International Journal of Group Psychotherapy
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
Family Therapy as Seen by a Group Therapist Bernard F. Riess To cite this article: Bernard F. Riess (1976) Family Therapy as Seen by a Group Therapist, International Journal of Group Psychotherapy, 26:3, 301-309, DOI: 10.1080/00207284.1976.11491951 To link to this article: https://doi.org/10.1080/00207284.1976.11491951
Published online: 29 Oct 2015.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ujgp20
Family Therapy as Seen by a Group Therapist BERNARD F. RIESS, PH.D.
THE TASK SET BY the title of this symposium is not as simple as it seems. Rather, it involves an old chestnut, namely the relationship between theory and therapy. For instance, what is meant by "group" when used together with the function-defining term, "therapy"? How does a therapy group differ from a family therapy group.'~ Are the differences, if any, related to the structure of the group, the therapist 's theoretical assumptions about group and family, or to the therapist's expectations and self-image in relation to his or her patients, clients, or subjects? A group, we assume, is more than an aggregation of individuals, but its essential characteristics have been so differentially perceived by various writers that it is difficult to define. On the other hand, the family as a group has been much more specifically delimited, even though, despite the conforming and converging pressures of society, biology, anthropology, and social psychology, there may still be discrepancy in the description of a family. As an instance, one may cite the definition emanating from the Southwest U.S.A. that a Navajo family consists of a father, mother, children, and an anthropologist from the University of New Mexico. What I propose to do in this short essay is to list some of the differences and similarities in the two types of aggregations of individuals who come for or are assigned to certain modalities of t reatment. Perhaps there is still reason to ask the old question: What kind of treatment for what kind of patient with what kind of problem under the leadership of what kind of therapist? For, in my Dr. Riess is Director of Research, Postgraduate Center for Mental Health, New York, N.Y.
301
302
Bernard F. Riess
view, what the therapist does in therapy is, or rather should be, a function of his own perceptual and theoretical attitudes toward his task . Let me first comment on the group as I see and work with it. For the most part my orientation is Freudian psychoan alytic , although I depart from this when dealing with industrial executives and other aggregates of people not seeking help for specific personality problems . The therapy group, as distinguished from the family group, is from the start a collec tion of individuals who h ave, as they see it , only one common ality, namely, that they recognize that something is wrong with them. For this they have sought or have been told to seek help . Sometimes the recommendation for group treatment comes after months or years of unsuccessful individual therapy and from a sense of desp air on the part of the therapist. Sometimes, and not so rarely, group therapy is sought because it costs less than dyadic private or clinic treatment. Occasionally, it is prescribed because the referring person feels that group experience is relevant to the specific dynamics of the individual patient. This last possibility for referral to a group is rare in the United States. I agree with Ferdinand Knobloch (1968), who, while in charge of the Institute for Neurosis at Carolinskaya Universi ty in Czechoslovakia, used group therapy to screen out those problems which required individual, dynamic therapy . All patients entered the treatment process through a group experience and then dealt with those facets of emotional disturbance which emanated from discrepancies between idealized and actual group behavior. The residual intrapsychic difficulties were seen as requiring individual psychoanalytic psychotherapy . In Knobloch's description of his rationale, he makes the following p oints , which I feel are important in understanding the operation of psychoanalytic group psychotherapy. A small social group . . . [is J a quasi -closed system for the following reasons : (1) A human being lives most of his life in a limited number of small. groups providing satisfaction for his needs. By choosing a small group as a quasi-closed system, a rule of isomorphism between research and behavior is observed .... If one plays a similar role in different small groups , interactive patterns are homomorphic . In behavior disorders such as neuroses , the outcome situation may be homomorphically unfavorable for the individual. ... One lives in a small group , even if alone,
Family Therapy-Group Therapist 's View
303
as is most vividly seen in dreams and phantasies .. .. A term, group model or schema ... [is used) not only as an aid for problem -solving and for training several skills, but also for substitute satisfactions not attainable in real groups or only at much higher cost ... . An individual interacts with the imagi;;1ed persons of his group's model and gets imagined feedbacks from them . Knobloch then presents the following conditions for therapeutic change: First , an artificial group must be a suitable model of a patient's group, i.e., it must motivate him to show his reflection of role performances. At the same time, the group processes must be simplified, so that the maladaptive role performances can be identified and demonstrated to the patient . . .. Second, an artificial group must stimulate a patient to see in it his group schema . . .. A therapeutic group, by a special technique , must give a special opportunity to a patient to regard it in a certain degree as a realization of his group schema. This can be achieved almost in pure form in individual therapy using the Freudian couch and free association and producing transference neurosis. But the levels in group settings, e.g., in a therapeutic community used by us, are sufficient for the aims of psychotherapy. Third, an individual must have in a therapeutic group enough freedom of social movement so that he can not only structure his performances of roles, but also restructure them if his needs are changed . ... Fourth, the therapist controls patients so that they do not create irreversible situations which would be the deadlock of psychotherapy .... Fifth , a relearning of the performances of roles must be possible .... A group offers a patient a corrective experience which has both emotional and cognitive aspects and both are inseparable .... [pp. 127-128). It is because of the contrast of the varying feedbacks from the real group and the group model or schema that group therapy works. In many senses, when one works with this conceptualization, group therapy is multiple individual therapy. Its goal is to identify, preserve, and liberate those forces that comprise the individuality and the uniqueness of the person. To the extent that this happens,
304
Bernard F. Riess
group therapy produces change. The goals of group therapy are to make the individual free to develop autonomy, creativity, and a sense of dedicated well- being as well as to alleviate the symptoms originally presented . The group is important in that it provides a corrective experience in the conflict between the fantasy group schema and the actuality of group existence. Vasso and George Vassiliou (1968, 1972) , see the group therapy process as an interaction of several subsystems in which the therapist serves as a catalyst-expediter. As is not the case in family therapy, in an analytic group, child-parental and nuclear family relationships are relatively unimportant. Yalom (1970) reports an unpublished study in which members of several groups were given a Q-sort of factors important to them in their therapy sessions . After factoranalysis of the responses , 12 groupings emerged , of which family re-enactment was tenth in order of importance and factor-loading. From another point of view there is validity in differentiating group from family relationships. It is becoming increasingly apparent that the family as a biosociologic necessity is disappearing and may yet become an archeologic artifact. Mitscherlich's book on the fatherless family (1963) offers some documentation of this . With the break-up of traditional dependency relationships, the peer group is a major factor in combating isolation. So, too, the analytic focus on self-image and self-understanding may help to remedy whatever trauma eventuates from the loosening ties of family structure. To sum up this attempt to delimit group therapy , it seems that therapy group members have uniquely individualized presenting problems and that these problems in the here-and-now are related historically and developmentally to each person's past . The group supplies reinforcement , confrontation, and reality testing against the imagined group life of the patient. It functions initially as a collection of peers to whom various transferences may become at tached. The therapist is a catalyst, an unreal parent, a changing influence who uses his knowledge, insight, and empathy to provide corrective experiences but who never becomes in reality one of the patient's peers. What then of family therapy? In what respects does it so differ from group treatment that the difference affects the measures of change? First, in family therapy there is a discrepancy between the ther2pist's expectations and theory and those of the family being
Family Therapy-Group Therapist's View
305
treated . The therapist who works with families is convinced, or should be, that the index patient is merely the finger pointing to family dysfunction. On the other hand, the family comes in either by request as a result of agency attitude toward the presenting child patient or because one of the family has become a disruptive influence in the home and has provoked the other members to the point where they feel something has to be done to stop the difficult member. The therapist's main initial effort must be to make all members of the family group see the family as the patient rather than the offending person. Once this is done, each participant must identify what is good for the family unit and in what way her or his behavior is dystonic. The "why" and "what from" of a person's repertoire of acts is less important than "who is hurt" and "how can I change" queries . Each person in a family has a role and these roles must fit into the family rules. Jung (1963) stated this well, "It often seems as if there were an impersonal karma within a family which is passed on from parents to children. It has always seemed to me that I had to answer questions which fate had posed to my forefathers and which had not yet been answered. . . . It is difficult to determine whether these questions are more of a personal or more of a general (collective) nature. It seems to me that the latter is the case .... The cause of disturbance is, therefore, not to be sought in the personal surroundings but rather in the collective situation. Psychotherapy has hitherto taken this matter far too little into account"(p. 233ff. ). It becomes necessary, therefore, to look upon the family as a construct , to try and see it both as a closed system and as a congeries of subsystems. Bell (1971) sees the family as a transactional unit: Events within the family occur within a total system of interdependent subsystems, i .e., individual, family, community, and value. The important system levels are intrapsychic, interpersonal in the family and the culture , i.e., psychoanalytic, social role conflict solution and culture-value levels [pp. 864-865). Within these levels and systems , the family can be defined from the eye-level view of the child, from the sociological communicative, activity and decision-making aspect, and from the cultural, institutional viewpoint with its emphasis on conformity and disunity with culture and its pressures. The action process of the family leads to mutual accommodation, which consolidates complementary aims and reconciles the conflicting de-
306
Bernard F. Rz"ess
mands of individuals, thus leading to the structuring of the formerly ambiguous and inchoate operational fields .... The healthy family shows by mutual satisfaction of its members and by action in concert that the complementary aims exist and are supporting functions and structures of the group as a group . It has available multiple methods for accommodating the mutually incompatible demands of its individual members. It has means of repeatedly evaluating the consequences of its achievemen ts of accommodation. Finally , it chooses to operate flexibly so that new methods of accommodation may be discovered [pp. 869-870]. The family is , then, much more of a closed system than the therapy group. Its existence as an entity is , albeit sometimes grudgingly, admitted by its mem bership. The role of the therapist is, therefore, greatly different than in the therapy group . His function , once the question of the family as the patient has been worked through , is to develop pictures of how each individual contributes to the disorganization of the unit. To do this , he has to ally himself first with one and then with another subsystem or unit. Zuk (1971) sees family treatment as a series of dyadic or triadic relationships with the therapist , who functions as an ally , antagonist , and gobetween to and with members of the family. In essence, the sessions are a series of dyadic or triadic encounters, the goal of which is to change the focus from the presenting or index person to the famil y as the etiologic entity. The therapist strives to catalyze the conflict so that the contributions of the various mem· bers are clearly perceived. In doing this , as Zuk sees it, the therapist must act as a go-between among the members, which inevitably and planfully results in side-taking. There are some dangerous b yproducts of these changing roles for the therapist. He fosters the family's dependence upon him as a leader imbued with unrealistic knowledge, power , and ability to see through and resolve conflict. Like siblings, the members of the family group may compete for the leader's favorable attention. Finally, as the family feels itself becom · ing more coalescent, all components of it may turn against the therapist with exaggerated evidence of dependence -hostility. With all these interrelationships taking place at many dynamic levels, the family therapy group more nearly resembles a Gestalt
Family Therapy-Group Therapists View
~07
encounter situation than a therapy group. The relationship of family therapy to individual analysis might be compared to a treatment in which only the oedipal triangle was the focus of analysis and interpretation. Again, viewed dynamically, the development of ind ividual transferences , regressions, and fixations may be and often are inimical to the progress of family therapy because these intrapersonal experiences tend to isolate one individual from participation in the unitary development of the family group. I am reminded of the experience of a black, ghetto, day care center where the children receive extremely good psychological help but where the home visitor (a black woman ) reports back that the families of the improved children seem to be under more stress and to deteriorate more th an those of untreated children . Another factor unique to family therapy is pointed out by Sorrells (1972) in comparing family group and encounter techniques. T he question of blame and responsibility is significant for family therapy . ... Families usu ally come for help with extreme feelings of guilt concerning the plight of the I. P. (identified patient) . . . . Generally the sense of guilt produces nothing worthwhile in terms of behavior change . . . . Thus, in conjoint family treatment , the goal is to teach each member to be responsible to and for himself . . . . When individual responsibility is truly a realized feeling in a family ,.there is simply no room for any member to be blamed for the behavior of any other member [p. 324ff.].
Since family and group therapy are demonstrably so different, it should not be surprising that the nature of the changes to be assessed and evaluated is d ifferent. Garfield , Bergin , and Prager (1972) have well researched this area . Statements about amount of change in any area or in total adjustment are almost meaningless . An objectively small change, for instance, in fear of meeting strangers, may make a patient feel a whole lot better . Again , it is necessary to point out that the goals of patients and therapists influence any measures of outcome. It has becom e trite to say that change from pre - to post-therapy Rorschach is rarely helpful to the patient .
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Bernard F. Riess
Yalom (1970), on the basis of his and others' research, organizes curative factors in group thereapy into 10 primary categories: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 .
Imparting information Instilling hope Universality Altruism Corrective recapitulation of the primary family group Developing socializing techniques Imitating adequate models Interpersonal learning Group cohesiveness Catharsis
If one obtains information from group patients , information yielded by indirect and theoretically unloaded techniques, what emerges is a relatively low role for re-enactment of family relationships , identification with the group leader, and rule-setting or guidance. Insight, as it is used in psychoanalysis, was found to be limited to "discovering and accepting previously unknown or unacceptable parts of myself." Most of the curative factors listed are inherent in the group which identifies, confronts, and reinforces the various components or behaviors. The role of the therapist as a change-agent is, of course, also important. However, here again, in a multitude of studies, patients do not see the working through of a specific relationship to the therapist as of great importance to the success or failure of treatment . What is said about the therapist as group leader is that honesty and the timing of self-revealing intervention is of importance in helping and in modeling group behavior. In contrast to the above, we have very little information on factors that have emerged from research in family therapy. One factor seems at least to be incontrovertible, that. is, increased and more open communication among family members. Second, the par ataxic distortions and / or transferences are important factors because of their resemblance to that of the family experience of the parents. The therapist factor in family therapy , therefore , has more value and potency than it does in analytic group therapy. As initially a good father or mother figure, the therapist seeks to facilitate better communication and a sense of identity within the family by
Family Therapy-Group Therapist's View
309
his interventions, siding with one member against others and acting as a go-between in the family diagram. In summary, therefore, of family therapy as seen from the viewpoint of group therapy, it is my belief that the two are widely varying approaches to widely divergent problems. The family , to the participants, becomes the patient only under the tutelage of the therapist, whose first task, as seen by some in the field, is to convert the family into the index patient. At that point, the nuclear family is not perceived as a viable unit but as a series of dyadic groupings, each vying with the others for authority. In contrast, the group in group therapy never becomes the patient. It is always merely the embodiment of the models with which each individual patient enters into the group process . As group treatment proceeds, the members provide an opportunity for the individual to test her or his group images and role performances against those of peers and to correct inadequate, irrelevant, or imprecise perceptions. REFERENCES Bell, J. E. (1971) , Recent Advances in Family Therapy. In: Theory and Practice in Family Psychiatry, ed. J. G. Howells . New York: Brunner/Mazel. Garfield, S., Bergin, E., and Prager, R . (1972), Evaluation of Outcome in Psychotherapy. In: Psychotherapy, 1971, ed. J. Matarazzo et a!. New York: Aldine. Jung, C. G. (1963), Memories, Dreams, Reflections. New York: Vantage Press. Knobloch, F. (1968), Toward a Conceptual Framework of a Group-Centered Psychotherapy. In: New Directions in Mental Health, ed. B. F. Riess . New York: Grune & Stratton. Mitscherlich, A. (1963), Society without the Father. New York: Harcourt, Brace & World . Sorrells, J. (1972), Groups, Families and the Karass. In : New Perspectives on Encounter Groups, ed. L. Solomon and B. Berzon. San Francisco: Jossey-Bass. Vassiliou , G. (1968), An Introduction to Transactional Group Image Therapy. In: New Directions in Mental Health, Vol. I, ed. B. F. Riess. New York: Grune & Stratton . _ _ _ , and Vassiliou, V. (1972), Some Deliberations Concerning General Systems Theory Application in Group Therapy . International Mental H ealth Research Newsletter, Vol. 14, 4. Published by Postgraduate Center for Mental Health. Yalom, I. (1970), The Theory and Practice of Group Psychotherapy. New York: Basic Books. Zuk, G. H. (1971), Family Therapy. New York: Behavioral Publications.
Dr. Riess 's address: Postgraduate Center for Mental Health 124 East 28th St. New York, N.Y. 10016
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
Family Therapy as Seen by a Group Therapist Bernard F. Riess To cite this article: Bernard F. Riess (1976) Family Therapy as Seen by a Group Therapist, International Journal of Group Psychotherapy, 26:3, 301-309, DOI: 10.1080/00207284.1976.11491951 To link to this article: https://doi.org/10.1080/00207284.1976.11491951
Published online: 29 Oct 2015.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ujgp20
Family Therapy as Seen by a Group Therapist BERNARD F. RIESS, PH.D.
THE TASK SET BY the title of this symposium is not as simple as it seems. Rather, it involves an old chestnut, namely the relationship between theory and therapy. For instance, what is meant by "group" when used together with the function-defining term, "therapy"? How does a therapy group differ from a family therapy group.'~ Are the differences, if any, related to the structure of the group, the therapist 's theoretical assumptions about group and family, or to the therapist's expectations and self-image in relation to his or her patients, clients, or subjects? A group, we assume, is more than an aggregation of individuals, but its essential characteristics have been so differentially perceived by various writers that it is difficult to define. On the other hand, the family as a group has been much more specifically delimited, even though, despite the conforming and converging pressures of society, biology, anthropology, and social psychology, there may still be discrepancy in the description of a family. As an instance, one may cite the definition emanating from the Southwest U.S.A. that a Navajo family consists of a father, mother, children, and an anthropologist from the University of New Mexico. What I propose to do in this short essay is to list some of the differences and similarities in the two types of aggregations of individuals who come for or are assigned to certain modalities of t reatment. Perhaps there is still reason to ask the old question: What kind of treatment for what kind of patient with what kind of problem under the leadership of what kind of therapist? For, in my Dr. Riess is Director of Research, Postgraduate Center for Mental Health, New York, N.Y.
301
302
Bernard F. Riess
view, what the therapist does in therapy is, or rather should be, a function of his own perceptual and theoretical attitudes toward his task . Let me first comment on the group as I see and work with it. For the most part my orientation is Freudian psychoan alytic , although I depart from this when dealing with industrial executives and other aggregates of people not seeking help for specific personality problems . The therapy group, as distinguished from the family group, is from the start a collec tion of individuals who h ave, as they see it , only one common ality, namely, that they recognize that something is wrong with them. For this they have sought or have been told to seek help . Sometimes the recommendation for group treatment comes after months or years of unsuccessful individual therapy and from a sense of desp air on the part of the therapist. Sometimes, and not so rarely, group therapy is sought because it costs less than dyadic private or clinic treatment. Occasionally, it is prescribed because the referring person feels that group experience is relevant to the specific dynamics of the individual patient. This last possibility for referral to a group is rare in the United States. I agree with Ferdinand Knobloch (1968), who, while in charge of the Institute for Neurosis at Carolinskaya Universi ty in Czechoslovakia, used group therapy to screen out those problems which required individual, dynamic therapy . All patients entered the treatment process through a group experience and then dealt with those facets of emotional disturbance which emanated from discrepancies between idealized and actual group behavior. The residual intrapsychic difficulties were seen as requiring individual psychoanalytic psychotherapy . In Knobloch's description of his rationale, he makes the following p oints , which I feel are important in understanding the operation of psychoanalytic group psychotherapy. A small social group . . . [is J a quasi -closed system for the following reasons : (1) A human being lives most of his life in a limited number of small. groups providing satisfaction for his needs. By choosing a small group as a quasi-closed system, a rule of isomorphism between research and behavior is observed .... If one plays a similar role in different small groups , interactive patterns are homomorphic . In behavior disorders such as neuroses , the outcome situation may be homomorphically unfavorable for the individual. ... One lives in a small group , even if alone,
Family Therapy-Group Therapist 's View
303
as is most vividly seen in dreams and phantasies .. .. A term, group model or schema ... [is used) not only as an aid for problem -solving and for training several skills, but also for substitute satisfactions not attainable in real groups or only at much higher cost ... . An individual interacts with the imagi;;1ed persons of his group's model and gets imagined feedbacks from them . Knobloch then presents the following conditions for therapeutic change: First , an artificial group must be a suitable model of a patient's group, i.e., it must motivate him to show his reflection of role performances. At the same time, the group processes must be simplified, so that the maladaptive role performances can be identified and demonstrated to the patient . . .. Second, an artificial group must stimulate a patient to see in it his group schema . . .. A therapeutic group, by a special technique , must give a special opportunity to a patient to regard it in a certain degree as a realization of his group schema. This can be achieved almost in pure form in individual therapy using the Freudian couch and free association and producing transference neurosis. But the levels in group settings, e.g., in a therapeutic community used by us, are sufficient for the aims of psychotherapy. Third, an individual must have in a therapeutic group enough freedom of social movement so that he can not only structure his performances of roles, but also restructure them if his needs are changed . ... Fourth, the therapist controls patients so that they do not create irreversible situations which would be the deadlock of psychotherapy .... Fifth , a relearning of the performances of roles must be possible .... A group offers a patient a corrective experience which has both emotional and cognitive aspects and both are inseparable .... [pp. 127-128). It is because of the contrast of the varying feedbacks from the real group and the group model or schema that group therapy works. In many senses, when one works with this conceptualization, group therapy is multiple individual therapy. Its goal is to identify, preserve, and liberate those forces that comprise the individuality and the uniqueness of the person. To the extent that this happens,
304
Bernard F. Riess
group therapy produces change. The goals of group therapy are to make the individual free to develop autonomy, creativity, and a sense of dedicated well- being as well as to alleviate the symptoms originally presented . The group is important in that it provides a corrective experience in the conflict between the fantasy group schema and the actuality of group existence. Vasso and George Vassiliou (1968, 1972) , see the group therapy process as an interaction of several subsystems in which the therapist serves as a catalyst-expediter. As is not the case in family therapy, in an analytic group, child-parental and nuclear family relationships are relatively unimportant. Yalom (1970) reports an unpublished study in which members of several groups were given a Q-sort of factors important to them in their therapy sessions . After factoranalysis of the responses , 12 groupings emerged , of which family re-enactment was tenth in order of importance and factor-loading. From another point of view there is validity in differentiating group from family relationships. It is becoming increasingly apparent that the family as a biosociologic necessity is disappearing and may yet become an archeologic artifact. Mitscherlich's book on the fatherless family (1963) offers some documentation of this . With the break-up of traditional dependency relationships, the peer group is a major factor in combating isolation. So, too, the analytic focus on self-image and self-understanding may help to remedy whatever trauma eventuates from the loosening ties of family structure. To sum up this attempt to delimit group therapy , it seems that therapy group members have uniquely individualized presenting problems and that these problems in the here-and-now are related historically and developmentally to each person's past . The group supplies reinforcement , confrontation, and reality testing against the imagined group life of the patient. It functions initially as a collection of peers to whom various transferences may become at tached. The therapist is a catalyst, an unreal parent, a changing influence who uses his knowledge, insight, and empathy to provide corrective experiences but who never becomes in reality one of the patient's peers. What then of family therapy? In what respects does it so differ from group treatment that the difference affects the measures of change? First, in family therapy there is a discrepancy between the ther2pist's expectations and theory and those of the family being
Family Therapy-Group Therapist's View
305
treated . The therapist who works with families is convinced, or should be, that the index patient is merely the finger pointing to family dysfunction. On the other hand, the family comes in either by request as a result of agency attitude toward the presenting child patient or because one of the family has become a disruptive influence in the home and has provoked the other members to the point where they feel something has to be done to stop the difficult member. The therapist's main initial effort must be to make all members of the family group see the family as the patient rather than the offending person. Once this is done, each participant must identify what is good for the family unit and in what way her or his behavior is dystonic. The "why" and "what from" of a person's repertoire of acts is less important than "who is hurt" and "how can I change" queries . Each person in a family has a role and these roles must fit into the family rules. Jung (1963) stated this well, "It often seems as if there were an impersonal karma within a family which is passed on from parents to children. It has always seemed to me that I had to answer questions which fate had posed to my forefathers and which had not yet been answered. . . . It is difficult to determine whether these questions are more of a personal or more of a general (collective) nature. It seems to me that the latter is the case .... The cause of disturbance is, therefore, not to be sought in the personal surroundings but rather in the collective situation. Psychotherapy has hitherto taken this matter far too little into account"(p. 233ff. ). It becomes necessary, therefore, to look upon the family as a construct , to try and see it both as a closed system and as a congeries of subsystems. Bell (1971) sees the family as a transactional unit: Events within the family occur within a total system of interdependent subsystems, i .e., individual, family, community, and value. The important system levels are intrapsychic, interpersonal in the family and the culture , i.e., psychoanalytic, social role conflict solution and culture-value levels [pp. 864-865). Within these levels and systems , the family can be defined from the eye-level view of the child, from the sociological communicative, activity and decision-making aspect, and from the cultural, institutional viewpoint with its emphasis on conformity and disunity with culture and its pressures. The action process of the family leads to mutual accommodation, which consolidates complementary aims and reconciles the conflicting de-
306
Bernard F. Rz"ess
mands of individuals, thus leading to the structuring of the formerly ambiguous and inchoate operational fields .... The healthy family shows by mutual satisfaction of its members and by action in concert that the complementary aims exist and are supporting functions and structures of the group as a group . It has available multiple methods for accommodating the mutually incompatible demands of its individual members. It has means of repeatedly evaluating the consequences of its achievemen ts of accommodation. Finally , it chooses to operate flexibly so that new methods of accommodation may be discovered [pp. 869-870]. The family is , then, much more of a closed system than the therapy group. Its existence as an entity is , albeit sometimes grudgingly, admitted by its mem bership. The role of the therapist is, therefore, greatly different than in the therapy group . His function , once the question of the family as the patient has been worked through , is to develop pictures of how each individual contributes to the disorganization of the unit. To do this , he has to ally himself first with one and then with another subsystem or unit. Zuk (1971) sees family treatment as a series of dyadic or triadic relationships with the therapist , who functions as an ally , antagonist , and gobetween to and with members of the family. In essence, the sessions are a series of dyadic or triadic encounters, the goal of which is to change the focus from the presenting or index person to the famil y as the etiologic entity. The therapist strives to catalyze the conflict so that the contributions of the various mem· bers are clearly perceived. In doing this , as Zuk sees it, the therapist must act as a go-between among the members, which inevitably and planfully results in side-taking. There are some dangerous b yproducts of these changing roles for the therapist. He fosters the family's dependence upon him as a leader imbued with unrealistic knowledge, power , and ability to see through and resolve conflict. Like siblings, the members of the family group may compete for the leader's favorable attention. Finally, as the family feels itself becom · ing more coalescent, all components of it may turn against the therapist with exaggerated evidence of dependence -hostility. With all these interrelationships taking place at many dynamic levels, the family therapy group more nearly resembles a Gestalt
Family Therapy-Group Therapists View
~07
encounter situation than a therapy group. The relationship of family therapy to individual analysis might be compared to a treatment in which only the oedipal triangle was the focus of analysis and interpretation. Again, viewed dynamically, the development of ind ividual transferences , regressions, and fixations may be and often are inimical to the progress of family therapy because these intrapersonal experiences tend to isolate one individual from participation in the unitary development of the family group. I am reminded of the experience of a black, ghetto, day care center where the children receive extremely good psychological help but where the home visitor (a black woman ) reports back that the families of the improved children seem to be under more stress and to deteriorate more th an those of untreated children . Another factor unique to family therapy is pointed out by Sorrells (1972) in comparing family group and encounter techniques. T he question of blame and responsibility is significant for family therapy . ... Families usu ally come for help with extreme feelings of guilt concerning the plight of the I. P. (identified patient) . . . . Generally the sense of guilt produces nothing worthwhile in terms of behavior change . . . . Thus, in conjoint family treatment , the goal is to teach each member to be responsible to and for himself . . . . When individual responsibility is truly a realized feeling in a family ,.there is simply no room for any member to be blamed for the behavior of any other member [p. 324ff.].
Since family and group therapy are demonstrably so different, it should not be surprising that the nature of the changes to be assessed and evaluated is d ifferent. Garfield , Bergin , and Prager (1972) have well researched this area . Statements about amount of change in any area or in total adjustment are almost meaningless . An objectively small change, for instance, in fear of meeting strangers, may make a patient feel a whole lot better . Again , it is necessary to point out that the goals of patients and therapists influence any measures of outcome. It has becom e trite to say that change from pre - to post-therapy Rorschach is rarely helpful to the patient .
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Yalom (1970), on the basis of his and others' research, organizes curative factors in group thereapy into 10 primary categories: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 .
Imparting information Instilling hope Universality Altruism Corrective recapitulation of the primary family group Developing socializing techniques Imitating adequate models Interpersonal learning Group cohesiveness Catharsis
If one obtains information from group patients , information yielded by indirect and theoretically unloaded techniques, what emerges is a relatively low role for re-enactment of family relationships , identification with the group leader, and rule-setting or guidance. Insight, as it is used in psychoanalysis, was found to be limited to "discovering and accepting previously unknown or unacceptable parts of myself." Most of the curative factors listed are inherent in the group which identifies, confronts, and reinforces the various components or behaviors. The role of the therapist as a change-agent is, of course, also important. However, here again, in a multitude of studies, patients do not see the working through of a specific relationship to the therapist as of great importance to the success or failure of treatment . What is said about the therapist as group leader is that honesty and the timing of self-revealing intervention is of importance in helping and in modeling group behavior. In contrast to the above, we have very little information on factors that have emerged from research in family therapy. One factor seems at least to be incontrovertible, that. is, increased and more open communication among family members. Second, the par ataxic distortions and / or transferences are important factors because of their resemblance to that of the family experience of the parents. The therapist factor in family therapy , therefore , has more value and potency than it does in analytic group therapy. As initially a good father or mother figure, the therapist seeks to facilitate better communication and a sense of identity within the family by
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his interventions, siding with one member against others and acting as a go-between in the family diagram. In summary, therefore, of family therapy as seen from the viewpoint of group therapy, it is my belief that the two are widely varying approaches to widely divergent problems. The family , to the participants, becomes the patient only under the tutelage of the therapist, whose first task, as seen by some in the field, is to convert the family into the index patient. At that point, the nuclear family is not perceived as a viable unit but as a series of dyadic groupings, each vying with the others for authority. In contrast, the group in group therapy never becomes the patient. It is always merely the embodiment of the models with which each individual patient enters into the group process . As group treatment proceeds, the members provide an opportunity for the individual to test her or his group images and role performances against those of peers and to correct inadequate, irrelevant, or imprecise perceptions. REFERENCES Bell, J. E. (1971) , Recent Advances in Family Therapy. In: Theory and Practice in Family Psychiatry, ed. J. G. Howells . New York: Brunner/Mazel. Garfield, S., Bergin, E., and Prager, R . (1972), Evaluation of Outcome in Psychotherapy. In: Psychotherapy, 1971, ed. J. Matarazzo et a!. New York: Aldine. Jung, C. G. (1963), Memories, Dreams, Reflections. New York: Vantage Press. Knobloch, F. (1968), Toward a Conceptual Framework of a Group-Centered Psychotherapy. In: New Directions in Mental Health, ed. B. F. Riess . New York: Grune & Stratton. Mitscherlich, A. (1963), Society without the Father. New York: Harcourt, Brace & World . Sorrells, J. (1972), Groups, Families and the Karass. In : New Perspectives on Encounter Groups, ed. L. Solomon and B. Berzon. San Francisco: Jossey-Bass. Vassiliou , G. (1968), An Introduction to Transactional Group Image Therapy. In: New Directions in Mental Health, Vol. I, ed. B. F. Riess. New York: Grune & Stratton . _ _ _ , and Vassiliou, V. (1972), Some Deliberations Concerning General Systems Theory Application in Group Therapy . International Mental H ealth Research Newsletter, Vol. 14, 4. Published by Postgraduate Center for Mental Health. Yalom, I. (1970), The Theory and Practice of Group Psychotherapy. New York: Basic Books. Zuk, G. H. (1971), Family Therapy. New York: Behavioral Publications.
Dr. Riess 's address: Postgraduate Center for Mental Health 124 East 28th St. New York, N.Y. 10016
