The body in group analysis

Transition from psychoanalysis to group analysis

Group analysis started as psychoanalysis in transition, in a movement best described by Schlapobersky in the title of his recent book: From the Couch to the Circle (2016). This movement located the therapist in a circle among other patients with actual bodies and changed eye contact between therapist and patient quite radically. In this article I intend to explore the implications of the transition to sitting in a circle face-to-face. I believe that my awareness of the crucial importance of this shift is a result of my other training and therapeutic experience in bioenergetic analysis (body-mind therapeutic approach).

The group analytic legacy is rooted deeply in the history of psychoanalysis. Haynal (2006) discusses the significant history of the body in psychoanalysis: Freud’s mortal illness, Ferenczi’s mysterious final disease, and their preoccupation with health in their correspondence, accompanied by pervasive silence about the body and its problems. Although Freud was aware that a mental factor may contribute to the origin and persistence of organic illnesses, he kept declining the treatment offered to him by Ferenczi and Groddeck, designed to ameliorate his cardiac and cancerous illnesses.

Haynal raises the question: How can a psychoanalyst feel at ease in his body? How does the analyst experience certain moments in his/her counter-transference—palpitations, extra systoles, cardiac arrhythmia? How does he/she experience his/her body, his/her skin: Is he/she pale? Does his/her face turn red from excitement? What is happening to his/her posture? When Haynal mentions all these symptoms, he has in mind an analyst who sits behind his/her patient; they become even more important for a group analyst who is visible to and observed by all participants.

Haynal presumes that Freud’s attitude established a tradition in which bodily phenomena are neither talked about nor integrated into the analytic field.

I believe that in this respect Foulkes was not different from Freud in his attitude to himself psychosomatically. He did not listen to Anthony’s (2010) recommendation to be checked physically, and it is well known that he died from a heart attack in the middle of a session with his group. What can be more present bodily than the conductor of the group lying dead on the floor?

This is a trauma in the foundation matrix of group analysis that has split off from the theoretical development that has taken place since Foulkes’ death. I think that this traumatic event has left the body as a topic that is unspeakable for a long time. This is expressed and illustrated succinctly in the tension between title and cover of Behr and Hearst’s book: Group-Analytic Psychotherapy—A Meeting of Minds (2005). The picture on the cover is a drawing of a group of people sitting in a circle, with body and facial expressions speaking a full physically-rooted body language, while the authors refer only to the mind. The ambivalence about the body is also expressed in the title of the GASI Winter Workshop in Budapest, 2005: ‘Body and /or Mind—Who is sitting in the circle?’ It seems that in 2005, group analysts were still not certain about whether what makes a person is a body or a mind, or the two of them together.

Foulkes’ idea about body-mind integration is expressed clearly several times in his writings. A good example is his famous sentence:

Group analytic method and theory do away with pseudo problems such as biological versus cultural, somatogenic versus psychogenic, individual versus group, reality versus phantasy. Instead we endeavour to use concepts which from the beginning do justice to an integrated view. (Foulkes, 1957: 27)

In writing about the group as an instrument in the hands of the conductor, Foulkes (1948) outlines four frames of reference that have relevance for the conductor’s interpretations. He describes the third of these as ‘the individual’s attitude towards his/her own self, particularly in its unconscious aspect and towards his/her own body. This latter point includes character-and psychosomatic-reactions which are continuously in operation in group analysis (Foulkes, 1948: 135)’.

The realm of the body in the group process is central to what Foulkes (1964) called the third level of communication, or the Projective Level—the level of bodily and mental images. He posits that ‘not only may individuals embody a part of the self, but the group as a whole may do so. The group often represents the mother image. The body image is reflected and represented in the group and its members (Foulkes, 1964: 115)’.

Although Foulkes held the body in his mind and his writings, his important concept of the Matrix (1964) relates to the group mind. In this respect, the concept lacks the dimension of the body. Powell’s (1991) concept of the ‘embodied’ matrix is relevant here; when discussing Fiumara’s (1991) article he quotes Fiumara, who says that the human psyche retains forever a kind of nostalgia for that first imprint of somatopsychic undifferentiation. This connects well with the theories of Winnicott (1949) who relates to the mind as part of the psycho soma.

Dennis Brown describes the power of the group to deal with somatic disorders:

Analytic groups provide a prime opportunity to study the communicational and relational significance of psychosomatic disorders and processes . . . The combination of support, regression, learning by example, identification, projection and introjection, provocation and response, translation and interpretation that characterizes a well-functioning analytic group does enable individuals to grow into awareness of the unity of bodily and psychological processes and bring more of themselves into relationships with others. (Brown, 1985: 93)

These are important ideas that were not developed further by others, as the field remained focused solely on the mind. I see it as another expression of the body being historically excluded from group analytic theory.

Looking backwards to the history of Foulkes and Anthony

In his article about his relations with Foulkes, Anthony writes:

At this time, on one of my visits back to England, he asked me to examine him for pains in his chest which I did, feeling that it was a queer reversal of the doctor–patient relationship. However, I said two things: That he needed a full medical check-up and that he should take a rest from his professional work. (Anthony, 2010: 83)

We know that he did not follow Anthony’s recommendation, but there is a question, also in Anthony’s mind, about his choice not to see his GP (did he have one?) and to consult his former patient/student. Haynal (2006) writes that no paradigm in the theory and practice can escape the influence on it of its originator’s life history. In 2016, Foulkes’ death is still a crucial issue in the writings of the most prominent voices in group analysis.

Nitsun (2016) speaks about the negation of death in the theory and practice of group analysis, and relates it to the shadow of the traumatic death of Foulkes in group analysis’ collective memory.

Hopper related to this split-off event in his account of the dynamics of the large group at the Foulkes Day:

The group could not risk the violence that might follow from the exploration of aggressive and competitive feelings in general. Not only are such feelings perceived to be a threat to our cohesion, but they are also experienced in terms of the death of Foulkes within a group of senior colleagues under circumstances which are both romanticized and mystified. This scenic configuration is used by colleagues who were not actually present in this ‘primal group’ but who have nonetheless become witnesses to it, as a collective screen memory against other traumatic events, both within GASI and in Europe at large. The fear of the consequences of murderous rage is hard to manage when a death in the context of such rage has actually happened, especially when it is the Father himself who was ‘murdered’. (Hopper, 2016: 18)

Breakthrough

In 2006 there was an important breakthrough that began to repair this rift. Nitsun focused on two issues which had been marginalized in our field: sexuality and the body. He posited that

The body needs to be brought onto centre stage. This is another area in which the therapist can lead by example, encouraging a bodily discourse as part of the sexual discourse . . . The body is the site of culturally mediated judgments concerning shame and disgust, as well as excitement and pleasure. (Nitsun, 2006: 261)

Nitsun points out the contradiction inherent in the fact ‘that the therapy group has such a strong physical presence, that the body is so much in evidence and sexuality so likely to be present in some form—yet this is spoken about with such caution and reserve (Nitsun, 2006: 261).

He emphasizes both the centrality of sexuality and its relation to the body, and the importance of shame in the therapeutic work with sexuality in the group. Shame stems from the inevitable gap between the private and the public self.

As both a group analyst and a bioenergetic analyst, I felt the need to explore and draw attention to the issue of shame (2008). My intention was to bring the body of shame to the forefront of group analysis. My main point was that shame, an affect so relevant in groups, is experienced in the body and therefore also needs to be addressed at the level of the body. In order to be aware of the embodiment of shame, we group analysts need to be aware of our own bodies. In that article I quote Conger (2001), a Bioenergetic analyst: ‘shame strikes at the foundations of the embodied self and disrupts the intention to be present’ (Conger, 2001: 71).

Pines (1984) reminds us that Freud himself admitted to his dislike of being constantly looked at by his patients and this, amongst other considerations, led him to construct the situation of the patient on the couch with the analyst sitting behind him. The very fact that this technique was so deeply accepted in psychoanalysis might indicate that the refusal to be looked at was not only Freud’s problem. Foulkes’ daring shift from psychoanalyst to group analyst who sits in a circle with his patients is a crucial transition, not sufficiently appreciated in group analysis. Was it only a coincidence that Foulkes made this move for the first time in 1940, one year after Freud died?

Anthony refers on one occasion to the difficulty that both patients and the therapist experience when exposed to the gaze of others:

It is customary to leave the central space of the circle furnished only with a small table. This leaves nothing to hide behind, so that the members of the circle are exposing those expressive and revealing parts—the face, the hands, and the feet—which ‘talk’ their ‘body language’ even during silent periods of the session. The therapist is one of the circle and equally ‘vulnerable’ to the eye. (Anthony, 1957: 63)

There are several studies in the literature of psychoanalysis that explore the connection between deep shame and the eye of the mother who did not mirror her baby (Broucek, 1982; Wurmser,1997; Ayers, 2003). In his commentary on my article, Malcolm Pines titled this connection ‘minding the gap’, and welcomed the ‘bringing together that which should not have been rent asunder: mind/body: body/mind’ (Pines, 2008: 180).

Following Nitsun’s breakthrough, a paradigm shift has begun in the group analytic literature on the body. Weinberg and Raufman (2017), in their writing about the social unconscious, contribute to this new effort to bring the body to the group analytic arena. They point out that the discussion of the foundation matrix many times neglects the importance of the human body as carrying meanings. In another article Weinberg and Raufman (2016) discuss Anzieu’s concept of the group skin-ego. They restate their previous idea that the foundation matrix includes two different levels: the symbolic social unconscious and the somatic social unconscious:

Fairy tales, with their phenomenon of the realization of somatic idioms, may reveal something about the border between both levels of the social unconscious and the ways in which they are connected . . . The human body is more universal than other conscious and cultural elements. Thus, expressions related to body organs and physical actions reflect more universal issues. It is possible that people belonging to the same foundation matrix experience similar unconscious somatic and sensory aspects—and that certain idioms evoke these experiences in them. Whereas societies differ from one another in many social, cultural and linguistic aspects, the primary/somatic level of experience is a more common field. (Weinberg and Raufman, 2016: 18)

These ideas may generate, in the future, further understanding of Foulkes’ (1957) concept of the trans-personal network. In writing about this concept, Foulkes gives a clear idea of how he sees the members of the group as human beings possessed of both body and mind:

Particularly through their nervous systems and brains the organisms of the group members are in a state of interaction, in a common field, in interpenetration and communication. They speak now through one mouth, now through another. Active currents within the group may be expressed or come to a head in one particular person, between particular persons, or may, in a sense, be ‘personified’ in individuals. But whatever is going on in the group is always regarded by us as a process developing in the total group. (Foulkes, 1957: 259)

An optimistic look towards the future

Over the last decades, psychoanalysis has begun to shake off the tradition of negating the body. More and more articles, books and conferences on the issue of the body have become part of the therapeutic environment. This change in orientation is present too in the field of group analysis. The concept of the ‘GroupBody’, which waited several decades to be interpolated, finally appeared in a dissertation by Maoz (2014). The goal of Maoz’s research was to explore and conceptualize the non-verbal dimension of the Group-as-a-Whole (GAW) in the context of the simultaneous interrelationship existing between the verbal and non-verbal dimensions of the group space. She defines the ‘GroupBody’ as a metaphor for the physical expressions of the group-as-a-whole.

The inclusion of the body in group analysis has also become more present in group analytic workshops. The invitation to a workshop held by the group-analytic network in London (2016) reads:

In our recent workshops on loneliness and the Internet, gender and the symbolic role of the father we have become increasingly aware of the impact our bodies make on each other. Connecting via the Internet, the instability of current gender roles and the desires and projections on to the single sex groups that we have been working with, have all led us to think about what we see and experience when sitting together in a room. How does a small group develop its own culture and also become embodied?

Clinical example

The following example will illustrate my own clinical experience of the importance and power of addressing the body, and embodied shame, in group analysis.

D., a woman in one of my groups who has a history of severe sexual abuse, says repeatedly: ‘I would like to talk about my body and I do not know how to do it’. While writing this article, I became more aware of my responsibility, as the conductor, to help her to talk about her body. At the beginning of this particular session she referred to it yet again, and I said: ‘I have been thinking about your request, and I think that maybe if everyone in the group talks about his/her body, it will make it easier for you to talk’. One woman, L., said: ‘It is a good idea’.

Another woman, F., began to talk about her tendency to grit her teeth, which has caused damage to her teeth and jaw, to the point that she now needs complicated and expensive repair work. Other people reacted by saying that it is a well-known symptom. F. has been participating in the group for many years, and it is still difficult for her to talk freely about herself. I asked her whether she would have talked if I had not invited them to say something about their bodies. She said she would not have because it was not interesting enough. I said: ‘You have learned to grit your teeth in order to make sure that you will never say anything not interesting’.

The discussion moved to body image. This was mostly relevant to two participants: M., a man, and R., a woman, who are both very sensitive about their weight. R. said: ‘There is no gap for me between the image and the body. For me my body is my image of it’ (she feels too fat). D. said that usually she talks with people ‘helicopter’ style—(hovering above without touching the ground), and these are her comfort zones. L. said: ‘But I am sure you want to get out of this zone. I remember how I was sitting with my secret (lesbian), wishing for it to come out’. D. reacted to her comment by saying again that she did not know how to talk about her body, how shameful it is for her, and then she said something she had never said before—that she washes her clothes very often.

People reacted to her, and while they were talking, I had a very strong association. I hesitated to share it with them, and then I decided to say it out loud. I told them about a meeting I had had several months before with a man who had participated in the Yom Kippur War 43 years ago as a paramedic, and who has struggled to function in all areas of life since then. Ever since the war, he has not touched his children, and has never hugged them (the youngest was a baby when the war broke out) because he felt that he could not wash off his hands the blood of the casualties whom he treated during the war. There was silence in the room and I felt my heart beating strongly.

I will mention here that the group knew about D.’s history of abuse. D. then went on to tell the group how she has always felt different because she has never been part of a couple. Then she talked about a toddler, aged two, who is her neighbour, and about the close relationship she has with him. R. said to her: ‘I do not know how old you are (she is beyond child-bearing age), but you have so much warmth to give to a baby’. The group went on to talk about the possibility of adopting a child, and D. said that it would mean completely changing her life. I said that there were other possibilities of having contact, and I mentioned the ‘hug a baby’ project for deserted children. This came to my mind following a reverie that I shared with the group: ‘I think about my baby grandson and how much I love to hug him, to feel his warm, soft body, to breathe in his sweet smell’.

R. was touched deeply, and with tears in her eyes, she talked about the sudden operation (a lifesaving procedure) she had had in which her uterus was removed when she was 40. She had had no preparation for this, and after the operation, she could not stop crying. (She had only one daughter because of previous operations). She talked about the difficulty of separating from her uterus, which represented for her femininity and motherhood. She went on to say that since her daughter had divorced, she cannot be sure that she would ever have grandchildren, and this is why she was so moved by what I had said.

In turn, D. talked about problems she had in her uterus, which according to her gynecologist would have to be removed sooner or later. She thought this was the result of sexual abuse. She felt she was not ready yet for that separation. L. said to D.: ‘R. is talking about her separation from the uterus, and you have not yet connected to it’. Then L. talked about her female partner who had no children, and how she gets excited whenever she sees a human baby or a puppy or kitten.

D. shared with the group her constant feeling of being ‘broken’ in her femininity. She never looks at her body. She does not have a mirror at home. She went on to say,

People compliment me on the jewellery I wear, but I never wear a dress; it is as if my body cannot put on a dress, because it feels like a lie. I like to walk around in women’s clothes shops, but when I see a beautiful dress or blouse, I imagine how it looks on another woman, not me.

D. went on talking, and began to find more and more words to say about her body—more than she had ever spoken before. Towards the end of the session, she said: ‘I feel that I can find the words to talk about an intellectual subject or to write an article (she is a successful scholar), but I do not know how to talk about emotions’.

The subsequent session started with a longer silence than usual. Gradually the members of the group began to speak about how close to each other they had felt in the last session, and D. said: ‘I went home feeling as if I was hugged physically by the group’. Then she told the group that she had vomited again (she always does whenever we touch on the trauma, as she used to do as a child after every sexual act with her father), but she added something new and optimistic: ‘I hope that one day I can talk about my body instead of vomiting and washing my clothes’.

Discussion

The story of D. is an example of a well-known phenomenon: traumatized people are dissociated from their bodies. As a matter of fact, all human beings are traumatized in one way or another, and have a tendency to dissociate from the body because it is the site of trauma, painful feelings and memories, and the reality of aging and death.

What I want to emphasize in this clinical example is my contribution to the discussion that took place. In that specific session I was strongly aware of my own body, feelings, and sensations, and noticed any reverie that popped up. This is not an easy task, and can be accomplished only when one knows how important it is for the group. This brings to mind Hopper’s (2016) discussion of Weinberg’s lecture on Foulkes Day 2016:

Groups connote unconsciously the mind and body of the mother. The perfection of the maternal mind and body depends on its optimal leakage and leakiness, one element of which is tears and crying. Thus, it can be argued that all groups are cracked or leaky containers. The participants in them will always need holding and containing in order to manage their grief, which tends to be reawakened in connection with personal and collective regression. This is one reason why we need strong as well as nurturing leadership. (Hopper, 2016: 14)

What then is nurturing leadership? I understand it as a sort of parental holding of the group. For me the meaning of parental holding is to hold in my mind both the bodies and the minds of all the participants, including myself. In the session described above, I felt that I was in a state similar to ‘Primary Maternal Preoccupation’ (Winnicott, 1963). In cases of severe early traumas, like early sexual abuse, the dissociation from the body is so strong that only in sessions like the one described, in which both the therapist and the other participants are in touch with their own bodies, can a participant like D. find words for the body which she has felt and experienced as an empty hole in her mind.

Conclusion

In this article I try to encourage group analysts to refer to the body, either in writing or in practice, not as a symbolic notion, but rather as a reality in the here and now which must be addressed.

The conductor needs to hold the reality of his/her own and of his patients’ bodies (as part of their person) in his/her mind all the time, in order to encompass the infantile baby selves that can emerge in the group. Some of the dropouts from the group might be a result of the failure to hold and to handle appropriately the primitive, fragile states of mind that can exist in the group. For the group analyst, holding the body (his/her and others) in his/her mind is a difficult task, especially in a context where the body is not considered an important issue in psychotherapy. Although there is a growing awareness of the need to introduce the body into the psychotherapeutic session, addressing this need is very complicated without proper training. I would like to see the subject of the body being taken further in the training programme in group analysis, fully recognizing that the body is inextricably linked to mental life and mental health.

It takes years of training to be in touch with one’s body and to learn how to work with it as a therapist. Proper training will enable group analysts to be aware of bodily processes during the therapeutic session, and in so doing create more space to work with human problems, such as psychosomatic issues; early traumatic events; sexual problems; growing older, with all that it brings in bodily terms; body image; eating disorders; illnesses and their impact on the body. All of these human problems are present both in participants and in conductors. Perhaps it may even make it easier for group analysts to relate to their own issues while working with groups.