Abstract
I am pleased to have been asked to respond to Between the Notes (2012), an article that addresses itself to important inter-subjective understandings of personal and collective change, through the synthesis of group analytic and musical theories and their possible applications.
As a clinician in the NHS I am aware that change is very much in the air like the late night Karaoke from the pub I live next door to, loud, insistent and demanding to be engaged with or enraged by.
Being enraged by the ‘noisy neighbours’ has become an image used by the media to describe the emergence of the new and its challenge to tradition; tradition sometimes experienced by the new as complacent, arrogant and out of tune. One example is the depiction of the current feverish rivalry between the established supremacy of the Manchester United football team and recently resurgent neighbours Manchester City.
Their competitive cacophony could be compared to the noise level generated by the current spectrum of psychotherapies in their efforts to manage and engage with change. This noise level and its effect on our capacity to think can be seen as one of many contemporary challenges we face as group analysts. I want to say something about change before going on to make some points about music generally and Linde’s article specifically, concluding with some points of my own provoked by the article.
One way of thinking about change is to say that it is personal, inter personal and systemic. You change and I accommodate, or not, with a corresponding strain or conflict within me or you, or between us resulting. This is what I understand Linde to be addressing when she writes that: ‘The very idea of intersubjectivity depends on the human capacity to develop a sense of intersubjective time within which to construct joint meaning’ (Wotton, 2012).
So we construct a joint meaning out of a sense of inter subjective timing—which will no doubt help us play in time and in tune. Our shared understanding will probably help us to agree that change is both sometimes desirable and painful and probably historically inevitable.
However, it seems reasonable, at least for a moment, to be uncertain about the direction change takes before following too enthusiastically. Because whilst we may be, as Linde suggests, biologically/neurologically programmed to certain call and response patterns in music and relationships, do we really want to find ourselves responding to the call of change like Pavlov’s drooling dog, or engaging with the ‘new’, like car drivers who follow their satellite navigation systems unquestioningly into the river?
In order to maintain a consistently high level of service to our patients, a critically challenging and reflective response to change as it applies to individuals and organizations is essential. However sometimes it seems that the process and pace of change in the culture of the NHS generally and in NHS psychotherapy specifically, could be compared to listening to the more challenging music recordings of jazz musician John Coltrane.
I offer as an example his 1965 recording Ascension, in which Coltrane takes change in giant steps and expands his long standing quartet into a group of 11, abandoning traditional time and harmonic structures in favour of a free approach that some listeners found, and still find, interesting but chaotic and alienating.
This recording subjects one to a sonic assault via what had earlier in Coltrane’s career been described as ‘sheets of sound’ (Ira Gitler cited in Fordham 1998: 136). Coltrane’s approach leaves the listener with little time or space to think or feel. One is compelled to either pull away or acquiesce. Resistance is futile. Here there is very little space between the notes to find an alternative.
Change like Coltrane’s latter musical output, can often polarize and divide and sometimes can be pretty uncompromising. I would argue there is a danger that whilst psychotherapy institutes may have become more reflexive to external political and economic demands they may become less reflective internally in their efforts to adapt to a more business like ethos, as well as taking on board ideas from Mentalization, ACT, CBT and other developments. As band leaders and football team managers will attest—you can only bring in so many new players at one time before the group starts to lose any sense of coherent identity. For players read new conceptual developments.
In psychotherapy as elsewhere in our fast paced world, to question the new wave of conceptual developments is to risk being out of tune with the wider culture and to be seen as no longer in fashion. To do so we might have to tolerate the anxiety of feeling that our voice, our creative output will be consigned to the bargain basement, like the CD of a forgotten X factor winner.
Such concerns seem to be crystallized by Peter Fonagy’s response to Sigmund Karterud’s 35th Foulkes Annual Lecture in 2011 (Karterud, 2011) in which group analysis seems to be portrayed by Fonagy as out of touch and out of tune with the manualized and standardized norm that now calls the tune we apparently have to dance to.
In his Foulkes Lecture response, Fonagy takes on the role of the fashion house designer in telling us what to wear for the coming season. That his response is not yet available in writing might suggest that we are still thinking of what to throw out of our conceptual wardrobe to accommodate his spring collection.
Sequentially, Farhad Dalal’s 2012 Foulkes Annual Lecture (Dalal, 2012) seems to offer a robust response that re-validates spontaneity, creativity and a restating of our core values as group analysts. Dalal reminds us that the task, in re-composing ourselves collectively for the new culture that we find ourselves in as group analysts, is to find a manageable tension between being adaptable, flexible and remaining rooted in history and tradition.
Group Analysis and Music: Transition in Tradition
The jazz musician Courtney Pine has recently engaged in something along these lines entitled Transition in Tradition (Pine, 2009). This recording is a homage to the spirit of New Orleans and the legacy of Sidney Bechet in a contemporary framework provided by Pine’s own original music. Interestingly, a musician colleague of mine complained to me that he was unhappy that there was not a single Bechet tune on the album! It was as if he could only imagine such a project re-immersing its participants and listeners in an institutionalized, stagnant re-playing of the past, a view of tradition that silences the new and demands that substantially nothing must really change. In this view the potential for transition and transformation is paralysed by a rigid and fundamentalist interpretation of the historical.
As an émigré Foulkes was surely aware of the creative tension between old and new. His work represents an on-going engagement with transition and tradition that Dalal (1998) has interpreted as an internal struggle between the radical and orthodox that may well be part of our organizational heritage.
Foulkes’ description of the group with two pianists (Foulkes, 1948: 102) is an example of contrasts between his light touch as a group conductor and his emphatic insight into the group’s use of different leadership styles to manage interpersonal tensions aroused by change. He demonstrates what it is for the conductor to operate as an instrument of the group and for the group to be played playfully by all its members, including the conductor as if it were itself an instrument for change.
Elsewhere in group analytic literature Powell (1983) writes on music at some depth and in her commentary Sharpe (1983) advocates the need for group analytic exploration of improvisation in music. Powell’s article is a potent mixture of historical, group analytic, philosophical and musical insights, particularly enlightening in focussing on the importance of both music, and by implication group analysis as ‘a special formulation of environmental space’ (Powell, 1983: 8).
It is important to note that the ubiquity of music as a social/anti social phenomenon in western culture makes it potentially one of the most valued and devalued aspects of this environmental space, the space between us that we all share as part of what Foulkes describes as the foundation matrix (Foulkes, 1971).
As an example of music’s ubiquitous presence in our lives, BBC Radio Four’s long running anti-dote to the social world, Desert Island Discs, entertains us with the fantasy of taking something musical into self-imposed isolation. The ambivalence evoked by this island scenario is reflected in there being no neighbours asking us to turn the volume down as well as the absence of an-other with whom we might discuss the relative merits of the music and its effect on us.
A different view is provided by Malcolm Pines who reminds us in the case of Foulkes and Fairbairn, that some degree of isolation from the group and distance from the clamour of conflict enables both to engage in creative work, although neither can be thought of in isolation from the social context in which they are located (Pines, 1991).
The fantasised absence of the other represents a drive towards the eradication of any sense of discrimination or differentiation.
We can see in music and in psychotherapy a drive towards homogenization in which difference and diversity is devalued. The homogenized view camouflages some uncomfortable truths, particularly the idea that even apparently harmonious group endeavours must manage and acknowledge other aspects of relational life such as hate envy and rivalry.
The struggle in groups to manage the dynamic between hatred and creativity so that they do not become extreme polarities, is described by Morris Nitsun (1995). He uses the example of an Irish soul band The Commitments, from Alan Parker’s film of the same name (Nitsun, 1995). Nitsun’s work on the anti group reveals how conflicted we can be about sharing with others and that creativity and our destructive potential are inextricably linked. We could say further that at the most basic level both musical dynamics and human relationships are about creating, tolerating and resolution of such tensions.
One of the ways in which these tensions become located in the group matrix is through the personality/pathology/preoccupations of its conductor. Linde offers us an understanding of this through viewing the matrix as a musical process in which the conductor’s role can be seen as the tonic or root note. Although the root note does have a huge influence on how a group (scale) of eight notes (an octave) is heard, it is the combination of and dynamic between those notes that determines the attractiveness of the melody.
Students of music are often encouraged to learn scales and modes from different intervals within an octave. This encourages improvisational skills. It would become too predictable to hear a pattern of notes that can only ever start from the root because the student knows of no other position from where to begin.
A group in such a ‘root restricted’ mind-set could be described as playing in the metaphorical Bionic key of basic assumption dependency, reliant on the conductor to lead in a new direction. In contrast, a work group in which all members are encouraged to take up positions of leadership may result in less predictable and more challenging musical output.
Having said this I do accept that the group culture is, in the early stages of the group’s life, given a significant push in certain directions in the way the conductor takes up his role. This may reflect the truism that group culture mirrors something of their conductors’ personalities—in the way that different children within the same family may highlight certain but unique aspects of the personalities of a parent.
For example, a once weekly group I conduct on a weekday morning seems to play different music and music differently to another weekly group I conduct on the following evening. These are groups with similar numbers, mix of pathologies and length of history.
The cultures of the two groups are very different and I hear myself as subtly yet recognizably different to myself in each group.
Occasionally I have wondered what it might be like for the groups to trade places and to meet a different me or to be able to hear what another group sounds like. Of course within the limitations of clinical work these remain interesting but unrealizable fantasies and possible enactments of the counter transference frustrations of the group conductor.
The psychotherapy group meeting on a weekday morning has developed a particular culture. This might be compared to the music of a band of jazz musicians who have a secure club tenure offering regular employment, reasonable ‘income’ in terms of the meeting of their therapeutic goals and some opportunity to express themselves without interference. They can exchange aspects of themselves at a part object level like the best of musicians often can with musical phrases. This group is able to adapt to change and to play sometimes complex changes through improvisation. In their music there is a clear emphasis on stability and co-operation.
However on reflection, the group’s relationship to me as its conductor seems idealized at times and inhibiting of openly addressing conflict or complex feelings around dependency and intimacy. This seems to be enacted covertly through a pattern over time in which one member seems to be missing every week.
The culture of the evening psychotherapy group by contrast could be compared to how one might imagine a group of jazz musicians travelling through the USA in the Great Depression (1929 not 2009), facing hostility, possibly racial discrimination and financial hardship. The group ‘music’ is flat, funereal and flavoured with deprivation and grievance. There is little spontaneity or capacity for improvisation and although attendance is collectively better than in the morning group, the evening group is heavy in atmosphere and lacks vitality.
The music feels to be lacking in meaning in the way that background supermarket muzak might lack the capacity to surprise or emotionally engage us. The atmosphere of mistrust and hostility remains unchanged by either interpretation or challenge on my part.
To be in and part of this second group is to hear something of the group, including its conductor, being caught in a groove, like a scratched old vinyl recording. It demonstrates the rigidity of what Linde describes as a group being stuck in certain formulaic patterns.
Playing the Changes—Changing the Players
Improvisation would seem to offer a counter point to this kind of creative ennui. Contrary to popular belief, improvisation, at least in jazz, to which it is not of course an exclusive device, is not just ‘making it up as you go along’. It is a spontaneous but informed by theory, creation of a new melody line, sometimes but not always using established chord progressions. In jazz this is called ‘playing the changes’—the improvised melodic line reflecting shifts in the underlying harmony
In relation to the two groups I have described, supervision has recently enabled me to emerge from what felt like a group induced coma in which inertia and sterility had become the ‘norm’, the home key. I have of late rediscovered a capacity to think and to initiate change and to think reflectively about the relationship in my mind between what might at times have been experienced by me as the ‘preferred’ and the ‘difficult’ child (group).
As group numbers fell in the evening group I have been able to find an alternative to a ‘two tone choice’ between carrying on with low numbers or simply closing the evening group. It is beyond the scope of this response to say more than that there were insufficient numbers on the department waiting list to make replenishing the evening group a viable choice.
I have in recent times been able to present both groups with an option to combine the two groups—bringing the remaining evening members into the weekday morning group.
Although this suggestion has been well received in both groups, considerable space has and will continue to explore the ambivalence and subtle resistance to change and the underlying dynamics that may deflect latent aggression onto the ‘strangers’ as an avoidance of anger towards me as the change agent.
There has also been a need to find space to think in supervision about my part as the conductor in a group that was forever ‘playing flat’ and why it was so difficult to either get help the group play in tune with itself or at least come to terms with the apparent loss of what Linde takes to be our innate musicality. I take this to be an example of group analytic improvisation.
To improvise is to do more than expected—it requires the ability and confidence to risk, tolerate, survive and repair being wrong, out of tune, sometimes to cringe level. It requires the critical internalizing, recycling and sometimes discarding of existing knowledge to create something new. This is what I hear Linde addressing when she writes that: ‘Crucial to my argument is that developing a sense of belonging and a sense of self depends on the ability to introduce variation and improvisation into the rhythmical exchanges that form the intersubjective narrative’ (Wotton, 2012).
In group analysis the encouragement for patients to use improvisation within their intersubjective narrative is to risk playing the wrong note.Patients can be helped to take these risks and opportunities for change by observing the risk taking capacities of the conductor, who whilst holding the group to task role and boundary, offers and embodies alternative ways of relating and communicating outside of rigid rules and forms.
These forms might be thought of as constellation of object relations carried around as a ‘relational score’ from which we need to depart or at least have the option to expand on as a social repertoire.
Relationally this would be the difference between knowing how to play a tune in only one key or time signature and being able to play a recognizable melody in a variety of keys and to be able to move between them. This capacity is what makes both music and relationships interesting—the moment of an emergent unknown that is still tolerable within our individual capacities. In jazz this process has been described as ‘the sound of surprise’ (Balliett, cited in Ratliff, 2007). Possibly group analysis shares something similar in helping patients manage the desire for and anxiety of the new.
In raising this issue of anxiety about the new, I want to acknowledge Linde’s analysis of an underlying fear of being ‘out of tune’ or not belonging as something, which can inhibit creative expression in the group. Linde’s article clearly exemplifies this with her use of the case material of Jane, the group patient whose ‘moment of suprise’ was already old news to the rest of the group.
Whilst the article demonstrates the roots of such a dissonant clanger in the patient’s history it is also reveals a disguised opportunity for the group to revisit apparently old workings from new perspectives, which I think is worth acknowledging.
In this instance I think the article also implies an important awareness of how our patient’s family and social histories may leave them with a need to find a third alternative between the polarised view of dissonance only arising from an out of tune individual or a dysfunctional group, rather than a counter point melody between the two. The idea of a ‘dysfunctional harmonic’ fit between personal and social may offer an alternative to a group matrix flavoured with aspects of control and coercion that leaves little space for soloists to express themselves; an essential counter point to the music of the ensemble.
This leads me to what I hear as the main theme of the article, the idea of the group matrix as a musical construct.
The arguments offered in support of this hypothesis, draw on the work of Susan Langer and child developmental theorists like Stern. They link group cohesion and a sense of belonging to language acquisition and the capacity to form and use symbols. Central to the debate is the work of Malloch and Trevathern on ‘communicative musicality’ (Ibid) which focuses on the importance of rhythmic patterns of speech.
Putting my scepticism to one side I find this reminder about the subtleties of communication reminiscent of advice from the late Norman Vella, who advocated that in the anxious early days of a new psychotherapy group it might matter as much how you speak as a conductor, as what you speak about. The musicality of one’s communication being present in the tone of one’s voice—like a parent’s verbal responses to a new infant—conveying warmth, holding and containment of anxiety.
Conclusion
All of which is to say, that whilst we are moving in group analytic psychotherapy towards ever more articulate verbal expression, music as an evocative and communicative phenomena shows us that an important part of the group analytic matrix, is always deeply rooted in the raw, undigested experiences of the unconscious.
So although I find much of the article useful, I find myself resistant to what Linde offers us as formulation that might lead towards ‘manualizing the matrix’; something that can be known, measured, evidenced—or even notated in the way that music can be.
In applying this resistance and mistrust of certainty to the impact of change on the organizational matrices of psychotherapy organizations, I hope it may be a challenge to the enchanting tune that we cannot seem to get out of our collective heads as psychotherapists. Predictably the tune has only three chords; preoccupation with short-term symptomatic change; the need for certainty through measurement; and that everything should have a financial costing.
What I take indirectly and probably unintentionally from Linde’s article is a need to creatively engage with this rather mindless (but NICE) music by placing a greater emphasis on the value of diversity and dissonance in our social experiences. At a personal and organizational level this may be about having the capacity to experience and tolerate desires to both belong and to be separate, to sometimes be out of tune and out of step with other psychotherapeutic/business models and/or retain aspects of our identities with all the risks of conflict it may bring.
I would like to suggest that group analysis, with its long standing tradition of integrative eclecticism could risk being a little less accommodating to the new schools of thought and when confronted by our noisy new neighbours, be a little more confident and assertive in asking them to keep the noise down a bit, because we may be at risk of finding it difficult to hear ourselves and others think.
We need to think about where change is leading us and what meaning/harmony there is or not, between the notes representing group analytic and other view points, so that we can discriminate between the different intervals of transition and tradition.
I feel the insights offered in Linde’s article help us in this task by encouraging group analysts to engage with change and innovation. To this I would add a need to retain our capacity to be surprised by the results of what we can achieve when we improvise beyond the manual and outside of the standard. Hopefully we can then continue to balance transition with tradition, both constructively challenging as well as valuing our historical attachments. Until clear evidence, critically analysed and digested, rather than the hue and cry from our noisy neighbours, tells us it is time to give them up.