Brighton Therapy Works Blog

Group Analysis - Difference is welcome

Group Analysis – analysis of the group, by the group including the group conductor:

Groups in general, and psychotherapy groups in particular, affect us in some ways that we are immediately aware of and in other ways that are completely outside of our awareness. We affect others in our turn – a group’s behavior is surprisingly responsive to any new member. The complexity of group processes means that group analysts refer to a group as if it is an entity in its own right. Just as we might refer to an ‘organization’.

So instead of seeing a group as a collection of individuals we need to see how other properties and dynamics emerge through group life. Sometimes this is conceptualized as ‘group-as-a-whole’. And no two psychotherapy groups will be alike – each one will have its own unique history and culture. This culture will have arisen through the personality and style of the group conductor, the personalities of the group members, the norms that will have developed around communication and the maturity of its development. The more mature and effective groups will have a capacity for self-reflection and an open culture that allows learning from experience and permits change. Such groups will have grown beyond the stage of fantasizing that their group conductor is all-seeing and all-knowing and members will be actively sharing the responsibility of the therapy work in the group.

Analyzing, for psychotherapeutic purposes, the visible and conscious group behavior and dynamics, and the subtle and unconscious dynamics, is group analysis, “analysis of the group by the group including the group conductor” (SH Foulkes). It is what makes this form of psychotherapy so unique and so effective for a very wide range of emotional and relational difficulties.

Group analysis is unique - in that the subjects of analysis are both the group-as-a-whole and the group members who comprise it, including the conductor. ‘Conductor’ is the preferred term for group analysts as opposed to ‘group leader’ as it better captures the democratic nature of an analytic group and the role and task of both leading and following a group’s unconscious agenda). Group analysis is effective - because every group member is developing both insight and outsight. Members have the opportunity to not only learn about themselves in relating to others but also to become aware of how others are experiencing them doing that relating.

Relating and attending to barriers against connecting:

This relating, this being in relationship with other group members and to the group-as-a-whole, provides a proxy for our intimate relationships, or lack of them, and provides a microcosm of our wider social relationships which are coloured by traditional cultural power hierarchies such as class and gender and race. But, importantly, the analytic group welcomes difference of every kind and a new norm is created that is inclusive and analyses any difference that is problematized.

Personal responsibility is expected if any group communication or behavior is experienced as having a negative intention towards another member. The distinction is made between declaring a negative feeling towards another or challenging a statement or behavior and attacking a person. Both the challenged and challenger will have something to learn if they feel safe to explore the conflict. Conflicts become points of growth as they are worked through in a way that leads to mutual understanding and compassion for hurts or offence caused.

Marcus Page

Group Analyst, Consultant Psychotherapist NHS (retired) UKCP no 5616

2.12.18

 

Why Join a Psychotherapy Group? 2 Scariness

WHY A PSYCHOTHERAPY GROUP?

WHY GROUP ANALYSIS? 2

 

Our felt experience of groups as scary and exclusionary:

We all will be able to point to experiences in groups that confirms the truth that groups can be scary. It may arise from our everyday experience of not fitting in with a social group or work team or from our past experiences in school or college. It may arise especially in situations where we are not known personally at all but others are pre-judging us on our outward appearance – our gender, our colour, our sexuality, our age, our clothing, our language or accent or any one of the numerous other signifiers that a group reads as ‘You are one of Us, you belong here’ or ‘You are Other, you don’t belong here’. In such situations, a group of people can feel like a gang – a gang that doesn’t welcome strangers.

The answer to the conundrum of how this most scary of situations, a group of strangers meeting for groupanalytic psychotherapy, could be the most helpful to us, is the unequalled potency of groups in shaping our experience of the world and our sense of our Self.

We are social beings and our Self is formed in a social matrix:

“We are social beings first and foremost” is the key principle of SH Foulkes, the founding father of Group Analysis in the 1940s, and one that has been borne out by decades of research in the fields of sociology, psychology, attachment theory and neuroscience. We are not born with a sense of Self – it arises from how we are regarded and related to by our parents, our family (our original group) and other significant figures in our life; we internalize the emotional ‘messages’ we receive about ourselves and are fortunate if they are predominately accurate, positive and emotionally supportive. This positive experience results in a ‘secure attachment’ style that is generalized to other relationships.

When however these messages have been mis-attuned and unsupportive of our Self, we unconsciously develop psychological and behavioral strategies for reducing our emotional distress. This may take one of several forms of ‘insecure attachment’ styles.

Attachment styles can be understood as the ‘solutions’ that we have developed for getting our needs met from our primary and secondary ‘caregivers’. We will have been born with rudimentary attachment programmes common to all mammals. These are our innate, biologically-based instinctual goal-corrected action-programmes. We are born helpless to meet our needs but wired with crying and behaviours that elicit distress in ‘goodenough’ caregivers until our needs and distress are assuaged and soothed. Those earliest relationships shape our neuronal pathways and emotional regulation and become our templates for intimate relationships and for when we feel helpless or distressed from any cause, external or internal, including our own thoughts.

In conventional psychoanalytic terms this process is described as a set of drives to meet human needs and defences against psychic pain. In systems theory, the process would be described as a biological organism seeking to maintain or restore homeostasis. In common parlance we might say that we feel safer staying with what we know - even if from the outsider’s viewpoint that way of being is uncomfortable, neglectful or even abusive to our Self.

Groupanalytic psychotherapy reveals in vivo the cognitive and behavioural strategies that we deploy in relationships. In a therapy group, we notice first how we think and feel just the same about some things but so differently about other things - especially our view of ourself. We often discover that we judge ourselves more harshly than others and are surprised by others’ understanding and compassion for us, and for our experiences and thoughts and behavior. Areas of our life - both external and internal life - that we might only have regarded as shameful and have kept secret from others come to be viewed from other perspectives. 

Once we are revealed to ourself, through the multiple mirrors of fellow group members, we understand better the distortions in our thinking and resultant behavior that has originated in our ‘singular’ mind. The process of therapy in a group, by the group including the group psychotherapist, gives us a choice to continue our strategies for managing relationships, if they remain functional, or to test out and learn new ones if they are not.

In my next article I want to say more about what happens in a psychotherapy group and how therapy in a group works at several levels simultaneously.

Marcus Page

Group Analyst, NHS Consultant Psychotherapist (retired) UKCP reg 5616

1.12.18

 

Why Join a Psychotherapy Group? 1 First Questions

 

WHY A PSYCHOTHERAPY GROUP?

WHY GROUP ANALYSIS? 1

Groups are scary! We all know the truth that groups can be very scary when other people treat us in ways that we don’t like and they seem to be indifferent or even take pleasure in our discomfort and vulnerability. So why would one join a psychotherapy group with six or seven group members who are strangers to us and whose motivations and personalities we know nothing about? We might perhaps trust the group psychotherapist who will be conducting the group for the 90 minutes meeting every week but what to make of the expectation of sharing difficult experiences and emotions and making known one’s thoughts about oneself and others? How could this most scary of places possibly be helpful?

I am a group analyst with 20 years experience of conducting psychotherapy groups of all kinds and want to show you that it is entirely normal to be wary when considering entering group psychotherapy. Your trust needs to be earnt and not taken for granted. Not everyone will benefit from group psychotherapy and it helps to know what factors make it more likely that you will benefit and that the preconditions of sufficient safety are in place.

Let’s start with the basics. Is the group psychotherapist you are considering someone whose training has included extensive experience of several years personal therapy in a psychotherapy group? Has that person, as part of their training and subsequently, conducted groups under the supervision of a qualified and experienced training group psychotherapist? Has this training been with a reputable psychotherapy training organization? Is the group psychotherapist registered with the United Kingdom Council for Psychotherapy or British Psychoanalytic Council?

Next are your needs. Are you being offered a full psychotherapy consultation and consideration being given to your unique therapy needs? What needs are being suggested would be met more effectively by group psychotherapy than individual therapy and by the particular group that you are considering? Do you feel understood and safe with the group psychotherapist? How have they responded to your questions and concerns – are they too quick to reassure you or have they taken the time to explore the full extent and roots of your fears? Has the possibility of individual sessions, prior to joining the group, been discussed with you either to assist your further self-understanding and sense of security or in helping to stay in contact whilst awaiting an agreed start date?

Next is the setting of the group. Is the building and the room quiet and comfortably furnished with a toilet available nearby? Does the entrance and reception offer a feeling of respect and confidentiality that engenders confidence in psychotherapeutic activity being understood and supported?

And finally, how clear are the boundaries for the group and group members? Will the room always be the same and the time of group sessions’ start and ending remain punctual and constant? How is it explained that group psychotherapy therapy benefits from being a ‘stranger group’ with no ‘dual relationships’ and avoiding of contact between members between sessions? How will group members be informed of breaks or of new members joining? How do you contact the group psychotherapist if you need to inform them of an unavoidable absence or lateness? What discussion is there of fees if different rates are offered to members? What explanation is given of the contract for mutual confidentiality of members and what happens if you know someone in the group or happen to meet them in another situation?

If you feel that your consultation has satisfactorily answered all these questions then you are probably in safe hands to begin your journey.

In my next article, I shall explore why groups do feel so scary and how group psychotherapy may be just the form of therapy to help you … or for you to avoid or postpone joining a group until you are further on in developing a sense of Self and are better able to express your fears whilst in the presence of others.

Marcus Page

Group Analyst, NHS Consultant Psychotherapist (retired) UKCp reg 5616

1.12.18

 

 

Online Rating of Therapists

 It can be a minefield trying to find a good therapist in the private sector, the voluntary sector or the NHS. That’s not to say that there are not very good ones in all these areas, but how do we know? Organisations such as the NHS will be setting their internal standards and will have ways of managing underperforming therapists, so the standards in the NHS are usually pretty reliable. But what about the private sector? I recently found my name on a rating site and had it removed. Does that sound dodgy?

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Staying Well

I have written in a previous blog about relapse prevention plans. Once a person is feeling better, no longer unduly anxious or clinically depressed, it is important to look at ways of keeping well. This can include how to respond if the anxiety re-emerges or the mood dips again, but hopefully we can go further than this and consider what for us constitutes living well. 

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Beautiful Restoration

When we seek help for our psychological distress we may hope the outcome will be a return to our “old” self. This may happen, but some of us may become changed, in a good way.

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Modern communication technologies, how are they changing practice?

Using video conferencing in therapy...

I am sometimes asked to consider using Skype for a therapy session with an individual or a couple, or for consultations. I have thought about this at some length and explored the issue with colleagues. A group of us are embarking on a study to look at the advantages and pitfalls. 

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Happiness will come when it comes

Dorothy Rowe, well known for her books on depression, says 'If you make happiness your goal, then you're not going to get to it. Philosophers have been saying it for thousands of years. The goal should be an interesting life."

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Mental Health Awareness Week- time for lunch

 Mental Health Awareness weeks starts 12th May 2014. This offers us all an opportunity to reflect on our psychological wellbeing. 

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Some tips for facing our fears

 

The idea of facing our fears has always been with us and has been much written about in ancient and modern scripts. Jim Morrison, of The Doors, said “Expose yourself to your deepest fear; after that, fear has no power, and the fear of freedom shrinks and vanishes. You are free.” I like this quote as it acknowledges the existential fear of freedom and is in keeping with a CBT approach to facing fears. 

 

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Will my therapist talk to other people about me?

 

We all want to know that when we choose to speak with a therapist about intimate aspects of ourselves this will be treated with confidentiality. But if our therapist is unable to talk about us then how can we be assured that the therapy is going as well as possible?

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Is it always best to face our anxiety?

A strong principle for the practice of CBT is the facing of our fears. There is good reason for this, and avoidances can certainly cause us more trouble in the long run, but is there a place for avoidance too?

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Arachnophobia

If you are alert to the presence of spiders you will know that there are still plenty of them around in the home and garden. And if you are alert to their presence this may be because you love them or because you are afraid of them. If you are afraid of them you are not alone, many of us find spiders’ long legs and their hairs brings up a feeling of disgust and anxiety which then renders us unable to cope, and with the best thing seeming to be to avoid the leggy arachnid. 

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CBT and NICE Guidelines - a good thing?

How helpful are the NICE Guidelines when it comes to psychological therapies?

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Should I Google my therapist?

We search people up online all the time, so should you look up your therapist?

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Why go private?

Paying for psychotherapy from a private practitioner can feel very odd, to both the patient and the therapist, to begin with anyway, for those brought up under the umbrella of the British NHS.

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Classification of mental illness controversy

The American Psychiatric association recently stirred up a storm by publishing the latest version of its classification manual, the DSM-5.

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CBT keywords or a description of psychotherapy?

Using the right keywords for CBT web pages may not be the best way to describe the therapy.

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Is anxiety or depression a weakness?

I am not even going to honour this question with an answer. However, what I will say is that it takes a great deal of courage to admit to ourselves that we are struggling and then also to admit to others that this is the case.

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Top tips for staying well

What better evidence than that of fellow travellers. As I was having an administrative tidy up recently I was looking at some of the notes I have written about clients at the end of therapy. 

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