Abstract
Being asked to review John’s book took me back to my first encounter with him many years prior to my training as a group analyst and subsequent committee work with him at the Institute for Group Analysis in London. The event in question was a meeting to form a new organization Psychotherapists and Counsellors with Social Responsibility. Along with other senior clinicians he invited a room packed full of people to form special interest groups around areas of social interest: race, politics, environment, gender etc. Out of the chaos, somehow trusting the process, we formed a range of groups, many of which continued to meet independently for years. I remember feeling excited and inspired by this method of facilitating people towards forming groups.
I will confine my contribution to follow on from Robi Friedman’s review, and concentrate on Section II The group analytic model, particularly in how it relates to the relevance for students of group analysis, as I see it from my perspective as a supervisor for the IGA in London and in the National Health Service.
John’s contribution to the literature is a comprehensive reference book for students and experienced clinicians alike and plays its part in helping demystify the model for both current and potential group members, some of whom will become the students of the future. I find it a book not to be read so much from cover to cover, it takes some digesting at times as it is so full of interesting themes, but one to dip into as required and out of interest. There seems to be something for everyone.
In recent years where the diploma course at the IGA means that students extend the work of group analysis into a range of institutions and settings outside the NHS this detailed explanation of the model is timely.
Chapter eight fleshes out Foulkes’ and Anthony’s three dimensions of structure, process and content, reviving and restating a framework for thinking which is useful in containing students’ anxiety about the often overwhelming projections they have to carry, which they bring to supervision to think about in a climate of cuts in secondary care health services.
John’s 35 years of experience of working as a group analyst shines through in his attention to detail in each chapter and the inclusion of a range of contributions by senior group analysts and newer graduates alike, from both Europe and ‘across the Pond’ in the US where he is well respected. The writing style he adopts can be likened to how John defines the conductor as being a member of the group and contributing to the discourse, whilst retaining both his personal and legitimate authority in the role with a particular tenacity for which John is renowned. I cannot begin to think about just how many students have been helped by John’s encouragement and intellectual rigour in his role in tutoring students. It is an act of generosity to include these student’s work, some yet to be published, to such a degree in the book. The way he references a range of international contributions whilst retaining his unique narrative voice is also impressive.
Students bringing their groups to supervision often describe their frustration at not finding their everyday struggles in clinical work reflected in Foulkes’ writings. John’s detailed vignettes go a long way to fill this gap. e.g. Vignette 8.2 (p229) students will find reassuring to think of the common phenomenon of group members taking it in turn to be absent from a session, a situation which can leave the conductor, particularly the trainee, with such feelings of shame and humiliation at not being able to stop this from happening at a time when the conductor is attempting to find their own authority.
The visible and invisible group (p232) expands our thinking about what for the trainee group analyst can often appear quite mysterious in terms of talking about unconscious processes as they unfold in the group.
The vignette of the story of the wooden spoon (p241) brings something of John’s humility in his use of self in therapy. He illuminates the complexity of the conductor’s own feelings of irritation towards a group member, going some way to shed light on the potential for ruptures and repair in the group. He cites an example where the power of the conductor is used to challenge an individual but in the process potentially enacts feelings belonging to the group member’s narrative of the content of the group. In his acknowledgment of this he demonstrates the potential for reparation from which the whole group can derive benefit.
In Chapter 10 on Process, concepts and applications, John elaborates a response to the question ‘How does participation become therapeutic in a group?’, a question frequently arising at assessment where a potential group member may wonder ‘what do I do in a group? How does the group work?’ He builds on Foulkes’ and Anthony’s group specific factors, developing the model in Table 10.2 (p251) to create a new working list of ‘process dynamics’ to include resonance, reciprocity, valency, mirroring, amplification and condensation, taking resonance as the key partnered with interpersonal valency. This list usefully brings the model up to date with an integration of developments in thinking from various fields from psychoanalysis, Systems Centred Training, musicology and communicative musicality, and neuroscience/neuropsychoanalysis.
I was heartened to see ‘reciprocity’ replace ‘exchange’ which I have often found the source of great confusion, reciprocity offering a much richer explanation of the concept, a term I often find myself using to explain the term. It takes us away from a bartering model.
As a social construct, positive reciprocity means that in response to friendly actions to please are frequently more cooperative than predicted by the self-interest model. And conversely, negative reciprocity means that in response to hostile actions people are frequently much more aggressive. (p254)
This feels particularly poignant as we face increased divisions and binary categorizations in society.
The inclusion of valency, with a broader definition than originally given by Bion, acts as a useful addition in helping the student make sense of why one group member might be more prone to respond in particular situations than another, a knowledge which can help him shape his interventions with particular group members. There is an in depth distinction (p266) drawn between simple, complex, descriptive and unconscious resonance which helps deepen our understanding of an apparently straightforward but highly complex concept. The amplification of familiar concepts continues throughout this section.
The clinical examples take us straight into John’s groups and convey to the reader the depth and maturity of John’s experience as a clinician and the degree to which people can both find and offer help to each other in his group. The detail of the examples are testimony to the complexity of our group analytic project and the time, patience and perseverance required for enduring change to happen, as John describes on page 259, ‘though her feelings did not seem to reach any part of him at the time, slowly and in painfully small increments, we were to bear witness to his steady development of previously unavailable feeling’.
The inclusion of letters from these group members at the end of the book, giving their consent for publication is touching and speaks to their generosity.
In Chapter 11 Content, key questions about narrative, discourse and the voice of the symbol.
It is a useful reminder to recall Foulkes’ quote ‘The conductor should be ahead of his patients . . . in hearing (what Grotjahn calls) “the voice of the symbol” . . . patiently waiting for them to catch up, cautiously helping . . . but most concerned with what is in the way, blocking the group’s own understanding’. This speaks to a common struggle when helping students think about the importance of the timing of their intervention. We run the risk out of eagerness to share our thoughts prematurely with a group. Whilst these kind of interventions are often accurate much of the time in supervision is helping students hold back and wait, to save it up for later use, allowing for a deeper and more meaningful intervention.
John develops a series of therapeutic challenges for the conductor which contributes to the development of symbolic thinking in both the group and its members. This is a very timely assertion of the role that group analytic groups can play to stand alongside other newer therapies such as Mentalization Based Therapy whose aim is to move from non-mentalizing to mentalizing states of mind. John provides direction and encouragement to students to expand their repertoire of potential interventions, demonstrating the complexity of the task of conductor.
The detailed analysis highlights the complex interplay between Foulkes’ four levels of communication, different conductor interventions, the power of the reparative potential of finding a narrative in a group to make what feels unbearable more palatable. John brings examples of his international contributions to various workshops and conferences.
In his introduction John states ‘Going to work as a group analyst is a privilege every day—it is sometimes humbling, sometimes inspiring, sometimes challenging and frustrating, but it is always of compelling and touching interest’ (p3).
For the new trainee at different stages this can also be accompanied by dread, feelings of being overwhelmed, incompetent and sometimes highly or over-identified with their own group members, the trajectory of their own personal development leaving them barely one step ahead of the people they are aiming to help.
In Chapter 12 John takes us to the central question of how each of us finds our style as a group analyst, through apprenticeship but also through finding our own influences with the tripartite integration of personal group analysis, theory and clinical practice. In this chapter he weaves together his model of relational to reflective to reparative experience as he presented in his Foulkes lecture, the role of the conductor as convenor, therapist and group member and the phases in the cycle of a group’s development.
Progress in moving from the relational to the reflective and then reparative dimensions of the work turns on the availability of the conductor as a person, their resources as a therapist and their capabilities as a convenor. (p301)
Students have to go through the inevitable phase where they remain baffled that what they are dealing with in their own therapeutic process also finds it way concurrently into their training group. As John puts it ‘What the conductor finds in the group will be a reflection of what the group finds in the conductor’ (p302)
This becomes a pivotal point in the development of the supervisee when s/he brings to supervision the part of her which is being tapped into, to shed light on her own understanding of what the group is dealing with, not to turn the supervision group into therapy but to take ownership of her own part in the encounter. Reflecting on the tensions between transparency, abstinence and use of self in the work is critical.
In his ‘Advice to aspiring group analysts’ (p303) ‘After reading the chapter it might be most useful to forget about it. Try to do the job by working as spontaneously as you can’.
This speaks to one of the central challenges for supervisors of students who are keen to get it right, to impress and to try out new ideas from the teaching. It comes as a blow to some to discover that along the journey in becoming a group analyst it is not possible to apply reading from a book to practice but that the converse is true; a need to seek out explanations in the literature for what we experience in the work or indeed where there are gaps in knowledge to attempt to put voice to what our own authentic experience can add to the field. This task is often particularly hard for those who have spent years building up a knowledge base of a particular profession, whether individual psychoanalysis, psychiatry or psychology only to have to shift focus to letting go of a particular way of seeing the world in order to acquire a new professional identity.
John ends this section with a quote from one of his major influential figures the group, even the most group-centred group, never quite surrenders its adoration of the therapist, and this was evident in the case of Foulkes . . . This point of view regards the need for leadership as a symptom of the group that is curable only by a therapist who does not lead. (Anthony, 1991: 85, cited p323)
In turn I expect to see John’s ideas and useful frameworks for thinking about aspects of the group-analytic model working their way through the student body of courses internationally, both as an influence in how students will think about their clinical work but also in how they take on John’s influence in their future written contributions to the literature in the future.
John’s book is a great gift and legacy which I expect will percolate throughout the community for years to come.