Group-as-a-whole systems theory and practice

Group-as-a-whole systems theory is presented and applied to the practice of group psychotherapy. The individual and the group are conceptualized as two isomorphic systems in a hierarchy of living systems. The basic component of the group-as-a-whole is its subgroups, which exist independent of individuals whose subgroup memberships may change while subgroups remain stable. Subgroups come together around similarities and separate on differences, and contain differences for the group-as-a-whole to integrate in relationship to primary and secondary goals. The primary goals of system survival and maturation take precedence over the secondary goals, which relate to the environment. Goal achievement and individual change is explained as a function of group dynamics. In a therapy group, the dynamics of each phase of group-as-a-whole development serve as a major therapeutic force. Within each member, salient developmental issues are aroused, which resonate with the issues that the group is in the process of mastering. The task of the group-as-a-whole therapist is to facilitate the developmental process at both the group and the individual level. Therapeutic interventions are designed to facilitate the discrimination and integration of information at the boundaries between systems and subsystems: within the individual member system (intrapersonal) and between individual member systems (interpersonal), within the group-as-a-whole system, within subgroups, between subgroups, and between all systems in the relevant hierarchy and their environments.     

Group-as-a-whole interpretations in short-term group psychotherapy

The usefulness of therapists making group-as-a-whole interpretations in long-term group therapy was actively debated in the 1960s and 1970s. Advantages and disadvantages were delineated. An often-cited survey study of therapy groups that had emphasized group-as-a-whole interpretations found that many patients were dissatisfied with the therapist’s technique and the outcome of therapy. Although group-as-a-whole concepts subsequently became a part of the theory of many orientations of group therapy, there has appeared to be reluctance among many therapists to make group-as-a-whole interpretations, especially in short-term group therapies. Contrary to this tendency, an argument is made and a case illustration presented, which advocate the use of group-as-a-whole interpretations in short-term group therapies.     

Group focal conflict theory: Description,illustration and evaluation

Group focal conflict theory makes use of a set of interrelated concepts to contain, order, and introduce meaning into the evolving dynamics of therapeutic groups and to relate and connect group and individual dynamics. Key terms are group focal conflict, disturbing motive, reactive motive, enabling or restrictive solution, individual nuclear and derived individual focal conflict, and resonance. The relationships between these are shown. Two illustrations are offered. The first shows the therapist attending mainly to the dynamics of the group-as-a-whole in order to facilitate a newly formed group to develop into a fruitful medium for therapeutic work. In the second, a period of resonance between group and individual focal conflicts shows how an intensive mutual transference between two patients is embedded in whole-group dynamics and how such an episode can be used profitably both by those centrally and not so centrally involved. Criteria for evaluating a theoretical model are described, and group focal conflict theory is discussed in the light of these. The usefulness of the model for research is discussed.     

Sexual abuse as a theme in group-analytic therapy

The group-analytic approach, which emphasises the individual in a network of group relationships, is described with reference to the subject of sexual abuse in childhood. Three different National Health Service psychotherapy groups run by the author provide contrasting examples of how the theme, originating in an individual participant, was manifested in the dynamics of the group-as-a-whole. The therapeutic significance to the individual and the group is explored.     

Group therapy as psychic containing

This article will examine how the psychoanalytic idea of containing can be used in group therapy to form a conceptual bridge such that the group dynamics are not simplistically reduced to individual dynamics, nor that the individual is lost in the "group-as-a-whole" concept. I take the concept of "containing" as versatile in the sense that Bion (1970) meant it to be-that is, the psychological phenomenon of containment is manifest at various system levels: intrapsychic, interpersonal, group, and societal. This article will explore how far this "bridging concept" can be pursued to understand groups theoretically. The article will review various forms of containing, following Bion's ideas, and in particular a therapeutic, or flexible, form in contrast to rigid and fragile forms.     

Dreams as portraits of self and group interaction

Dreams presented in group psychotherapy portray different aspects of the dialectic between the group and the individual. A self psychology perspective emphasizes the interplay between the current self-state of the group-as-a-whole and the selfobject needs of the individual. With this focus in mind, the therapist should help the group to deepen its awareness and capacity to reflect on emerging new abilities ("forward edge") which dream imagery conveys and the needed human responsiveness that can actualize these abilities and thus help the individual and the group to break and transform chains of repetition compulsion. We illustrate this approach with two clinical examples.     

Group-as-a-whole concepts and the therapeutic milieu on the inpatient psychiatric unit

This paper focuses on large group process on the inpatient psychiatric unit. General systems theory and group-as-a-whole concepts are used to understand the dynamics of the therapeutic milieu. Using this information as a tool, the therapist can make various interventions on an individual and group level that will help patients understand and deal with their own psychopathology. Another benefit of this process is that it will develop a community on the psychiatric unit where patients help each other to get well. Three clinical examples are used to illustrate the relevance of this concept. With the advent of short-term psychiatric hospitalization, the therapeutic milieu has shown a drastic decline. Emphasis has been placed on the individual as opposed to the group and a valuable therapeutic tool has been lost. Using a group-as-a-whole concept can help reverse this trend and make the milieu on the inpatient psychiatric unit instrumental in the recovery of the patient.     

Systems-centered training groups' process and outcome: a comparison with AGPA institute groups

In this quasi-experimental study we compared the process and outcome of six experiential Systems-Centered Training (SCT) groups to those of American Group Psychotherapy Association (AGPA) Institute groups from two prior studies (MacKenzie, Dies, Coche, Rutan, & Stone, 1987; Tschuschke & Greene, 2002). The SCT training compared well overall and the results provided preliminary, indirect support for the usefulness of "functional subgrouping" - SCT's conceptual and methodological bridge between the group-as-a-whole and the individual member. However, quasi-experimental design limitations make other interpretations equally plausible. Within-group change in the process variables for the SCT groups was also explored, as well as the relative contributions of these variables to post-training learning outcomes and anxious and depressive experience. The results partly corroborated prior studies, but also suggested that SCT may alter training group dynamics, learning, and emotional experience in ways consistent with SCT theory.     

The clinical vignette: Use in teaching and evaluation of group therapists

This paper describes the use of a written vignette as an aid in teaching group psychotherapy. Educators can determine in advance their expectations of the students' understanding of the vignette. Trainees evaluate the salient data, recognize patients' and therapist's contributions to the process, and conceptualize at three levels: intrapsychic, interpersonal and group-as-a-whole. This method supplements the usual training methods, and offers information about both the individual student and the entire class. This approach has an advantage of enabling educators to assess students in a relatively standardized fashion.     

Reflections on Preparing the Group Leader for an Analytic Perspective

Preparation of group therapists for an analytic perspective involves awareness of unconscious processes at the group and individual levels. The adequately prepared group leader should have familiarity with dream interpretation and group-as-a-whole transferences. Training in the use of long-term treatment methods is useful whether or not the practitioner uses these methods in actual practice. The ideal training program would include didactic seminars, weekly supervision, the experience of conducting a long-term (at least two years) therapy group, as well as personal analytic group therapy. Previous individual analytic therapy is also encouraged.     

Self psychology and group therapy

This paper illustrates how the theories of Heinz Kohut elucidate the curative aspects of group treatment. Group therapy is an ideal milieu in which mirroring, idealizing and alterego transferences can be experienced and worked through. Transmuting internalizations, or psychic structure building, occur when optimal frustration of these needs can be provided by available selfobjects. In group therapy a patient can use the group-as-a-whole, the individual members as well as the leader as potential selfobjects. With the help of individual sessions to reflect on group encounters, a patient can gain a more fully integrated therapeutic experience.The author wishes to acknowledge Susan Sands, Ph.D., Jane Jordan, M.S.W., and Ruth White, Ph.D., for their help.     

An experiential group model for psychotherapy supervision

This article presents an experiential group model of supervision constructed for both group and individual therapy presentations, emphasizing concepts from object relations theory and group-as-a-whole dynamics. It focuses on intrapsychic, interpersonal, and systems processes, and stresses the group aspect of the supervisory process. Its central thesis is that material presented in a group supervisory setting stimulates conscious and unconscious parallel processes in group members. Through here-and-now responses, associations, and interactions among the supervisory members, countertransference issues that have eluded the presenter can make themselves known and be worked through on emotional as well as cognitive levels. Selected excerpts from supervisory sessions demonstrate various attributes and strengths of the model.     

Group Psychotherapy in the Psychiatric Training of Medical Students

Group-as-a-whole theory is a relational paradigm of some complexity. Despite the growing popularity of this perspective, there is abiding confusion about the essence of group-as-a-whole practice and whether the approach attends sufficiently to members and part processes. The threefold aims of this article are to (a) show how group-centered thinking differs essentially from traditional psychodynamic theory that relies heavily on familial dynamics, interpretation, and transference analysis; (b) present the mind-set and working principles for a generic treatment that specifically utilizes collective forces generated in the context of the group matrix; and (c) compare and contrast the thrust of recent dyadic relational therapies with group therapy generally and the group-as-a-whole approach more particularly. The relationship between the whole (group) and its parts (members and what they bring) is detailed and demonstrated as it appears in the context of fused, affiliated, fragmented, and differentiated groups.     

Obituaries

This article reviews the growing contribution of self psychology to group psychotherapy. The basic self-psychological concepts as they are applied to group dynamics and the treatment process are explored. Tranference, countertransference, and self-restitutive patterns are illustrated in a clinical vignette that includes a “difficult” patient's impact upon the interactional and group-as-a-whole processes. Several directions for future investigation are described.     

From identified patient to identifiable group: the alchemy of the group as a whole

Group-as-a-whole theory is a relational paradigm of some complexity. Despite the growing popularity of this perspective, there is abiding confusion about the essence of group-as-a-whole practice and whether the approach attends sufficiently to members and part processes. The threefold aims of this article are to (a) show how group-centered thinking differs essentially from traditional psychodynamic theory that relies heavily on familial dynamics, interpretation, and transference analysis; (b) present the mind-set and working principles for a generic treatment that specifically utilizes collective forces generated in the context of the group matrix; and (c) compare and contrast the thrust of recent dyadic relational therapies with group therapy generally and the group-as-a-whole approach more particularly. The relationship between the whole (group) and its parts (members and what they bring) is detailed and demonstrated as it appears in the context of fused, affiliated, fragmented, and differentiated groups.     

Using dream interpretation to resolve group developmental impasses

This paper focuses on the use of dream interpretation in psychoanalytic group psychotherapy. One of the goals of the paper is to demonstrate that the kinds of dreams, manifestly about the group, offered at various points in the life history of the group, are influenced by, and, in turn, influence developmental phases in group. Dream interpretation also helps the therapist to identify emerging developmental themes in the group-as-a-whole as well as illuminate developmental impasses and resistances of the group. The second goal of this paper is to demonstrate how interpretations of these dreams can help lessen resistance and help the group to resolve the impasse. The paper first reviews some basic principles and approaches to dream interpretation in a group setting and then elucidates typical phases in group development. Two extended case examples are presented to illustrate how dream interpretation may be utilized to help the group move beyond the impasse.     

Alliance to the group-as-a-whole as a predictor of outcome in psychodynamic group therapy

Abstract Eighteen patients diagnosed with burnout-related depression and receiving short-term psychodynamic group psychotherapy were included in this study. The participants completed the group version of the California Psychotherapy Alliance Scales (CALPAS) five times during treatment and evaluated the relationship positively. Alliance increased significantly as treatment progressed; however, the amount of change was small. Level of alliance to the group-as-a-whole, averaged over time, was predictive of two out of three outcome measures, whereas growth in alliance during the early phase of therapy was not predictive of outcome. Exploratory examination of the alliance at different time points showed that alliance to the group-as-a-whole at mid-phase of treatment was substantially correlated with outcome. Personality features such as dismissing attachment style and being overly nurturant or exploitable were predictive of early growth in alliance.     

The place of self psychology in group psychotherapy: a status report.

This article reviews the growing contribution of self psychology to group psychotherapy. The basic self-psychological concepts as they are applied to group dynamics and the treatment process are explored. Transference, countertransference, and self-restitutive patterns are illustrated in a clinical vignette that includes a "difficult" patient's impact upon the interactional and group-as-a-whole processes. Several directions for future investigation are described.     

Use of the Group Therapist's Personality Via the Countertransferences

Rather than use the term therapist personality, the author uses an operational definition of countertransference to examine the intersubjective field between group therapist and individual patients, the group, and subgroups. Differentiating between objective and subjective countertransferences, the author traces their sources to the transferences and resistances that arise from individuals, subgroups, and the group-as-a-whole. The transferences, resistances, and their related countertransferences are then integrated with enactments and history to create interventions. The charismatic leader makes no differentiation between the countertransferences and primarily acts on impulse or a rigid system.     

Spontaneous Personality Synthesis in Group Therapy

Combined therapy is defined as concurrent dyadic and group therapy with the same therapist. This paper focuses on a neglected aspect of combined therapy: broaching and exploring this question with one's individual, patient. The author shows how raising this question: (1) alters the therapeutic field whether or not the patient joins; (2) can sharpen the therapist's understanding of the indications and contraindications for group membership; (3) offers untapped therapeutic approaches and opportunities to clarify issues in the individual treatment; and (4) stirs up countertransference issues related to issues of profitability, the transference of the patient in individual treatment, and the transference of the group-as-a-whole. Several case examples are provided.