

158

158

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

Jung1

Nitsun2

Garland1

Foulkes16

2. Generalfactorsofgroupanalysis

Differencesbetweenindividualandgrouptherapy18

159

159

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

160

160

Sex1

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

161

161

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

162

162

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

163

163

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

164

164

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

165

165

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

166

166

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

167

167

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

168

168

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

169

169

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.

170

170

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.

171

171

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.

172

172

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

173

173

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.

174

174

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)

175

175

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)

176

176