From analyst to conductor

Consider the possible impact, on a group, of adopting a classical stance, taking as example the work of some clinicians working at the Tavistock Clinic, during the 1950s. Clinicians such as Ezriel and Sutherland took inspiration from Bion's ideas, which had been developed with training groups, and applied these to therapy groups.

Ezriel (1950) described efforts to apply a "strictly psychoanalytic technique" to group therapy, with, amongst other things, a "rigorous technique of transference interpretation". Building on the tradition of Strachey and Rickman before him, Ezriel assigned overriding importance to transference interpretations in the "here and now" of the group session. The task of therapy is universalised by Ezriel, as to do with the resolution of infantile, oedipal conflicts, and so the material is always viewed in this light; to quote Ezriel (1952), all the material "is considered as the idiom used by the patient to give expression to his need in that session for a specific relationship with the therapist" (p. 120).

Isolating some key aspects of Ezriel's approach with respect to the role of the analyst, ultimately centres the communications of the group on the analyst himself and, by extension, on the analyst's overarching framework. Ezriel goes as far as contending that the other members of the group are reducible to co-present "stimuli", there to attract the projection of internal defences. Brown (1979) argues that this type of analyst-centred mode fosters another kind of "basic assumption dependence" and thereby infantalises the patient. It radically reduces the importance of understanding and engagement from and by other members, as an end in itself.

As with Freud's idea of abstinence and neutrality, the analyst's own organising principles (including theory and training) are bracketed out of the equation, with the therapist viewed as being external to the setting. The framing of all material in terms, for example, of unresolved infantile conflicts is, from an intersubjective viewpoint, already a structuring and organising (and, thereby, constraining) viewpoint contributed by the analyst, and is, because of that, far from being "neutral". In Malan's (1976) empirical evaluation of the Tavistock groups, he points to the resentments often encountered by patients to an unduly impersonal psychoanalytic approach and to the emphasis on conflictual object relations alone. In a (mild) recommendation, he says, "... it does seem possible that therapists ought to feel less constrained by what they have learned from their classical psychoanalytic training ..." (p. 1315). Using an understanding of groups afforded by self psychology, we could see such resentments as expressions of protest at the imposition of a "technique" and as a reaction, in some cases, to a felt undermining of the total self and the group's efficacy as a whole.

It needs to be noted, however, that although Foulkes had a lot to say about the "dynamic administration" of groups, he did not specify the actual qualities required by the conductor. In this regard, there is a similarity with the neglect, in classical psychoanalysis, of the real or desirable qualities of the analyst (Kantrowitz, 1986).

The transference: an intersubjectivist view

There are several drawbacks to the classical view of transference and its role in treatment. The early generation of analysts (and many who came later) tended to see themselves as representing a position (in potentia) of objective truth, vis-à-vis the patient, taking their own conceptions of the main contents and structurations of mental life as already established and valid. This resulted in many extremes, and Ferenczi, as one example, challenged this prevailing epistemology by disagreeing with the implied infallibility of the analyst and in taking the patient's criticisms as valid. This led him into severe difficulties with his peers and with Freud himself (Eisold, 1997). Another problem was the failure to recognise how dependent patients could be on the acceptance of the analyst and, through this, the patient's dependence on seeing "reality" through the basic concepts that organised the analyst's observations and interpretations. Ferenczi's pupil, Balint (1968), took up this theme in his warnings against the dangers of "over-insistent interpreting" and the "obtrusive analyst", and Stolorow (Stolorow & Atwood, 1992) expresses the dilemma in the following way: "This is the requirement with which patients often felt compelled to comply as the price of maintaining the vitally needed tie to the analyst" (p. 91).

If we take "field complexity" and the "uncertainty principle" of science seriously, then modern analysis, be it in groups or with individuals, has to fully incorporate the idea of the analyst as being a subjectivity in his own right and to acknowledge the essential indivisibility of observer and observed (Stacey, 2003; Stolorow, 1997). Interestingly, the word "understanding" has different connotations to the term "interpretation" and may convey this indivisibility more clearly: as Orange (1995) describes it, "The term 'understanding' thus refers to both person and process, to both self and relation" (p. 5).

We are indebted to Kohut (1977) for a systematic attempt to clarify different kinds of transference and for broadening the concept away from an exclusive emphasis, as with Freud or Klein, on intrapsychic conflict (and this narrowly conceived in feeding, sexual, and aggressive terms). Through his work with narcissistic patients, he discovered so-called "selfobject" transferences, where the individual attempts to find experiences which will help him have, or maintain, a basic sense of cohesion and well-being. These transferences stem from areas of unmet need, particularly around the formation and cohesion of the self. So, in addition to what the person might wish for, the area of repressed desire, there is also the question of what the patient needs, the area of developmental deficit; as Stolorow and Lachmann (1981) put it, "experiences that the patient legitimately needed but missed or prematurely lost are understood in the transference in order to assist the patient in his belated psychological development" (p. 309). Kohut (1977) postulated a variety of basic, narcissistic needs and a relationship to the analyst as a "selfobject", which is distinct from the analyst as an object of instinctual conflicts. Symptoms and fears can be understood more widely and affirmatively, as "developmental and restorative necessities" and not merely as "compromise formations" based on psychic conflict, as Freud believed (Lachmann, 1986). Within a group, other members also continually evoke and respond to these selfobject needs, creating a new matrix from which new development might proceed, if all goes well. The group is a complex spatial and temporal reality within which recurring, restorative, and emergent experiences unfold.

The relationship of selfobject to other dimensions of the transference can usefully be framed in terms of a continually shifting figure-ground relationship, with different constellations at different periods.

It could be argued, for example, that until a person is assured through a selfobject experience that her self is supported or cohesive enough, the less likely she will be in being able to tackle psychic conflict in a safe manner. Furthermore, selfobject needs are not confined to the overtly "narcissistic" patient, but apply to areas of narcissistic need in all individuals.

There are rich implications for the understanding of groups, although the literature in this area is still relatively new (Harwood & Pines, 1998). The group conductor is faced with the complex task of responding empathically at different levels, both between different members of the group and within the same individual at different times (often within the same session). Howard Bacal (1998) has suggested the term "optimal responsiveness" to describe this flexible capacity in the therapist, replacing the traditional notion of neutrality. The group therapist helps foster spontaneous reactiveness and responsiveness taking place unconsciously, and preconsciously, at all times, between the members.

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