International Journal of Group Psychotherapy

ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20

Group-Analytic Psychotherapy Jeff Roberts & Malcolm Pines To cite this article: Jeff Roberts & Malcolm Pines (1992) Group-Analytic Psychotherapy, International Journal of Group Psychotherapy, 42:4, 469-494, DOI: 10.1080/00207284.1992.11490719 To link to this article: https://doi.org/10.1080/00207284.1992.11490719

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I NTERNATIONAL JOU RNAL OF GROUP PSYCHOTHERAPY, 42(4) 1992

Group-Analytic Psychotherapy JE F F

R 0 B E R T S, M.D. MAL C 0 L M PINES, D.P.M.

ABSTRACT Group analysis is a flexible and effective method ofproviding group psychotherapy, there&y promoting maturation and symptom relief Its metapsychology remains incompletely worked out but provides potentially exciting interfaces with biological and physical sciences, through Foulkes's (1973) seminal concept of the group matrix.

S. H. FOULKES AND THE DEVELOPMENT OF GROUP ANALYSIS The development of group analysis is intimately bound up with the life of Sigmund Heinrich Foulkes (born Fuchs) (Foulkes, E., 1990), with his creative synthesis and use of the ideas of his mentors and colleagues. He was born in Karlsruhe in 1898 and undertook medical training in Heidelberg, Munich, and Berlin. He then moved to Frankfurt for his postgraduate medical training. Like Freud he had important experiences in neurology, having had the good fortune to work with Kurt Goldstein, one of the earliest proponents of a truly whole-person approach to medicine. The influence and example of this great neurologist deeply impressed Foulkes. Goldstein, working in the 1920s and '30s, proposed a dynamic neurology that differed radically from that of Freud, which itself dated from the mid-19th century (Pines, 1986, 1991). Freud had been greatly influenced by Hughlingsjackson, who developed a schema in which higher forces of the psyche hold in abeyance the lower forces, culture against drive, id held down by ego and superego; this was the manner in which the higher levels of the central nervous system held in abeyance the activities of the lower levels, as demonstrated by Jackson's "doctrine of levels" (Dewhurst, 1982). Goldstein's (1939) model was different. In response to damage 469

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to the central nervous system it is the total person who engages in the compensatory struggle. The organism attempts the best possible adaptation to its inner and outer environments. Organism and environment are inseparable and have to be studied together, which includes the effect of the observer, who is part of the situation by his or her very presence. Goldstein asserted that the function of any neurone in the brain is of a pathway in the total network and therefore no part of the central nervous system can be studied in isolation. In illness, the damaged element ceases to be nodal (part of the communication network) and becomes focal, that is, isolated from the whole functioning network. This affects the balance and functioning of the whole system. This observation of Goldstein's was the source of Foulkes's vision of a group functioning as an organism, a functional system, constantly adapting to both inner and outer environments, in which each person is like a nodal point in the common network. Disturbed communication arising from any one person in the group puts him or her into a focal position, which "locates" the disturbance in the group. Foulkes asserted that emotional disturbance arose from incompatibility in the root network of family and that these incompatibilities would be revealed and repeated in the communicative network of the group. Then, they could be clarified and worked on with the aim of restoring to the person and to the whole group a capacity for functional adaptation. Foulkes was also influenced by the Gestalt psychologists, who recognized that the figure-ground relationship was fundamental to the process of perception. He attended lectures by Adhemar Gelb. After discussion with Karl Landauer, a f?Sychoanalyst he met in Frankfurt, Foulkes decided on a psychoanalytic training in Vienna. Landauer said that it would be useless to apply to Freud so Foulkes applied to Helene Deutsch, at that time Director of Training of the Vienna Society. Following the completion of his psychoanalytic training he returned to Frankfurt where he became Director of the Clinic of Psychoanalysis. Here ideas of the significance and nature of group and social processes would come from personal contact with Norbert Elias and other participants in the Sociological Research Institute of Frankfurt University (later known as the Frankfurt School). Marxist sociologists and Freudian psychoanalysts shared the same building and met and discussed together the interpretation of the nature of psyche and society and their interpenetration. Foulkes's exposure to

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the sociologists of the Frankfurt School in the early 1930s sensitized him to the interpenetration of the economic and political forces with the psychological. It was there that his association began with Norbert Elias, who has contributed profoundly to the foundation of an historical sociology. Foulkes reviewed the two volumes of Elias's (1937/1978) great work, The Civilising Process, then still in German, for a psychoanalytical audience, which with few exceptions (e.g., Robert Waelder), was little influenced. Elias was able to demonstrate through historical material how the personality of "Western m an " had evolved since the 13th century (Mennell, 1989). His source m aterial , books of courtly etiquette, gave eloquent witness to how bodily process such as eating, excreting, sleeping, cleansing, and copulating were regarded and performed. Western men and women slowly required privacy, and consequently the psyche became more compartmentalized into public and private sectors. Internal boundaries developed that constrained consummative and appetitive behaviors ; the ego was strengthened socially against the id . Elias also showed how the state developed and laid claim to a monopoly over violence. Combat, punishment, and the setting of disputes were taken into the legal and police systems, and the individual had to restrain aggressive impulses. In return for this , each person was offered protection from the aggression of fellow human beings. Superego restraints within the individual were enforced by the demands of society for obedient citizens. Furthermore, as demonstrated by Weber (Nisbet, 1973), the economic forces of protestantism and capitalism encouraged the development of mobile, individuated persons-each his or her own inner policeofficer, who could service the requirements of advancing industrialization. The boundary between inner and outer became obscured . Foulkes also read the works of Trigant Burrow and appears to have been aware of, but not to have studied deeply, Kurt Lewin's field theory of group interaction and behaviorial determination. Foulkes left Germany in 1933 and came to London, where he courageously set about gaining a British medical qualification and membership of the Institute of Psychoanalysis in London where an important figure for him was Ernest Jones. From here he moved in 1939 to a large psychiatric practice in Exeter and quite soon was impelled to satisfy his curiosity as to what his neurotic patients would say to each other if he put them together in a group (Foulkes, E .,

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1990, p. 16). The results of these early experiments are recorded in a paper published in the Lancet (Foulkes & Lewis, 1944) . He joined the army and was soon posted to the Northfield Military Hospital, famous now for its two "Northfield experiments," in which a conventional British Army hospital became a therapeutic community. The initial culture was developed by Wilfred Bion ( 1961) in an experiment that was terminated by the authorities since it was perceived as incompatible with military discipline. Quite soon after, however, and presumably owing a considerable debt to the creativity of Bion, the therapeutic community was reconstituted under the leadership of Harold Bridger, with important contributions to its development being made by Foulkes, Tom Main, Patrick de Mare, Martin James, and James Anthony. As Foulkes was the sole trained psychoanalyst among this group he had considerable prestige as a teacher and therapist. During this time Foulkes began a lifelong friendship with Patrick de Mare which would later contribute significantly to the growth of group analysis and particularly to the development and use of median and large groups (de Mare, 1991; Kreeger, 1975). Foulkes conducted many groups with a wide range of disturbed soldiers, played a significant role in developing social therapy at Northfield, and contributed significantly to the organization by linking various groups together through his presence in them . Papers in the Bulletin of the Menninger Clinic (Bridger, 1946; Davidson, 1946; Foulkes, 1946; Main, 1946), a foreword by Karl Menninger (1946), Bion's (1961) Experiences in Groups, and for us most importantly Foulkes's Introduction to Group-Analytic Psychotherapy ( 1948) give collectively a picture of the energy, enthusiasm, and creativity of this short period of time. When he left the army, Foulkes decided to continue with his work in group analysis as well as to resume his psychoanalytic career, to which end he became a training analyst for Anna Freud's group. He had by this time developed his group-analytic method and had a small cohort of like-minded people who shared an intuitive understa nding

of this method with him . These were Anthony, de Mare, and Ronald Casson, all of whom had been at Northfield. While the method was at this point well developed, its theoretical basis was not, and there was much work to do in the area of observation of the phenomenology of these groups. Foulkes now set out to teach a nd disseminate his method and to develop a theoretical framework that would enable the method to be developed further and transposed to a variety of different

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contexts and tasks. An important milestone in this process was Group Psychotherapy, the Psychoanalytic Approach, written jointly by Foulkes and Anthony (1957). In 1952 what was originally an informal group of interested people became the group-analytic society, and in 1971 the Institute of Group Analysis was founded and would become a rapidly expanding body dedicated to the teaching of group analysis and most importantly providing a qualifying course in group analysis, thereby insuring the maintenance and dissemination of the method.

GROUP ANALYSIS IN PRACTICE Group analysis is preeminently a method of treatment of patients in small groups that harnesses group processes and promotes the development of the group itself as a powerful therapeutic tool. Foulkes (1975, p. 3) talked of "analysis of the group, by the group, including the conductor." He saw the group as providing "ego training in action" for its members. Implicit in his approach is the hope and expectation that each member will discover a leader (or perhaps steersman) within himself or herself as an important step on the road to autonomy and maturity. For this reason Foulkes deliberately avoided the role of group leader and named the therapist in a group-analytic group "conductor." In his groups Foulkes saw people struggling to talk about symptoms and gradually in a free-floating conversation, the group-analytic equivalent of free association, becoming ever more articulate so that little by little the latent meaning of the symptom would become public. At this point the patients in the group could start to talk about life problems rather than be bogged down by circular self-defeating preoccupation with neurotic misery. The human unhappiness they now discovered could be shared and, as Yalom (1985) suggests, existential factors could come into operation to help this unhappiness be accepted as one of the shared givens of human life. The conductor is a "dynamic administrator" of the group: selecting patients, providing a venue, setting major boundaries of timing, frequency of meetings, and setting the expectation that group members will speak honestly, without undue censorship and on the whole say what comes into their minds as a result of what they see and hear in the group. Early in the life of a group the conductor needs to be more active and apparently accepting of the group's belief in him or her as

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leader. This is done with a clear expectation that in due course (the timing will vary from group to group) he or she will be deposed to a far less central position. Narcissistic difficulties on the part of the conductor may lead to a failure to fall gracefully from power and to a long-term infantilization of the group members.

Convergence Between Group Analysis and Contemporary Psychoanalysis Approaches by John Bowlby and Heinz Kohut (Maratos, 1986) are being integrated into the body of psychoanalytic theory and converge toward the group-analytic model. Bowlby emphasizes the child's need for secure attachment as a basis for emotional growth and this is provided by group cohesion and the group matrix. Individual emotional growth goes with that of the group-as-a-whole, for this group entity, composed from its individuals, can have a higher developmental capacity than that of any of its members. (The conductor's essential contribution to this is discussed later.) Thereby all members can be helped in dealing with their conflicts and developmental lags. Vygotsky's "law of proximal aevelopment" (Weitsch, 1985) is a clear model for this process. The measurement of the child's own level of achievement in intellectual tests and social functioning is below what can be achieved when under guidance or in collaboration with a more capable other. The more competent assists the less competent to "reach a higher ground," from which to reflect more abstractly about the nature of things. The more competent serves as a "vicarious consciousness" (Brunner, 1986; Josephs, 1992). From this higher ground, we achieve perspective, can perceive patterns, and can view and integrate present and past, which gives continuity and coherence to the self. The self psychology movement within psychoanalysis, initiated by Heinz Kohut (Maratos, 1986), has developed a model of human development that gives human interconnectedness prime place. Self with other is contrasted with self against other of a psychoanalysjs based on drive theory and one body psychology. Self psychologY- maintains that healthy personal growth occurs in a matrix o good self-object relationshlps, where the other, the object, is willingly and competently availaole to the child; the child is born strong, not weak, because the powers of the caregivers are appropriate!¥ available to it. The selfobject

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is experienced as part of the self, and this partial merger with significant others remains throughout the life-span, though its features change as the immature child develops its own innate capacities through internalization. Self psychology describes three essential features for such healthy development: mirroring, idealization, and twinship. These become the tension arc within which the innate talents and skills of the person can grow, and these essential ingredients are available in the well-selected and well-conducted group-analytic group.

Mirroring Foulkes and Anthony ( 1957) paid attention to this process in their joint writings, and these have been developed by Pines (1984), Zinkin (1983), and others. In group analysis, the inoividual has the opportunity to see himself or herself in others ("self in the other," other as object) and to see the other in the self (self as object). This leads to a clear, more realistic recognition of onesel , both in terms of limits and potentials, a reduction in neurotic defenses and compensations. The mirroring of the group-as-a-whole, which recognizes and supports the patient's struggle for growth, can enable its members to resume blocked developmental paths, so often closed because of the failure of significant others to empathize with and to support individuation and separation. The mirroring process is not smooth or inevitable. Much of what the person has not been able to accept and to integrate as part of the growing self is denied, ignored, externalized; what is rejected in the other is re-presentation of what is unacceptable to the self (Leal, 1982; Pines, 1984). The "me in you, you in me" rhythm of re-cognition and acceptance is particularly disrupted in a narcissistic and borderline patient, whose self-image and self-cohesion are precarious and maintained by projective mechanisms that involve splitting and denial. Though the process here is more stormy and difficult and is one where the group conductor must be more active as negotiator or mediator between the conflicted persons, significant achievements can be made (Battegay, 1992; Pines, 1984; Zinkin, 1983).

Idealization As group cohesion develops through individuals accepting their membership in the group, so the gradual process of merger with the group-

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as-a-whole takes place. "The group" can come to stand for a powerful, calming resource, greater than the individual. "We-ness, us-ness" (Klein, 1976) are both created by the group members and internalized by them. This again can lead to release from the constraints of an overindependent or counterdependent personality structure, the roots of which may be in a premature attempt at individuation/separation, fear of prolonged dependency, or overinvolved parents who make inappropriate demands on their offspring.

Twinship Finding likeness to oneself and others and later recognizing differences is an inevitable part of group development. In the group-analytic group, this process of recognition can go much deeper. Here again, the "we-ness, us-ness" can develop through which the individual's sense of identity is confirmed. Many persons have not had such opportunities, either through being only children, being socially, religiously, politically, or geographically isolated, or having shunned such opportunities when they were available.

Adversarial needs Wolf ( 1988) has added to Kohut's selfobject functions that of being a benign adversary, someone against whom one pits one's strength, someone one engages competitively, someone one enjoys victory over or defeat by. There is a joy in exercising one's full capacities in the competition that can happen in groups, which the person may have missed in childhood when faced with a father who must never be defeated, a father who will not compete, a damaged mother who must be supported, damaged siblings who have to be cared for, and so on.

The Psychosocial Interface It was Eric Erickson who made it possible for psychoanalysis to include

the social in the developmental process, with his epigenetic schema. Foulkes paid tribute to Erickson in his first book in 1948 and the psychosocial concept is intrinsic to group analysis. Foulkes. recognized that the colossal forces of society penetrate the individual to the very

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core through the culture into which he or she is born and that the power of these forces are akin to the power of the biological drives. When we bear in mind the power of these two forces, the social and the biological, how can we begin to define where the outside ends and the inside begins? Inner and outer interpenetrate and are inseparable, and it is only by creating boundaries through constructs that we are able to define differences. The continually reversing surfaces of the mobius strip well illustrate this concept, as do the paradoxical graphics o£ Escher (Abercrombie, 1969). Developmentally, as Vygotsky (Weitsch, 1985) demonstrated, the social fact precedes the psychological. It is the social interaction that produces the person-through culture, language, custom. Foulkes (1975) named this the "foundation matrix," which enables people from a given culture immediately to understand one another and to find denizens of another culture strange. Group analysts in Europe have been exploring the cultural roots of personality through the European Association for Transcultural Group Analysis. These issues are studied both theoretically and empirically at meetings, where group therapists meet in experiential groups that are composed of persons from a common language group-English, French, German, Mediterranean languages- but are conducted by a therapist from another language group. This figure-ground constellation has enabled us to explore more deeply the basis of personality in social process (Brown, 1992a,b; LeRoy, 1987). THE GROUP-ANALYTIC PROCESS The therapeutic style of group analysis grows directly from the premise that symptoms develop from blocks in communicative systems. Primarily social, arising between self and others, problems become personal as a consequence of such blocks. What the person brings to the group reflects an incapacity fully to recognize, accept, and work through these communicative distortions. In the group-analytic situation, communication is the prime therapeutic factor. Each benefits through working toward a freer expression of conflicts through the group situation, those of oneself and of others. Neurotic and even psychotic disturbances are bound up witn aeficient cgmmunicaoility. "Ihe language of the symptom, although already a form of communication,

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is autistic. It mum les to itself secretly, hoping to be overheard; its equivalent meaning conveyed in the words is social" (Foulkes & Anthony, 1957, p. 259). This memorable phrase, "it mumbles o itself secretly, hoping to be overheard" reflects something of Foulkes's style of writing and of his work.

Location One of Foulkes's early achievements was his appreciation of the significance of figure-ground relationships in human perception. This enabled him to view his groups in a far more flexible and creative way than other psychoanalysts who attempted to do analysis or therapy in groups. Some analysts such as Wolf and Schwartz (1962) could only see the individuals in their groups and developed "psychoanalysis in the group"; others, such as Bion (1961), could only see the group and developed "psychoanalysis of the group." Foulkes sometimes saw the group, sometimes the individual against the background of the group, and sometimes subgroups of two or more members against the background of the group. In other words he was able to allow his attention to float and to alight eventually on the location of the currently most significantly active or meaningful element of the group process. In this way while many methods of group therapy anchor their members in a one-dimensional process the group analyst has found a way into a multidimensional experience of his or her group.

Transference and Countertransference in Groups Since one of the key disciplines informing the development of group analysis was psychoanalysis, the group analyst is naturally interested in manifestations of transference and expects to find hot transference issues where his or her attention alights. These issues will be enacted by the individuals involved at the location and may or may not include the conductor as one of the dramatis personae. The free-floating discussion of the group is listened to by the group conductor as representing a meaningful communication at an unconscious level. The decoding of this hidden language is an important part of the conductor's task. The conductor's understanding Cloes not necessarily have to be translated into words because , when the process is moving freely, this in itself is therapeutic. T he therapist's attention

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is addressed more toward blocks or deficits in the group conversations. Group-analytic listening is helped oy the recognition and acceptance that valid communication takes place on several different levels.

Social level, group as forum The members of the group as citizens, adults, are concerned with the current level of their life situations and of the group situation. Communication at this level is valid unless it seems to develop into resistance.

At the transference level There is the constant interplay between group members that is the manifestation of transference. We can confidently rely on group members becoming aware of the way in which others use them as transference figures and how their own transferential patterns are recognized by others. This recognition leads to work being done, both to understand the source in the past of these transference patterns and to free relationships in the group from the grip of the transference patterns (Cortesao, 1971). This is slow, ongoing work, and, though a good deal of this can be left to the group members themselves, the conductor certainly has a part to play in helping to identify such patterns, which as well as being directed toward group members, may well be directed toward the conductor's person and to the group-as-a-whole.

At another level of transference It is possible to identify earlier types of mental activity. Seen most clearly with borderline patients, these are situations where other persons are related to, not as whole persons, but as representations and externalizations of part of the other person's inner world. Feared, unwanted, and threatening aspects of the person's inner world are externalized and the other person treated as more or less an equivalent. The powerful mechanisms of projective identification can be seen at work here, and the recipient of projective identification can be unconsciously maneuvered into an appropriate position, so that they seem to be the originator rather than the recipient. Again, these patterns can be recognized and worked through by virtue of the fact that the

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other members of the group can bear witness to what is happening and bring the situation to a higher level of recognition and consciousness.

At the deepest level Foulkes described this as being a primordial or Jungian archetypal level. It may have a very powerful effect upon the nature of the group atmosphere and processes. This work is being addressed by writers who often have a Jungian framework (Boyd, 1991; Prodgers, 1990; Usandivaras, 1986). An intrinsic part of the therapeutic process is the exchange that goes on between the group members. Just as the child is led to higher levels of development by being responded to from above, as it were, so in the group, the capacity of the group-as-a-whole to work with the primitive and conflictual is often very striking. There are two ways of regarding these processes; one, using the framework of object relations theory, is that part object relations are made manifest and are responded to at the whole object level. The other, using the framework of self psychology, is that these splits into, say, good and bad, loving and hateful aspects of the self and of others are not intrinsic to psychic development, but represent the relative failure of the caregiving environment to help the developing person integrate these polar elements. The group can begin to perform that function for the individuals, acting thereby as a more caring and caregiving entity, which helps the individual bring together otherwise split aspects of the self.

Intersubjectivity Group membership gives persons the opportunity to speak about the self and to listen to others, and inevitably, over time , there will be an increase in the range of responsiveness and understanding that individuals have about themselves and others and the situations between them. The balance between therapeutic openness and self-protectiveness is always shifting, but under appropriate conditions, the move is to greater depth of exploration and understanding. There are two basic dimensions to this increasing depth, the vertical and the horizontal. Psychoanalysis has enabled us to grasp the intrapsychic dimension, the vertical depth; group analysis, the interpersonal dimension, hor-

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izontal depth. What goes on between people, as they come to understand and to know each other in ever-increasing depth, is in itself a powerful therapeutic factor. Empathic attunement, lengthy involvement in each other's psychic world can lead to remarkably sensitive and deep mutual explorations and understandings. On this basis, it seems that human beings can begin to resume psychic development, a process of increasing maturity.

Listening While people come to the group with the intention of speaking about themselves, they are perforce also in a situation of being listeners. The capacity to listen sensitively, respectfully, imaginatively, and intuitively is greatly increased through membership of a group-analytic group. The innate possibility that we all have to listen more sensitively and to respond more sensitively is facilitated and supported by the listening capacity of the group conductor. In the conductor's reflective responses to the group processes, the group members can begin to see wider and deeper perspectives than they could by themselves. This is often evident on those occasions when the group conductor may have to be absent from the group. However glad the group may be to have him or her gone for a while, it welcomes the conductor back for the function that he or she can perform in giving the group a perspective on its own processes.

The Group Matrix A seminal concept in group analysis is that of the group matrix. Foulkes ( 1964) saw this as the "hypothetical web of communication" (p. 292), established in a group over time, which becomes the background on which the individual psyches of its members exist (in the group but also for some outside the group as well). This matrix can come to be experienced as a container within which the individual psyche may be formed or transformed. In this way the group can become a kind of mother vessel or alchemical crucible with powerful therapeutic properties (Prodgers, 1990; Roberts, 1983, 1987). The role of the group-analytic conductor is first and foremost to nurture a group that is activel y working toward understanding itself

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and its members and also developing a complex web of relationships in which all members experience themselves as involved. The coherence of the group matrix is almost certainly a function of the degree of cohesiveness of the group. The group-analytic conductor will therefore be intent on promoting the development of a cohesive group. He or she will provide ground rules that insist on regular attendance and encourage the development of a group culture in which regular, involved attendance is the norm. The conductor will also contribute to this aim when selecting members for a group, doing the best he or she can to put together people who will be interested in and attracted to each other. The idea of the matrix is one of Foulkes's most important contributions to group-analytic theory. Foulkes defined the group matrix on a number of occasions. One of the most accessible of these is as follows: The matrix is the hypotehtical web of communication and relationship in a given group. It is the common shared ground which ultimately determines the meaning and significance of all events and upon which all communications verbal and nonverbal rest. (Foulkes, 1964, p. 292).

With the generation of this idea he provided a means of linking our understanding of human communication in groups with a substantial body of science to do with creation and metamorphosis. In a previous paper, Roberts (1983, pp. 123-124, emphasis added) writes: According to the Analytic Psychologists, particularly Neumann ( 1954), consciousness can be thought of as an (individual) creation that has emerged slowly and painfully out of the collective unconscious over many millennia. Foulkes effectively says the same and in promoting group analysis was, it might be suggested, intimating that it is therapeutic to submerge one's consciousness in a group [in order] to struggle to emerge from the group having strengthened and redefined it. Thus the development of consciousness can be closely related to the figure/ground phenomena of perception, and be seen (somewhat simplistically, but accurately) as defining oneself against a background. The group matrix can form such a background, from which a damaged individual (consciousness) may emerge revitalized. This point of view corresponds nicely with other meanings (Oxford English Dictionary, 1971) of the word matrix: I. Mother, pregnant or otherwise. 2. Womb.

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3. Background substance. 4. Mould, in which something is made. 5. Place where something with structure, often alive and perhaps extremely

valuable is held during its formation or transformation.

Roberts (1987) suggests that "the gorup matrix can be viewed as a context in which a safe and remarkably deep regression may be obtained, with a potential for enabling a significant new formation or transformation of m~or personality elements."

Intervention in Group Analysis A conceptual framework for this is the helpful analysis of the components of an ongoing therapy group made by Patrick de Mare (1972). He proposed that a group can be understood as comprising: (1) structure, (2) process, and (3) content. A not unnatural expectation of the conductor would be that his or her interventions would aim (a) to maintain the structure of the group, (b) to facilitate the process, and (c) to clarify the underlying content of the statements and interactions in the group. In an ongoing research project (Kennard, Roberts, & Winter, 1990), an attempt is made to identify the pattern of intervention of group conductors. Early results from this project indicate that the group analyst is concerned to provide a clearly bounded structure for the group in which much of his or her subsequent activity is aimed at facilitating a process. This process tends to lead toward the exposure of underlying content or meaning, which, in a group-analytic group, is at least implicitly interpreted through the group process. Nonetheless the conductor of the majority of group-analytic groups will from time to time make clarifying interpretations of unconscious, or what has very often become preconscious content in the group. As well as the type of intervention the research (Kennard, Roberts, & Winter, 1990) has also concerned itself with the element of the group addressed by the intervention. Each intervention is likely to concern any of the following or any combination of them and their interrelationships: the individual member, the group-as-a-whole, parts of the group, for example, pairs, threesomes, all the women, all the men, and the conductor. Foulkes (1975, p. 3) offered a definition of group analysis as, "Analysis of the group by the group including the conductor." This

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should leave little doubt in the conductor's mind that it is very important that the group should be allowed to develop itself as a therapeutic instrument. As mentioned previously, narcissistically inspired displays of pyrotechnic interpretation are not required and will disable a group and its members. Foulkes also said of the conductor's role, "It would be quite impossible for [the conductor] to follow each individual at the same time. He focuses on the total interactional field, on the matrix in which these unconscious reactions meet. His background is always and should consciously be the group as a whole" (Foulkes & Anthony, 1957, p. 29). He went somewhat further in suggesting that the conductor observe the group with a free-floating attention that allows him or her to become aware of the "location" of the most important issues for the group.

Conductor Activity Group analysts distinguish among leadership, analysis, and interpretation as aspects of the conductor's role. As in the Chinese proverb, the best general is the one who leads from behind. Thus, the leader is in the paradoxical position of following the group and leadership is manifested through attention to the way in which the group is functioning. As "dynamic administrator" (Foulkes, 1957, p. 99), the leader has a responsibility for setting and maintaining group boundaries of time and place, for group membership, and for helping the group to establish the therapeutic norms. Though the group will, to begin with, wish to put the leader into an exalted position so as to experience dependency and relieve anxiety, the leader, as Foulkes (1964, p. 61) put it, gradually weans the group from this dependency on him or her. In this process of weaning, significant work is done on the superego aspects of the personalities. The therapist's attitude of acceptance and tolerance is of course very often responded to as neglect and remoteness, and work can therefore be done on these transference projections. A dictum by Foulkes ( 1957, p. 117) was that we only use interpretation when analysis fails. By that, he meant that the group's capacity to understand and to analyze its own interpersonal processes and experiences is the most significant part of the work. A great deal of effective group work goes on at the conscious and preconscious level.

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People come to know themselves much better in the course of group membership and the subtle and sensitive exploration of states of mind is an intrinsic part of the work. This is to be differentiated from intellectualization, as a defense, which is easily recognizable as such. The group analyst's attitude toward interpretation is to regard this as a process of translation. Something that is not yet fully conscious is brought into consciousness by the therapist. The word "interpretation" is open to several meanings, and the most appropriate ones for a group recall, firstly, the role of the interpreter who finds a common language for persons who are speaking different languages, and, secondly, that of the interpreter of a work of art. A person can interpret and understand more deeply the meaning of writing, of music, of all art forms and bring out latent and disguised meanings. This brings in the aesthetic, creative dimension, which is a very satisfying function for the therapist and for the group members when successful! Metaphor, imagery, humor, can all be part of the therapist's interpretative style. It is important to emphasize that group analysis, based as it is upon a figure-ground Gestalt model, encourages the therapist to work individually with group members, as well as with the group-asa-whole. Knowing that changes in any one member of the group will bring about changes in others in the group-as-a-whole and recognizing that group therapy is basically on behalf of the individuals in it, the therapist is quite often drawn into work with individual members. The group conductor does this when the analytic and communicative efforts of the other group members have been ineffective, or when the conductor believes that he or she has something of importance to communicate that has not yet been recognized. Very often, after this piece of interactive and communicative work, the conductor can withdraw, leaving the work to be carried on by the other group members.

Resistance to the Group Process Individuals in the group will each manifest personal resistance to the group process and to their own analytic experience within it. The group conductor will from time to time need to address the interference with an individual's progress and development in the group as a result of his or her resistance and characteristic defensive activities. However, of greater concern to the group analyst are those defenses and resistances

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that appear to be phenomena arising out of the group process itself or that are group phenomena. These are outlined below.

Resistant conversations Groups from time to time, and new groups almost invariably, contrive to have harmless conversations, whose function is to insure that nothing beneath the surface is disturbed or exposed. Such conservations, skillfully skating the surface of the real issues, may resemble the free-floating conversation of Foulkes, but will be effectively content free and contribute nothing to the growth and development of the group and its members. The collective underlying anxiety will concern what might be discovered under the surface. Such a group may eventually break the surface by moving to an alternative collective resistance. The surface that is broken will be that of an individual who nominates himself or herself as a patient or is chosen as such by the group. In this case profound depths may appear to be plumbed but only in the chosen sacrificial victim. The conductor's concern in both these eventualities will be to help the group to find a more creative activity. There are various possible exits from such a situation and of these the group analyst tends to favor those uncovered by the group itself. A well-selected group is likely to contain two or three potentially insightful risk takers. These will usually not allow the cocktail party to go on too long. Failing this the conductor will be alert for unconscious elliptical reference to what is happening in the content of the conversation. If he or she eventually decides that the impasse has continued too long, the conductor will indicate to the group that their current activity may be defensively motivated.

Resistance to joining the matrix The most profound therapeutic effects of group analysis are derived from active participation in the process of the group. The individual member achieves this by becoming, as it were, a part of the larger whole, which is the group matrix. The effective group-analytic group is one in which all of its members are engaged and involved in the struggle for ever-widening and deepening communication in the group. Such a group will undoubtedly be a cohesive one and thus provide a

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high level of one ofYalom's ( 1985) most important therapeutic factors. It seems likely that the degree of cohesiveness in a group is directly

related to a far deeper phenomenon, the coherence of the group matrix (Pines, 1986). Individual and collective resistance to the development of a group, rather than a collection of individuals, is thus a particularly destructive form of resistance that can impede and even nullify a group's therapeutic effectiveness. Individual patients can insist on sitting at the edge of the group and act more as observers of the process or therapists' assistants than group members carried along by the powerful currents of free-floating conversation. A more collective variant of this resistance is found in the group that never seems able to come together. In a once-weekly group three or four members have for the past 6 months been invariably late (not always the same members) and every week one or more people have found pressing reasons for being elsewhere. This group appears to have an unconscious and shared fear of belonging together that it is acting out by carefully orchestrated lateness and absence. This group has two black members and issues of race and racism have never been addressed, which may be a factor militating against a freer sharing and involvement than we currently have.

The most powerful and destructive manifestation of this form of resistance is to be seen when one or more members begin actively to attack the fabric of the group. They become the participants of an antigroup faction, whose primary motivation appears to be to undermine all attempts to work together as a group. Nitsun (1991) points out that the belief that the group is intrinsically creative and hence therapeutic can only be the consequence of a blinkered idealism. In his experience, particularly in a new group, and particularly if errors in selection have been made, an antigroup will develop whose apparent aim is to fragment and undermine the group, thereby defeating its integrative and therapeutic potential. What emerges from Nitsun's work is the crucial point that the balance between group and anti group is far more precarious than many group conductors would wish to believe. Thus Roberts (1991a) suggests that a "feather" might tip it either way and writes, "I would like to think that Foulkes would agree with me that at the right moment, the feather is the intervention of the conductor, which gently tilts the process in favour of group rather than anti-group" (p. 131).

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A rather promisingly articulate and well-motivated new group included a man who had been in previous therapy groups of a more directive nature. He was also far more narcissistic than had been appreciated at his initial assessment. Right from the very first meeting this man complained bitterly about the freedom the group was given to develop its own pathway, despite lively and meaningful interaction from the other members. He attacked the therapists unremittingly for not having directive techniques, which led to a rapid disillusionment in the group. He began to get an increasing following among the other members. Like the Pied Piper he was leading every member to attack the very foundations of what they all would need to depend on . After 12 sessions he left, followed quickly by three other members. It has been very hard even after 2 years to repair the damage done by this protagonist of the antigroup. In this group a truly reparative intervention was not found .

Malignant mirroring and resisting the truth The group-analytic therapy group has been poetically compared by E.J. Anthony with a hall of mirrors (Foulkes & Anthony, 1957; Pines, 1984). In most writings on mirroring the assumption is made that the effect of finding oneself in such a hall of mirrors is beneficial to the individual and contributes to the positive development of the group. That this is not always the case was pointed out by Zinkin (1 983) in his article on "malignant mirroring." He makes the point that the view of oneself gained in the "hall of mirrors" can be experienced as intensely persecuting. The results of this opportuity for outsight to become insight can be joy, transformation, and growth; they can also be rage, panic, denial, and Hight. As Zinkin suggests, the sight of oneself in a mirror can be an intrinsically alienating, rather than affirming experience. As indicated in his article, peculiar and terrifying phenomena can be associated with this quasi-magical reflector of images. However, mirrors also display the truth. The ultimate horror for some may not be contained in the mirroring process itself nor yet in the distortions that may be present in the image. The hated and truly dreadful experince, often repudiated with amazing violence, is almost certainly an experience of the difference between what is perceived in the mirror and the individual's expectation of what he or she will see. One patient in a group of one of the authors is, in effect, transfixed for much of

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the time (as was Narcissus) in front of a mirror he holds up to his life and self. He is transfixed, however, not by the beauty of what he sees but, as was Conrad's antihero, Kurtz, by "the horror, the horror" (Conrad, 1902/1973). The psychoanalyst and group analyst are , we believe, engaged in a quest for the truth, with the expectation that an uncovering of the truth will facilitate healthy growth and development in the individual and the group. Some people, however, are not ready to face the truth about themselves when it arrives, and indeed may never be ready to encounter their truths. These people are likely to react catastrophically if the truth arrives too soon, too explicitly, or in too large a quantity. The likelihood of a catastrophic reaction to experiencing this truth will also vary according to the mode of its delivery and the context in which it arrives. A tactless confrontation in a new group is entirely different from the slow emergence of truths in an established and caring matrix. The effect on a group of the catastrophic reaction to self-discovery through mirroring is likely to be the initiation of a destructive phase or the amplification of destructive processes already in train. One such destructive phase is vividly described by Zinkin (1983). Awareness of these issues has important implications for the selection and composition of groups and also for the timing of interventions in the group process. It also gives food for thought about those patients who suddenly leave groups, whatever the manifest reason for this. It is likely that such patients are having problems facing truths about themselves, which are being exposed in the group. The more energetic the departure the more likely it is that the truth will never be faced. After all, Kurtz's confrontation with his truths was on his death bed.

Resistance of change A proportion of patients in group analysis does not achieve positive outcomes. Various hypotheses have been put forward to explain this. These include misdiagnosis, rigidity of defenses, and refusal of the client's personal matrix to accommodate his or her changing. Beyond this there is an apparently innate conservativism in some individuals that amounts to a resistance to change. Such individuals refuse to make the concessions or moves that would free them internally and

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externally and set in train processes that would result in change and maturation. Roberts ( 1991c) sees this as a refusal to let go of "precious" things, people, ideas, places, experiences, and so on, which results, like Collum in Tolkien's (1954 - 1955) Hobbit, in their being slowly reduced to a shadow of their former selves. This is particularly the case with the multiplicity of human addictions. Narcissus and Lot's wife suffered from this kind of inability to relinquish precious attachments. Bion ( 1962) suggested that resistance to change might be more simply explained as a hatred of "learning from experience. " Foulkes (1975, pp. 167-168) had a somewhat different model and suggested that the difficulty in learning from experience was implicit in the fact that new learning requires unlearning. Unlearning is not an activity that human beings find easy to do!

Difficult Patients in the Group As we become more experienced in group analysis, while being grateful

for Yalom's (1985) elegant portraits of difficult group members, we become more aware of difficult groups, not difficult patients. Our concern then becomes how to manage a difficult group that may be, as it were, throwing up a difficult patient as a manifestation of its disease. There is a strong case for arguing that the monopolizer, the silent member, and the antagonistic group member are leaders of different manifestations of the antigroup (Nitsun, 1991 ). Our approach in these situations is to support the group and its healthy development as far as we possibly can. The group analyst will hope to disarm and dissolve the antigroup and anticipate that in the resulting processes important healing can happen also for the dissident. If not he or she may (though comparatively rarely) have to be sacrificed for the greater good. For a more extended discussion of the treatment of a range of patient types see chapter 7 in The Practice of Group Analysis (Roberts & Pines, 1991) and in chapter 8 of the same volume a discussion of

destructive processes in groups by Roberts (1991a).

CONCLUSIONS Foulkes, in our opinion, had a vision of the group of extraordinary depth and breadth. His work, while in some ways diffuse and his thinking often confused (Roberts, 1991 b), is at a nodal point from

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which one can radiate in many directions. Some quotations from a live dialogue in which the history of the group-analytic practice was discussed (Roberts, 1991 b) give intimations of the qualities of S. H. Foulkes that were important in the development of the group-analytic method. Patrick de Mare: I didn't like the look of him at all when I first saw him at Northfield I thought "God what's this." Then I met him personally a week later or something up in his big consulting room and he said he was interested in Rorschach and there were all sorts of colours on the desk, bright colours and it was a wonderful sunny day and it was kind of brilliant, you could sense an excitement and brilliance and that's really when I felt suddenly very drawn to him. Malcolm Pines: I think the person who best described his style is James Anthony in a paper in The Evolution of Group-analysis (Anthony, 1983), who said talking with Foulkes is "like watching a fish swimming under the water, you'd catch a glimpse of it every now and then and then it would disappear and come back again," there's always some sense of depth and elusiveness and you couldn't quite catch what it was all about, and then suddenly you'd see it and then you'd lose it again . ... Robin Skynner: There are two other things: I thought he was very confused, his thought was really confused. Partly that was why he was original. The two things went together because he wasn't a clear thinker and couldn't put things very clearly. The second thing was that he was an extraordinarily nice person in the sense that he was a good man, he was warm and very positive in the sense we've described, even though he would resist your moving away from his ideas or struggling with him; when you did so he would always come half way to meet you or accommodate to some degree. Robin Skynner: I asked [Foulkes's daughter] once why he had this extraordinary effect on so many people, whether she'd ever noticed anything that would explain it because we couldn't and she said "well, no, the only thing I can say is that when I was with him I laughed a lot." And I thought that was absolutely fundamental because you got an enjoyable chuckly feeling from conversations with him, he was in a good humour most of the time. He was happy and I think in many ways a very normal and healthy person, ... I felt vastly the better for knowing and being influenced by him. Patrick de Mare: The other thing he said that we've all read is a good

[chairman] leads from behind his group.

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Foulkes was above all a great facilitator and has modelled for us a method of working with people that has surprising power and gentleness.

REFERENCES Abercrombie, M. L. J. (1969). Foulkes and Escher: Visual analogues of some aspects of group analysis . Group Analysis, 1 (3), 157-160. Anthony, E. J. (1983). The group-analytic circle and its ambient network. In M. Pines (Ed.), The Evolution of Group Analysis (pp. 29-53). London: Routledge & Kegan-Paul. Battegay, R. (1992). Projective identification as a regulator in the group process: The three levels of interaction in analytic groups. Group Analysis, 25(1), 7-13. Bion, W. R. (1961). Experiences in groups. London: Tavistock Publications. Bion, W. R. (1962). Learning from experience. London: Heinemann. Boyd, R. D. ( 1991 ). Personal transformations in small groups. A jungian perspective. London: Tavistock/Routledge. Bridger, H. (1946). The Northfield experiment. Bulletin of the Menninger Clinic, 10(3), 71-76. Brown, D. (1992a). Transcultural group analysis I. Maastricht and Heidelberg. Group Analysis, 25(1) 87-96. Brown, D. (1992b). Transcultural group analysis II : The use and abuse of cultural differences. Group Analysis, 25(1), 97-105. Brunner, J. (1986) . Actual minds, possible worlds . Cambridge: Harvard University Press. Conrad,]. ( 1973). Heart of darkness. Harmondsworth: Penguin. (Original work published in 1902) Cortesao, E. L. (1971) . On interpretation in group analysis. Group Analysis, 4(1), 39-53. Davidson, S. ( 1946). Notes on a group of ex-prisoners of war. Bulletin of the Menninger Clinic, 10(3), 90-100. de Mare, P. B. (1972). Perspectives in group psychotherapy . London : Allen & Unwin. de Mare, P. B. (1991) . Koinonia: From hate through dialogue to culture in the large group. London: Karnac Books. Dewhurst, K. (1982). Hughlings jackson on psychiatry. Oxford: Sandford. Elias, N. (1978). The civilising process. Oxford: Blackwell. (Original work published in 1937.) Foulkes, E. T. (1990). S. H . Foulkes: A brief memoir. In Selected papers, psychoanalysis and group-analysis (pp. 3-20). London : Karnac Books. Foulkes, S. H . ( 1946). Principles and practice of group-therapy. Bulletin of the Menninger Clinic, 10(3), 85-89. Foulkes, S. H. (1948). Introduction to group-analytic psychotherapy. Studies in the social integration of individuals and groups. London: Heinemann . (Reprinted London: Karnac Books, 1983.) Foulkes, S.H . (1964) . Therapeutic group-analysis . London : Allen & Unwin. (Reprinted London: Karnac Books, 1984.) Foulkes, S. H. (1973) . The group as matrix of the individual's mental life. In

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Symposium on Group Analysis, Oxford. Roberts, J . ( I99Ia). Destructive phases in groups. In J. Roberts & M. Pines (Eds.), The practice of group analysis (pp. I28-I35). London: Routledge. Roberts, J. (I99Ib) . A history of the group-analytic practice. In J. Roberts & M. Pines (Eds.), The practice ofgroup analysis (pp. 48-49). London: Routledge. Roberts, J. (I99Ic) . Special categories of patients in groups . In J. Roberts & M. Pines (Eds.), The practice ofgroup analysis (pp. I 04-I 06). London: Routledge. Roberts , J., & Pines, M. (Eds.) (I99I) . The practice of group analysis. London: Routledge. Tolkien, J . R. R. (I954-I955). Thelordoftherings, Vols. I-3 . London : Allen & Unwin. Usandivaras, R. J. (1986). Foulkes' primordial level in clinical practice. Group Analysis, 19(2), II3-I24. Weitsch, J. (1985). Vygotsky and the social formation of mind. Cambridge, MA: Harvard University Press. Wolf, A., & Schwartz, E. K. (1962). Psychoanalysis in groups. New York: Grune & Stratton. Wolf, E. S. (1988). Treating the self: Elements of clinical self psychology . New York : Guilford. Yalom, I. D. (1985). Theory and practice of group psychotherafrY (3rd ed.). New York: Basic Books. Zinkin, L. (1983). Malignant mirroring. Group Analysis, 16(2), II3-I26. Zinkin, L. ( I989) . The group as container and contained. Group Analysis, 22(3), 227-234.

jeff Roberts, M .D. Malcolm Pines, D.P.M. The Group-Analytic Practice 88 Montagu Mansions London W1H 1LF England