Abstract
In 2017, the International Journal of Group Analytic Psychotherapy published a series of articles from Richard Billow on Relational Group Psychotherapy, namely Relational Group Psychotherapy. An Overview: Part I: Foundational Principles and Practices (2017a); Part II: Relational Models of Group Process (2017b) and Part III: Modes of Therapeutic Leadership (2017c).
All these articles were widely commented on by group analytic colleagues from various countries and regions of the world. Moreover, in 2012, the Journal published two important contributions from V. Schermer (2012a, 2012b) on Group-as-a-Whole and Complexity Theories, which also were commented on.
Readers of these and others can now continue, extend and deepen this discussion by consulting the volume: The One and the Many: Relational Approaches to Group Psychotherapy (2015), a most wanted and most welcomed introduction and overview of relational approach(es) as a whole. It assembles 13 tightly argued, theoretically ambitious and clinically rich contributions, carefully edited and introduced by R. Grossmark and F. Wright.
In so far, it really is the first textbook of relational group psychotherapy. The range of its contributions is wide and impressive, covering the foundations of the relational and/or intersubjective understanding of groups, group processes and group psychotherapy as well as their application within and beyond the relational field. Following the editor’s introduction, the opening chapters of Wright, Grossmark and Weinberg describe and discuss the specificity of ‘relational’ approaches in relation to the more traditional approaches of dynamic group psychotherapy, namely Bionian and Foulkesean. Whereas Fosshage, in his chapter on the ‘Use and impact of empathic, other -centred and self-listening experiences in analytic group psychotherapy’, outlines their advent as a paradigm change in epistemology (ultimately building on Heisenberg’s Uncertainty principle from 1927) from positivistic to relativistic science, now called objectivism to constructivism, which ‘significantly contributed to a second paradigm change from intrapsychic to relational field theory’ (Fosshage, 2015: 129). According to Weinberg, the differences between the relational and classical psychodynamic approaches mainly concerns the conceptualization of ‘transference and countertransference, resistance, interpretation, change, enactment and dissociation’ (Weinberg, 2015: 39–41).
Grossmark in his chapters on ‘Enactment, disruption and emergence in group psychotherapy’ and on ‘The flow of enactive engagement in group psychotherapy’ adds to this by highlighting the importance of the relational shift regarding the theories of psychological motivation from ‘traditional drive theories towards the basic assumption that the primary motivator in psychological functioning is the maintenance of self continuity’ (Grossmark, 2015: 77; italics mine). Moreover, he points out the relational turn towards theories of complexity (cf. Schermer, 2012a, 2012b) and a dynamic systems theory in order to conceptualize group dynamics.
In contrast to classical systems theory (cf. Von Bertalanffy, 1966), groups are thus said to operate on ‘the edge of chaos’ (Grossmark and Wright, 2015: 58). Due to this, in order to adapt to changes in the internal and external environment (Grossmark, 2015: 61), disequilibrium and instability are emphasized rather than states of equilibrium and homeostasis. These considerations are supplemented by Wright’s reflections concerning ‘Group leadership from a relational perspective’ and his elucidation of the concept of enactment whose origins he usefully summarizes (Wright in Grossmark and Wright, 2015: 29–36). According to Wright, enactment is of central importance to many relational theoreticians (Wright in Grossmark and Wright, 2015: 29), a view that is shared by Weinberg who argues that for relational clinicians enactment is the focus of attention more than the notion of resistance, transference and countertransference that governed the scene in traditional psychodynamic approaches (Weinberg in Grossmark and Wright, 2015: 40).
For example, in contrast, to the psychoanalytic concept of ‘acting-out’, an enactment can be defined as an automatic, unformulated, non-reflective moment involving all participants in the therapeutic interaction (2015). Conceptually, this is also crucial for his idea of a ‘flow of enactive engagement’ (Grossmark in Grossmark and Wright, 2015: 75–90).
Building on Bromberg’s understanding of enactments as the royal road to the unconscious (Bromberg, 2000), this suggests that the engine of contemporary group psychotherapy is the flow into and out of group enactments of traumatic phenomena (Grossmark in Grossmark and Wright, 2015: 75). This is an important statement in so far as it clarifies that in contrast to more classical analysts, the relational understanding of psychopathology focuses much less on repression, but on trauma, traumatic phenomena and thus on dissociation. Moreover, although Grossmark acknowledges and quotes Foulkes’ statement from 1948: The Basic Rule of group analysis, in so far as the patient’ s verbal communications are concerned, is the group counterpart of free association: talk about anything that comes to your mind without selection (Foulkes, 1983: 71; cf. Grossmark in Grossmark and Wright, 2015: 76).
However, he emphasizes that with regard to what he refers to as the ‘flow of enactive engagement’, group associations should be considered rather ‘as things that happen in the group rather than the verbal associations of the members’ and the group analyst as ‘embedded in the process rather than abstinent or neutral as in the original model of Freud’ (Grossmark and Wright, 2015; italics in org.). In spite of this difference, (which in my view is due to a misunderstanding of Foulkes’ theory of communication), the concept of a group associative ‘flow of enactive engagement’ can rightfully be conceived as an extension of Foulkes’(1983: 71, 86) notion of free floating group discussion.
Grossmark’s conceptualization of the access to unconscious processes in groups is followed by Billow’s chapter on ‘developing nuclear ideas’. Such ideas, he claims ‘may evolve from any mental phenomenon that captures attention in the group and thus may be felt, fantasized and thought about, on conscious and unconscious levels’ (Billow in Grossmark and Wright, 2015: 92). Accordingly, nuclear ideas ‘may articulate an observation, a feeling, belief or memory that takes place in the group and which may be about the group, or any group or a personality, such as group member or leader’ (Grossmark and Wright, 2015). Consequently, ‘anything that takes place in group has potential to inspire and develop into a nuclear idea’ (Billow in Grossmark and Wright, 2015: 92).
As an evocative concept with Bionions, Foulkesean and even Lacanian connotations, a ‘nuclear idea’ will eventually and over time ‘entail a process of thinking and developing thoughts’—in the group situation as in the readers of Billow’s chapter (Grossmark and Wright, 2015).
Levine and Livingstone in their contribution address the dynamics of ‘Progressing while regressing in relationships’ (Levine) and ‘Interventions at an impasse’, i.e. the ‘The leader’s use of self, and sustained empathic focus as a bridge between theory and practice’ (Livingstone).
Flores, in the next chapter examines the interface between ‘Group psychotherapy and neuro-plasticity’ from the vortex of attachment theory, highlighting the ‘mentalization, narratives and self-reflective function’ (Flores in Grossmark and Wright, 2015: 173; italics in orig.). Cohn uses ‘a systems lens to illuminate the intersubjective field in group’. For this, she continues to assess and to reflect on systems theory in general and ‘dynamic systems theory’ in particular, and criticizes the latter’s tendency to emphasize ‘disequilibrium and heterostasis’ as ‘incomplete’ and one sighted, arguing that ‘homeostasis and heterostasis are a complementary process made up of alternating states of balance and equilibrium’ (Cohn in Grossmark and Wright, 2015: 203). In her view, this is not just a matter of theory but very relevant in clinical work, for which she provides convincing examples.
The last two chapters, Rizzolo’s ‘Rethinking Tavistock. Enactment, the analytic third and the implications for group relations’ and Segalla’s ‘Relational experiences in large group. A therapeutic and training challenge’ offer two relational readings of established psychodynamic approaches to analytic groups, i.e. the group relations model of the Tavistock and the (mainly) British approaches to large(r) groups. Criticizing Kleinian, neo-Kleinian and Bionian concepts, namely projective identification, Rizzolo makes a plea that ‘an intersubjective approach to group relations requires us to shift our focus from how reified mental items are projected and contained to how mutual participants collude unconsciously to co-create subjective and intersubjective experiences in the group’ (Rizzolo in Grossmark and Wright, 2015: 236).
Apart from t/his overall conclusion, I was more impressed by the detailed assessment of the differences between different relational and intersubjective authors, positions and concepts; for instance, his pertinent comparison between Ogden’s view of the ‘Analytic third’ (cf. Ogden, 1994, 2004) and Bromberg’s perspective of enactment on the one hand, and pertinent distinction of a ‘literal’ and a metaphorical use of non- linear dynamics theory on the other (Rizzolo in Grossmark and Wright, 2015: 238–239).
Both illustrate that the ‘relational field’, far from being homogeneous, is indeed a heterogeneous one, heuristically, conceptually and with regarding to its origins. Segalla, in her chapter sets out to explore large(r) group experiences ‘under the umbrella of self-psychology as well other relational theories’ (Segalla in Grossmark and Wright, 2015: 250), focusing on why and ‘how self- psychological and relational theories’, due to a gradual shift of emphasis and style of leadership, ‘have had an important impact on large group experience’ by having ‘created opportunities for dialogue that support efforts at connection in the group’ (Segalla in Grossmark and Wright, 2015: 250).
Building on this, she also refers to the work of Pat de Maré, namely his idea of ‘an impersonal fellowship’ among the group members (de Maré et al, 1991: 89). Interestingly, by misquoting his term of an ‘impersonal fellowship’, she speaks of an ‘impersonal brotherhood’ (Segalla in Grossmark and Wright, 2015: 215), perhaps not by coincidence. Whilst the notion of brotherhood in the last instance is ‘familio-centric’, i.e. based on bloodlines, fellowship according to de Maré means a community (literary and spiritually) derived from Greek word koinonia, constituted by group dialogue (de Maré et al., 1991: 157, 191).
Although Segalla mentions dialogue, she does it loosely and without acknowledging its conceptual status as ‘group dialogue’—which de Maré meant to be an extension of free floating group discussion (de Maré et al., 1991: 17, 70). In contrast to free-floating group discussion, group-dialogue therefore reaches ‘beyond the confines of the familio-centric group’ (de Maré et al., 1991: 4). As a consequence of this, large(r) groups provide the setting ‘in which we can explore our social myths (the social unconscious) and where we can begin to bridge the gap between ourselves and our socio-cultural environment’ (de Maré et al., 1991: 10). These implications of de Maré’s work on large(r) groups are really taken into consideration in her chapter.
However, considering the The one and the many (2015) as a whole, I have been most impressed by two of its features: by its ‘interdisciplinarity’ and by the quality of dialogue between psychoanalysis and group analysis throughout the book which struck me as more cooperative and on equal terms (from both sides) than it is usually the case. Moreover, and regarding their ‘interdisciplinarity’, the relational approaches remind me of Foulkes’ early momentum to clarify that ‘in my approach, the qualifying word analysis does not refer to psychoanalysis alone. Instead, it reflects at least three different influences, all of which operate actively’ (Foulkes, 1990: 129; italics mine).
However, there is an exception in Weinberg’s contribution and clinical vignette (cf. Weinberg in Grossmark and Wright, 2015: 50–53), the socio-cultural and political aspects in The one and the many ‘operate’ a little less visibly and vigorously than the psychoanalytical and the systemic ones. To say this, it needs to be mentioned too that several chapters of the book highlighted what Cohn calls ‘the value of hermeneutic thinking’ (Cohn in Grossmark and Wright, 2015: 203–204). Segalla mentions Gadamer’s view of ‘dyadic conversation’ (Segalla in Grossmark and Wright, 2015: 254), whereas Grossmark in his reflections on meaning-making in groups and group therapy (Grossmark in Grossmark and Wright, 2015: 82) draws on Gadamer for his claim meaning should not be considered as a linguistic formulation but as an event (Gadamer, 2004 quoted by Grossmark, 2015: 83).
From a group analytic perspective, this brings into focus and perspective both Foulkes’ notion of the social unconscious (Foulkes, 1951) and his mature model of the tripartite group matrix (foundation–dynamic–personal) (cf. Nitzgen and Hopper, 2017) including de Maré’s view of large(r) groups and group dialogue (cf. de Maré et al., 1991). In this context, we may remember that it was de Maré building on the work of Cassirer (1944) and Langer (1967), who extended the scope of Foulkesian group analysis when he claimed that the human psyche is governed not only by the pleasure and reality principles, but by a third principle, that of meaning, understanding, verstehen (de Maré et al., 1991: 7).
In the relational and intersubjective approaches, this principle in my view resurfaces afresh, in a new key with renewed momentum. Offering much food for thought as well as a wealth of clinical material for interested readers, students and advanced clinicians, The one and the many therefore is not only an excellent primer of relational group psychotherapy, but also a relevant and reliable guide to the study of their complex epistemological foundations including their philosophical roots. The one and the many both enriches and challenges more traditional psychodynamic and/or specifically group analytic theory and, as can be gathered from Nick Barwick’s and Martin Weegmann’s recent textbook: Group Therapy. A Group Analytic Approach (2018), the (mostly) American relational-intersubjective approaches have already become influential in contemporary contributions to group analysis across continents. Therefore, the book of Grossmark and Wright is an indispensable companion and a source of valuable information for students and experienced group analysts as well as for all teaching programmes in group analytic training institutes and institutions.