The couch and the circle: a story of group psychotherapy [1. ed.]

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The Couch and the Circle

The Couch

and the Circle A

STORY OF

GROUP PSYCHOTHERAPY

BY

HYMAN SPOTNITZ M

New

York

. D ., Med . Sc . D .

:

Alfred

1961

· A . Knopf

== =

Library Medic 31

: 488

RC

, 576

in

neously

All be

printed

Manufactured

Published

McClelland

FIRST EDITION

in

.

America

.

or

Canada

by of

a

in

the United States

review

newspaper

writing

reviewer who

simulta

Stewart

Ltd

.

except

may quote brief passages magazine

book

rights

repro

,

publisher

,

the

this

without permission to

any form

.

may

&

.

from

in

duced

by

No

reserved

Hyman Spotnitz

© 1961 by

part

BOOK ,

a

Copyright

61 –7121

A. KNOPF , INC .

BY ALFRED

a

PUBLISHED

IS A BORZOI

:

in

THIS

card number

be

catalog

in

. C.

of

L

090 - 23819

My

Patients and Students Teachers

all

-44

TO

61

RE

Preface

for

,

,

to

,

of

the reality

the

ex

a

,

in

by

I

to

-

of

a

to

treatment

.

group

,

In

need non technical exposition have been aware keen desire my practice share the enthusiasm and interest kindled public general spirit with the Written this the book

of

responding

the

.

perience

was written

allied fields with Possibly the book

in

.

treatment

help some readers prepare

for

this form

.

of

of

is

of

the nature

will also

—

the subject this book acquaint the layman and the specialist

and future

It

,

its

THE RELATIVELY NEW and rapidly developing field of group psychotherapy — origins methods importance

to

fo

re -

of

on

.

I

of

to

subordinates theoretical concepts and techniques im pressions human beings working together have cused primarily the words and feelings those who meanings experiences search for new old and direct their lives through corrective relationships

formed

within

references

necessary

to

it

should not the patient

on be

my many

to

,

.

the therapy circle Strictly speaking

explain

the couch who

com

viii his

Preface

,

of

.

,

is

, of it

in

”

influenced

the results

of

,

be

by

the thera

of

.

“

a

is

or

themselves

will

both partners

unmentioned who have influenced

tioned

or

,

as

analyst The twosome though municates privately with psycho designated individual the terminology group Moreover therapy permeated with the also deeply presence unseen but felt other persons men

treatment began

to

allied

and group treatment

in

the

thoughts

as

.

my

of

the reality

them

ne into the field led me

my practice individual

I

.

convey

relating

to

impossible

without

group psycho

in

experiences

In

in

but found

these experiences science which

my

terms

to

,

therapy

why both forms more personal

of

solely

in

it

write

reason

this book

is

principal

encompassed

it

But are are

.

the

peutic process

de

to

in

of

all

infinite detail

in

an

their feelings and behavior underwent changes To trace their transformation

.

variety

of

,

wells

.

I

,

or

.

I

.

bly

,

are inextrica clarify linked have endeavored their common nominators and intrinsic differences my patients figure Directly indirectly the ob servations record Between our first meeting and our fare

to

I

.

at

to

our relationship my own mind while

stages

I I

also

various revealed what went

in

have

me

on

they appeared

of

of

,

give characteristic was not possible but have tried by indicating how glimpses development their emotional

,

of

.

,

my thoughts and feelings about them and the them objectives which shaped my own communications

treated

realities

their

lives

to

.

of

carefully disguised the external

I

's

of

ac

,

Nevertheless the ethical requirements medical confi my patients have been dentiality and the protection enlightenment corded priority over the reader have

in of

is

of

.

I

so

.

of

as

,

as

faithfully their anonymity while preserving possible the flavor and integrity their personalities many cases that The same emotional problems dominate persons may suspect they several that are the subject story each relate The fact the matter that many

safeguard

Preface

dividuals have undergone similar experiences and have made parallel disclosures in the course of treatment . Some patients I write about were extremely complex personalities suffering from mixed and , in some cases , grave psychiatric disorders . I have described them as simply as possible . Though a pattern of behavior may have been de

by hundreds

termined

of different factors ,

I have

tried to

, .

of

an

all ,

of

I

, be ,

Its

meet the demands of elucidation and brevity by emphasiz ing those which were outstanding within the context of the case . In other words , explanations were oriented to clarity rather than scientific comprehensiveness . The shortcomings of the book are my own. virtues may many they persons whatever reflect the efforts would acknowledge first indebtedness beyond outstanding teachers who prepared me for my clinical practice and research pursuits and those too personal way the workings who have illustrated for me my patients and the mind sickness and health

,

,

-

stu

a

in

in

of

in

to

to

measure

.

dents

,

at

guidance

I

.

Alfred

benefited patience

.

stimulating

A

.

and suggestions

editor Henry Robbins

,

my

his

.,

,

Knopf Inc

to

valuable criticism

grateful

for

am

I

stages yielded

of

.

of

I

,

had willing assistants among colleagues friends and relatives Their careful reading the manuscript various

from

of

am

I

,

To

.

his encouragement and remarkable greatly indebted for editorial Julia Older Bazer

ink

.

's

printer

. of

to

of

in

assistance the organization and preparation the text making lightened professional She the formidable task material comprehensible the lay reader and worthy

Contents Part

·I:

INTRODUCTION

TO

THE GROUP

SETTING 1 2

My

First Group

The Third Psychiatric Revolution

Part · II : THE ANALYTIC TREATMENT PROCESS

53

The Phantom Figure

4

Themes with Variations

107

My Office

138

Hear

"

See

Recovery

in

9

A

10

Some

Looking Ahead

Group Leaders

Talk

the

THE PSYCHOTHERAPIST

Group Psychotherapist

164

191

in

:

III

of

“

I

Shall

11

·

Part

Treatment Settings

Afternoon

The Meaning

87

or

An

Whatsoever

8

6

Patients

7

5

and

3

Shop

223

Making

225

243 262

Part ·

I

INTRODUCTION

TO

THE GROUP SETTING

[1]

My First Group psychotherapist ? ”

patient

a

,

am

.

of

to

I

.

,

The answer

on

I

rm

,

plexed

a

that both per explain that psychoanalysis went psychotherapy Frequent questions

other day

so

me

asked

psychoanalyst or

the

a

of

ARE YOU him

“

me aware that many people are con overlapping professional the and crisscrossing I

.

whose specialty

;

a

psy am

psychoan

the practice

To

to

diseases

of

physician

treating mental

chiatrist who devotes himself

alytic psychotherapy

A

professionally

psychiatry the science

?

, I,

Who is

start

shall therefore

clarifying my own status am

by

out

psychotherapists

.

among

identities

of

fused

of

by

this sort have made

conduct groups

I

,

of

now

The name commonly

applied

of

.

well we

as

in

a

of

.

complete the identification psychoan small but rapidly growing number alysts who began their careers practice individual and

one

of

,

in

I

a

,

.

is

analytic group psychotherapy work with one patient time and at

like

to

I

,

century

like

to

to

give one the group treatment various forms which were introduced this country during the first half this

work

the

, . to

was accustomed

to

.

I

,

in

in

to

a

he

achieve

group and

.

it

,

thank

other

All the more momen he

was telling the group something had not told intensive individual and out his ten years in

me during

of

,

he

patients for helping him

but

individual treat my patients declare his persons

from

ment but was the first psychological independence

it

remember

hearing such expressions

of

have good reason

to

I

in ,

,

,

ready

."

.

.

can look without any

I'm

'

,

I I'm

,

me

done for

Years have passed since Donald made that statement

tous

an

saying

so

,

folks

after my family and business from here more trouble and they can look after me pull out here

of

a

—

most

you

thin

difficult patients

So on

of

all

“

:

to

.by

-

Thanks for

treatment

combined

feel cured

I

-

,

one his group

my

ve

of

I

nounced

group

.

.

;

better

that fact some years ago when

sandy haired man good

Some persons require

needed

some need both experiences

became convinced

Group Setting

basically different procedures but do

,

in

And

to

a

These

my opinion both dividual treatment others

in

.

group

a

with

are are

Introduction

-m

were joined

therapeutic

their new

for

appeared

alliance

,

In

two years earlier

first

patients whose cases

several other

standstill

.

a

and

at

be

Donald to

y

had formed the group

by

I

.

psychotherapy

they

—

of

value when

it

an

ill

"

to

of

,

in

to

of .

suffered impressive demonstration

re

that time like the entirely

Nevertheless feel cure the severe kind The group setting gave me

its

he

felt himself

vital ingredient

ness from which

the sole measure

think and act

of

a

is

cured

person ”

well

.

He did not

accepted

at as be .

cannot

.

covery

Donald thanked be

whom

Feelings

he

outside

—

a

in

.

of

a

in

man who had been individual treatment my colleagues These were the allies psycho one my office and total strangers logical intimates once week

with

produced that

My

in Donald . odd years

He had on

thirty

-

feeling

during

balanced precariously

the borderline between

his

First Group

neurosis

and

he

.

be

defiantly

it

selfish

,

need

to

a

realized how unnecessary

and

Yet there deal

was

He

unable

seemed

to

he

,

.

even though

demonstrated

also

never been hospitalized

anxiety which he

,

with

residue

He had

states were already past history

of

a

was

at

had made considerable progress during been coming me intermittently for

individual treatment his acute anxiety

the group

entered

to

he had

the decade

the time

to

for

,

was baffling

insecurity

.

His emotional

he

.

psychosis

have his

,

.

he

.

to

be

as

,

to

own way about everything and obtain approval for feel ing and acting did At the other extreme he still tended emotionally withdrawn with the problems which had already been inability overcome his case the man become more sociable human being seemed rather insignificant a

to

.

insoluble difficulty

.

an

seemed

who bogs down

indefinitely

just

He

few

a

a

be

traveler

also

to

was like

,

However

it

to

be

's

,

in

Compared

after

of

:

a

.

low

these

going

grade worry

.

least

-

into

a

at

blow

his

,

to

in

on

them

business partner

Small Donald could always find something up

and the office shared with settings were

with his wife and small daughter as

shared

his

apartment which

he

in

.

of

.

on

destination

of

of

his

covering thousands miles schedule Even more frustrating was the reali zation that what was keeping Donald bogged down was his way life He revolved monotonously constricted orbit the miles short

,

asked

,

was son much better Tas

he

his

constant bickering he

it,

himself so

.

wife Blaming why now that

he

again

,

with

for by ,

’

little girl was being damaged his

his

parents violent quarrels which had Painful memories made his own childhood miserable intensified his fears that again

seemed

and

bent

familiar refrain

in

life That was

a

daughter

Group Setting

to the

.

on ruining

's

his

Introduction

his

ill

or

of

.

When a

I

;

he

his prolonged hobby did not watching

Why

:

,

asked

friends professional

outdoor sports

might enjoy fishing

game Donald

no

.

at

a

skill

or

,

steam

”

off

let

he

“

to

had never cultivated

pointed out that baseball

because

do or

how

Understandably

“

he

.

ness

He had

home

any social groups

in

belong

associations know

to

and did not

,

they had remained

if

twosome

a

,

as

”

, "

going out meant accompanying Donald wife neighborhood movie where they were isolated as

a

to

To

.

his sessions

good

you waste my

irritable

he

less tense and

him

home

,

make

at

to

to

? ”

money talking about sports acknowledge that outside activity Unable

would tend that

insisted

he

-

to

social situations

.

to

unable

also seemed

of

of

my first group The female members weave themselves into the fabric

society

.

properly

in

to

of

“

to

.”

to

he

solve his immediate problems before would spare energy He was clearly for non essentials have unwilling learning tolerate the anxiety function had

Though

a

, .

delicate

oper

to

open his eyes and look

,

a

.

ation

about

through

a

to

his

sight who has regained persuaded but cannot him For different reason

be

person

a

on

I

of

as

,

,

,

too had made substantial headway

in

overcoming the problems brought acute which had them into treatment thought refractory patients Each these four women hesitated fearfully the threshold better life like they

each

woman

seemed

dis

her dread

of

it

,

of

because

having

,

,

.

public Home however was not much She was constantly being provoked into

in

.

haven for her

.

of

at

an

to

working hours

epileptic seizure

a

of an

outside her

a

,

,

a

to

make permanent crutch treatment Deborah for instance was vivacious young secretary spend evening who hated home yet rarely left posed

My First Group

; they

arguments by hermother and sisters her

as

their inferior . Deborah

ment during

five years

had always treated

improve

had made marked

of individual

psychotherapy

,

This ,

.

combined with anti -convulsant medicines had kept her free seizures for more than two years , and the symptoms

from

of

functional disorder had practically disap peared . But, as long as the bitter family quarrels associated with her earlier attacks were apt to begin again , therapy her

earlier

for her . New

necessary

seemed

some understanding

interests and activities and

friends would have helped

counter

to

balance the harmful effects of the dissension in her home ; but her fear of being similarly stigmatized in other settings The progress of Faith

.

early thirties she was

quiet woman infancy from

smile who had been trained The only child school superintendent

up

timid

in some social situation

,

librarian in

alone

of

drinker , was also retarded

.

with

and

a

a

, a lonely

being disgraced

of

a

A

strong fear

her

by

dangers .

to new

live his

expose herself

to

to

a

made her hesitate

a

to

the bottle was

outweighed the pleasure

people

,

,

that the companionship

of

one lone bout with

In

to

safe and

however

of

relatively

from the city

.

she discovered

married business

keep their relationship

rebel against loneliness far

it

,

she began

to

secret

love with

was not difficult for her During his frequent absences

, . it

man

to

so

,

herself that when she fell

in

.

of

.

on

a

in

,

unloving wife she had been brought small New England community any Both parents had frowned keeping display emotions Faith was accustomed

being with

of

. .

,

to

For this and other reasons she became addicted alcohol That was one the problems which brought her

.

ous social and professional activities

her

them

sex in

to

on

She projected her own strong disapproval join and drinking those who invited her

of

.

into treatment

life

vari

Cutting herself off

Introduction

the Group Setting

to

of ,

a

, or

gratifi

emotional a

was possible that she would become

,

compulsive

.

,

me

send

hopeless

find out why

to

wanted

patients whom

cases and

to

regarded

were

to

untreatable as

be

colleagues

I

my

.

I

they considered

practice psychoanalytic psychotherapy

to

began

to

I

When

some other

them

again

had requested

they

to

Without

it .

cation

loneliness amid the ups and downs

of

as

to

perpetual antidote

drinker

,

.

her career

no

in

she seemed her life

to

Although she had made great longer drank compulsively treatment and SO regard her weekly therapy sessions sort

and threatening progress

in

of ,

all

unnecessary ties was essential from her opinion keep her skeletons from breaking out her personal closet

investigate

to

.

to

newly developed methods whether they would respond among Helen and Edith were the patients sent me for this

Helen had suffered for years

from

her mid thirties

,

brunette

attractive

and

-

cultured

in

A

.

purpose

severe

anxiety

attacks

engagements

successive

marry

.

her

9

off

to

, of

few

a

of

. .

,

,

as

to

on

which caused her roll the floor grovel and shiver way out She had once attempted suicide this suffering Her first acute attacks had coincided with her breaking

Her

last

,

“

help

her

,

of

he

not

and

.”

know

am

me

I

please

if

but

let

case the terrified virgin that she would never overcome

“

,

relations

the

take the opinion

could

insisted

have

that this was the only way

a

love with

handsome

affair with

him

.

Helen decided

an

falling

to

,

naval officer

after

to

years later

,

Two

in

.”

her fear wrong

decided that

to

me

expressed

of

He

sex

challenged

on

,

some months

he

to a

on

. of

suitor turned down the eve their planned wedding psychiatrist After treating Helen for had brought her

She

test her conviction

My First Group that she would never find

a

she was sexually

man with whom

.

compatible

The affair proved to be mutually satisfactory and eventually she lost her terror of sexual intercourse . this message :

sent her first psychiatrist

well

as

no

marriage but Helen had more acute attacks and she became much happier person in

.

her teaching career and functioned capably

for her

household

father and mentally re vege her tendency

sick

we investigated

.

tarded brother When

to

of

a

,

lead

She advanced head

her lover ' s, their affair

as

;

not

to

did

of her own

reasons

anxiety as

been

.”

stormed

For

The gates have

“

, I

,

to

.

the

in

be

a

arm

,

at

tate home during her leisure hours however Helen com plained that her slightly crippled pained her whenever appointment offing social was This pain seemed continuing anxiety connected with her that acquaintances

a

.

if

they found out about her physical dis would shun her ability Her undue sensitivity about condition which was

severely

it

I as

an

.

a

once

up

-

a

,

her

her

clerical years

last

father briefly

in

six

.

well

own

re .

only

in

to

;

to

along tolerably

mentally

his

took care She was hospitalized

Later she was During the next

adrenalin

treatment

,

years Edith

mixed

went down

was

pressure

at in

private

of

and

seven

me for

woman

her blood

she was given

when

,

jobor

Or se

to

referred

sorrowful

.

stead

example

-

For

of .

creature

up

cated that this slight

ill

treatment

, , .

shock

her got

went

her there she also under drugs indi Even her responses

psychotherapy

administered

by

”

sick from

in

"

depressed

hopelessly

in

a

as

described

,

widow her forties was the year one sociate who had examined her New York hospital

,

Edith

.

to

to

,

of

in

noticeable

to

would have yielded time new right interests and the kind friends but was difficult for her make the effort necessary cultivate them

scarcely

Introduction

10

, during my first , when

.

Her mother who

.

,

living

had

mentioned this

Edith

,

giving birth

reproached

she had

almost died

in

them

she could remember

to

herself

her equi

maintain

to

,

far

back

for

As

she felt unable

as

without

librium

the Group Setting

summer vacation after her treatment

sessions started

so

quest

to

often that the tiny

.

Life often

anew

seemed

thoughts

of

.

driving

,

around

death

to

her

in

be

to

caving

each

her

for

and she blamed herself

,

of

in

to

of

's

.

girl felt wholly responsible for her mother suffering She reacted similarly the death her husband Several other relatives died suddenly the course her therapy

from

treatment Edith eventually became able me without feeling overwhelmed The

,

stage

hostility depressed her

.

to

accept

it

the early

of

Although any expression

in

of

.

suicide

of

,

said to

differences

these five together

.

of

. progress

slow

their cases and life histories

Despite substantial

their backgrounds and

of or

a

Personal circumstances and illness had people that mold them into one relationship

excitement

, is

;

not focused

on

when

the

,

their thoughts and feelings

”

“

.

ure helped

to

or

a

of

were

of

cases

,

In

,

their

in

two respects strikingly similar their years individual psychother memory apy these patients had never unfolded dream pleas feelings group experience which had aroused disorders

.

psychiatric

, ,

."

reviewed

the

in

, I

patients

dissatisfaction

out socially at

In

my

to

made her unwilling

go to

or

by

“

as

of

knowledge that she was being exposed hostile feelings part therapeutic process prevented her the she being hurt from suffering 100 per cent Still her fear might deserted others whom she become attached

them of

.

,

be

of

.

,

to

significance overcharged with tended person they one other Hence had become more and more isolated from the stream normal social activity selves

My First Group

11

That fact, by itself , was not too significant. “ One re psychotherapists the offices and the majority emerge without undue difficulty into more satisfy

to

influence the outcome

,

cir his he

's

never meets may decisively

environmental control and people

treatment

cumstances beyond the therapist

of

forms

other

ven even

psychotherapy

In

.

activities

wean

naturally

them

,

than

social

of

more

in

pleasurable

into

hand

a

,

and

they have relatives friends the old life patterns and draw

from

them

as

their therapy and the leave prolonged are not unnecessarily rule

taking itself because

final phase

The

at

.

ing lives

of

through them

,

of

of ily

lationship ” and even " no relationship ” people stream stead

in

in

for

incentives

of

They lacked opportunities

.

be

to

,

regular

contact with That was the second common factor appeared more serious than the first

it

.

sociable people

these cases and

patients was

these

and

But none

of

.

cases

changing their

,

for

-

a

to

of

I

I

,

.

to -

association one patterns one When reviewed these cases twelve years ago was consulting psychiatrist the Jewish Board Guardians New York child guidance agency where therapy groups we were conducted

in

.

,

,

of

at

a

, ,

. .S R .

children and also for parents played analytic group Slavson who has historic role therapy directed group treatment the agency Some psychologists the psychiatric social workers and psy

of

a

other

field

analyti

therapists about the groups which they then experimentally rather Information obtained

my own

sluggish cases

ex

the group

.

fillip

for

perience suggested

a

these sources about the social values

of

conducted

by

group therapy

as

.

of

in

interest

studied the reports published

cally trained from

my

.

.

research

aroused

I

pecially

in

on

chiatrists who consulted me there discussed the personality changes going members their groups Slavson es

Introduction

Might

this training not instill

of

stresses

bona

fide

social situations

of

their first experiences company

this sort

like the child who

inter confi

the extra

the potential

After undergoing

familiar

and trusted

kindergarten

enters

his

,

with

them

to

asked myself

grappling with

begin

to

dence they needed

assistance

.

my

and with

regularly

?

my presence

together

,

these people

in

in

act

Why not bring

Group Setting

to the

I

12

for the

.

expressed

therapy

That was and

feeling

the first time

that

the

ease

could

with which meeting period

more comfortable than

obviously

felt that

mine

.

low patients

was

safe

as

;

me

seemed

it

alone with

They

reveal themselves and readily accepted

of

to

when

, .

-

painful feeling out but they

of

.

I

to

five problem patients adjusted themselves together had expected their first session be

to

my

a

I

,

at

.

living without psychotherapy From the start was surprised

for

and

group

in to

the

individual treatment

go

twelve years

the

.

independent social functioning which Donald two years later

my first

on

formed

bridge between

he

a

serve

I

,

on

that hypothesis as

group

to

Acting

be

to

,

's

to

to

first time clinging mother hand they ought cope better able with such situations without anxiety

each other

fel

This bond and their long conditioning

,

a

In

.

to

do

I

,

in

in

individual therapy accounted for the unexpectedly com fortable shift treatment settings After introducing them by their first names had little way relatively they more relaxed and informal talked frankly about difficulties which they concealed from up

.

their daily associates

It

.'

'

to

am

and

up

“

I

,

,

critically said Helen sized her behave the same way feel terrible about

.

always to

People she had

the time

.”

me fearful

all

“

:

I

my brief introductions with this Donald followed trying statement break my worry habit makes

My First Group ,

doing

declared

."

I am

“

,

she added

it ”

Faith

work

13

:

I

“

“

and

hated

I

trying

am

.”

find out why

to

my mother ,

my

I hate

and now

epileptic , ” were Deborah s first words .

'

an

Donald

spent

and Helen

anxieties together

.

time exploring

considerable

They

to demonstrate how if to This what want you help me with When Donald remarked that could make any situation Helen said anxiety out the same way to

happen

“

.

s

It '

to

me

don

my own

.”

course

.

”

.

by

the

,

said Donald

He made me

misquoting me distorting some his emotional difficulties He ridiculed

flagrantly

.

-

me without his usual self consciousness

He

so

comments

talking

.

of

my

most

or

squirm

your silence

of

by

,

After that

did

been respecting he

We have

on

“

,

fault

of

blame you people for not speaking

't

parade her defectiveness

.

was the last

to

Edith

I

.”

to

I

.

always expect something horrible

shopping

me

When

to

people

go

.

I'

“

:

talk

to

I

get chills when

m

he

I

is

:

,

of .

I, I

Sometimes

tried

say

their

helpless they were , as

had been

of

to

back

the situa

for

the almost

into

overthrow

in

realized exhibit superiority

him

not

the father

.

forced

the son trying

it

,

unconsciously

was difficult

that his great craving

I

But

to

felt

and need

to

for admiration

.

I

to

betray how

gotten role

I

.

and analyzed his behavior

counterattack

tion

I

in

friendly and respectful the preceding months that was by this new attitude As checked my impulse

startled

-

Deb later

,

.

his

.

to

he

in

,

's

impressed with

tried unseat me their affections fantasies during the opening session she told as

daring orah

They were

us In

group meetings

first few

he

,

”

co

to

“

at

a

,

Indeed for man who had often asserted that women always bored him except bedtime was amazingly gallant and attentive patients during the his female

Introduction

14

Donald was a “ secret psychiatrist sist me in treatment. With

the Group Setting

to

who was present to as

”

group

the advent of the sixth

member

several

old

in

a

.

wisecracks group interaction ev every week introduced

Jack

's

other

each

a

of

one relationship

to -

the one

in

or

a

father during the early years

of

for

is

It

to

.

mother

much more difficult

to

with

these

.

to

can

those with

life

the lives

the acute needs which individual treatment meet The analyst working alone with provide him with emotional experiences similar

had failed

patient

their behavior

studied

I

.

recognized

into

,

As

people

I

Two hours

some strikingly different experiences

of

laughed

personal affront when the women

of

at

.

it

ment Donald took

as

's

therapist

at

to

homosexual He was admitted the group request after doing poorly individual treat

.

-

year

a

,

- of

his six

air

months later , Donald acquired a peer rival with whom he repeated this provocative behavior . Jack , a husky man with thirty uncertainty about his movements an was

to

;

six

said

She then stood

,

Vividly

,

,

she

unable

recalling her

that she wanted

with

heart

been

to

,

stand

by

“

a

of

a

moment she had

.up

.

or

poem

great deal

make

of

once

stanza

con

hall when The Flag Goes

assembly

a

at

,

,

a

word even mortification she

the memory

Flag Day ceremony

She knew the to

at

,

recite

the appointed

.

by

's

amends

Bennett

years old

the school

in

her father

Henry

on

By

”

to

father

was

She described

she had been called

but

she

to

by

.

her

ducted

experience

the statement that she had

up

herself when

on

troubled

utter

;

opened one session with

Faith

disgraced

went

particularly great need

.

a

this group had just such situation

a

of

or

a

patient the emotional validity being with create ser playmates several brothers and sisters and the members

dig

2

My First Group model

child

,

of

a

faced the group , and , with the

air

,

nity

15

:

recited these lines

!

Hats off Along the street there comes

:

;

of

,

a

A

of

bugles blare ruffle drums And loyal hearts are beating high !

Hats off

massive burden

from

of

these

few

lines

her mind

group experience brought Donald many special satis

.

for

I

underestimated him

members

this was heartening

him

;

his illness maligning

-

,

.

of of

severity

co

the

was

when warned the group that he they took self confident and well mannered as

't

the -

be as at

accused wasn

I

His

factions For instance his

him

the delivery

.

is

see that

to

It lifted

a

was plain

by

passing

!

The

flag

he

.

.

to

beginning Later the point of my warning became clear When he

of

.

to

-

-

at

,

all

spouting

him

,

of

ease

a

with the women became foun feelings out the sexual that during the give and take stirred through the ses sions He shocked them by saying that he ought be able felt completely obscenity tain

,

level

accept

the

expressed

were

dis

couldn

needs

.

low

't

was that they

he

series

of

A

notion that people had

”

,

complained

“

he

them

,

“

a

.”lay

”

I

to “

neck with anybody want anywhere and Deborah punched him for calling her good The trouble with

perverse ideas which

them

.

on

.

them

and made

not acting

on

his anxiety about having accept the frustration

of

him

to

for

it

these ideas reduced

easier

to

to

of

;

in

the sessions this was gratifying Donald The willingness the other patients comment frankly

cussed

Introduction

16

to

the Group Setting

The women studied him , analyzed his dreams with more or less psychological sophistication , and made suggestions about his family and business . They advised him to get better

on

his wife .

terms with

Faith and Helen

cally attractive

both told

. He

him

benefited

, which

He

was

astonished when

physi

that they found

him

especially

Faith s

from

'

in

fluence and affection he reciprocated . They enjoyed talking about getting together outside the sessions , but suc cessfully

resisted the temptation

to

do

out of

so

concern

for their own improvement.

cen was cured was as Donald 's dramatic announcement that he was

not

accepted at face value

his behavior .

He

was

improvement

and

to

. It

launched

called

on

to

an

investigation

of

of

his

give evidence

report what his wife and business as

sociates said about it . His co -patients also gave their own impressions of his conduct . Impatient as he was to leave ,

a

accepted

then

longer

somewhat

situation

' s verdict that he required period of interchange in a controlled

the group

overcome some remaining

to

stabilize

" graduated

Donald

difficulties

the progress he had already made. from

and

to

One year later

the group with the enthusiastic the

he

of

of

She outshone them few

's.

Donald

in

pressive than

's

-

,

co

To

.

.

of

its

approval consent of members and his wife and my most chal partner This marked the close one lenging cases improvement was more im patients Helen her the

early

.

after

,

months

she announced

.

she

On the whole

In

she adjusted

.

in

a

to

,

however the ease and rapidity with which self led meteoric career the group

that

,

tears

less than

her six

burst into

,

she

talked about her problems with more feeling

that she was entirely well and she

,

and

;

him

,

inhibited

”

"

,

speaking

of

signs fluently and with anxiety perfectionistic complained Then Donald that her attitude

sessions

29 DE

BOMBEN GIBRARIES

My First Group

17

could not be persuaded that she was overconfident . About

gave her individual

of

.

,

.

'

less

He

enjoy

gradually

.

showed interest

found himself vying

.

her attentions during the sessions

't

of

.

His

his

.

women

few

couldn

who

understand

his dead mother for whom

him

deep hatred

the

He

Jack

feelings for Faith turned began discuss the possibility

,

this because she reminded

sexually

of

him

Ex

attitudes

Jack

developed

He

especially Faith

distress about the warmth to

had ever attracted

so

-

,

.”

,

she

someone

CVE reverent

the group

told the group that she was one

he

she reproached

in her to

for

,

for

.

six

it

-

co

members

still retained

Then

For the first time

That was her first triumphal moment

marked improvement

of

she

.

on

, I

had known her

the other group members

with Donald

too

about her emo

judgment

was right after all

me had made possible During his first months his

Though

On resuming her reminded me that had

,

posure

to

.

beside herself

say

derived

her companions

an

to “

the years

my

several occasions

against her better

You see

I

in

all

added

the group

:

joined

to

,

brief participation

she gently

individual treatment

in

sick

respect her silence Edith spoke feelingly

tional problems

to

its

on

,

to

for

read rebuff into each attempt

to

Edith

Even

was too

she

,

to

her

lives

joined the group

prove that

some benefit from

prone

who

.

,

the depressed widow and then tried

other members

live more satisfying

to

varying extent

real

psychotherapy

,

her

it

referred

until she recovered . The group experience helped

.

I

she

further treatment. An associate

ized that she required whom

,

impatiently

so

a

year after she had left the group

it , .

a

panic

when

the group

.

of

to

of

to

,

,

to

their marriage The in depression creased anxiety and revengeful feelings that any accompany abandon his homo real effort would way sexual life and permit himself become more

Introduction the group

to

talk

he

pulled

of

He

Group Setting

at

of

To

.

, of

in

he

I

,

out

.

Had remained and discussed his emotional difficulties further believe that overcoming his fright would have succeeded the my thought disclosing his hostile feelings the best

.

about

to

women were too threatening for Jack

to

attracted

the

18

the unaccustomed

her morale

.

boosted

of

,

in

me

in

her sessions alone with

they gave her sharply

consideration

enjoyed

fessional women

the presence

and pro

The fact that businessmen her

but

she had

as

other patients

freely

as

did not communicate

Deborah

of

.

knowledge the group experience ended his treatment

company

helped her get over

.

of

.

,

to

on

;

.

,

on

inferiority From the first session her feelings she frankly talked about her epileptic condition later she began talking about going long dates Not after the group ceased function Deborah moved out the city She

but

they enjoy

.

people

.

of ;

to

,

.

club

She

She stopped

.”

little psychopaths

for psychotherapists

their treatment experiences

refer

themselves

;

I

life

She became active

women

on

of

the effects

,

's

know

,

to

't

customary

no

to

It

isn

found that she enjoyed being with referring her neighbor children

but

apparently

's

joined

and

to

-

.”

doing good

and

a

in

esteem

as “

interest

philanthropic work

"

stimulated

last

major contribution ,

that she had made

recovery brought her self an

's

Donald

not her

her attitudes and way a

The realization

in

the group belle was

marked changes

in

to

led

lonely woman into

it

a

.

,

to

in

found work her liking another community where she had her own apartment and found sympathetic friends The treatment experience which transformed Faith from

immunity against psychological change

often benefit from

pa a

as

on

to

be

It

.

on

as

of

,

,

indeed

it .

The day may yet come when they will evaluate the psychological impact their well themselves treatment process might also helpful for patients give their tients

and

My First

Group

19

opinions on the emotional they

instruments to whom

I believe that my for me

as

of

development

those human

entrust themselves .

first group experience was as significant

for my

patients

—

significant for me personally

making me feel more secure in other group situations, as e well as professionally in introducing me to ann exciting new in

of

of

is

one

the

the group

,

In

the psychoanalyst

.

of

living that a

atmosphere

and more spontaneous

emotional processes were

at

several lines

of

.

time Yet the brighter

as

as

.

It

keep track

—

a

ability

communication

a

.

one qualities to

lot

Functioning hour after dimly room with one

more sociable and challenging required The situation was more leadership well technical skill and the

of

lively

a

human being

of

I

occupational disabilities

in a

at a

time shuts out

felt much more

.

research

; lit

and

shadowy figure

a

of

practice

of

at

field

hour as patient

one and the same time more

of

in

,

.

I

,

to

of

,

of

.

of

relaxing and more invigorating The dramatic spirit the feelings repartee intensity interaction the and the the coming the fore made more me come alive the group sessions feeling became aware too that the being revitalized often carried over into my individual

of

the understanding which one patient

the group

and

greatly impressed

favorable

traits which

me

.

in

The healing value gives another personality

of

.

treatment sessions

Strength

not

had

been

of

of

.

I

in

selves

in

extended individual treatment revealed them various group situations found myself less con cerned with the causes illness and basic pathology than with the current functioning and social resources each

delineated

today there

procedures

and about many

vigorous

individual and

other aspects

of

group

of

,

Among analytic psychotherapists

disagreement about the relative efficiency

is

.

patient

these

Introduction

20

Group Setting

to the

would prob

experiences . Most practitioners

two treatment

his

ably agree , however , that the analyst who has been trained exclusively in individual psychoanalysis is bound to experi in

first therapy

group

.

setting

a

.

as

into

of

Could

situation ahead

,

.

I

the unknown had never felt individual analytic session even

an

a

fear

before

me

for

semi

group therapist

I

gave rise

unprepared

so

about

how

effortlessly

suppose that the entirely new

,

retrospect

to

of In

I

transform myself just

me

But

chairs faced the desk

a

,

.

of

circle

and

?

create the new

their treatment The couch had been removed

?

enough

had been easy

It

my

minutes before opening session

to

assembled

its

the

for

in

insecurity

few

.

I

of

to

ability ence certain anxieties about function the group setting recall my own uncertainty and feeling

I

which

maneuvers

in

the countless

on

with

familiar

go

to

. I

,

of

during my first weeks practice because had some per guide me Until became sonal experience and training

I

if

be

no

I

I

.

I

be

be

.

Would

what would

?

alone analyze and respond appropriately inexperience and insecurity about my change

my

patients

And would

I

know how overprotec the line between suitable control and sensed

?

to

draw

track

impact

myself those the uncertainties which beset me before my first

years that have passed

,

questions

since

I

the

In

?

of

status

keep

let

on

my

,

going

Would

able

personalities

be

several diverse

the simultaneous

sustain

and complicated

?

how

of

know

invariably

tion

was bringing together

experience

to

of

I

a

with Would

I

.

provide the difficult patients

truly therapeutic

by

able

to

to

of or

in

or

I

,

to

individual analysis would think back what my own psychoanalyst control analysts would have done one previous personal eventuality another But had knowledge the group setting wondered would

asked

My First Group group

have been

session

were answered sam

e t evening

same therapy

21 dispelled

.

Some of my questions

by the group

. Many more

experience which began that Swers answers emerged out of other

or training groups . Some of these groups I con ; others I observed from a distance , like a myself ducted

but unseen godfather , in the capacity of consultant psychiatrist to their respective leaders . What I have learned , what I have observed , and what I

deeply concerned

have experienced

in

stance of this book

.

the course of

these activities

is the sub

[2 ]

The Third Psychiatric Revolution medical student , I was sur knowledge prised to learn that firsthand of the structure of the human body , the foundation of modern medicine , was not available to physicians until the last few centuries .

from

processes on the body

our present understanding

Their ignorance

seem

very

far

disease

a

earlier notions about the causes and effects

of their

of

of

ANATOMY as

the body was nurtured

by

Many

STUDIED

removed

.

I

WHEN

the super

descriptions

of of

on

rely

by

dents were forced

to

.

,

stitions and mystical beliefs which long hampered medical training and treatment Until the fourteenth century stu the human

a

was

finally

cadavers

for

permitted

an

,

as

few

medical

,

When

schools were allowed

it

sacrilege

.

act

of

of

,

or

written

,

Galen Greek physician the second century copied descriptions later writers who his be cause the dissection the human body was regarded

anatomy

demonstration

pur

The Third Psychiatric

they were permitted

one annual dis

to hold

an

executed criminal

.

corpse being that

of

the

section ,

23

,

stole

The

of

signifi

1543 anatomical dissections added little the detailed structure

its

of

of

cant knowledge

Vesa body

human anatomy was

whose textbook

of

in

published

, ,

Before Vesalius

.

his

of

,

of

lius the founder modern human anatomy gallows investigations from the for one

a

; usually

poses

Revolution

the body

and

to

my

attention

.

,

to

his predecessors came

of

,

by

so

of

It

.

parts the relation was easy for me understand why this was when three drawings anatomical dissec tions illustrations from the texts Vesalius and two

a

on

cadaver some distance

instructor directs and

;

demonstrates while the servant wields the scalpel

cepted for nearly fifteen hundred

of

the human

pigs

ac

faithful descrip

was actually

organism

monkeys

studied and

been

years

the

had never dis

himself

What had

based

on

that Galen man

to

dissection which led Vesalius

.

a

sected the body

of

discovery

as

of

This was the kind astounding

an

hand

.

skeleton close

at

to

, .

dissecting

of

the

is

neither dais nor textbook

The professor himself stands over the cadaver explaining and referring articulated human

evidence

tions

the title page

from

from

beneath

of

,

Vesalius

,

historic work

the third drawing

of

his dignity

but here

his dais expounding as

on

is

perched

handle the corpse was still regarded

In

.

Galen

. To

,

too

the professor

,

,

anatomy

in

-

the second illustration

In

.

textbook

a

while his barber servant dissects away

,

In

to

Galen

's

medical bible

the

the assembled students

an

.

dais reading —

from

sits

a

medicine

on

of

of

anatomy finally These drawings vividly suggest how or emerged out professor the Dark Ages the earliest

the

and goats

by

.

,

,

dissection The earlier ideas about the body which were not supported such direct

;

observations were abandoned

and

we

gradually

acquired

Introduction

24

Group Setting

to the

our present knowledge of the

relation between bodily struc

Ure and functioning and how ture

one influences

,

psychiatry

too , we

the other

.

In have moved closer to our data and abandoned many distorted ideas about the anatomy of

mind

the

group from

it

and how

operates

psychotherapy which

. With

we acquired

to investigate

the introduction

a

of vantage point

new

of

the dynamics

behav

human

ior .

some respects, the development of psychiatry as a medical science has paralleled that of anatomy. The popular In

superstitions

religious prohibitions

and

'

which

retarded

scientific knowledge of the body s structure also helped to preserve the mysteries of the mind . Mystical notions about

clinical medicine during the first two history Abnormal mental states were thousand years not regarded illness due natural causes but evidence as

. .

The person

afflicted

or

that the ancient world offered

him

was

to

to

and large

or

By in

evil spirit had entered the body some witch demon

the grip

, of of all

that

was

an

as

.

its

general

of

the pale

of

ill

evil spirits , like those about dead spirits which interfered with the study of the cadaver , kept the mentally outside

sorcerer designed

and

had

apart from

's

in

,

,

In

was zeal

,

or

,

punished

.

in

them

be ,

,

shackled

set

and the evil spirits

to

.

fires

misuse the word here

applied with torture racks branding irons bon the stake They were sinners they were criminals

at

ously

—

—

and their treatment

to

to

be

.

a

the incantation witch doctor drive the evil spirit from his body the Middle Ages the deranged were thought sinners Satan clutches

They were

the community like loathsome

out

.'

"

or

of

,

I

often heard people born wild

the devil

beat the badness

to “

Some parents try

boy

”

as

of

.

on

These notions linger As being possessed described

a

.

and dangerous monsters

children who

The Third Psychiatric Revolution

's understanding

misbehave. The psychiatrist

ior

related

as

accepted

25

or faulty

to illness

Tan training

of bad behav is

still not fully

.

cians imbued with the humanistic

ideals

of

The first glimmer of recognition of this idea times came during the sixteenth century , when a

modern few

in

physi

the Renaissance

and

its

to

spoke out against the superstitious approach mental illness and the cruel treatment accorded victims during the

to

which has come

be

known

,

This movement Psychiatric the First Revo

,

medicine

.

within the province

them

as

of

ill

of

ate

a

of

.

,

Inquisition Men like Paracelsus Vives Weyer sparked crusade for the abolition restraints and for compassion treatment the mentally which eventually brought

freed had

thirty

or

posts

as

long

Bicêtre

he

in

.

dungeon

The men

as

the Asylum

chained

been

de

inmates

to

of

,

received dramatic

in

expression Paris 1793 when Philippe Pinel struck off handcuffs and anklets from the

lution

forty

.

years

them

had resided

.

Perhaps the evil spirits

the bodies

of

which troubled

ill

:

of new

would respond

it

and

in

kindness

Pinel and others like him was dominated concept Mentally people needed to

entirely

an

by

The approach

their tor

Physicians brought into the mental institutions project themselves into the situation urged their were patients and manage them through persuasion instead his

,

of of

to

of

.

mentors

.

,

,

to

of

It

.

vided

.

amenable kindness than the treatment pro bloodletting chiefly consisted cold baths salves

more

to

be

to

a

of

.

force Pinel and associates introduced the practice taking detailed history each case The patients proved

.

and emetics Physicians then believed that they were dealing these

patients

suf

different kinds

of

a

to

.

with one illness Slowly they came recognize that unitary fered not from illness but from

Introduction to the Group Setting

26

,

disorders. Their description and the early efforts

of

beginning

by symptoms,

classification

their causes marked the Psychiatric Revolution . It cul

understand

to

the Second

minated with the discovery by Freud and others that certain forms of illness described by Emil Kraepelin could be cured . But kindness alone wouldn 't help individual

basis

patients . They

these

and close study - treatment

needed understanding

also

on

an

.

of the doctor - patient relationship , a new form of treatment - scientific psycho therapy - developed during the nineteenth century . It was private consult administered to less severely afflicted the traditional framework

be

of

in

.

to

,

,

on

of

,

.

the emotions and childhood illness His investigations

.

form

the unconscious

psychotherapy

:

the personality

the most intensive

in

Later Freud dis

—

of

confession

of

of

of

in

of

the development

the irrational aspects

-

the

on

.

the reason and will power the pa emotional bond with the physician and the

liberating effects the act importance covered the

ushered

an

of

these

appeals

experiences

psychother

were first em important byway was hypnosis Freud More intensive systems developed later suggestion

to

on

tient

,

based

on

explored

by

one

his

;

ployed

clinics Systems

community

and

of

rooms

apy based chiefly

of

ing

the

Within

his

..

is

psychoanalysis

a

life especially to

tended

,

a

medical student literature

In

psychoanalytic

find out what

.

read

them

as

these discoveries

I

of

was aware but only because

heal

mother

reactivate his

.

that the analyst could usually

his

his

experiences with

,

in

past

they were and what was needed

I

with

to

problems

so

The treatment situation

, . of

significance

or

his

sulted from memories connected

persons

father

,

,

to

it

,

When Freud and collaborator Breuer treated neu patient apparent rotic became them that his illness re

my

The Third Psychiatric Revolution

27

courses thirty years ago , I heard nothing about these findings . I was taught that some mental illnesses were auS Tas caused by brain damage and that the cause of others was

psychiatry

unknown . The belief was current that persons suffering conditions of uncertain origin

from

had defective brain

also

tissue, which would be proven with further refinements

in

microscopic research . 'OSCO as rarely 1 Discussion of Freud 's microscope of the mind was circles at that time. Few

sanctioned

in

professors

suggested the possibility

academic

of

using

an

university

instrument

controversial as psychoanalysis , or that one might be able to find out the cause of an illness and alleviate it just by listening closely to a patient and analyzing what he said . Since then , however , the concept that detailed study of one as

person

by another

therapeutic

is

meated psychiatry .

some cases has

in

per

the

A

-

he

limit himself time that

much

.

For

confronted

other

?

practitioners

physicians treating physical and psychosomatic in

psychiatrists

clinics

the mental and

,

and community

.

helping professions

general hospitals

and representatives

While

some

them

of

them

,

illness

issues

larger number

,

These and other

among

help

a

social responsibility

of

's

analyst

to

's

,

of .

,

of

,

the other hand treatment was costly ome way way Was there some out this dilemma some reconciling the patient need for lengthy study and the those

helped

to

to

rigor

many others who needed his services

help

on

not

could

so

.

of

,

ous and costly training and then had required few patients Each them

he a

The analyst underwent long

,

pondered

.

frequently

Its

.

Later it became evident that treatment twosome practical consuming created difficulties time nature was

the other

were primarily

.

of

or

,

concerned with helping more people others sought easier dealing with their current cases additional ways

Introduction

—

which

its

in

can

, ex in

applied

large

the significance

what has come

to

.

at

interaction

human

of

is

of

,

in

,

.

its

of

,

, of

this

of

”

of

at

of

of

.

,

country

“

.

the

early the scene most Hersey organ Joseph 1905 Dr Pratt Boston consumption home sanatorium treatment

In

originated

history

in

a

As

understanding

as

in

be

own

function

the Third Psychiatric Revolution reported method treatment group psychotherapy

known

ized

society

essence

to

A

therapy groups brought new

the general nature and effects

This

force

the spontaneous

family and numerous other groups the interests

presence was

-

therapeutic

of

in

of

.

of

was

joint

that their

observations

,

;

beneficial right Moreover people

form

the recognition

the group

or

theory developed

be

studies

re

were expected

treatment And finally group how members affected each

this

of

to

other led

ing

.

what happened

a

plain

body

groups . Good

in

than

of

in for

often better

could be accounted psychoanalytic

treat patients

to

,

.

started

sults were reported

of

practitioners

their own purposes , these various

for

of

and there ,

Here

the Group Setting

to

he

;

,

.

whose teachers

them

brief

repress their

them

treatment

.

keep

, ,

young physician

and his

in

talks were thoughts and

device

help of

pessimistic

given to

inspirational

timesaving to

was admittedly

a

class

,

a

the outpatient clinic the Massachusetts General Hospital called His weekly meeting with indigent patients which

The

medicine had included

,

's

and

a

in

.

as in

no

regimen

ex

outdoor life the slums porches shacks tents

.

or

,

improvised

as

at

first more than the physical improvement

the prescribed

they could live

This meant sleeping

it

stressed

Pratt

in

plained how

got scant notice

,

those who adhered

in

on

He

in

of

.

pleasant social hour

to

;

he

group meeting itself reports regarded earliest The

an

as

on

Osler and Welch knew that recovery from tuberculosis de pended much what goes the head the chest

The Third Psychiatric Revolution

.“

have come

our

know

to

so

been fortunate

.

'

of

” 1

'

fibroid phthisis and that Elmer and Patrick

case

'

of

pyopneumothorax but

we

We have

of

in

and

this

as

', as ' ,

patients not simply

1906

the individual

Pratt told the Johns

,

,

Society

small class

a

in

having

head

,

that

is

forgotten

not the disease that needs treatment

Hopkins Medical

slept with

.

window

never

”

“

It

should

roof,

to use yard or be

a

of

sticking out

roofs . One patient ,

it

refused permission

tenement

on

his

pitched in back yards or

29

a

of

“

:

,

to

in

“

the newcomer

the patients probably

deeper impression than anything that

said

2

a

most

.”

the healthy appearance

makes

The testimony on

a

exerts

say

powerful influence

is

but

He went

of

star patient

of

.”

a

common disease

on

to

Pratt later attributed the spirit camaraderie which developed among these patients their common bond

of

.

C

-

.”

,

,

to

them

.

,

with Con

of

,

many years

'

'

.

Pratt

In

of

.”

in

wanted

things

3

his

all

he

“

continued

because they

The Home Sanatorium Treatment The Johns Hopkins Hospital Bulletin Vol

H

XVII

140

.

: . ”,

p

),

xxvi

by

issued

the Lancaster

.

Press

in

,

.

404

”

,

of

"

.

p

, .p

the Anniversary Volume

.

3 In

(

1922

1937

largely because

treatment

The Principles Class Treatment and Their Applica Various Chronic Diseases Hospital Social Service Vol VI

Idem

), to

2

(

1906

class “

's

Joseph

original

sumption

tion

well but

very queer and very human state

Pratt 1

get

people

instrument

not wholly

for

to

Pratt

and improved

class

buoy

and

sorts

the class members persisted

:

— a

wanted

to

,

please

observed that

hopefulness

his natural liking for very powerful therapeutic

opinion

's

to

a

him

Cabot

sixty fifth

Pratt

who had watched Pratt conduct the

, ,

a

.

made

,

joined

“

its

in

Cabot

early years

ancy

commemorating

statement

in

Cabot birthday

's .

by

of

Another reason for the remarkable success this pro gram Dr Richard was suggested thirty years later

,

model

many

by

was

and

a

operations

its

change in

little

Group Setting

to the

for

Introduction

30

The same approach was adopted other physi sup including psychiatrists management cians the psycho plementary treatment persons with physical group composed early somatic conditions One was

or

for

.

of

or

of

,

, .

others

to

gaining weight became children whom game Over the years physicians have obtained good regularly bringing together patients with results from chronic conditions like diabetes heart disease hypertension

,

, In

facilitate

it

,

has been

and rivalry

to

the condition and stimulate

treatment

other fields

medicine

,

active

of

,

Pratt himself although

,

patients with no

.

mem prob an

continued

be

,

admit their to

of his

of

,

less than

year before

his

.

first group

a

anniversary

his

less

indeed

the treatment but his approach be authoritarian Pratt commemorated the fiftieth

of

came

own personality

class

;

in

as

,

of

.

lems The force important element

their

He

suppress worrisome thoughts

and feelings first tuberculosis group bers his later were stimulated

to

to

patients his

longer encouraged

as

as

,

functional nervous disorders addressed himself mental attitudes well their physical symptoms

to

for

”

-

“

1930

he

the Boston Dispensary

in

.

at

In

continued

a

to

work with groups and acquired more psy thought orientation his control class

chological formed

small

.

operation

-

their

in

co

their emotional adjustment

groups

know each other

mutual encouragement

in

found that their

to

enough for members

and obesity

.

rheumatism

to

,

ulcers

get

peptic

,

,

a

.

, ,

undernourished

.

death

.

ex

by

a

the Philadelphia

General Hospital

.

at

twenty years

ago

than

.

,

to

to

of

grouping patients with psychosomatic con weighty repeated ditions whose medical charts testified visits clinic was adopted other physicians For ample Dr Samuel Hadden introduced similar groups more ore The policy

III

HERN

STY DI

LIBRARIES

them

,

said

,

directs the group program

at

clinics which

Peters who now

returned repeatedly Joseph

. J.

had not helped

”

“

why the patients had

.Dr

Wewondered

to

The Third Psychiatric Revolution

the hospital

.

,

to

their dependency

ferred

a

Dr

free

-

symptom

group after they trans

in

.

becoming

remain

to

needs When they were permitted

,

to

,

Often they returned with fresh physical symptoms prob ably because the clinic helped satisfy their emotional Peters continued

the

group

and their symptoms

.*

were often alleviated

to

New

in

At Mount Sinai Hospital

for

.

bed patients

the

to

tend

it

of

Some general hospitals have been sufficiently impressed group treatment for outpatients with the results ex in

,

,

,

York City first group was formed 1945 women with menopausal complaints who years after their phys iological symptoms had subsided haunted the gynecology

.

isolation and guilt about their vague

,

Aaron Stein

complaints

ceased

psychiatrists the treatment

therapy

group

or

the clinic

hospital

has replaced to

wards according hospital who directs the diversified the psychiatric

mark

introduced

of

staff

improved

these women

Dr .

“

morning

physical

's ,

early rounds

on A

patients

.

ized

1952

group techniques

and

to

.

.

diminished

groups

All

in

their visits

and

In

edly

was

their emotional difficulties and

social interests

,

considerably

whom

airing feelings

of

understand

to

They came developed new

of

the oldest

other

The

. of

each

”

with

in

,

-

identified

this group

,

thirteen members sixty five

other clinic visitors

socialize with

of

,

to

clinic apparently

group

.

32

.

P

New

the

1958

,

,

the Proceedings the Second Annual Institute Group Psychotherapy Association New York

in

Greene first reported of

James Sonnett

,

From

American

,

City

of

4

York

Dr .

the National Hospital for Speech Disorders

From

in

.

therapy activities

group

treatment

the Group Setting

stutterers

He called

this

his

on

to

.

his

1935

of

Introduction

32

of

.

work

"

of

to

of

.

later

types

prob

some common

institutions and other settings

.

formed

in

were

,

,

devoted

Other

said

the solution

to

",

groups lem

Greene

contacts

,

social

,

to

in

to

”

.

open office door psychiatry Stutterers passing being join door were called those treated inside He brought society overcome his fear the stutterer

,

early

in

,

of

,

While Pratt the internist was stimulating the develop ment medical group therapy others who figure the were more directly

history

emo

with

concerned

theories

Dr

.

the field

is

still active

Jacob

on

of

.

is a

-

identified

,

.

.

The cathartic

I.

which Aristotle observed more

other therapies based

on

,

two thousand years ago are exploited

than

psychodrama

spontaneous interaction

and

.

in

Vienna before World War

the drama

,

effect

of

social groups

in

L

name

is

with non analytic treat notably psychodrama widely used form ment and This action therapy based his experiments with various Moreno

His

,

,

.

of ,

other

each

, ;

were unaware

's

they

methods and findings One these pioneers

in

,

generally

of

to

.

Psychiatrists began tional illness and social maladjustment work independently with groups for different reasons

a

in

,

in

of

,

a

to

that their interactions would

mutually bene

be

prisoners

so

:

,

he

Moreno introduced the terms group therapy and group psychotherapy though first used them 1932 grouping tangential connection system describe a

.

in

.

,

ficial About twenty years ago these terms became shelter ing blanket for the many strange bedfellows the field

Vol

.

Medical Association

,

the American

a 104

as

in

on

.p

2242

of

The Journal

),

(

1935

.

5 In

.

on

to

carry Alfred Adler was probably the first psychiatrist hygiene systematic class discussions mental school guidance clinic He did not envisage himself de

The Third Psychiatric Revolution

counseled

child

,

'

of pro

the presence

in the 1920 s in

teachers ,

studying

as

regarded

of

,

,

in

in

of

counseling

family

to

the United other Adlerians are enthusiastic exponents

.

States

of

He and

.

,

's

method

or ,

group psychotherapy sort group guidance Rudolf Dreikurs who con alcoholics Vienna 1928 introduced

more precisely ducted groups

a

therefore

of

.

of

a

.

's

on

However

Adler

Adler

treatment when he

and others their presence had favorable effect relationship with the child This type counseling

—

cedures

is

Vienna

in

physicians

,

adults

a

of

the individual method

from

his

parting

33

to

to

his

to to

. various

of

about the poor morale

of

Psychiatrists

eni different

in

for

ex

,

in

,

by

and

.

of

them

arouse

their

confidence

of

the introduction

another kind

of

and

in

social interests and stimu Counte counteract their isolation and to

,

emotional withdrawal to

him

was employed

to

,

.

The need

appealing

overcome

different results

their lack

lating activities

to

,

him

institutions became concerned their patients

was designed

a

.

at

's

to

purpose and with

,

,

Riggs lectured his Stockbridge his sanitarium

Later the lecture method

led

easier

Austen

to

plain the patient problems prevail upon intelligence

groups were

for psychiatrists

,

-

.

Massachusetts

recovery

this century

loud speaker Initially this approach

a

patients over

Dr

it

make

the inmates

.

influence

to

assembled primarily

in

In

.

treatment the mental hospitals early

group

group

's

psychoanalytically

young

permission

of

oriented staff psychiatrist received

Hospital give

a

St .

Elizabeth

to

1918

a

use was In

Washington

, D .C .

in

Its earliest reported

in

.

therapy

to

to

.

W

.

about their war experiences and their illness

Though

some

of

causes

and symptoms

.

the

simple language

of

them

in

.

to

of

groups lectures war veterans confined the schizophrenics spoke wards for Dr Edward Lazell series

Introduction

34

to the

Group Setting

fantasy

or mumbled to themselves while he was talking , he observed that men who had been described as " unreachable ” patients absorbed much of what every

in

suddenly became

word , realizing

Lazell conducted

some

Later for psychotic

these lectures

.

by

,

was initiated

men

recovery

eventual

similar lectures

later .® these

his career

in

the

opinion

his

In

that here was

,” he reported

someone who understood their troubles

inter

,

and drank

ested

boys

dreamy

patients

in

. " Silent ,

of

told them

in

of

he

lost

seemed

them

in

he

of

psychiatry

employed

as

the psychological equiv terminology religious or

its

of

he

I

before entering field techniques which described

“

War

,

the

A

.

. L .

by

.

other mental hospitals Cody Marsh was influenced Dr Lazell but lectured informally more minister and morale officer World

at

Massachusetts

.

in

State Hospital

,

,

.

at

”

,

alent the revival without objectives He worked with severely disturbed patients Kings Park Hospital New York and later the Worcester

pa

,

,

,

of

music ancient phonograph The group bond through principles crowd of

.

an

of

the

to

development

a

and dancing

his

stunts roll calls singing

discussions

,

tients through lectures

of

Marsh worked for the emotional stimulation

"

.

his

a

in

"

a

as

student

of

in

,

small

civili

),

1930

(

,

347

.

1931

Vol

VI

hospital personnel and

.

for

.

-

education

Medical Bulletin

Vol XV

to

,

to “

-

in

the great subject

.p

,

patient

each

'

activities

Veterans Bureau

Mental Hygiene

re

'

a

group

.

. .

U S

6 In

organized

.

? In

.p

733

and therefore required

'

”

He

condition

(

Marsh

who has received

patients met

twenty

regarded

),

less than

.

basement room

a

to

it

groups averaging

zation

,

-

, ,

a

,

, of he

psychology morale boosting soul winning and salesman ship said made easier for him sell sanity mem patient solitary office His group than bers

The Third Psychiatric

Revolution

35

relatives of patients , and attempted in various ways to inter est the community at large in their rehabilitation . Stressing

the social and environmental aspects of mental illness, he adopted the credo :

By the crowd have they

By the crowd

shall they be healed

Many who conduct groups philosophy . Marsh dealing with needed

probably

emotionally

sought to give

broken

been

today

did

,

. this treatment

share

not realize that he was

starved adults , but he intuitively

the psychological nourishment they

them

. of measures

The importance

to

reintegrate the hospital

patient into society was stressed by others who worked

ized

in the mental institutions

Klapman took

a

during the 1930's. Dr. Jacob

more didactic

approach

M

.

than Lazell and

Marsh , whose experience he was unaware of when he began grouping psychotic patients for treatment . To counteract their easy distractability , he developed a system of peda gogical therapy

employing textbooks, scripts , or lectures

various aspects

on

took turns in was designed

of

social adjustment

. Group

reading to

aloud from these texts stimulate emotional release

.

members

The method and the ob

of problems; and the leader played an role . Klapman and other directive psychia

jective discussion authoritarian

trists also administered

treatment

such

in

their private prac

tice .

Another Chicago psychiatrist seriously

disturbed patients

mental hospitals , was

,

who worked with the most

especially after their discharge

.

.

.

Dr Abraham A Low He de group therapy known as willtraining , which was used chiefly in the Midwest . This approach was from

veloped

a system

of

based on the notion

that the spotting

of verbal errors

Introduction

36

Group Setting

to the

- helped a person to talk and perhaps , there , fore to think more sensibly . Brochures and a regular news

" self - sabotage ”

letter , “ Recovery

News,”

, who

were

among Low

circulated

's

an organization of their own . , Resurgo them founded by Klapman , groups developed therapy have out of the conducted in the

group members

Similar bodies , among

formed

mental hospitals . Among the first few psychiatrists to apply psychoana lytic principles to the treatment of groups in the mental hospitals were Dr. Louis Wender and Dr. Paul Schilder . Their reports the main

groups during the thirties influenced of development to a much greater extent

these

on

stream

Dr.

of

than those

, who

Trigant Burrow

as the first American psychoanalyst

apy .

recognized

now

practice group ther a social theory

to

of Freud who later developed

pupil

A

is

which he called phyloanalysis , Burrow s first reports on his private practice of “ group analysis ” were published in 1924 , years after had started He and SI experimental groups students analyzed each other twenty members Burrow emphasized the from four

'

disorders

primarily

social

.

neurotic

to

were oriented

of

social aspects

.

to

in

of

.

it

his

behavior

six

of

His

group activities rather

research

than

.

therapy

They identified

each

a

at

pointed

stimulated more spontaneous

the subsequent release

Wender regarded the group

.

He also of

with

individual

other and became more

a

,

munication

in

.

with

about their own difficulties

that the group setting sentment

groups than

better

as

objective

did much

.

.

therapy

them

in

some

of

to

,

to

in

Wender started work with groups 1929 New hospital York mental after observing that patients entering group living He found that the hospital responded well

out com

anger and

re

family unit and

The Third Psychiatric

his fatherly

37

interest

its

maintained

Revolution in

they

members after

Bellevue Hospital

in in

his

Schilder conducted groups York City first reports

at

.

were discharged from the hospital

New

,

on

A

.

on

an

as

by

,

he

as

his

;

were published 1936 powerful therapeutic instru four years before death psycho outstanding authority ment himself well analytic techniques worked out analytic procedures for them

be

,

to

he

.

his groups which were later adopted other therapists Although considered individual psychoanalysis the ma more efficient method he pointed out that his patients often experienced powerful emotions and disclosed significant

of

.

practices were

clinics Several distinct or

employing

or

.

-

,

introduced

activity

play

was first

children

exclusively

in

the child guidance

disturbed

made

also

It

,

in

its

community

the treatment

in

chiefly

utilized

therapy

group

During the thirties analytic appearance the general

in

a

.

.

to

him

to

in

information the group which they had been unable recog reveal when alone with Schilder came close nizing that the group itself was therapeutic force

the

the

of

of

for many

responsible

of

group

therapy

.

cam became director

in

in

“ A

.

.

you create the proper situation And

can

incredibly it

can

do

It

said

“

once

.

he

",

if

is a

wonderful thing

amazing things

career

in

he

decided that

and concrete than

a

civil engineering because working with steel was less interested building healthy personalities child

Slavson abandoned he

he

1934

,

of

Guardians where

in

at

of

of

analytic methods and techniques group therapy Some developed out them his experi mental work with problem youngsters the Jewish Board

.

theoretical concepts

who

is

Slavson

, ,

. R . S

that

of

is

.

in

treatment process combination with interviews The name name most prominently associated with these therapies

terribly

be distorted

if

the Group Setting

to

the

Introduction

38

you create and maintain

wrong

,

education

and

1911

a

in

,

essence

rec

and

his

,

in

reational group work which began psychoanalysis during the twenties

,

to

therapy

progressive

personal

of

fusion

group

his experience

in

of

His contributions

are

."

situation

for

not

a

.

Slavson has

for reason

it

to

of

discourage the use group therapy tried expediency He has frequently warned that

of

scientific advancement

,

in

its

.

,

,

workers marily interested

,

.

In

of

the face inertia active opposition psychologists and psychiatric social conduct groups Like others today who are pri field

trained psychiatrists to

extensive theoretical and

the basis

his

as

them

is

he

in

work

using the

,

setting

to

he

,

.

One the few non 2S analyzed before entering medical pioneers who was the principles transplanted psychoanalytic group field the

cure

.

all

.

to

for

a

in

Jew for

program

treatment

activity

creative

.”

creative activity

art

the earliest clinic groups puzzled Slav

, of

in

of

, .

What went

for what was called on

“

but

therapeutics

their own

assist the

,

clinics

purposes

services

paint

was de

program

developing Guardians similar This was therefore introduced not

of

its ish

.

activities Slavson volunteered Board

This

discover their talents through

them

his

help

creative work

arts

,

,

signed

to

,

to

do

groups had been encouraged ing music literature and other

or

's

earlier school and recreational in

Slavson

in

Young people

The youngsters made unimpressive

use the and significant handicraft materials provided nevertheless changes for the better were taking place their behavior

of

.

dis

they

thorough

the sessions

A

improvements attributed

one

of

of

's

high quality

of

personality

what should these one year records

sufficiently

?

of

effected

be

to

analysis

,

have played

the

what they fashioned was not

to

If

in

;

.

son

these

The Third Psychiatric groups led among

him

the

to

the children

It became clear to

of

had been him

that many

conclusion

interactions

therapeutic

that the group

.

significance

situation

itself had

factor in . Various other curative aspects und functioning the collective were identified later .

been

of

Revolution

the therapy

a

has told me

Slavson

interesting

an

story in connection

with the reorientation of this program . Having satisfied himself that it was therapeutic rather than creative activity ,

of

at

program

He was ,

.

on

first person

the

to

,

was

prison procedures

use

few

Slavson

,

. in

,

publications

not

in

therapy

Moreno had already used both terms

known

is

as

far

group

a

Dr

years earlier as

.

referred

The agency

.

was therefore

medical terminology as

in

to

. it

their activities

The latter advised Slavson that psychiatrists presumptuous for lay therapists describe to

,

of

Guardians might think

aware that

,

his

he suggested that the agency 's program should be called group psychotherapy . He thus informed brother John Slawson that time the director the Jewish Board

them

Activity

on

.

their current sense

group therapy

a

,

relationship

.

himself wants with the group leader the next five years Slavson and his associates

,

other procedures

As

experience

conducive

the expression

needed

a

groups

or

activity

of

well

to in

cated that some children were either too disturbed

setting

indi func more

their thoughts and feelings

,

with

to

experimented

.

he

During

tion

“

Each child interacts with

the other children present and forms the type

of

communication

.

the medium

of

as

.

,

sports and similar activities

which

an

by

,

is

feelings symbolically through play arts and crafts Hence activity replaces words

,

-

pent

up

”

,

to

.

are

in

in

,

which was introduced regular basis widely used today the clinics 1934 They encouraged with young children uncon ditionally loving permissive therapist discharge their

Introduction

the

40

to

Group

procedure was introduced 1937 Play group therapy for preschool youngsters interview

,

.

in

ere were introduced

first used with adolescents

discusses

a

to

a

When

1935

leader were put

group

his

test

he .

in

grueling

he

as

.

the next two years Slavson natural gifts

's

in

,

group therapy

and

-

in

the activity interview

Setting

early experi

Because

restore order

,

of

a

state

own attendants

their

hysterical

and

he was

he

police had been unable

in

had been

the

state

to

.

rebellion

weeks they

asked

,

For

to

.

York

six

at

's

at

a

of of

is

in

,

recalling riot which took the field fond during the summer that year the agency residential center for delinquent girls Hawthorne New ences

place

take

out

-

The teen agers complied

forbidden

two hours Slavson was hooted

he

but

an

,

for

.

in

them

;

of

territory for

the

come

because the lounge had been

and

to

them

staff lounge later curiosity

the day

,

He invited

.

with all windows barred

found that

their rooms behind locked doors

to

the girls were confined

he

materials for group activities

,

assortment

to

of

to

.

thought were necessary whatever measures Driving out the institution with two assistants and

of

for their rights he often had

respected fight

Let

's

:

them

;

for fighting

the girls and told

to

He thanked

he

hear what the mug has

and called out

“

the gathering

.”say

silenced

to

ringleaders

.

-

.

to

and jeered every time tried address them He faced good naturedly and bided his time Finally one them the

them

for his

They were asked present their complaints and these were recorded and given serious consideration Slavson told the girls that trusted them He was asked

,

.

by

the next day

.

unused

.

.

,

returned

The doors were then un

and the window bars removed

.

locked

to

prove this turning over the keys the main entrance the building The keys were handed over They were

,

of

to

he

.

all

.

to

own

The

Psychiatric

Third

Revolution

41

Though there were probably deep - seated causes for the riot , according to Slavson , the strict disciplinary measures instituted by the center 's new director had sparked a great deal of emotional tension . She was asked

.

ately

ing group procedures

for therapeutic

educational and recreational activities

leave immedi year , introduc

to

remained at Hawthorne for

Slavson

a

purposes as

.

well

as

There were no more

riots .

The unplanned and often accidental start of many early therapy groups

again

is reflected

in

an

account by Betty

Gabriel of the genesis of the first activity -interview group . Mrs . Gabriel was one of the first psychiatric social workers practice

to

group

therapy

. As

she reported

1939

in

,

she

had been holding office hours twice weekly in a neighbor hood center some distance from the guidance clinic with

brothers

;

informally with the children problems they also played

in

,

Mrs Gabriel

visitors

time

from

held

time She talked

about their home and school games

together

put

and

on

at

them

.

for

.

to

Reluctant

sometimes

the youngsters who were

the center

turn away her

impromptu meetings

consult her

to

sisters and

came

, .

also

of

Mothers

individual treatment

in

then

in

.

pointments

bringing

to

to

the

which she was affiliated . Her hours at center became drop generally known and children began without ap

,

,

.

puppet shows Eventually these gatherings were turned weekly meetings combining activity and inter therapy into views for seven boys and girls with serious emotional

.

movable wall sat in

a

Orthopsychiatry

1939

corner )

(

their activities She

Vol

The

manipulate

.pp

Mrs Gabriel

IX

Journal

for

helped

.

American

69 .

–

146

often

. .

to

allow more space

8 In

it

little group members

,

where they met had

,

room

of

The

a

.

problems

Introduction

42

,

to the

Group Setting

as unobtrusively as possible what joked went on . The children with her about her notes and occasionally helped her decipher them . In 1941, Dr. Lawson G . Lowrey , an outstanding figure

recording

child psychiatry , was commissioned by the Jewish

.

-

he

sampled

101 cases

,

the

cluded that good results had been

achieved

con

per cent

the cases

by

:

my

,

father

new

this

is

you are

group

'',

comments

the The

and infantilized children

.

frustrated

it

the extent that

clear that group therapy works

To

, ..

best for deprived

is

the past

It

a

.'

home The group does offer opportunity for the have those positive experiences which have been

in

to

missed

therapy

a

such

to

,

do

making

as

children

child

tenets

Lowrey stated been carried out recognize the similarity family

had

just like

the basic

. .

group

out that

Dr .

Pointing

of

.

of

After

the records for nineteen groups 70

study

Board

group therapy program

in

follow

-

a

and

up

a

of Guardians to assess making critical analysis

of of its

in

the room

“

of

substitute for the depriva

can adequately

."

a

is

,

of

,

tions free the frustrations and give opportunity for growth and maturation group the individual child therapy successful and economical procedure

1939

The

system

the

of

were treated

to

Dr .

by

Center

therapy

the guidance

in

treated

earliest parent groups

Brooklyn Child Guidance

community

at

The

children

in

.

clinics

enter

.

groups were parents

of

Among the first adults

,

of

American

.

-

.

,

.pp

)

(

.

's

,

.

See

.

their children 90

progress

of

therapeutic

Dr Lowrey unpublished survey Orthopsychiatry Vol XIII 1943 648

the late of

From

Journal

the

-

to

on

In

of

interfering with

.

,

,

therapy developed John Levy which combined analytic and educational techniques was employed embarking parents the objective the treatment prevent them the child guidance clinics was from

The Third Psychiatric Revolution

43

Treatment designed specifically to help parents form more understanding relationships with their youngsters has de veloped

over the years

into

the

so

- called

" child -centered

of parents .” ? This form of consultation has been rather widely employed for parents whose chil guidance

epilepsy

or

schizophrenia

or

,

example

problem

.

—

,

organic illness cerebral palsy

of emotional

the same type

from

,

suffer

dren

for

group

-

the child guidance centers often

of

at

the groups

in

Parents

group therapists

This

,

the children

,

,

however

it

treatment

Gen

the start

.

at

into clients themselves often unwillingly erally

the practice

in

some

of

who turned parents

was

the Brooklyn Child Guidance Center

, of

at

.

to

their own unconscious conflicts

of

a

as

of

,

evolved treatment goals their own sometimes volun tarily and sometimes result the more direct approach

was found that mothers and fathers who in

of

to

recog insisted that their children were the problem came effecting some change nize the desirability their own

of

.

personalities

by

indeed when one compares

it

in

group therapy The steady but slow development settings seems placid both institutional and community the emergency

with

om boom

of

,

,

and less expensive than individual treatment dash use during the war and the extravagant

its

.

it

as

to

,

.

II

initiated World War This was what brought the new treatment method the knowledge the expedient general public But while the layman hailed paradoxically

rather

slap

claimsmade

"

it

,

Dr Ernest Harms ).

;

-

in

in

“

rather big boats

of

,

”

wrote

sailing

.

.

science

:

.

R

therapists are

Child Centered Group Guidance International Universities Press 1958

Slavson

York

:

New

of

Group

the waves 1S .

on

.”

medicine

(

,

in

to

it

for some quarters made group treatment unpalatable many practitioners Ironically they labeled wonder 1945

Parents

Introduction to the Group Setting

during and immediately

took more than

this public

psychotherapy

and

firmer

a

group

a

espousal

after the war emergency

of

build the structure

. It

Child

to

The Nervous

retrace the steps that

to

on

decade

to

the journal

in

led

44

.

foundation

's

the army

.

.

to

director

of

.

,

Menninger

C

William

as

.

C

its

.

of

on

group psychotherapy The use both the war and officially home fronts was sanctioned General George army psychiatrists Dr Marshall recommended use psychiatric to

of

a

A

to

as

as

its

on

in

cil

.

,

circulated

on

military group procedures manual meeting establishments the National Research Coun applications gave fur group therapy and 1944 impetus for well such treatment for civilians ther service

running

into

,

inspirational talks

;

it .

help

2

feelings proved and group

exhortation

analytically

There was also was patterned in

hyp

oriented

after methods which psychiatrists

Foulkes and other British

with impressive results

classes

,

-

,

re

of

Some

were

the patients themselves

.

by

,

. .

H

. S .

veloped

education

employed

nosis were treatment

,

”

“

.

Explanation

Dr

some conducted

sessions for the ventilation

Lecture

films for groups

and

the hundreds were common

and discussions

ful

classes

of

,

courses

Gripe

one individual

than

.”

more

so

mental health

,

of

"

to

,

To

.

in

military service the United States War Department group psycho improve the therapy was any procedure which tends

those

had

de

their military treatment

.

centers

in

an

of

of

caseload

one third

whom

estimated were

,

psychiatric grounds 1944

dis

mili

.p 7 .

103

),

No

(

Technical Bulletin

.

than

active service

Department

.

War

from

With

.

,

?

charged

more

,

900 000 patients

on

.

various war theaters

a

of

of

psychiatric Efficient management and rehabilitation casualties were major goals the group therapists the

The Third Psychiatric Revolution tary psychiatrists had

handle

to

treated

casualties as rapidly

these

too , that the men be close to the combat zone as possible . Admittedly ,

possible . Experience

as

45

as

,

dictated

ther

group therapy was recommended because not enough apists were available to give individual treatment . "

of

discussion

A

the relative

group psychotherapy G

.

N

.

Raines and

Hospital

in

the

in

Dr.

L

individual and is absurd ,” wrote Dr.

value

Navy

. C . Kolb

the Norfolk Naval

from

an article published in

a

of

journal

psychiatric

in

1944 . Military organizations which worked , played , lived , and fought as a group had no other choice than to be

group . The magnitude of the

treated

in a

confronting the psychiatrist

task

it was suggested in a postwar report by Dr. Robert E . Peck . In 1943 he was one and his inadequate preparation

of

psychiatrists

three staff

chiatric patients

in an

chotherapy largely

treating

Africa.

the choice was simple : group

or no psychotherapy . The former was

because

psy

hundred

seven

army general hospital in North

cases ,

For most of the

for

the soldiers

to benefit

seemed

psy

selected

their

from

own bull sessions in the wards .

"My previous experience with group therapy consisted only in an interest in it while attached to a state hospital,” Peck wrote . “ At that time I had surveyed the literature a few

ing psychotics . This seemed

of

I

extant .

techniques then

months ' practical experience with

it in

treat job

also had

of the various

very little help in the

I

and had some idea

*

.

the combat

,

1951

)

. 1 ,

Vol

(

of

all

Psychotherapy

,

In

.

of

Group

in

of

was characteristic

International Journal

.

.

P

8

This experience

365

he

, .”

North Africa on

he

in

Although the first groups were reported getting better results unsatisfactory ventures Italy when carried the same kind treatment faced

Introduction

of

learned how

treating

them

and

process

tested

,

as

,

,

,

and other

groups while

improvised

patients suffering from states hysteria concussion

exchanged techniques out fatigue battle acute anxiety headaches

to treat

They

Group Setting

,

in

psychotherapists

to the

disturbances

streamed

into

the base

for evacuees from combat zones spoke

1943

and often with

intense

feeling about

,

a

After hearing

others talk with the group

occasional interpretations men discuss harrowing experiences

leader making

to

,

.

so

to

.

in

They were their experiences foxhole and jungle couraged talk after few sessions but not forced

to

in

simple language

en

the South Pacific and Mediterranean

do

in

of

.

hospitals from the battle fronts groups formed Members

,

,

.

areas

the

46

a

of

his

of

to

a

up

of

.

to

in

,

who had been unable individual interviews be gan disclose their turmoil and fears The airing succession similar and yet dramatically different prob pattern lems built common experience which enabled each participant view own difficulties more

.

objectively

,

also

gained

, of

insight into the main his

Not infrequently he springs

.

,

he

a

as

.

the current disturbance One soldier recalled schoolboy about fighting other boys His acute worry that had showed cowardice under fire was timidity

when two other group members disclosed their neighborhood bullies own childhood fears cite an To

his

a

soldier who had collapsed after seeing

his

die

,

other example

.

of

relieved

,

also

.

treatment

available

,

was

group

both

in

the military installations time and money emerged

,

experience accumulated

in

.

favorite cousin

other values besides the saving from

,

he

in

-

an

As his

-

as

of

group how buddies one bloody engagement told eight year old had witnessed the accidental death

Where individual forms were

used

psychotherapy

with

greater

The Third Psychiatric Revolution

,

and comparative

Some psychiatric

individual treatment

evaluations were possible .

who

casualties did

discrimination

47

O not responded

had

to

groups

the reverse was group behavior and attitudes provide guide sessions was found more reliable diagnosis and the screening out persons unfit for military duty than the impression single observer Group treat

;

in

better

this

to

.

men

returned

.

military

to

ill

Among the most seriously

duty

non combat

to

men transferred

,

rehabilitation

social adjustment and the

eased

-

agreed

also

,

was

of

,

ment

it

a

of

of a

to

study

in

of

The

.

also true

of

.

a

as

,

,

military hospitals

the Veterans Administration

group

.

Dr Florence Powder

Frank

.

civilian

life many

,

Jerome

.

Dr

their return

to

On

by

,

extensive research

conducted D

maker and

has been

.

treatment

including

the hospitals in

Washington

a

instituted In

's

country

has been

on

.

therapy

, .C .

,

the

basis

Reed Hospital

in

regular of

related services

group

Walter

psychiatric

were

D

war

-

other

Since the war

in

in

casualties

groups

in

were treated

also

or

”

“

doing

a

in

,

in

in

hospitals country group therapy resulted marked improvement morale Merchant seamen suffer torpe ing from convoy fatigue the aftereffects

psychotherapists

.

in

or

in

military settings entered who had worked with groups private group practice became affiliated with similar hospitals and social agencies Pre treatment programs on

,

to

be

dictions that patients consulting private practitioners would group treatment proved unfounded hostile the

first report about 125

the

of

this form

of

notably

,

,

literature tell

on

Pratt

's

when

through 1939

and on

of

expansion

World War

,

, ,

method appeared

the professional

II

story

enormous impact ment From 1906

.

of

impressive

the growth

of

an

Statistics

on

.

whole

treat

his

class

papers were

48

Introduction

to the

Group Setting

.

During the next decade more than four times that number of items were added to the professional litera ture, including several books on theory and practice . As

published

the year 1959 drew

to

close , the bibliography

a

2,000

of

group

entries ,

contained more than the ma jority of papers being clinical reports hundreds group practitioners An estimated 200 reports now appear annually most them the professional journals the in

in

,

of

.

of

of

the

psychotherapy

.

field

of

of

Some the papers published are more distinguished for concepts than for their their enthusiasm and originality

admittedly

are

.

to

,

by

.

convey

to

example

describe

his colleagues

in

give

, it

it

.

comprehensible

to

be

difficult

than

is

a

communication

let

with

an

preoccupation his

of

the

of

ap

semantic difficulties

To

aggravated

the psychotherapist

terms which will

the numerous

intensity make for consid

finds clearly nature own activity procedure often easier for him

,

group

.

his intense

processes

is

,

This

of

,

Despite

.

,

proaches methods and levels erable confusion

the common many

that there are

there are practitioners individual psychotherapy too

techniques

concepts

of

One

.

theoretical

far apart

to

as in

the field

treat

explain difficult use methods which

respective

is

them

complaints

to

appear

be

their

,

similar

information

as

,

which

histories

case

on

” —

but little

is

“

relatively

In

numerous

many psychotherapists

Though

make

are

stories

success

process

ment

There

value

.

scientific

mostly

his

for

as

as

or

is

is

he

as

procedures

The average

therapist

regards

an

aesthetic living experience

his .

,

an to

patients

is

as a

as

he

.

of

alone the general public His subjective view own activity may range from the notion that dispensing scientifically exact organic therapy mathematics drug creating the impression that what his

- -- -

The Third Psychiatric

of

amalgam

-

- --

Revolution

scientific

49

elements, but

artistic

and

tends

to

which reflect his own approach and tempera ment . At one recent professional meeting , forty different definitions of psychotherapy were proposed . Our as yet stress those

incomplete

contribute

gence in therapeutic

factors which a great diver

encourages

also

.

activity

of the group setting has created

But the introduction

tower of babel. More

new

of many

understanding

mental illness

to

than

.

discussed in one recent textbook or are

have mentioned , there

- five

twenty

a

methods were

In addition

to

I

methods

,

others employing drama music

,

very

-

so

-

.

,

of

therapy

still

a

new

scientifically

—

of to

others

treatment

the erratic development

this a

valid form

development has scarcely

treatment whose systematic

all

in

,

some and

to

makeshift

to

is

view

conflicting approaches

and

of

inevitable

concepts and modes

in

The great diversity probably

as

,

as

,

-

,

,

,

,

drawings blackboards well called leaderless methods multiple psychotherapy the self help method round table therapy and hypnotherapy puppets

-

of

.

so

or

.

is

.

,

begun Nevertheless there are indications that the over picture becoming less complex Some the methods becoming already devised are outdated fast Some

.

small enough

the

other

are

each

key

from

the

change

.

83

57 –

.

pp

)

.;

of

,

;

to

—

therapist

New

(

and

of

all

interaction

patient

Group Psychotherapy Corsini Methods Book Company Inc 1957

J - .

:

twosome

sorts

of

the of .

Hill

York

unit

people

in

—

Raymond McGraw

tiniest

to

desirable personality

with

the future

Close study

*

of

the

interests

of

in

note

communicate

,

permit their members

Groups

.

as

group practice becomes stabilized

to

to

,

,

,

were employed for special purposes notably research Others like the lecture methods are now used only rarely outside the mental institutions and will continue decline

- --- -- - -

-

Introduction to the Group Setting

50

the foursome and larger aggregates conventionally therapy group has shed new

as a

lems; this knowledge in

light

behavioral prob

on

has greatly

turn

known

influenced

the

course of psychotherapy . Treatment based primarily

,

suggestion

,

repression

,

inspiration

,

coercion systems which

on

support

and

,

,

it

.

This means that

explanations which eventually

of

, , a

his

of

.

total organism The phenomenally

produce com functioning as

and integrated account

patient

each

a

giving

of

him

they analyze the behavior and statements prehensive

regard

concepts and procedures

their

in

the

of

divergence

out

appears that four

analytic approach

an

five employ less

private practice

in

ing

groups

of

given way to analytic reflect our growing understanding of unconscious processes . From the latest evidence available to me, covering psychiatrists treat has

of

in

in

is

,

.

of of

.

One

the cause

which govern the personality

and

as

The other brings the mind into many different engaging

.

more lifelike

matrix

It

it

laboratories penetrate

interacts with one other person

a

learn how is

to

-

and effect relationships

laboratory

makes direct observations to

especially

now

two excellent well equipped in

in

action

probably

.

these

is

the mind

in

,

in

of

,

England this country and more recently unparalleled healing the annals the arts The psychotherapist

few

to

.

,

its

in

of

.

Its

is

it

it

,

are

rapid

it

has

development group psycho many taken into new fields There settings where not used today few problems which growth many applied parts has not been the organized development world largely the wake therapy

in

an

,

,

The first laboratory

of

,

at

social situations

.

and generally

in

its

,

of

sharper focus apparatus relationships kinds and possesses valuable devices for scrutinizing simultaneous interactions home work

The Third Psychiatric Revolution course ,

is

analytic

51

; the

individual psychoanalytic therapy

group therapy

second is

.

There are about as many different points of view the second laboratory

as there

were about the first

tion or more ago . Some psychotherapists that the first laboratory others consider

are

a

of the

about

genera opinion

has been superseded by the second

the second

be

to

;

inferior substitute for

an

the first .

I disagree my

practice

with both

these points

, the needs of my

newer channels of activity but doning

of view . As I continue not only take me into prevent me from aban

patients also

of

the treatment settings created by the second and third psychiatric revolutions . Both seem to me to

either

be crucially needed

peutic laboratories

— as

which

well

will be

as the other

opened

in

psychothera

the future .

Part ·

II

THE ANALYTIC

TREATMENT PROCESS

[3]

The Phantom Figure of psycho

OMA beginning her third month WOMAN

YOUNG

A

analysis lodged

odd complaint the other day

an

leaving my office . “ Maybe

was

as she

shouldn t tell you this ,” Rose

'

I

, “ but I'm afraid something must be analysis . It 's giving me such a wonderful

far

so

,

suffer but

Maybe

.

very enjoyable

time Are you sure you

re

good

to

're

supposed

'

too

having

me correctly

you

you have been

treating

? ”

I'

m

feeling . People my sessions with

.

this

a

wrong with

say

began rather diffidently

,

about

per

therapeutic

me did

and they

as

of

to

agreeably

seem

benefited

affect

to

,

mused

an

I

,

,

favorably

I

people

good doctor and boot Something ?

pretty

sonality

to

a

so

.

to

This was pleasant think about during the brief interval before my next session Since Rose was making good prog myself pleasurably was ress not entitled think

from

my

my doorbell

.

of

self exaltation

-

But this mood

of

.

friendly manner

ended with

the

sound

The patient who followed Rose would

The Analytic

56

Treatment Process

certainly not echo her sentiments . Quite the contrary . For many months Hector had bemoaned every hour spent with 11 . Admittedly , these “ visits to hell ” were leading to a me

marked improvement

his relations with his family and business associates and in his physical health , too . The no longer

certain was incurable

he

of

he had been

him

asthma which

in

at

.

a

?

to

.

.

am

I

.

not

of

do am

is

. I

of

it

;

-

,

little

respond

is

it

,

,

his

of

,

me

early

his

his mind

,

in

transfers

which were patterned

the

to

he

regarded

in

and

as

me

;

to

of

past and present

represent the images which exist

I

.

strivings

producing that identity he

In

.

in

he

relationships

characteristic

identity between

his life the course involuntarily comes regard significant figures his childhood feelings and attitudes

that occurs

instrument

of

produce

an

mind

as

functioning

the

talk about everything the

of

's

freedom

my way to

his

of

really They

the professional nature under way until

this gets

once

treatment dramatically intensify situations

?

for to

to

as

presence and

inspires

Rose

talking about me is

to

I

am

patients

to

to to

my

my

the

.

to

him

which

esteem

that the person

any

robs me

also

terminate

patient and

of

self

remind myself

our relationship

A

being but

I

of to

them

admit

realistically

to

that

me

sense

significance

about

so

an

me

exaggerated

forced

contradictory

this apparent paradox really not the tormentor that

simple explanation

,

It

answer

accuses

Neither

seems

well the equally patients which other refer him

reassures

Hector

benign one patient entering his office And the next one

to

There

torturer

who

of of

in

terms

,

.

can

analyst

malignant he

so

appear how

can

vel and over again that me over

Yet he had told

slave driver and

How

is a

a

I

was

and mind

of

body

of

”

as

“

;

had been whose existence the cancer bothered gnawing just stopped away certain had the vitals his

Figure

The Phantom

I reawaken the images Hass..

emotions which surround these mental

and

Man 's inborn capacity

one person with im important

another

discoveries

to associate feelings developed

. He called

of Rose and Hector indicate

The attitudes

for

of Freud 's most it transference .

person was one

trans

how

ference operates in individual analytic treatment . Rose was not exposed to an inordinate amount of frustration during the first

of her

years

few

. Her relations

life

parents were relaxed and gratifying in some respects . Having been steam ” in their presence , she did

during

taneity

her

to

—

with

both

too much

so

,

to “ blow off with the utmost spon

permitted so

her sessions whenever the recall

some

of

distasteful experience aroused her anger . After one of her brief explosive outbursts , she felt free to enjoy the rest of the session . For Hector , on the other hand , emotional and

had

condi

early

developed

the

During As

he

bouts with frustration

,

.

feelings

stewing

.”

the child

. it

,

The spontaneous reactivation

un

postpone

or

do

not

is is

to

capacity

toto

.

of

,

of

's

increase the patient

his wishes

.

of

to .

to

,

,

1 In

in

defeat but

tion

my

emotional attitudes during analysis usually leads gratification other words ods my withholding When used withhprocess process frustration reference the treatment denotes delayed disappoint frust not gratification The objective the analyst

,

healthy

of

,

.

-

conflicts

because

grips with

of

deep rooted

tactical use uncovering and coming

and makes

some

psycho

it

the process

eases

but the analytic to

it

therapist fosters

relations

me

to

,

human

of

in

extent

all

or

hood experiences were reawakened and directed Detected undetected transference operates

to

,

the sessions the negative feelings generated

by

1

by

“

habit

in

of

his own juice memories my frustrating these situations were kindled attitude

unhealthy

of

to

to

him

tioned prolonged

in

give vent

his parents had not

his

was an ordeal because

release

gratifica

The Analytic Treatment Process

58

the actual or symbolic recall of long -forgotten events which were significantly linked with these

to

or relationships

dis

to

,

of

in

as

.

him

.

a

the trans to

in

to

respond

the analyst rarely emerges IC his own right

repetition

the emotional it to

in

pa

the

gradually becomes better adjusted of

he

impressions

an

of

.

.

* 6 '

in

,

patient

to

.

,

phantom

transference relationship will bring lasting changes for the better the

mental life As

reality

maintain

feelings toward himself and

the compulsive

the

,

's

tient

and lead

his

,

end

in

disorder

To

into

whatever parts fall life drama Working consistently

totally distinct personality

Hopefully

facilitate

.

the

the inner needs

of of

as to

enactment

of

,

in

to

secure the flow

a

the

his

he

submerges himself

re -

,

ference

to

and intangible

chameleonic

,

of

"

will

behavior

This dual role transforms the analyst figure

their

modify trou

blesome feelings and develop new ones which

more desirable patterns

pro

more persons

he serves to

deconditioning agent helping the patient

the

the conflict

the central

or

as

,

Later

on

one

the guise

original history

.

,

's

in

edition

new

the analyst emerges

appearing first

the patient

this

analyzed and resolved

of

.

,

called

By

.”

that they may

it

as

tagonist

be

so

print

treatment relationship Freud

of

these conflicts has reawakening feelings and transference helps revive these

,

“

out kindling memories turbances

blotting painful realities out

the original history

In

gone

in

usually

ways

of

consciousness

,

of

Since the mind

of

has

attitudes .

analyst become less and less

of

The phantom figure the transference slowly background recedes into the and the analyst stands revealed true identity

the group

the more obvious

.

the communications

In

One

of .

in

is

,

setting many changes take place ones the form and spirit

carried

in

process

on

this treatment

of

When

is

.

his

in

,

.

distorted

Figure

individual treatment the personal history flows autobiographical narrative . Feelings bound up

'

as in

the pa

in

transferred

the

Generally he does

.

a

,

a

at

time since the

treatment session

a

.

held throughout

therapy

group

,

of

same emotional tone

one image

than

a

himself into more is

not

fit

in

are

tient s images of childhood figures analyst sustained and consistent way

along

to

The Phantom

through

their spontaneous

The members more dynamically

relive their experiences interchanges

,

the

.

of

a

as

as

They can strike many well their memories covering different feeling tones during session whole through

,

of

the

in

the as

is

.

to

this role

a

,

my real

shady nook into sensory clues

to

emerging from

The greater abundance

of of

I

if

were

a

little heard

.

I

,

as

couch felt the midday sun

carry

encounter after serving for years presence behind the analytic

to -

and

seen

the functioning on

.

face group

face dimly

started

to

figure When

phantom

I

Another striking change

in

is

of

.

in

scale human emotions their fantasies Hence the group presentation close drama emotional conflicts

me encourage

, of

tients get

.

a

on

as

as

identity many additional well the presence profound have stimuli effect transference The more rounded and lifelike impressions which pa speculation

about

thoughts

and also about my personal life much earlier individual therapy On the other hand their im

,

,

.

in

and feelings than

my

pressions and also their fantasies about me are less sustained develop

each

charged

The

feelings

other mitigate the effects

of

emotionally

.

less

for

and

which

they

their feelings

transference

of

law

,

Indeed

does not operate independently

supply and demand

of

.

for me

for in

a

the

,

of

as

the

.

The group setting shatters monopoly which the therapist enjoys the individual only object relationship the investment available mental energy and thrusts him into highly competitive

the

The Analytic

60

. It

situation

is a

Treatment Process

buyer 's market which offers

a

of

wealth

offerings

emotional bonds with other patients as well as group the leader . For this reason , “ impulse buying ”

with

rather common

is

offerings

obscure

. As patients , even the

almost imperceptible

shop around among the more

of

inflection

mannerism

voice

a

off

touch

can

or an

startling

a

. One

unconscious involvement of this sort between a man and woman produced so many verbal explosions in the early sessions that one of their co-members love duet or

war?”

a

figure enjoys

market . Group

the transference tically take the attitude

investment

their therapist is the most profitable they

go

on

must

of

like

in

a

,

of

in

had

to

in

of

's

mother and boyhood quar

disclosures

recall similar

his

and

his

group

childhood

The two adult strangers

angry siblings

group gradually

, of

to

,

's

Jim

Jim

Jim

be ;

all

of

his own brother

tangled together

the same household

become aware that they talking about themselves throughout treatment a

Members

a

.

with

him

.

scraps

stimulated

and

person

treatment with

violent counterreaction

in

his

in

a

brother

”

“

induced

him

memories

rels with his younger brother

hostility

while mem

the sixth member my presence

times

early

involved

group who reminded

who kindled

one group

the fifth identified me with

fantasies

of

,

but became emotionally

to

reacted realistically

his

the group

man

custom

their own father another group

.

I

,

father

"

own mother

woman

woman

represented the kind

wanted the ideal

with

make . The

healer , they

at

to

fourth

his

To

can

in

.

to

as

,

of

both parents

”

.

ber

and

me their feelings for

kindled memories a

I

transferred

man

a

him

respected authority , the professional arily relate to their parents

Rather typically

characteris

members

that an emotional

a

on

position

favored

a

.

a

he

this

Is

, the phantom

,

:“

Naturally

in

asked them

his

emotional reaction

Figure

The Phantom

61

but that the therapist does not intend

give

to

any

them

information about himself . His impersonal attitude tends early to reawaken the feelings which they developed in

frustrating situations . When , on the other hand , he feeds ” them gratifying words or attitudes , they frequently the

isfied . Hence ,

figure

phantom

is

respond as they did when their infantile

were sat

cravings

both the

good parent

”

"

in

“

life

the

of

“

.”

and the bad parent

an

as

.

's

,

of

a

be

to

to

as

,

Accordingly therapist identical impressions omnipotent parental figure will cause one group member regard him prince heaven while another patient takes him the devil own helper The phantom figure

described

on

an

me me

at

have been

and

in

of

en

's

. be

,

assigned

are apt

to

I

group

dramas am

the group

the roles

a

,

I

unfinished

family

all

keep track reactions

grotesque

put into words during

many

of

ence transference

cravings

in

easy

off homosexual

touched

get infantile

fears in

play roles to

I

and forgotten

not

.

-

young man and

work

to

a

As

I

.

, ,

since

is

It

session

on

as a

,

some time fantasies images

a

a

young stop daydreaming When problems scrutiny woman sexual were under mixed group one her male treatment mates jealously lady killer The spotlight then focused for visioned me

.

gusted and had better

told dis

a

be

,

to

only treatment have been acting bored

's

I

later that

I

.

a

to

of

session

attack another and

third member

minutes

few

the course one patient

on

egging a

sabotaging

in

images

of

fleeting

numerous

of

antithetical attitudes are obscured

These accused

by

.”

a

mas

fury

:

a

,

,

man shouted You should haveworked for the Inquisition and

as a

one session

painless healing

in

of

.

“

ter

In

as

the group

in

of

a

woman

's

to

a

to

who seems have wonderful understanding one patient problems can appear another few minutes later evil genius controlling everything going

The Analytic

62

.

evanescent

Some of the patients

Treatment Process

assign

dif

me many

ferent roles in the course of treatment . Those who relate to me throughout as to their father or mother may transfer their feelings for the other parent to the group as a whole or distribute them among their co -members . A group mem

as

other

each

to

, ,

they

aunts

reincarna

uncles

and

,

even

,

and

charged with

of

,

cousins

often

"

to

of

.

,

to

siblings

,

,

the atmosphere

of

”

that parent are reawakened

brothers and other relatives Because the group configuration that the

sisters

the similarity

tions

for

patients relate

of

-

once related family

in

.

member consistently

More of

later

or

is

co

a

by

formed earlier

life

ber 's feelings for a parent at one stage of childhood may be transferred to the image of the therapist , while those

,

.

.

him

." of

how

patient will

,

a

In

.

some instances like the person toward

in

.

.

it to

After

-

children

,

behavior

as

taken

experience past situations members usually reactivate their own patterns

they

,

recognized

the resolu Though the feeling per

has been

able control some extent behave more realistically

treatment

behave

The

either

re

group

When

ever

feelings transferred step

to

begins

to

that

he

the speaker

, ,

sists

another member

understand

the transference reaction is

of

tion

he

",

the first

and verbalized

never

in is

of

origin

could

A

.

I

“

:

the

When

the brother

like

speaker added

the

just

sounded

of

a

in

woman

out torture me just like my sister one group told another man was told that to

re

You

'

“

.

grandparents

his feelings

whom

other

In

.

child

.

family parties a

,

conduct

Jane identified with herself

as

Jane about her gauche

group situations

at

,

in

,

.

were originally directed After ridiculing another woman as her group for several sessions Jane realized that she was identifying with her mother who had frequently taunted She

The Phantom

Figure

63

inexplicably shouted at a man in her group who reminded her of her father . Later on , the mystery was cleared up by her passing reference hearing

.

It is important for feelings

.

them

the fact that her father was hard of

to

during

group members

to develop

intense

the treatment sessions and to talk

functioning , which

cover the essential facts about their eventually

have to be conveyed

to

about

me un

Their reactions to me and to each other help them

in

therapeutic

a

way . Nevertheless, the study of transference reactions is a aspect of the treatment process . Throughout subordinate the sessions , I am primarily concerned with another phe nomenon . to

. “ What have

is our purpose ? ” reas our own reasons for being here ,"

member answered . “ I don 't think the group has Maybe it will develop one .” also

him

,

resolve

to

,

the same Words

to

,

his

the idea that

past experiences

and

currency au

words

my

patients

.

tell

I

"

,

so

say

hate and

,

“

and

.

I

,

are the only

indicate

help

to

communicate

and memories

thorized this transaction spontaneously and with feeling

Love

them

make

—

so

to

,

, for do

members

thoughts

is

his emotional

understand help him

educate the group member

responsibility feelings

chooses

.

his

main

always

his

is

I

gradually

to help

to

,

and

if

problems

experience

that the treatment

realizes

primarily

pass

.

fully

designed

The choice

a

at the beginning . Usually many hours

him

he

.

purpose

conscious purpose in , but this is un purpose has an unconscious

he

mind . He known to before

does come with

them

is

of

Each

a

another

.

We

his

session “

has

co

at

happen here ? ” asked one woman ,mystified the absence of any formal instructions during her first

What

his

“

spoken

64

The Analytic Treatment Process

When

group

a

functions is bound

sides transference

, which Freud

phenomenon

way , something be occur. The other striking this

in to

discovered

also

, is

resistance

.

Each patient develops unconscious resistances to what he has consciously agreed to do . However eager he is to get he

.

in

his

he

it

developed

.

young child

he

he

the group member knows that

talk freely about himself subjects which his own disclosures on

,

and expected

censor

be

as a

family living

although

personality

,

,

,

permitted to

depends

his resistances reflect the defenses

example

tends

on

he

,

circumvents

goes about

adjusting himself

For

time and money treatment various ways

to

in

;

structure

is

so

how

to

Precisely

he

to

do

problems and however much

his

over spends

,

He may

basically

similar

frus

and generates

inevitable

.

is

.

-

co

addition

presence and —

them

at

of

cations demanded

in

of

in

,

resistance

engaging consistently

In

.

therapist

the kind

the beginning

Patients are

of of

the group

the group

to to in to

.

at

times

coming late

,

understand

in

and

The development

of

some facts

butmuch more difficult

trating behavior each member manifests other resistant behavior his members incapable

up

.

is

at

Resistance

's

his resistances

all .

,

keep track

instance

group treatment to

and

of

not

individual

to

or

sessions

dam

his feelings

for

He shuts off

resist more crassly

also

guilt

and

by

,

fear

,

shame

.

about himself

,

in

, ,

barrassment

as

ordinary social groups such perverse taboo personal weaknesses and violent hatreds Em sex practices

would

communi treatment

;

it .

until they have successfully completed The early psy choanalysts generally discouraged resistant behavior they as

as

.

it

-

an

as

,

it

to

quickly possible through their overcome interpretations because prevented the patient from func tioning emotionally mature and well adjusted person tried

Figure

The Phantom A

significant

change has taken

place

of

the handling

in

resistances with the increasing recognition that they have a distinct social and personal value . Many patients need to resist talking about themselves in order to maintain their

of re

in

pain and fever alert us to the

ills

problems, just

their

to

of

the group . Moreover, the patterns sistant behavior they engage in give us many clues equilibrium

the many analytic therapists today regard : resist imitive forms primitive disguised resistances communica ecoV recovery tion rather than obstacles as

or

of

,

Consequently

.

to

as

as

.

body

be

in

to

.

I

is

to

my approach often help group members talking resist about themselves order find out why and That

.

in

so

,

to

treating

them

.

the

for results

this method anyone who

inefficient

is

,

never any pushing

functioning appears totally

in

have been

acquire

in

-

the more successful

Since there

they

frustration

I

,

and tolerance

to

,

command process

needs

these

that

their treatment

recognize and taught how The more self understanding self to

meet

frustration

these needs

They are then helped

.

to

.

sessions

of

dosages

will refeel and manifest

is

they

them

of

needs and expose

to

I

in

to

how they permit themselves swerved from their task join them their defenses against uncovering their basic

?

find out the

reason

for

it .

to

while trying

I

-

,

co

of

a

is

:

-

his silence

in

to

him

on

.

of

not aware the total treatment plan Group members going They call attention often wonder What here support the non participation member and

talk

she attempted

to

her

;

that the other patients wanted

to

to

it

preserve her emo One woman who found difficult integrity during group tional her first few sessions realized

that her

embarrassment

about

I

,

to

,

to

.

I

;

explain her silence praised her for making the attempt help her continue then resist talking assured her revealing

intimate

details

The Analytic Treatment Process

66

of her

life was natural. Resistant behavior often meets with and

mild commendation

while

its

understanding

causes are

correction

behavior and hampered

of

patterns

the development

of

to

of

.

I

to

is

of

my behavior myself directly concern address the emotional tendencies which have led the formation undesirable

primary

or

The improvement

not

.

being investigated

to

work well together to

me and

raw material for analysis

.

are also

How

quietly

to

feelings

to

.

members

-

co

his

in

.

factors which prevent

the treatment process The feelings which each patient transfers

of

part

dramatically

is

Learning

.

good group functioning

show

to as

,

,

The individual problems which the interchanges are approached

up

of

he

of

is

,

.

to

good func more desirable ones When the impediments tioning are cleared away the group member helped trace the origins his troublesome behavior and become conducting himself the way capable wishes

.

there

I

other resistances

.

the same way

as

with

are dealt

in

-

,

ever these are studied and allowed develop until they interfere with self revelation Then they

forms

are quick

than

of

to

of

as

of

in

analyzing

group treat The first phase individual treatment be point out inappropriate attitudes that

of

much easier

cause they and

feelings

great deal

.

catalyzing

me

assist

a

members

of

well ment

is as

Group

to

communication

.

all

as

of

fore conceive the whole treatment process one helping group members resolve free the obstacles

resistant behavior which

they

themselves of

,

Consequently

I

follow

the flow

of

tension

,

irritation

or

states

of

's

.

to

or

the

a

.

't

engage

in

rapid alleviation their symptoms usually takes place during first four five investigate months As they slowly acquire the ability problems without developing undesirable each other don

the

com

EASY S3 The

TERRI

SSAN

Figure

Phantom

67

munications but intervene only rarely . Later

my

on

task

is

much harder , especially in the final phase of treatment, on when the patients are apt to confront me with common

me as

attitudes and to defy

to handle rely

then

than

process .

analytic

solely

on

unit. They are more difficult they individually opposed the

a

when

I have

less assistance from eso

,

them

my own resources to resolve

and must

the group

which they present .

problem

My

general

ment is

policy

focus first

to

01 individual and group treat

in both

on clearing

away the obstacles

verbal discharge of feelings of hostility , develop

of

the ability to get anger out

on , barriers

their systems . Later

of

to the verbal expression

the

to

that patients will

so

affection

receive

high priority .

various ways

emotional

severe

indivi

disorders

. As

,

excessive

and often later

or

,

I

as

during their formative years

,

,

patients checked concealed they talked about themselves

buried their feelings got the impression that they had been exposed

frustration

the

as

or

I studied

of

cases

in

the

the

dual treatment of

out of my experience

to

This policy developed

too

that the patients thirsted

up

apart

or

to

of

release

in

how

giving

receiving

language

the

feel free

do

every not emerge generally hate me has in

this sort

to

problems

getting patients

of

.

disintegrating

Although

,

incapable

and

hostility which made them feel that they were split

to

, -

pent

or

until

they had learned

to

.

for love but were

the family

in in

observed

tensely

it

.

became psychologically

digestible

case

by up to

feelings

do

these

I

of

until

,

children are often taught

,

as

society

—

rage

—

by

to

to

for

.

,

well Their needs may have been exceptional within nor mal limits but difficult their parents understand The patients also appeared have responded undue frustra bottling developing patterns tion resentment and

The Analytic Treatment Process

68

be more important than getting them to feel free to love me. In group treatment , moreover , they are more capable of serving as “ loving healers ” to each other after they have discharged much of their hostility to the phantom proved

. most the interpret too

As one

its

,

on

,

to

of

grab

to

so

so

of

she

is

all

,

and why

to let

to

,

“

:

talking

willing

impede free

deals with the various factors which

undue

to

without exposing group members

communication

spontaneous drift about themselves ward emotional evolution takes place was this general man approach through which the man whose story follows achieved basic changes

on

.

it

He

settle down

.

three

-

thirty

as a

strong need

of

inability

for

.

the age

in

requested

to

at

his

of

indicated

He

normal simple male

in

to

us

it

's

of

functioning amazingly detached way Bart develop individual sessions made difficult for

an his

."

“

especially

Bart

a

dividual psychotherapy he entered treatment

as

him

and

shall refer

when

complained

under the influence

actor whose name was rather well known to

an

.

Broadway

his personality

group process and transference

I

of analytic He was

in

IS

It

.

a

,

talk

to

pressure

one woman

brought the situation their Why are willing you

to

oblige you

the

Hannah

members became irritated but

the tendency

the stage

asking

other during

? ”

attention

each

I

of

do by

the center

to

.

no

voiced

objection

you are hating

of

“

I .

,

it ”

a

as to

hide

going

told one group repeatedly

early sessions When

all

in

its

whole

All in

of

.

in

as

possible members engage As much other patterns behavior relation what and trying

the

of

patterns of resistant behavior which

the group

sub

and

to

phenomena

possible on the group

as

, making many interpretations of

I

group

much

as

is

concentrate

or

I

all

figure

to

Figure

Phantom

69

effective working relationship

and for me to give him

. Though

he

of

the

objec

his

-

he

, -

.

twelve year old sister child had hardly

a

suddenly

an

.

,

.

be

As

his life just

as

of

out

he to

accident had taken

automobile

,

tragic events childhood their beyond seemed recall His mother had killed herself when was three Four years later him

tively reviewed impact upon

the

experience which he needed

emotional

his

The

's

,

.

of

on

a

,

known his father construction engineer whose work kept him abroad and the move most the time Over years the since his wife death the father had maintained relations with women wherever his duties took

clandestine

usually

.

on

.

he

to

for

who

,

in

be

intense nostalgia

to

be

himself

as

has the

faces and

new

for

.

he

that the role kindled less and less seemed unable shed Women he

.

it

to

but

had lost his

he

him

who

the gay deceiver

he

recognized in

.

always

of

He spoke He

For the man who his mother very early life

captured

connected with his yearning had never really known

seemed

the mother

excitement

Bart

's

charm

experiences

gaiety

from

the chase after the

the elusive and unknown woman

,

greatest

.

it

is

prize allowed herself was suddenly separated

hail and

the more ardently

zest went out to

all

but

;

them

With

and off for attractive café society The more

. of

the theater

they appeared

unattainable pursued

of

young women

be ,

farewell

turned his feelings

or

he

's

love life was not unlike his father

,

a

's

Bart

a

.

him

he

.

a

-

.

do

chasing

My

rainbows

met any woman

I'

still

worse

d

,

,

haven

I

as

I

I

believe world

.

my make

-

in

,

thirties are going fast and here

am

looks

't

it

me but

, “

told

,

”

he

“

guy

.

to

if

will

in

to

,

more than could give maintained That was why marriage did not appeal him even though family had expected settle down middle age with My father will leave behind him only me this mixed up asked

The Analytic

70 spend the rest

Treatment Process

of my life with and make the mother of my

children .”

The actor ' s mildly positive transference

become aware

his emotionality seemed

be

our

to

to

did

of his

feelingly

to

of

.

when

me produced

of

,

and

All

feelings

respond to

relationship

for

was hard

,

. It

him

of the vital emotional

memories

childhood

he

few

to

experiences

his

for

reserved

.

the theater

be

of

to

. on

to

a

he

.

had

.

as

he

saw

.

words words

no

about

talk

,

problem

,

impulses into words

want

to

't ”

head

“

,

in

had was

a

he

He

me

the group much

really didn

,

his

all

.

me

one

new

They met with

week

Bart functioned

alone with

.

a

office one afternoon

him

in

we decided

placed

go

a

,

I

.

a

in

group

with three other men and four women

to

of

he

;

to

;

be

In

. it

him

with his treatment in

my

good idea for him hope the that they would

discover his own identity

himself Since put need

facilitated

out

step

of

him

might

Initially

those

got the impression

other patients their emotionality more aware his own painful feelings

meet with other patients

when

.

on

I

.

be

of

.

He would

likely

Bart agreed with me that

my

not

feel that

to

.

of

more security

shoes and into the shoes

might make to

his own painful feelings

from

group his treatment might actually

this tendency

help

seemed

,

a

,

by

in

other people gave

that

of

a

off

fence himself

him

to

tendency

He

lying the couch He aping whomever was with

in

he

feelings sufficiently mobilize my chair instead was sitting had developed

did

why our partnership

explain

his

problems helped

to

's

his

with figuring out my responses

preoccupation

Bart

There a

,

in

of

.

at

in

be

it

's

a

2

of

Since the separation one life strand from the others group badly focused group picture closely woven fabric creates should borne mind that the problems these seven other patients were being dealt with the same time

be

too sane

trust with

on

m

I'

by

.

,

,

and

even

weep

on

gesticulate

about them

talk

absolutely necessary to

't

it

Was

superiority

The

and even more

they

,

shriek

?

by

,

as

.”

"

.

-

members

Bart had expected

said

couldn

excited

,

,

to

them

his

what they

Why

without getting

co

”

,

he

.

said

him

the way they asked

told

you work me him they did but not

WO women irritated

he

plan

better

it .

Work

selves

He was

immature

to

,

to

on let

“

I

have

going

the group was too

his life

story

a

the

Besides

of

.

happy

:

was only one thing wrong with

to

him

The Phantom Figure

as

?

to

for

of

His air he calmly chided them inappropriate behavior was not easy for them

occasion

of

of

.

For

in

be

to to

he

the

her

him

as

a

in

,

Strong willed

to

many

in

But

Bart

's

,

took violent exception

them

her

irresponsible

and

.

e

the actor described

insecure

of

up

,

Ann

about

when

flippant

Shir

and disputatious

of

to

a

-

of

to

her tendency

,

who was thirty two was called murderess because interrupt the others give her own ver

,

ley

them

helpful

withdrawn spinster

-

and

remarks

perked as

,

-

terms

Shirley

emotionally

time one

thanked for saying that her ego was eggshell and Stella vivacious divorcée her

mid thirties such

his criticism

time trying was from

;

as

an

,

late forties

brittle

that an

Martha

,

example

,

women

recognized

though

of

rule

,

brutal objectivity

.

,

acceptable

the a

Nor was

as

.

stomach

-

at

,

.

,

a

was speaking

few in

too

constructive after

a

's

he

skin

as

he

to

realized

under Bart

up

he

regarded

,

.

sessions Before

creep

,

began

what it,

criticism

to

The angry reactions

."

it

't

“

:

I

to

.

to

:

”,

group

"

twenty eight the what they were saying Ann baby was coldly rebuked for the opposite reason She longed create life When she talked repetitiously get married and have about her desire child he told her won make and neither will you

sion

The Analytic Treatment Process

72

. The

fact that he was becoming emotionally the group give - and -take animated and agitated

me

expect is happening

listening you beginning feel like

session

feel naked

taunted

,

”

of

problems

Martha

gently

“

.

For

to

? ”

a

of

,

.

Another month

ma mounting

said Stella

patient you act surprisingly like you getting our fees share Are went by before Bart yielded the

feels like

assistant therapist

”

,

about time that you did a

, .

Yes Bart

it '

,

who

"

your

him

someone an

one

name

Then

s

“

.”

patient

here ” to

fifth

,

me

to

a

makes

't

to

during

said

speak

didn

.

Bart

I

the

“ Something

Just

.

him

“

in

.

tones

I'm

angry

involved

pressure

he

.

to

talk about himself Then he launched into his first significant disclosure with the statement that

length

.

an

about

actress named Pearl

.

talked

an

He

at

it

,

to

“

.”

was boiling mad Since the group had made him feel this way important decision help him make would have

She

“

. so

, “,

went

on

part

he

she got another

But there arrangement that this would end

,

soon

turn her out

to

have the heart

”

didn

clear understanding as

as

was

a

,

return

't

he

.

on

of

he

,

to

,

.

was young and beautiful She had been stranded between plays the previous summer when Bart help her out gave her the use his apartment while was abroad Finding her still unemployed visiting his father his

she stepped

.

,

'd

months ago

.”

what she said

six

,

least

is

at

't

.

into our affair with her eyes open Besides she had one unfortunate marriage and didn want another one That

to

wasn

sure

was trying

tie he up he

she

meet to

,

a

with more attractive woman but wanted her around any more and here

expect

't

didn

he

He

't

sure

.

Bart wasn

't

?

love her

.

in

;

to

.

But the situation had changed since then Pearl was after marry her she said she was him love with him Did

Figure

73

into

The Phantom

him

A

.

didn

.

as

and she

,

times

.

,

understand

't

disturbed

off the wrong way when he felt tender

him

him

and this made her

She

really

seem

.

hateful The first

him

definitely

seemed

at

,

In

fact she

triggered

't

of

so

of

life

for

him

up

nar Onai who would rush mar riage just because he had done much for her out the goodness very levelheaded his heart didn strike woman

-

-

-

,

do

you expect

view to

:

dim

us

What

“

he

asked

convey his

off

?

"

,

-

such goings

on

of

.

divorced wives and three children about this

old

anxieties centered about his two To

whose

do

business executive

forty five year

a

to

respond was Robert

. I

is

In

so

I

this

.

.

I

did

. 't If

;

to

.”

's

,

do

that

Probably you

easy

call her

a

of .“

here

me brawl

gets

to

of

another

.

That

the other horrible things

us ."

or

”

to

the handle

her the way you

,

mind

but that

; 's

my

,

driving me out

of

told her she

's

I' '

ve ve

called

explain something

the midst

in

are

Martha told psychotic confessed some

understand

“

“

a

I

?

try

him

you talk

When

she flies off

we

and there to

If

,

started

she

calmly

,

her very

be

I

wife would

"

get

,

't a

of

to

I

,

and

don

you

.

,

”

every knew after me but they don eye crowd around now the way they then marry Pearl may never married But what kind

twenties

me

ran

girlis

. it 's

of

I'm

so

"

Help me get the rack Bart pleaded wish having knew why much trouble ending affair Probably making complete break that the idea my Age beginning paralyzing tell against me

or

m

I'

.“

”

.

't

is

to

try

I it .

,

the simple truth Bart replied not mean malicious just show her how she really But she can take do

of

as

,

is

to

be

.”

,

of

it

.

you women That rubs me the wrong way just something about each one here Under the skin there you that remindsme Pearl Henry thought would hard for her not react

The Analytic Treatment Process

'

. An

his

Bart s general hostility to women

to

who

engineer

you think you

to

't

't

,

don

,

.

Anyway

be

." If

.

,

”

't

this stew

in

's

don

" 't I

by

,

Henry worried about own unpopularity with them himself was shocked Bart attitude think you only hate her said Shirley there wa something else between you two you wouldn wasn learn

could

,

”

in

'

Robert She

.

'd

go

'll

,

if

-

your

ruin

a

the same thing with the next woman

through

you find one who

,

in

this

.

wife In

them

.

of

all

feelings for

”

,

.

the women

no

of

this mess Forget

nice understanding

a

have

Bart

,

love with someone here Otherwise

.

falling

in

be

'll

time you

to

You sure developing warm

'd

. re

'

You

be

Pearl and think about marrying one group

right

absolutely

simple way out

of

Robert

is

cue

but there

a

,

“

my

's . “

That was told him

I

."

wants you

trouble

you married her

make terrible wife and you break off with her you

'd

if

.

miserable

she

if

“

.

as

But

children

be

“

sounds

You

if re

you

,

Whatever you decide

asserted

for

? ”

love her

d

'

,

to

an

my mind

is

m

at

a

love

,

know

”

lovable once you get

her

."

'll

'll

“

. .

I' .

to

a

-

at

A

I

you

to

woman

is

“

one woman here whom

No

and

",

so

it

he

in

“

'll 's

,

to

.

thirty nine still bachelor found easier talk about mental telepathy personality than about his and career problems saying That not contradicted Max All stranger that you fall love with You find least read

lawyer

,

, ”,

'll

do

to

's

he “

."

't

if

you don want Pearl lose her appeal for you you marry quickly better her keep you from making That unwise decision you opposite knows the said Max who was trying

Bart

date

them

you

pop

I

told

him

.

women

,

these

”

know

and

't

You can

never get

can

you

't ' ll

"

"

But

to

.

replied gloomily

into bed with

Figure

The Phantom them

You ' ll see

.

75

just once

them

week here

a

this office

in

.

That ' s just long enough for you to develop intense feelings

member

”

,

the group

a

t'

isn

" Too bad that Pearl

of

look for any other woman ,

for them . You won 't have to your problem will be solved ."

so

Henry She

him

snapped

.“

at

”,

Shirley

here

by

.”

.

There

's

“

.

Ann

said

,

second that

my prediction

”

“

I

can

want

marriage counselor

a

go to

I

"

don

her

't .

quipped

She was also encouraged

more

enough

than

competition

,

“

.

that she

of

demonstrate

to

looks and youthfulness liked understanding person was Bart

outclassed

an

Martha

in

, .”

here now

“

job

of ,

.

. to

a

to

she refused with

him

.

.

fit

of

a

,

He

had

.

here

that

of

me

accuses

her And

.

goading me

That

a

.

help

's

She to

tried

.”

,

I

when ask for help she insists downright mean woman for you

“

.

Bart exclaimed

for her because

ve on

wishes

I'

death

!”

“

a

? ”

us

they

'

crazy

re told

something

women

Is

.”

Stella sounded or he

Bart

you

the way you treat

that

project

.”

to

,

according

are

she

,

least

wishful thinking What female

and

My

find her dead

reminded

's

At

too

job

She died when

depression

construction

was home

from

your notion that ,

s

“

.

.

dead

It '

triumphant her

dead as

I'

“

m

returned home one day

on

,

he

when

the world

of to

jump around

replied

in

,

Killed herself the Philippines

.

in

father was off They quarreled

he

? ”

my mother

know

was only three

”

't .

I

“

I

didn

perhaps

,

His mother

someone

And

",

't

"

he

says that the women here remind him Pearl she stated but hasn said anything about Pearl reminding him

attraction

Stella

.

center

“

.”

Thanks very much

the

of

be .

that to

"

Thanks for saying always seemed pleased

All

The Analytic

76

that

's

“

So

of salt

life. I want plenty

why

to be a

goody

a

me mean ; - goody is not

call

to

real human being with plenty

pepper

.”

and

of

. Being

too kind

ve

my idea

I'm

says

waiting for someone

of

everyone

been

you

been hounding

me from

the start

",

I've

life

'

my

Treatment Process

. to

;

do to

am

,

I

he

.

I

so

the

in

going

on

is

.

deal

possible because

the unconscious problem

.

as

and inoffensively

directed

presented

. I

consciously

to

that they appear

being

work

existence which

always the important factor

on

literally

me

this permits

to

as

with this

is

which

the problem

con

thought

consciously

What

Bart

's

,

this case

to

my interventions

his

of

of

a

.

is

at

the moment

live

to

had been conditioned

couch

what they should

and the loveless and irresponsible

wanted

group

up

to

responding

dic

matter fact the current situation

with

concerned

Alict about the marriage which

he

As

mind about

patients

be

appear

process

in

I

which

even suggesting

analytic

he -

to

is

not primarily

help make control the conduct

to

,

persuading

contrary

to

tating

try

or

.

, I

't

don

him

was not trying

Pearl

be

I

.ing

an

in

I . ”

's

s

it

It '

I“

.

on

thought something was going Bart remarked here about time you cut out Max impression that functioned that session U prevent Bart from making unwise decision was mislead

from

talking

a

on

to

of ,

.

him

of

the emotional realities Other statements are for

the mental shackles which

freely

about

his

to

his

release

with

to of

is

he

a

alert therapeutic way

feelings

and

on

.

session

in

mind during that

was concerned with what was going

I

,

over

had both motives

in

I

.

interfere thoughts

to

mulated

in

situation

him

.

,

a

designed primarily

or

an

to

I

I

speak when want make emotional impact patient mobilize feelings help him unaware put them into words Some these interventions are

More

the group

Figure

The

Phantom

as a

whole . My statements

77

, though

nominally

to

addressed

Bart alone , also applied to the behavior of the others during the sessions . They , too , though to a lesser degree , were

I

,

In

.

and talk about their feelings this sense making group interpretation was As far Bart himself was concerned my motive was

of

his

,

as

a

.

recognize

of

all

either unaware that they were developing feelings of love for each other or were concealing these feelings in indif ference , contempt, or hatred . I wanted to stimulate them to

;

of

be

, in

un

force that him

his mind

;

from

stifled

his

who loved

woman or

to

insidious

down

him

explained

his

concealed with

that this was the emotional logic

of

.

woman was

He understood

was driven

They tied

and

eliminated

to

own love for hatred

a

was therefore someone

be

.

conscious struggle against love would trap him into domesticity

he

in

.

his feelings

was leading

an

life

as

he

of

to

the opposite direction the kind

he

.

accepted the idea that

A

had intellectually

by

he

to

In

to

of

.

entering treat more specific One conscious goals changing his way ment was become capable life marry and settle down wanted his individual sessions

in

a

did

his

in

to

of on

to

N

act

The process

itself lessen his tendency

to

would

into words

to

get those feelings them

tended mobilize feel objective that point was

them

My

individual ses

at

him

verbalizing

with

me

.

help

was not aware

of .

ings

the group more emo in

had responded

his interchanges

he

;

sions

than

the women to

tionally

he

Bart responded

to

.

he

as

behave

to

,

his irrational behavior but this understanding had not produced change the feelings which impelled him

.

so

to

on

in

I

of

.

,

explore them but even more vital was the need from many different points view the sessions interpretations The made focused specifically the two contrary impulses which were troublesome Bart them

The Analytic

.

had achieved

by

To

was threatened

his

Treatment Process

jaded Don Juan

he

to

go

behaving like equilibrium which

the uneasy

life

sensible

a

lead

a

to

impulse

impulse

on

His

78

upset

between

more amenable

a

be

his

dictates

the

by

”

,

and understanding

release

of

havior would

be “

If

.

verbal

to

combination

be

of

of

to

I

,

at

was striking the barrier which kept him talking about his impulse from continue his present way impulse irrational life this could tamed

those impulses

his

,

for instance

on

of

this

keep

to

easy

Bart

into her gestures and behavior

.

“

leaked

instead

of

of ,

,

In

one session

making

Her feelings were

conflict

rooted

since they

track

reactions him aware

transference

help

great deal

”

deeply

Stella

. of ' s

me

gave

a

The impact

in

of

.

reason

expressing her

con

by putting her words she demonstrated hands her ears and turning her back him when talked When voiced his anger she drew her hand across telling him her throat instead like cut your

he

to

d

I'

"

:

in

or

co -

not uncommon

,

resistance

is

as

of of

is

it

so

.

,

in

.”

about them behavior This pattern

of

feelings during the sessions treatment interferes with talking operative generally regarded non

throat The acting out daily life the course

engaged

to

,

of

.

he

to

it

,

in

tempt for Max

but

.

moment were often necessary

stimulated her

to

to

moment

the reminders

in

"

“

from

.

it

in

with unusual vehemence Reminders that she was acting out the various impulses stirring her

Stella

At

times

remember some significant

had developed

, ,

first

I

,

,

for

aroused her

me

at

her transference

her father

.

In

.

years old

him

.

she was

emotions detected the feelings

Her memories

eighteen

to

died when

deepest

and brother

she

who

sister

,

,

mother

of

or

In

of

.

in

her life relating certain painful impressions her childhood contempt Stella talked with indifference about her event

She talked

Figure

Phantom

79

about being his favorite child , and she same preferential position in my group “

.” Her inces

and approval , which

sant demands for attention

her new “ siblings , ” made herself

induced

it easy to how child within her own family

a

in

she had conducted

as

resentment

tried to secure the family

see

The

.

circle

2 on After maintaining this attitude toward me rather con

of

,

of

group activity first two months reactions me began fluctuate

all ,

.

to

transference

's

Stella

to

during the

sistently

on

to

as

as a

First her feelings for me father figure became perceptibly less intense Bart began reawaken certain a

in

.

,

other feelings she had developed for her father Later no took place while more decided shift her feelings for me

to

. or

sharply

fluctuate

their

parents and other persons they talk about the sessions He painted highly contradictory pic

of

.

mental images

the

,

with Pearl the actor demonstrated

group members

of

tendency

in

he

seesawed between

complete break

during

hotly debated issue marriage the alternatives

of

As

about marriage was

a

's

indecision

of

a

Bert

he

in

. At

a

thisbe

mistake

a

,

other times

seemed

leaving equally

refer

to

.

the group to

belonged

interpretations continued the

My

to

;

convinced that

he

;

individual treatment

had made

in

just

say that

at

would

he as

.

,

he

the

of

times

or

the young actress either she was wonderful she crazy continuing was His attitudes about member group veered sharply during period tures

the conflict

However was primarily going group concerned with what was inside that Why they feelings time and how did conceal love the rivalry which they stimulated each other Why and

,

relationship

I

.

these

of

me

focused

on

?

I

feelings gave

questions

the an such

as

involuntarily

to

they express these

they

?

did

in

.

how

swers

or

at

the

on

outside

.

about

The Analytic Treatment Process

of

get

why you

imagine

can

't

't

I

“

.”

rid

that Pearl was " wacky

him

proved

cited an incident which

her

,

, Bart

session

don

In one

”

80

to

said

.

Shirley

.

”

.

,

”

."

.

she

? ”

't

,

to

II

them

To

find out how

certain

that she was about

once remarked

as

,

I

of

responded

over with feelings and

who brimmed

.

to

you trouble aren feel somelove from you

surrendered herself

them

ice

d

woman

I'

a

,

frequently she was

in

“

You really are Anyway like “

But there they are and who wants

Stella was

Bart told her

? ”

'

"

my love

have wanted

“

“

Stella suggested

,

Love me instead Many women

for

her

realize that

it

, of

I

some time

to

by

.

as a

of

responsive block The absurdity this statement was immediately recognized the others but took had actually

meant the

.

reverse

.

or

angered many persons him

for

have crushed

anticipate hard Stella 0mm comments which would

.

to

responses were generally invigorated

by

Her

was frequently

She

thanked Bart

re

, ”

his

as

a

as

.

I

if

of his

a

of

,

to

.

to

.

of

“

it

;

as

being psychologically hearing had made her come alive again she ported later The substance relatively his remarks was unimportant her Because her deep craving for objective criticisms attention she responded they were the sentiments perceptive lover suspected way youngster that she had reacted the same when her saying that she impressed

dead

attention

from

him

.

kind

of 's

attitude impressed her

as

being hostile Perhaps any made her feel vital and worth

father

.

while

to

in

,

.

him

be

on

to

to

.

of

's

for

O

rejecting attitude seemed intensify her craving his love At the beginning one group session she said that she had come only with Her complete during difference what went that meeting told me Bart

Figure

81

her “

my

quiet and detached study of longer appropriate for Bart was

no

.

this love created

to

ment which

to

have

be

act out her impulses more than Bart would

transference

The overexcite her was provoking her

.

ever

resolved

Her

because

transference now

it

”

love

in

that

to

The Phantom

impeded

he

on

to

a

I

.

and unselfish

she

in

, .

him

The group

.

emotional benefit

the momentary

gratification

place during the next few

Stella

's

transformation

in

.

members

startling

A

Be

love affair

the lasting

for

not

,

its

of

one

into

a

to

to

a

of

the whole group

therapy

understand and help

for

experience was designed

was afraid

her outside my office

interfere with

were mature

would make real effort trying stead lure him of of

he

,

if

to

him

if

,

her love for

take her out

she suggested that

like her her that this would

reminded sides

refused

resistance came during Bart

dared

.

he

.

might get

he

a

date When

as

it

handling

begin

the following meeting Stella

saw

to

My cue

.

rather than helped her talk with real feeling

.

sessions

feelings for me took

The

figure

phantom

presence

in

a

. .

I I

it

to

an

to

which had revived her feelings for her father seemed entirely different role have been relegated her highly frustrating fantasies sensed that had become

from

to

her СОП comment

any said

her

"

,

to

about on

it

,

? ”

talking

talk

me sad Stella went my big bad mother

makes

”

.“

the use

of

's

what

impossible for her to

the group

It

it

that self

was practically

in

.

he

very hard say statement Max that found thing that afternoon Seconding the complaint she

a

clear

, to

The picture became by

.

Stella

on

of

by

to

.

as

as

it

if

to

wondered she now related she had her mother when she was unconsciously regarded stand ing between Stella and her father This hypothesis about her negative transference me during that phase eventually treatment was confirmed

but

The Analytic

82

Treatment Process

The embarrassed silences with which Bart met her pro fessions of love were

in

contrast with his increasingly

sharp

manner to the other women . I sensed that Stella ' s emotional involvement with him had introduced a disturb friendly

his relations with Pearl . Could she have

of an

he

leave

if

him

Bart 's report

in

ultimatum

continued

Pearl that

from

waver

created

she

would

of of

too ?

it

flurry

a

element

sensed

to

ing new

she

he

.

a

to

insane

his

by

.

of

of

announcing

.

,

”

,

woman

That

a

it

of

marrying Pearl but that would be Bart retorted

:

to a

in

wacky

.” .

me that

Told

by Martha

"

to

to

marry

Pearl

own accusa

days

few

Bart out

talk

.

to

catastrophe “

tried

not budge

he would Prove

married

a

The group

peak

's

or

that they were

's

,

brought the excitement be

he

tions

his own

had painted

defending her against

stubbornly

against another

reminder

each

the black pictures

to

After

angrily

he

He reacted

misgivings

of

woman

feel the need for some protection ?

sciously

a

of

to

.

it

clear that the prospect ment His attitude made marrying her had become less threatening his equilibrium complete break than the prospect Did uncon

the only

thing that

stop me from marrying her the

will

.

,

U

on

Since others could not pass judgment someone as unassailable whom they had never seen this position was

One week later Bert calmly informed the group that the

,

had taken place The women made only brief comment

braced

woman

by

,

”

a

.

marrying

given

up . ”.

to

disposed

't

but haven

I

,

The men were more favorably

“

Stella

said

spurned

,

been

you spite yourself

”

ve

don

I'

"

Now love

't . “

told

Martha

."

him

"

by

”

“

a

,

What disaster Ann murmured For years you spited yourself not marrying

you

for the

.

,

.

ceremony blow

the marriage

Figure

The Phantom

Henry congratulated you here to live with “

It

something

was

me toward it.”

speeded In

Bart and solemnly added :

more

negatively

.”

society

I

had

.

he answered

do ”

“

You

than one sense, this seemed to be true. The suggestible actor had been spurred on by the

of the group 's opposition . Besides , his own trans

intensity

exceptionally

reactions made Bart

ference

,

to

We taught

“

vulnerable to

.

the group situation

to

exciting

man

have

Nevertheless

the

the fact that

expressions

of

.

sessions

with

idea

them

love and that one

affair with

him

to

wanted

them

a

of

him

accepted

contact with

have any

,

.

the treatment

they bombarded

consciously

was dangerously

who habitually

succumbed with childish

on

outside

,

Besides was not supposed

to he

that

an

he

enough ”

him

for

The women in the group , he bluntly remarked on more than one occasion , were too old or not " wild and sexy

,

him

,

.

he

him

to

to

panic Bart told the group

he

.

,

a

the new

to

woman his horizon who wanted might somewhere The thought that gratification be denied sexual had once thrown into

weakness

make love

he

about his sexual desires made

gers

treatment

a

in

in

of

.

in

—

he

to

on

,

,

made this significant disclosure was talking about his travels abroad but unknowingly Bart was react ing what was going the group The requirement only talk and talk freely that the presence stran When

highly

's

to

love exposed in

to a

woman did

he

Stella

the group

know

and liked

veritable

panic

well

at

consider marrying

a

girl

In

did not know

preferring a

His

the women came

when

sensitivity

.

enough

to

whom

them

the danger he

him

to

understand

were weakened

of

these

to

but

.

,

tion

in

of

.

frustrating experience Objective criticism and the provok ing hostility were his unconscious defenses this situa

the

The Analytic Treatment Process

84

in this highly impulsive manner , finally mobilized himself to marry Pearl as a protec

thought of acting again

.

tion against the other woman

had

Bart

I

it

himself impetuously

so at

flinging

,

interpreted

for

As

I

him

.

,

He thought that this step would demonstrate that he mastered his irrational tendencies but did not agree with a

he

that juncture into situation which had avoided years was like jumping into the fire because the fry ing pan was too hot handle eventually Bart decided that there was rational way out a

It

.

it

, .

how

so

do

did

It

not

The

to

.

under

help him

the group sessions

,

in

he did

This

in

to

us

,

of

.

ever

Quite the contrary

as

was

with the matrimonial during reported

cope

and utilized

felt and acted

.

behave more appropriately

conflict between his emotions being good husband

and his reason made Bart capable

a

the

of

The resolution

old

help

to

.

followed

of

to

he

why

them

frequently

was investigated him

formation

how

which

the months which

and

to

to

advising

stress and strain

stand

resolve

him

,

ever

by

group helped

him

the marriage

made the working

though

problems more crucial than

his emotional him

of

out

success

a

make

course that appealed

he

to

the situation

:

of

a

.

to

many

speculations

countless

on

experience

,

is

While

.

rise

going

on

group treatment

-

,

retrospect to

gives

session

about the core

of ;

Nor

.

these

to

I

how close

their problems while

am

'

the emotional

feelings are developing

do

the members feelings for me and for each other

never know

I

but

of

origin

in

be

to

studied

after session

.

had ever played

To be fully understood has

and father more satisfying

husband

it

any other

than

roles

.

the

his marriage was assured because

a

found

The success of

.

did

he

he

None

of

to

to

It

.

and father also gave him the freedom embark any other course which might seem more desirable him

Phantom

I want

Figure

,

this might interfere with my spon by

to know

85

for

The

al had

to

.

completes

treatment

whom

to

or

he

and

of

him

to

be

,

Often will able recall what patients which reminded

or

his

another

-

me

or

they were transferred

treatment co

at

. of

.

can

me the same

tell the group what feelings were reawakened

one stage

was about

in

assemble his own emotional history

He can

of I

,

as

.

's

.

his behavior

influenced

The patient who successfully generally

When this history why each feel

puzzle

comprehend

to

a

it

it

child

easy

is

fit

assembled

into

all

-

as

fit

a

picture

ing developed and how

him

co

a

in

of

fully

,

is

pieces

in

a

to

It

these

it

group member

members which particular treatment situation Ultimately feelings neatly into his life history the separate

se sensed

way

the truth

together

our work

then becomes clear me why feelings the various for me and his

reconstructed

.

a

,

later

of

product

as

ways comes

case

,

.

In

or

it

may have whole nuclear problem from many minute elements either

be

.

up

a

it

making taneity and inhibit analytic activity purely intellectual process One sudden flash may light the

he

for

the women

compulsive

experience

from

search

the

recognized

face and the fresh Stella the the feelings which Bart and had reawakened

.

as

in

difference

of I

new new

of

,

had turned during

for

whom

his

that Stella symbolized

,

example

him

.

in

of

some member his own family revived memories significant events his life Bart eventually recognized for

father figures

I .

.

she had

her father

seven

or

which

eight

as

impressions

of

in

in

fitted her image her father when years she was three old The more erotic feelings which Bart aroused her during many sessions matched the her

have

I

to

,

from

this analysis

,

it

In

.

Bart started prevent her

of

her transference

already indicated when began ing about herself the course

to

The analysis

, of

.

years later

talk which

The Analytic

86

Treatment Process

during many sessions , we first in vestigated what it was about Bart which reminded Stella of her father. Memories of childhood situations in which he had censured her for misbehavior without betraying any proceeded

in

snatches

.

,

,

mental images her Through this analysis

process

,

real person

.

him

she

In

own disclosures about himself

aware

a

Bart

became

explored

as

gradually

also

's

supplemented

by

father and Bart were

Stella

. 's

differences between

of

Bart

of

to

The

of love she tended bluntly impersonal criticism

expression

an

to

regarded it as respond similarly

's

Having

his

emotion were reawakened by Bart 's objective criticism of her during the group sessions . She had been sexually stimu lated as a child by her father 's critical but attentive attitude .

the

be .

him

ended

.

about

As

they became genuinely

interested

in

,

to

he

;

,

some illusions were shattered she discovered that was not the lover she had imagined him Her atti friendly tude became more and realistic but her fantasies and helping each other their interaction group mobilized new feelings both them group explain When member able the salient facts

in

of

.

di

it

chrono

the group from

me

that

has

a

that indicates

trace he

,

ferent perspectives

to

it

in

,

about own emotional development logically and discuss intelligently

to

his

a

is

to in

the

,

understanding

good

in

.

of

himself Explanations which are spon taneous and create significant changes his behavior dem

understanding

the crucible

have been

transference

sit

of

all

to

of

relationships

.

.

personality

in

uations and human

of

his emotional disorder Feelings appropriate sorts

onstrate that the adverse effects have been corrected

fused into his

[4 ]

RESEARCH

psychoanalysis

in

my

analysis have sharpened

my own psycho of

YEARS OF

of and

Themes with Variations awareness the vast amount which people give about themselves without intending and sometimes without knowing that they Beyond the literalmeaning their words countless aspects

of

.

so

,

of

,

do

information

by

their inner life experiences can be discerned

the ana

.

lytically trained listener

them

no

its

.

of

loco

an

of

,

I

its

the size method

can

identity

.

studying their random behavior during their sessions tells me

don

These involuntary communications were identified

in

.

or

something about

animal

do

patients

Everything they

clues

more prevent

the physical condition the footprints great deal learn

't

my

examining do

about

and even

by

creature

without

than

depositing

the naturalist determines species

,

,

motion

by

as

Much

sand

emerging

from

no

a

move through

history

can

to

,

.

this personal

they

or

of ,

not

are

willingly divulge Nevertheless

,

themselves

light

in

this way which the speakers consciously aware would not

facts come

to

Many

the

The Analytic Treatment Process

88

. It

chapter as resistance patterns

last

was pointed

out that

pure analytic ore as conscious co - operative

for

not as communications; nevertheless , they often shed light on con flicts which a patient is not consciously aware of or cannot express in words . That is why everything he says and does

be

be

learn something

the

words

with

to

and other

.

,

his true feelings His gestures tone body language are also studied along

covers

,

,

voice

troublesome inner forces These are

up

he

which

statements

.

his defensive

from

effected

about these

“

I

desired changes can

the unconscious struggles and understood before the

”

to

which have

clues recognized

of

through

is sifted

.

these are

However the involuntary com munications which are most significant for my purpose are not perceived through my sensory apparatus They are the

.

.

,

with his aimless actions

behavior and the un controlled urges and impulses which are crucial for hu analytic man behavior the course treatment these psychic functioning are converted into vital statistics conscious

rational and emotionally

,

In

of

significant communi

,

,

of

.

so

—

the stored

—

of

patterns

emotions

.

cations

a

of

.

by

The group setting stimulates these involuntary messages because they are mobilized frustration When the basic urges which move the members therapy group are frus

trai

frustration which

party relationship

not subjected

IC

are inevitable

certain

the group

not

the

of

of

.

time and talking has d

is

at

.

with courteous listening This does mean talking any moment that the group member who is

paid

sharing

The privilege

for

be

to

attention

these

with other patients

is

The most obvious

of

.

situation

cur Be

.

two

to

the

e

types

those present

person treated individually

of

, a

sides

more intense emotional

in

rents than

create

is -

they naturally

in

,

trated

.

is

it

-

can

,

.

This

get

.

as

it

not

ashamed

his

I

fact that

to

to

in

is

,

am as

healthy balance

sounds

by the

stimulated

Varying degrees

others

be

co

his

patients that

he

-

and also the impression

of

the idea

,

of

of

”

.

oneman explained when questioned about silence laughter which followed reflected the novelty The roar

,

quiet

them

being frustrated frustrating

present and the situation

are

in

in

of

be

“

I

to is

and gratification

keep structured complicated

a

members very satisfying

times being silent certain respects and satisfying frustration

, . or are

CO - n

co

that

am

At

being gratified

89 his

and

Themes with Variations

I

,

to

.

of

of

Without know

get

.

attention

be

.

he

much but

,

so

do

colleagues should

ashamed

really envied

them

it .

for

able

talking

to

themselves

to

to

his

as

,

his

a

was unworthy

was always working the group elimi had eliminated himself An implied meaning

statement was that

for being

the truth He wanted talk soul who had convinced

timid

he

it,

he

ing

of of

him

was

he

,

but

himself that nate

he

that this was the opposite very much

,

.

to

a

of

saying that the speaker had found humorous way Actually really did not want though recognized talk

On the other

talking about oneself without any always group easy especially when reservations not just beginning function takes time break the shackles training life and social conventions After the attitude

is

a

to

from

the motions embarrassing

which they have

no

subjects

in

on

, .

topics and keeping feelings under control That members often start out with methodical labored ments

. of

his

damaging

real stake

why state

or

to

is

this dilemma while backing away

through

psycho

waste

is

too quickly may

be a

has

trouble exposing

bare himself means go

to

. of

,

self revelation

-

of

One way out

strip before strangers has been

so

person

logical nakedness Not time and money but

do to he to

into

,

trained

unbecoming a

is

that

it

.

of

.

to

It

is

,

,

hand

are

The Analytic Treatment Process

go

not ready to

. Some prepare mono

about spontaneously

talk

logues in advance or come

in

envelopes stuffed with

with

notes on their dreams . This is the kind compliance brated

for which

fiction

in

the good

. At times , a

of defiance Schweik

soldier

group seems

new

through

cele

is

full of soldier

Schweiks . group members resist meaningful

As

,

communication

their behavior reflects the patterns of adjustment which they developed early in life. By studying their characteristic

reactions to frustration , come to recognize how they were trained to behave by their parents . subject them to sorts they can stand and what

for they relive their infantile training seem

be

.

I

each other

,

me and

significant experiences which linked with their emotional problems of

get flashbacks

are easiest

to

As

behavior

to

.

kinds

their transferences

in

experiences

in

engage

to

them

all

I

find out how much frustration

of

stresses

to

psychological

to

of

I

a

in

,

by is

to

I

have

this single response

,

of

.

alone with me

other patients go

.

me Instead

all

a

is

relates

he

he

whereas when

patient behaves toward

to

the way

deal from way

the group also great can learn

I

an

The spontaneous emotional exchanges important communication have value

the

there II .

.

of

a

.

of

a

or

to

of

a

is

multiple interaction evoking responses wide range speaker stimu The presence several persons listening variety of mild lates intense reactions By comparing the

. refuses

Often

they

talk

about himself with real

attention

to

pay particular

are the key

to

.

actions

I

,

feeling

person

to

When

them

a

each

of

in

or

I

,

attitudes the silent members can usually sense the feel ings which the speaker subject the under discussion stirs

these

spontaneous

re

some significant life

a

of

in

.

experience which has not been divulged This happened the case woman

who spent her

Themes with Variations

four months

first

91

group therapy working against herself .

in

Her feeling that she was too superior to be helped by anyone butmyself made her a standout during that period. marked her

session

as a

the

She

Clara's behavior during the first

in

few

.

A

a

manner

deliber

the

schoolgirl presenting

a

and

composition

of

impersonal class

.

ate

,

sessions later she talked about her childhood

in

.

I

't

,

.

to

no

prac consistent objector . lost time objecting tical arrangements The hour was late and her chair was talking enough uncomfortable Besides wasn

1

,

to

of

to

The response this approach was not encouraging and contempt this seemed reinforce her original attitude real feeling

talk with

to

Besides refusing

of

.

for her colleagues

her

in

character

soap

a

reminded

in

They

a

.

themselves

of

,

about herself Clara made fun the two other women the group when they spoke with earnest simplicity about

's

,

.

in a

of

,

,

or

high school play While opera she said the ingénue she mowed down the women with such comments Clara

toward the three men was more friendly She they were attending chatted with them times dinner a

if

as

at

.

attitude

.

party

, .

of

twins

her

word

was

or

sweet

.”

't

he

“

because she

been

patients

said

,

every

that these

-

her reactions

that

co

.

.

It

say

The then

recall when

I

that

may have

except

She clung

I .

to

complained

this

don

to

In

me

her attitude

husband to

,

never mentioned marked contrast him

treatment

me the impression

gave

might include her

began suspecting

her into

and the mother

to

Clara

old

getting along

in

the difficulties

brought

college professor

to

I

why

"

people

a

of

years

“

wife ten

with people which had

I

nsti demonstrated

She often

was

and often

Someone pointed out her that she was bored with everything except what the a

Members

of

had

.say

”

boss

to

"

.

to

neglected her

therapy group usually start

The Analytic Treatment Process events

the group leader wears

company

other

each

in

and they become more interested

one

his "

.”

of

as a

siblings

unit meant

her self isolating

-

every facet

ties

it

I

explored

of

this end

,

To

in

,

threatened with the same fate one During that period preserving the group keeping Clara and strengthening her

to it .

by

psychologically killing himself off

from

prin or

on

a

of

the verge

on

.I

the

,

of

I

concentrated

of

concentrate

preventing Clara eliminating herself from group often apply this ciple family living when group member appears the child

their on

the parents

to

Just

as

.

's

is

in

danger

of

the life

that parents face when

emergency

of

attitude confronted me with the same kind

Clara

saving

off

to

.

their conspicuous deference

children

of

the normal sequence

in

's

this attitude , but

out with

is be

92

I

.

to

.

rebuff

each

In

it

to

deliberately ignored behavior and tried understand her demands for attention while investigating her reactions

individual treatment

help

the group

gave

to

,

In

.

be

dealt with

the

would not have had the

me

during

this exploratory

an

re

,

a

's

in

to

,

both

of

the women

to

to

in

her

,

than

more exquisitely differentiated learned more from her distinctive attitudes the to

I

.

actions men

as

me and

were stimulating

important source indirect was the extreme contrast Clara group the whole her group peers

addition to

to

responses

though

.

data

In

,

This help

analytic

of

.

which process

could best

though

,

,

to -

one relationship

one

I

oped this attitude and how

it

I

to

.

to

of

.

of

't

,

have been talking being unaware her either She would have accused me problems her and indifferent her needs Meanwhile figure out why she had devel would have been trying

I

wouldn

whom

she responded

,

I .

's

of

supercilious indifference with about the same degree While reviewing Clara behavior during that period

Themes with Variations

93

,

some explanation

can

this context requires

in

it

since

be

built up various working hypotheses about her conflicts . I did not know which , if any , would be correct. “ Correct ”

in

is

is of

to

That hypothesis

no

.

subscribe

opinion

,

In

.

the word constructive inner change

leads

the

in

it

correct unless

my

to

mean

I

is

which they happen

by

not what

to

psychotherapy

of

or

is

.

in

,

different ways For some analysts the cor conformity with hypothesis rect the one which Freudian theory the concepts some other school interpreted

,

I

to

's

of

indicate

from

her

random

examined these within

different

during the

frames

of

I

,

my

shall

behavior and other involuntary communications sessions

Clara

some

.

to

In

as

doubt but

;

still

of

are

the ultimate fate

under

Since

of

.

produce the desired change

about her

this woman

get the patient

one them was confirmed trying extract inner meanings

how

a

to

time

not yet terminated

speculations

hypothesis espe

unco operative

in

a

even longer

an

and

develop such

,

is

case

it

stand

takes

to

.

It

was

patient

as

long time

a

It

takes

cially when

is to

.

patient

refer

at

will

of

In

structure

me

this woman

understand why

to

,

other life patterns

impressions and other clues

and

devise

personality

she behaved

as

skeletal

which would enable

theory

,

upon

my

's

used

of

I

,

the kind

of

Drawing memories

a

. I

adult

me

.

an

as

child and

other patients and what they told looked back into my own life

also

as

experience with

about themselves

to

my

.

in

.

of

ence Accepted theories about the development the per sonality were one frame another were the fruits

how well

I

know

told her helped her

to

what

I

.

life

If

with her would

I

to

.

did

and why she could not have behaved otherwise Not until the time came share this conditional understanding she

had

reconstructed

her

recall the experiences

The Analytic

which had trained her present attitudes into her significant

changes

also

's

the

suggested

start

a

objections

Clara

at

of

The vigor

tolerate doing what she had consciously

to

basic inability

.

.

I

in

a

,

re ,

the

,

of

of

I

.

in

,

would know that my reconstruction was correct Certain types feelings therapeutic memories and behavior would signal living experiences only permanent the traumatic but change her behavior would prove that had actually Only problem solved the time would tell to

her behavior

led

Treatment Process and

94

I

.

to

in

do

joining the group wondered what early this conflict between her will and her emotions Could there have been some difficulty

agreed experience

Was

an

she perhaps

un

. two women

in

to

's

,

identifying with this attitude her reac point All could certain this was that in

at

of

be

I

them

the attitude

hostile and superior

she was

.

to

tions

Clara

as

her had been experienced

and that

the other

the impression that her mother

gained

by

I

,

group

her infancy to

which she had experienced From the way she related

in

of

?

an

least

,

at

or ,

unwanted daughter She seemed communicating be some attitude unconscious rejection

wanted child to

the family

in

about her presence

?

.

in

was reflected

they

did

on

to

I

of

.

Some

;

in

to

-

amused her

that

she

reminded her

an

,

in

.

,

critical but

businessman

being sweet natured

The witty remarks

late thirties

the men gave rise

advertising

of

,

rather

her

was satisfied that

phlegmatic

casually during one session

her husband his

relating

Bob

impressed

keep

the evidence

of Al , he

.

to

of

mentioned

I

.

distinctive ways

his forties

like this until

the weight

other speculations

man

it

or

;

by

would have

.

's

in

impression

was substantiated Clara

her family

, of a

it re -

evaluating

else

as

someone an

tude

to

to

in

she had experienced this same attitude early her life from perhaps so someone close her had been her own atti

them

were

not make her uncomfortable

with Variations

to

to

worthlessness

attention

re

She

in

of

thirty -five-year -

engineer who was usually too submerged pay much

.

old

real feeling

,a

feelings

what went

the

in

sponded indifferently at first to Fred

on

were not barbed with

they

because

95

his

Themes

I

,

in

My

in

for

's

a

.

into

,

know

him

.

to

"

him

.

I'm

real bitch And

going

.

one from now

of

.

I

told him

.

the most honest thing you ever said

”,

's

That

on is ” a

.“

as

treat her

Clara

criticism

biting emphasis

.

big trauma

quar

she had given him

of

it

of

a

Fred

“

was

exploded

with

the

She accused

particulars With

a “

bill

Clara

she

spiked

,

and asked questions that were Clara did not hide her irritation piecing together bits information

with

to

rel

to

.

Fred especially became interested sertion that the neighbor was wholly blame

distorted

defensive as

Clara

's

into

she was embroiled

which

neighbor

added that

may

.

inquire

to

to

My statement

help each other

them

dispute

a

to

reference

an

's

Early one session group that the members were not

in

a

real effort

have stimulated

Fred gave me

her mental state

the opinion

expressed

making

attitude

.

clue

to

A

important

Clara

in

change

sudden

to

.

sessions

I

do

To

.

at

choice that moment was between defending Clara praising and Fred the former when was not sure therapeutic

he

in

praise

to

a

,

Clara

had

even

ob

Besides

no

not directed

groove

,

the

. I

out

, .

my remark was

I

phonograph

her reading other meanings into This might hostility release some her which would be desirable

.

,

in

it

to

jection

then

that

had gone round

his own worthlessness like record and wanted commend

for finally getting

though

Until

of .

groove

my mind

at

him

the

,

defective

doubt

desirable for Fred

and round

in

be

would

there was

of

hand

,

other

no

.

it

be

be

for her would like muddying the finding water before out what was underneath On the would

The Analytic Treatment Process

96

But there was no counterattack . Clara remained grimly silent. The others present did not hide their surprise . Al asked her if she couldn 't think of something to say . She did

.

not answer

Bob

remarked

that Clara and Fred

reminded

infantile characters in a play he had just seen . Then the group moved on to another subject .

of two

him

Clara ' s failure to

development

back at Fred was

lash

. I thought

about it

a

illuminating

an

great deal, and compared

it with her customary reactions to the othermen . They gave her sweetness without feeling , and she found it acceptable . Fred had

on

ness ness and

she

this occasion given her feeling without sweet had promptly crumpled , suggesting that it

was extremely difficult for her to hold her own under attack . true, would help to explain her reluctance to invest her emotions in any group encounters , since these would This

, if

intensely hostile feelings . Although she welcomed sweetness without feeling from

sooner or later expose her

to

Bob , Clara continued to seek somemore significant response from me . She solicited my opinion on various

Al and

subjects

, and usually

without success . However

guarded comment which

of

the women

blond hair was invariably drawn her head As the speaker went

into to

the back

of

.

at

a

bun

and on

Her long

grooming

the

personal appearance

.

a

casual discussion

? ”

One

course

some other

asked her this question

in

'

it

don t you cut your hair , Clara, or

Why

way

fix

this case .

of

“

one.

prog

opened the door to further

of

ress in

, I made

if

I

severe

way

fixing

it .

less

.

her

I

figure out some

of

tried

to

ever

ask

to

a

,

make some suggestions for new hairdo Clara interrupted her what thought about hair asked she had

later her hair was cut short and arranged with

.

attractive simplicity

The striking change

her

week

in

A

.

That ended the discussion

appearance

Themes with Variations for

97

several sessions She

.

was the subject of group comment

.

,

to

I

,

,

on

there like mummy she went was how bored she was with the a

I

think

she could

of sat .

and

?

my money

earn

all

to

a

's

,

to

please me had cut her hair she said Clara irritation over my frustrating attitude became acu acute few weeks later Was ever going do anything

.

group

of

“

he

What Clara And under

“

“

.

them

added

.

the two

affection

and

,

is

care

The trouble was that there

of

.

real bond between real

.

.” ?

I

't

remarked

I

no

I

,

That was obvious needs

was trying very hard

realize that

"

.up

Al to

Didn

keep her entertained

was

You

Someone

you

should take care spoke

her

.

to

to

"

I

, ”

You are the most boring person here told give you some attention force me are trying

."

standing

give her some Clara asked She really

.

needed some attention

Because

.

,

I

't

didn

of

why

Then

me

she had cut her hair

.”

",

be

,

him

he

persists

",

if

in

to

says that

your

your new

problem

.”

he

and

the symbol

of

's

That

, .

in

'll

junky

.

the way you want

jewelry

is

your hair

to

can

't

you

lose you

this attitude You are conflict with your husband because yourself with him He objects your wearing

be .

I

interposed

he

him

Tell

“

“

.

.

,

much Clara continued her feel very guilty

in

Still she liked her husband very Talking about this way made

.

cheapened her appearance

,

.

, all

the damage

It

of

professor and that the new jewelry com junk was his opinion and

the wife pounded

a

be

to

.“

I

“

a

to

.

in

.

and bought herself some costume jewelry The upshot was that she was real trouble with her husband your Tell husband that you have right attractive investigated told her His objections ought He thought that her new hairdo was too undignified for

The Analytic Treatment Process

for

he

,

't

a

's

in

world

real killer

timeClara spoke hide her true feelings

, .

the first to

without trying

the

have

.”

that

For

.

,

us

and

“

,

A

. ." “

fight

accomplished my purpose

frankly

man who doesn

the sweetest guy —

a

is

I

,

man who never picks

to

told her

”

't

for anything all

to

ask

isn

't

“ to

that

for anything and

ask

I

a

And

Bob said

”

“

have

doesn

man wants

a

If

.

rarely asked her anything you always guess what

,

very sweet

he

. He was

Clara defended her husband

and

98

or

at

In

what she disclosed about her childhood that time my nothing disproved there was that either confirmed

well known

.

to

d

'

he

say

He was

husband had failed she deserved

much

.

.

This was the first time she had made

it

.

told her

is

"

of

times

.

so

hating self for being dissatisfied and your own Punishment for that kind hatred

her

death

, ”

him

She blamed at

her

.

hurt

by

sweet

for

He was much

be

.

her disappointment and anger about many things to

of

know

much

as

rather than have him

as

loved her

On the other

,

hand

he

him

die

't

But

loved

as

.

because she hadn

,

had related

to

she

to

.

Her

.

in

throw

could love anyone She would

she should

I

in

.

.“

became clear that

It

”

he the

if

us

about her husband

one critical situation after another

Clara continued

too

he as

,

this

his

when she was introduced

the two men somewhat similarly

her

understand

drowning

the university

her father

We used

group saw

greater length

.

by

instructor

took the time

at

an

She talked him

told

Greek

Clara admitted that their ties

at

a

line

of

us

,

children

she

“

My father never

once before

had been mentioned

terms but now were thin and disappointing

try

sympathetic

classical scholar who had been

to to

dead several years

Her

sensitive area

."

.

A

explored

with her mother another

to

to

her father pointed

to

about her relationship

he

be

references

; , -

speculations

possible

Themes with Variations

for me

99

with her my

to share

of her emotional

understanding

all

conflicts .

the

,

at

being discovered

,

of

I

,

-

.

fury

stood

of

,

Her deep sigh of relief was that could have wished being under laughter feelings sigh for The like tears and certain other

of

it oil .

of

as a

,

to

us

,

to s

'

of

I

.

a

It

to

is

of

one

is

—

most pleasing psychotherapist told me that was striking my interpretation made possible acceptance Clara having her stay home and for me tell her that instead functioning member die we wanted have her with emotions

responses which

eruptions

.

the group

,

soon

is

to

Clara was

out thoughts and

Janet poured

it

,

.

so

about herself

as

tell

all

determined

tell nothing However feelings conscientiously

as

was

to

as

.

a

to

it

,

to

as

as

Though group members rarely work vigorously give away any secrets Clara did not not uncommon hearing display special for them defect which requires equally patient handling One woman with this difficulty

became evident that she

deaf

to

was psychologically

She

the sound

of

.

could not hear the simple obvious things she was saying

her own

not

thera

.

to

,

,

in

-

re

.

She had married

aid

of

unhappy years later

man who pleased

Janet divorced him

please

her first analyst

.

,

few

thought this would

she

her social difficulties find the right people a

hard for her

to

a

she

a

;

her mother because

summed

as

it

was

leave the wrong

up

.

saying that to

who

divorcée

the ideal setting

hearing

gave Janet the kind

needed

She was

it

group

,

a

therapy

is

.

.

this purpose

in

to

of

for

It

easily

reverberate

as

They need

echo other voices and contexts what they have been saying Since thoughts and feelings

hear the echo and

by

them

persons with this difficulty

a

own words back

their

peutic approach

at

Shouting

is

.

voice

The Analytic Treatment Process

100

When the group began functioning , Janet was living with her mother and there was an intense relationship between

. How

much longer they would be together was un certain ; Janet reported that she was facing a painful deci sion . Her mother , who had suffered for years from a degen erative disease , was becoming too mentally deteriorated to

with

after session Janet brought this problem giving any evidence that she was moving any

,

with

situation

that

her

,

the

laying action

closer

the group tried

She would insist whenever

,

to

investigate

.

to

her decision

hospi

possible

up

soon

Session

out

that

be

Her physician recommended

.

talized

dur

be left alone in the apartment

.

as

the

ing

day

to

she

of herself or

take care

as

them

was de

she

, .

while

.

as

to

a

?

Much

the

,

Janet her unadulterated feel more

them

stopped

they

dearly

and more on

After

helpless

with

this theme made her a

of

other members repetition

one she loved

sympathized

so

that

,

could she

to

do

an

be

:

to

Sending her mother for only one reason sending cemetery How institution would like her

commenting

the

's

on

,

dress manufacturing concern

.

a

personnel director for she

was

a

.

.

no

,

a

,

in

of

.

air

in

it

on

situation and were left hanging Mary woman the same group who complained social maladjustment had rarely commented Janet con flict This attracted attention since Mary was still having difficulty talking about herself She had disclosed that she reports

of

in

She was obviously

.” a

in

no

's

m

place fast

my office one evening

state

under great pressure

to

.

of

Then Mary walked into excitement

getting

I'

.

Mary went

on “

”

,

my life

't

.

“

in

,

Admittedly was almost daily contact with many important people the world fashion and had traveled widely But don think there anything glamorous about

been

sitting

on

ve

know that

I'

suppose you

all

"

I .

talk

some

Themes with Variations

I

off .

“

started

have

But

talk

description

of

She launched into

a

.

it ”

.

my whole

to

before,” she life has just unfolded Now

I couldn 't tell you

thing that

about

101

her visit over the week

had moved

her family

twelve years

.

in

to

's

,

Her father who

of

had rarely been visited members trip first the institution

This was Mary

.

by

down

to

she

, .

a

-

to

end the state hospital about two hundred and fifty miles away where her mother had spent more than thirty five psychotic break years Since her commitment following

the West Coast many years

't

.

go

so

.

to

she insisted that her

.

was

rec She

know more because

,

,

I'd I

told

been

tried not

to

she had

guess

breakdown

and her

's

find out that mother

illness followed

."

a

“

:

I

was convinced

family pattern

explained

,

whatever

Mostly

Mary

them

I

of

ollection added

, 's

father tell her the true facts about her mother

She had never known

.

the hospital

dim

to

During their drive

,

to

them

do

,

ago was spending his vacation with her when they suddenly together She wasn sure what had prompted

decided

,

's

Weaving her own memories into her father story Mary departure from home for the Army when she was only seven She rarely saw him during the

by

.

's

told about her father

,

and wife lived together

strangers

.

,

.

,

and was dead within her mother

a

,

's

followed

three years her junior few

mental break as

.

soon

After that husband

's

infantile

days This was

paralysis

by

contracted

Mary brother

,

a

About

syphilis

,

from

as

found his wife suffering year later

.

a

,

.

,

an

.

few

years Her mother beset next loneliness and prac neighbor She tical problems drifted into affair with returning neglected her three children Their father home

.

,

,

down and when her illness was eventually diagnosed incurable by her commitment At the time she had taken

- -

The Analytic Treatment Process

102

her bed , Mary and her older sister were given to

.

disease

Mary

could recall having little feeling the time She had felt neglected both

,

.

by

her mother parents and the

at

mother had heart

under

for

to

Sla stand that their

shown her brother had made her feel persecuted well She told the group about her mixed feelings the

time

at

of .

as

favoritism

his

and her

death

later when her

satisfaction

leave home Years later Mary began

to

,

,

, can

't

Janet

said

Mary

sorry

. .“ “ I 'm

d

'

her

he

stop

better

,

perhaps you

but

interrupted

the men

”

,

mother one

of

to

.

as a

.

to

think having way monster for felt that As she began talk about the weekend meeting with her

of

mother had herself

grim

take

.”

this

,

stand

it ”

can

to

my

happening

her account

of

you realize that this

't

I

stand

is it,

,

can

't

“

.

't

Don

? ”

.“

she moaned

I

loudly

sob

to

permission

glanced

me and then resumed After first mistaking

,

Mary

at

mother

as

who had been crying accepted the interruption

,

Janet

the

, "

,

by

.

to

“

the disgrace and

every penny

thought

I

if

he

had

He still hates

. .

,

he

me

asked

deeply

she could leave

On

the

top

her sickness cost him

He seemed

of .

,

You

on

see

.

.

still atoning

his ambition and his dignity too but talks about taking her out

all

he

, I

back

She

is

“

.

,

else

lost think

,

her

this

, of

everything

in

moved

church

all

by

pray for her

.

Mary

.

,

reunion

sister

's

her for her older mother recognized her calling her her crying joy name and with She had some lucid moments Mary continued forgive her and She asked my father weekend

trip

the institu

the sort Mary told her

't

in

one

people

"

'

It s

me now

you

?

to

.

can

I

happening

put my mother

Why

it

I

stand

to

is

't

can

have

.“

Nothing

“

I

that this

now

”,

understand

places

And

.

those

of

of

:

Janet wailed

“

.”

tion

not happening

-

Themes with Variations

give her

Why

all

can

lot

get

? a ”

better care than you

she' d

your mother . And

to

.

at all. It 's happening

you

to

103

this

fuss

,

Janet stopped sobbing but she remained silent while the asked Mary many questions She told young woman she had put aside thoughts them that marriage She had heard about families which gener all

.

in

,

as a

't

uninterrupted personal

intense feelings

narrative

whether

venti

the

some lively interchange among

anti

an

the next session often produces

of

,

group members

past

the

,

,

”

.

of

“

risk

she stated

reawakening

in

of

lation

couldn

my own

child

dramatic

an a

After through

I

her mother a

problem

the same mental con being the same awful

suffered from

of .

dition

to

as

ation after generation

or

,

of

.

other group members

in

.

of

to

Recognizing the delicacy

their

what they

have just witnessed and usually show little eagerness

to

their colleagues make little reference

to

,

situation

self exposure

.

wisdom

-

of

at

of

, .

climax The dramatis personae the last scene lurk the wings still recovering from the strain performance their They seem times have second thoughts about the

take

did not surprise

me

to

,

it

Consequently

.

icant communication

a

-

up

.

over the stage Several sessions may elapse before any signif pressure for self revelation builds once more into hear Mary speak

it

of to

their own

for

in

much

the bring

indecisively as

so

.

them

as

,

discomforted

it

after clinging

Janet

silence her unfinished business was

,

the face

..

help her resolve thematter

's

In

ability

to

,

many weeks

of

an

up

acute problem

her silence Her failure to

I

sensed that the other members

group were embarrassed

by

close

,

to

drew

a

.

.

on

to

to

.

no

without any fire during the next session Janet made ef MU group get problem fort the focus her She was unu sually quiet then and during the following meeting As

the

for

last

mo

.

in

His manifest 11 expression his own of

an

to

the session man help her probably was a

of

desire

discussion during the group

by

brought up

finally

ments

few

The Analytic Treatment Process

104

to

feelings

he

,

obvi For

,

continued

:

great pressure

speaking under

Then

.

other

's

each

am

to

hurt

“

an

,

of

group members

ously

.

a

in

dealing with need for help somewhat similar problem any At rate he made awkward reference the tendency

.say ,

to

to

be

on

I

am

I

to

I

it ,

instance know that hurt Janet now but maybe going will help her hear what The way you carried when Mary was talking gave me this going

for

.

her too get rid

of

to

to

to

you manage and care hard have There must have been times when you wanted

as

as

't

to

to

a

do

as

.

a

It

be

'

in as

ve

.

,

it

It

painful Janet made me feel that wouldn your you making yourself been out have mother hospital must great strain for anyone who works

idea

ve

.

'

,

do

“

.

I

Janet replied have mixed feelings feelings about Mother leaving me We had

true

of

sorts

, "

That

's

all "

.”

her

of

I

and

, , I .

of

?

to

at

ve

I'

But

thinking about Mary

been

all

realize

. -

't

didn

it

I'

ve

I'

ll

if

.

I'm

to

,

can

thank her for some my worst taking mistakes used the bitter with the sweet But who knows guess ever find anyone take her place thought living been terror stricken the alone and

some bad quarrels

and

If

.

,

is

.

That really

I

a

too

mother

the

best solution

he

human single

a

office listening

of

different notion

my

to

in

sit

existence than when

this way triggering memories feelings through words and

,

in

's

other

amazingly

I

I

,

each

on

go

”

group members

and influencing get behavior

an

As

my

of us .

apart from

for both

it

do

those years without her mother how she got along she could and turn into such fine person can live

,

of

of

I

.

patient The more tells me about himself the more aware become the unique and highly personal aspects his

Themes with Variations existence . When

105

I listen

bers have helped each

and are drifting along on the same emotional

.

,

up

or

the

a

com

are such

Life

with

father

.

session

with brother sister Later authority Lonely self

figures

.

or

affection

with peers

the

with mother

.

for their

relationships

from

Life

.

:

as

these

to

I

Struggle

find that

of

.

to

a

is

he

When what often emerges

themes

a

the other

story

over and above the one each telling Each helps build common apply my knowledge symbolism

speaker thinks

, .

one

from

I

these

headings tell

note

and

,

the group shifted

session

in

I

If how

mon

a

,

topics discussed

in

.

human existence

list the main

to

in

commonplace

topics

high

experiences are

multiply Realistically symbolically auditory impressions these communications group tend accentuate the universal and the seem

to

therapy

story

these

psychic experiences

of

,

through

together

them

they

to

which lighted

by the number of

struck

or

I am

tie

currents,

. As

-revelation

self

to a group , especially after its mem other to clear away the obstacles to

social maladjustment Dissatisfaction some elusive with everyday reality and the endless pursuit preoccupation

of

.

and

or

,

it

,

,

,

unique way

its

has

.

a

facts

the common

life in

delineating

en precisely the same manner Each variation

of

out twice

in

spins

theme bandied about continuously throughout one many sessions never or

discontinuously

is

a

often

as

As

.

happiness

a

,

psychic disturbances

often get strikingly different impressions same experience within short period time Early

.

of

a

I

the

one

was

or

years old

.

's

sudden death when

six

man discussed his childhood and recalled his grief

ove over his mother

he

a

session

tan

of

directly

in

symbolically

,

gentially

or

Whether realistically

,

.

of of

.

It

presents own emotional overtones different sequence events different linkages between the causes and effects

responsive chord his

of

her striking

,

love

his

about

for

his

He talked

a

The Analytic Treatment Process

106

speaker told how

,

.

,

he he

,

a

's

I

powerful

induced

became aware

feelings together

,

Keeping

.

the three sets

of of

to

in

analyze

I .

,

his feelings for her and

the feelings created me the communication deciding what words the speaker needed hear

of

to

Before

in

,

in

.

of

,

him

impact

by

in

.

,

in in

feelings for

early manhood

The cumulative

man talked

be

suddenly

of

on

,

he

incest

rapid succession

each

,

.

As

of

, ,

in

's

his mother

childhood

adolescence

de

from his father night during his ado

slept near his mother early

scenes

me

child

shield him a

to

failure

as

of

being rejected

about the danger

-

Life with mother late childhood and

of

had

.

in

's he

as

.

came panic stricken

four

The

.

her his love

The fourth man focused

these

had never

and gratitude

touch with her Tracing back his present

feelings

lescence when

of

Since her recent

,

to to

keep

scribed his mother

reactions

and later

speak said that his mother was living but

indifference anger

to

to

convey

to

,

no

desire

had

crisis after crisis

said

he

able

next man

also

group member

the

had been filled with remorse because

death

been

She had managed

he

through

,

college

had helped

to

send him

to

.

through struggle and sacrifice him

carried

.

on

,

in

one listeners The second mother widowed when her four children were very young

logic four lives almost simultane providing and the corrective responses which each speaker needed made me feel like the manager twelve ring circus track

the emotional

on

of

in

is

.

to

life We want them actually has happened

.

go

't

everyday the group which don imprint psychic But the what it

in

Things

on

. go

a

of

ously

.

zest and excitement

of

is

it

,

to

.

of

,

In

.

each member which we search for way together eventually this we discover the uncon full The search for our activity scious purpose

Patients and

Treatment Settings patient of mine arranged

of

,

I

,

a

,

at

at

.

.

in

to

shall call this couple

great distress

minutes later

few

entering treat

my office the designated hour find before me man and woman who

learned that they had two children

,

divorce

and had consulted

lawyer

responsible

to

the man

,

,

-

She

planned

can

stand

't

a

couple

.I

“

me any longer

that

fifty three years

’s

asserted

:

wife

surprise

together

.”

at

his

after

glaring her picking

living

of

expression

,

my

separate

on

To

it .

that they contemplated about

fiftieth anniversary was also informed a

I

.

of

,

five grandchildren and had observed their marriage three years earlier

the

,

I,

A

possibility

their seventies The Clarks

appeared

be

in

I

was astonished

were

uncle appointment for himself

a

to

.

to

and wife discuss ment When they arrived

an

as

his

a

the

of

on the telephone as the her

MAN WHO identified himself

A

The Analytic

108

I . ”

a

Wouldn

I

!"

ecom recom

make

those

both

books

on

of

rid

“

.

a

I

evi

cite

to

to

I

“

,

sick

was the

to

her

't

10r behavior

have one important recommendation you said with smile Get ”

She

.

to

a

I

.

interrupted

.

as

enter treatment

's 's

.

compulsive

He

tee

that her husband

certain

”

“

to

."

. talk

?

.

.

of

I'm

.

,

I

on

the radio

one who needed attention

of

if

up

I

a

to

.

asked

about psychology Webecame interested and got couple m That how found out my wife com

Mrs Clark was just her

my busi

Badly

The books describe her case

mend that she

. of

to

'd

She needs

man

it .

books about

sold

get like little enjoyment out willing living with her But

discovered this

and psychoanalysis

dence

person out the kind years ago have broken

the chance until

it I'd

.

't

I

he

"

We heard

of

get

treatment

How had

pulsive

“

.

I

.

,

for her

Now

can

a

d

I'

I

's

.

is ”

and retired

.

inquired

find

We

But never had

life and

pay

began

Clark said

Clark retorted

last two years

two years

“

"

when

Mr

known

ness

of

That

,

she

Mrs .

.

What happened

ago ? ”

the

I've been miserable

's

“

any more ,”

up with him

it

I won 't put

"

Treatment Process

the

to

reading

the books and

.

,

subject

I

on

explained The torturing trouble was that they were each other with their knowledge taking they stop new would each other apart thought that they would be able living together some information

of on

go

,

.

first fifty years their marriage they Before the consultation ended were both greatly they

during

the

had

as

I

to

,

. If

quiring

objection

no

There was

ac

.”

psychoanalysis

.

't

I

seen

the Clarks since then

.

haven

't

I

.”

“

.

:

.

It

was obvious that they welcomed the advice Mrs Clark said wonder why we didn think about throwing away those books ourselves relieved

Their nephew

tells

Patients and Treatment Settings

me

they

that

have abandoned

their

and also their plans for

a

ventures

psycho

in

divorce . the

analysis

109

is

,

it

,

in

do

I

. of

a

or

's

on

a

,

advice

,

he

.

-

a

to

Freud

scene

Bruno

.

of

midwestern

university

join

He

A

.

if

had been invited

the music

he

that

revealed

his

fright was to

and stage

he

alternative great anxiety

from

also

psychotherapy

to

of

unduly stressful situation has

to

.

change

would need treatment continued Asked whether he was deeply committed

a

felt that

well there He was philosophical about his ambition become great solo performer and ,

about giving

his concert

career

be

He

no

.

enjoyed that the change would desirable teaching and experienced psychother further need for

I

agreed

.

unrealized

spoke without anxiety

a

to

.

would get along

up

he

it,

taken

not

get along

can

mild disturbance

.

convinced that concert work

he

violinist suffering

department

Italy

constructive

a

as

The termination served

trip

time

this connection

in

often recalled

alleviate

he

's

is

therapeutic

to

activity may suffice

Walter

person who feels

Some professional advice

or

.

it

to

than

therapy

action less costly

full scale psychotherapy

an

,

effort

and

recommend

without

some course

of

relieved through

money

a

to

Even when people do not exaggerate mental distress psychiatrist which prompts them consult often

.

ару

After completing treatment for

,

a

in

a

of

a

in

nervous wreck when she consulted me about resuming my future adjust Wouldn this help her

"

"

some misgivings

on

?

.

she was certain that was what she

she admitted

to

asked

I

with this man When

wanted

if

.

't

treatment

to

”

"

of

.

She complained

.

rotic man

a

mild disturbance her work and personal highly neu love with being sleepless nights and

young woman found contentment life for two years Then she fell

that

The Analytic Treatment Process

to

,

difficult

to

may

be

it

the need for

of

,

ranted

is

for

the other hand when psychotherapy

On

and

she

married someone

.

em future she wanted without having

strenuous battle

a

wage

later

.

barked

months the kind

forget the man

to

it

About

out another possibility :

,

on six

I pointed

of

score ,

else

110

actually

war

without

establish

.

of

to

at

a

.

competent diagnostician the services Some persons who require professional help appear function well their daily tasks The symptoms others seem insignifi

it

harder

to

good stride may

in

living

everyday

of

ieties and stresses find

re

.

-

as

,

are

;

to

an

cant untrained observer measured against the crucial problems which beset the world their complaints garded self indulgent One who takes the normal anx that profound suffering

comprehend

and

a

,

usually

. were just sym

her masochistic

V

whose an

.

helpless women

as was

in

,

the second

of

than

, of

.

of

,

is

-

with the massacre unknown village gave free play

the Czech

The first woman

disorders

no more self centered

preoccupation

world war

last

on

by

-

.

the

The topics they dwelt seated

dis

cure than that

the destruction

to

of

probably

Lidice their deep

of

in

,

bols

of

village

news

her bed

she went Yet her

order was more painful and difficult OL the woman also treatment during who was tortured

crack

a

about

pursued her wherever

to

room

kind which

only one

; it

ceiling

”

“

shares with normal people One woman talked incessantly

he

,

to

believe

difficulty

the

petty

does not

and give the impres

,

that

his

,

sion

the

.

talk about He may prefer

he

may have more serious ones which

in

.

problem

on

in

acute conflicts are often masked such complaints and symptoms Moreover person who harps some trivial

fan

serious disorders are not aware psychiatrist because they

seem

to

.

them

They consult

a

Some persons with

be of

.

tasies

111

Patients and Treatment Settings to everyone else, and

why . can 't understand my , my coming " I 'm here because wife insisted on " Hans told me on his first visit . “ She calls me a misfit and my boss a

problem

says

I'm

impossible

. Nothing

wrong with me, but

is

me.”

I don 't

the

want people complaining about

Many

He grasped

character

overcome

, he a

,

his

without

to

disorder

that

and developed

had

a

recognized

he

he

a

try

at

the process

great

that time he was deeply troubled

in

it .

to

lose another

a

handicapping

few

,

.

causing them

In

his troubles for

to

jobs

get

the suggestion that we just explore months and find out what was

.

struggle

desire

wanted

had lost too many

to to

But Hans

By

and

he

.

treatment

their repeated without marriage preserve

reasons manage

by

the

and

of

their behavior failures and disappointments ateness

for

persons who never recognize the inappropri

.

therapy

,

to of

,

to

of

his

Had he been willing to go on accepting criticism job breakup marriage the loss and the his would not have had commit himself intensive psycho

which

needed took nearly five years

to

personality

he

.

of

about himself and convinced that psychotherapy was dispensable The intensive study and reorganization his

com

.

plete

—

of

O

Emotional problems centering around work and love fruitful living motivate most persons who

the essentials

of

alleviated

requiring a

to

five sessions

from

week

two

is

generally

five years

accomplish

,

one

from

,

and intensive

with

,

prolonged

this kind

to

,

For various reasons treatment

to

of

,

,

radically some extent and many can influenced t hrough permanent change analytic psychotherapy achieve

to

now

can

to

disorder

.

emotional

be

every

be

tically

.

or

,

,

.

to

psychotherapy Many them have unreasonable problems fears anxieties and sexual which seriously inter purposeful fere with their work other activities Prac turn

per

The Analytic

112

Treatment Process

well as relief. The cases of hysteria psychoneurotic conditions for which this form of psychotherapy was originally employed are seen infrequently today . People tend to put off treatment

manent improvement

to

them

severe

psychiatric

disorders

Experi

of

.

as

influencing the most

in

more ago

decade

becomes increasingly effective

enter psychotherapy

it

or

custodial care

a

and

hospitals

to

resolve

persons whose conditions would have consigned

and more them

their problems and Moreover more

magnifies

,

;

as they

lengthens the time needed

.

this

mild

can

long

as

as

relatively

and other

It

patients

,

Another group

.

-

still difficult and time consuming

of

is

;

to

ence has led the introduction new techniques which brighten the outlook for such persons but their treatment

though usually

incapaci

less

of

am

to

the gen capa

I

best person They usually

dis

.

my patients put

it

one

be

places and

the

a

great contribution

of

, "

of

,

to “

eral welfare becoming ble

make

of

go

to

feel driven

as

them

.

in

a

to

to

of

,

long periods analytic psycho commit themselves therapy because they have great desire realize their potentialities for achievement maximum life Some tated

sense

;

intrinsic

Its

realistic

.

treatment

the

standing about how much

is

to

an

their own capabilities but we cuss their ambitions and hopes and come some under

have

termina

,

in

understanding

and improving their

personali

important consideration

Fees are

,

themselves

in

in

no

is

point where they need tion order when they reach dealing with their emotional problems further help

.

,

.

specify

are

probably

the regularly

for treatment

in

I

Those which

New York City where fees where Persons with limited

—

,

.

the time spent with the patient are

visit

course

an

scheduled

Cost

is ,

predicated

on of

.

ties

higher than else incomes may enter psycho

Patients and Treatment Settings clinics , where fees range from

individual

an

a

ten

,

-

The total

are

fees

considerably an

in

of

in

,

fifty dollars

twenty five dollars

group

group

a

for

The

and the

the psychotherapist receives for

what

than

reflecting the fact that group treatment

session

more taxing

is

,

dividual

the members

from

collected

higher

sessions and from

the patient treated

psychiatrists

twenty

—

of

of

a

session

psychotherapy

.

—

to

for individual

ten

group

to

for

twenty

charge from

individual treatment

for

session

a

.

psychoanalysts

five dollars fees medical psychotherapists majority analysts range from from

from

Unfortunately

.

lay

,

-

to

In

private practice

twenty five dollars

and

session

session

a

ten

fifty cents to group dollars many clinics have long waiting lists

fifty

,

fifteen dollars for

cents to

.

at psychiatric

to

therapy

113

their more experienced

colleagues

.

charged

Individual treatment which usually entails from

one

prefer

as

week

Many

more

afford

persons

intensive

some

treatment

,

each

intensive when there are

,

three

well

can

regarded

.

,

two

whom

is

,

least

sessions or

of at

five weekly

to

tomarily

by

.

,

and require more Many psychoanalysts beginning preparation and review their practice treat patients for lower fees than those cus

,

the sessions are longer

a

at

or

to

.

to

limit themselves one most two week and make satisfactory progress Good results have been secured varies with his ability "

psychological feeding

different

stages

can

enter the most intensive form

.

psychoanalysis

Standard

it

, of

possible

:

psychotherapy

cases

,

quickly

as

as

and are concerned

most patients who afford getting possible about the best results

,

In

.

psychotherapy more typical

patient with to

the intensity

of

,

assimilate

two weeks For the

.

session every

at

with one

grave disturbance "

a

even

psychoanalysis

ess The Analytic Treatment Process

five

persons

five years

the rate

at

a

of

period over more beneficial

of

.

,

with limited incomes hours For example two hundred than the same number held

I

have

husband their sessions spread

one

week

five times

are

to

.

at

less cost

at

.

that their

better results

Other

spacing

a

have observed to

I

intervals leads

the sessions

a

the frequency

on

equal

,

things being

of

de

—

,

of

—

benefit pend primarily

advised analytic

now

the therapeutic effectiveness the sustained individual analytic psychotherapy does not

However

longer

week

,

sessions

.

three

to

involves from

six

which formerly required five or

a

114

week

a

or

a

in

,

my

the office minimum

few

rule

a

to

,

clinic

meet as

are

to

to

expected

accept Those reality come and leave

.

sufficiently

office unescorted

I

control their behavior during their sessions

.

and

to

oriented

is

private practitioner

I

a

of

The individual seeking treatment requirements

re

week

.

twice

a

or

.

ceived little study

once

group sessions has the present time most groups meet

of

varying the frequency

At

effect

of

in

,

is

.

It

my impression that similar within one treatment year principles would apply group psychotherapy but the

rarely

will

of

that

at

one

contend

dead

the

against

set

-

conscious

allow

is

a

same time with

to

change are too formidable

to

.

to

't

a

person who doesn work with enter psychotherapy personality his own volition Unconscious resistances

his

.

treatment

.

by

He appeared

few

.

so

do

he

he

kill me

return unless

weeks later

,

not

to

him

a

I

-

,

be treated

insistence that

tear my office apart and

told

.

really wanted

co

had threatened operate

rather than

'

his parents to

because

to

After

he

,

discovered

of

I

,

A

a

,

a

on

patient changes mind that score young man whose college career was halted severe only breakdown entered intensive psychotherapy soon Occasionally

Patients and Treatment Settings

his

115

on

.

long and and there were no further interruptions in arduous treatment Additional qualifications are usually imposed the

.

other

a

or

He

curtail

needs

the

one relationship

the one

.

afforded

patients

diabetes

to -

action

greater protection

by

the freedom

of

of

,

such heart disease might which interfere with his own functioning

,

as

serious physical illness

or

a

is

.

in

regu for group psychotherapy Membership suffering not recommended for person from

candidate lar group

be

more desirable for anyone who would ex posed emotional wear and tear because some extreme difficulty talking once this has been resolved however addicts

generally

groups

Many

,

problems

in

.

in

in

,

.

of

we

get our best results with those whom

most comfortably

can work with

be

we

or

including

rule more interested work patients than with others Generally

,

are

mixed

,

,

Psychotherapists ing with some types

from

Alcoholics Anonymous which are psychotherapy

as

to

-

not actually engaged

excluded

drug

and

the special groups

their respective

deal with self help groups such

as a

of

.

ganized

do well

them

Alcoholics

,

,

beneficial

are among others

therapy may

group

.

be

;

in

to

of

also

is

This

to

,

TO

.

to

in

,

WII warrant

to

or

a

at

.

brighter patients handle younger psychological change reasonably rapid a

, is

”

in “

he

feels more competent

prerequisite Some persons nevertheless psychotherapy quickly respond their sixties can rate

the

The psychotherapist

or

case because

for to

Capacity

psychotherapy

.

benefit from analytic may turn down the and disposed

These are not usually justified gray matter too lacking

too old

or

is

fact that

he

.

age and intelligence

by

,

.

a

patient may For that reason con fronted with special requirements notably with respect

over enough

.

it

in

to

their entering Others become rigid person alities much earlier life because they have experienced

The Analytic

116

.

great deal of frustration

a

does not always

Since flexibility

equate with chronological age ,

basis

Treatment Process

I

individual

assess it on an

.

I have

not found intelligence

be much of

to

issue

an

in

either group or individual treatment, because conduct as primarily emotional processes . It is true , of course ,

I

both

child because

a

seem

healthy

unnatural

feeble minded

.

him

would

into

-

disowning

a

as

to

me

blossom

as

cannot

is

unhealthy moron

an

genius ; but to refuse to treat

he

that

a

a

they didn

't

.

low

fully

-

comprehend

the therapeutic

se сои course

in

take

a

have

to

d

know

I'

't

"

I

.

process

didn

and

psychotherapy

,

them

even when

average intelligence

to

found

responsive

very

analytic

of

patients

have worked with

I

a

at

of

is

;

in

Placing patients with low intelligence quotients group generally avoided but mod with extremely bright ones degree discrepancy erate stimulates efforts communi cation and may make for more emotional experience

psy

human

.

is

.”

.

me time and time again during Just get me better can

.

I

so

explain

't

“

:

bright little girl said her treatment Don

to

to

of

“

I

to

a

",

chology here woman making good headway told me just wanted you make me well But this attitude not persons limited low intelligence An extraordinarily

.”

leave

highly intelligent person

,

though

a

frequently

,

More

will

course intellectual knowledge important and fight against involving himself the ”

-

psychology

in

him

.

The easier

knows

prove

,

say

treatment just

it

.

He may

he

,

process the more

to

in

is

,

attitude

from

time

time

in

.

about his illness

to

such

it

the

I

find out

an can

to

understand

give

therapeutic

may fight against

never get well and

meet with

I

or

he will

he to

him

for

is

it

stubbornly

try

to

experience which

emotional

all he

as

all -

“

regard the

patients

Patients and Treatment Settings

to

,

way

,

in

this

itself For .

the treatment

or

frightening degree relationship

classical psycho

They are

procedure

more responsive

to

.

not the most therapeutic

is

punish

They may

become more confused

persons who use their intellect analysis

they tend

.

to

it

on

dependent

acquire

themselves

in

become absorbed overly

or

-

themselves with

Instead

they

highly motivated benefiting from the to

.

self knowledge which

are

who

, of

intelligence

psychoanalysis

a

superior

to

of

undergo

117

will

intellect and emotions into better balance group where well difficult

.

They

are

through their

.

of

to

to

.

intellectual attitude

behave more spontaneously the feelings other patients

stimulated exposure

is

it

,

a

in

indiscriminately to

101 maintain

some modified analytic approach which

do

them

an

Some

of

bring their

did

to

.

.

too

”

much

their uninhibited

them

“

at

knew to

she

behave the way they She reacted sternly admonishing first

behavior

by

to

would tell the other members that

“

at

on

of

-

I

recall one self absorbed woman whose group frequently con spontaneity commented the start her lack She

stop this

,

a

's

“

express

a

may

group

If

.

treatment respect his wishes unless our mutual investigation

he

I

,

does

enter psychotherapy

for individual

or

preference

of

he

about

to

Someone decided

? ”

of

:

.

in

.”

A

year and nonsense and hit half later she was feelings engulfed being her own and taunted for acting unreasonably More than once she was asked Where yours that famous old common sense reality

I ,

or

.

I

if

or

the

treatment lively

unless there

is

his

,

better

a

good

the reverse

.

to

a

tête

-à -

reason

so

quiet tête

do

to

into

to

like

't

equally

for yearns force someone who for

don

compelling

be

be

.

uncertain which would

settings appear

,

when

I

plan

am

be

in

his complaints indicates that treatment the setting might favors undesirable for him also follow his own

party

some

The Analytic

planning

enter treatment frequently group therapy would think individual better setting

assume that the choice classified

it

how their case

,

on

depends

They tend

as

.

them

to

for

of be

or

I

whether

to

is

People

Treatment Process ask

118

usually would

How

.

if

they were entering treatment for physical illness

of

a

,

,

in

.

,

is

in

prescribing ever diagnosis less significant course psychological treatment The psychiatrist following the organic medicine recom same general principle applied

be

es

.

in

he

by ;

of

be

mends the procedure which will least taxing for the patient but the clinical description his condition does helped not itself indicate how can most rapidly psychotherapy More reliable guides and with least stress

he

are

,

."

to

I

“

:

I

.

a

his

.

,

he

of

problems and the kind has pecially those associated with talking about his feelings problems He may not know what when first psychiatrist consults When asked one woman what was troubling her she replied came here find that out Like the infant wailing for his mother she was distressed are his personality

know

,

and

always tally

the case

,

we agree

be on

for

't

don produce the change which

if

to

good augury

a

impressions

patient

he

his

I

,

.

fifteen hours with

impressions

on

.

desires

is a

he

complaints

know mine Our our opinions how

; It

nor

do to

exploring gets

three

to

spending from

his

After

know why

.

't

but didn

he

he

if

.

if

't

if

points but we don the preferred course will during out treatment We are more advanced honestly disagrees with me than complies superficially both

mapped

the theory that the

investigating

,

ther sug

difficulties

in

that we might begin

about individual

social situations

I

occurred

suffered

-

his

consulted

me

,

attacks

his

gested

Since

mid thirties who

in

.

apy

his

from

accountant

anxiety attacks

in

,

Richard

an

.

on

with my impressions and opinions doctor knows best

Patients and Treatment Settings

enthusiasm

The

.

beard

a

great

about

of

dream

his his

several

about

comments their urging

to

agreed

at

and

a

,

.

off the

he

,

shaggy appearance

reported

some scathing

made

associates

suggestion with

the dream

In

the beard he was growing office

the

group sessions

few

a

After

He accepted

.

show

he

of

the group setting .

119

shave

ended with his being applauded

dream

“

dream

my way here

made me very uncomfort

would shave off my beard just doing guess intention that

I

. I

it .

of

?

I

them

had

can see

and

,

tell

did

I, I

As you

said

it

Richard

Why

.

able

”

,

tonight

the

remembered

no

“

I

suddenly

on

.

for the decision

interpreted

it

.

.”

I

.

I

.

I

't

I

to

really what would please them most But don feel like saying anything about the dream feel very secretive tonight wonder why came The group discussed his dream anyway One member say

wanted

He

in

to

"

I

.

.

he

him

to

up ”

't

he

like treated

but

. he

benefit asked

,

I

, 't

it

,

.

didn

't

“

because

I

replied

,

he

,

optimism

wouldn Then why

?

his

in

feelings

enthusiastically ”

so

to it

my

, .

on

,

group treatment that

discourage you

."

to

rsons who leave the choice Some persons

need

he

us .

.

prove that he doesn

't

just

of

well

to

getting

-

honestly

to

he

progress became more apparent after began says patients with me and his Now co

I is

being

was was

was that

advanced

get people

interested

letting

appear that he was

his

,

faked

His work

it

to on

agreed

“

want

wasn

believed

he

and

he of

at

;

him

the start

had

The third

anything

was that

did not comment immediately the interpretations though Richard admitted that had felt strongly

Later

he

say

make

wanted

cover

to

to

.”

Richard would told him that

interpretation

Another

"

to

determined

objected

that Richard

mean

his hair down

eatiICIIL setting treatment

The Analytic Treatment Process

120

don 't care much about the relative values group of and individual psychotherapy . One who feels that to their therapist

he has reached the limit of his endurance is likely out with the plea : Make me feel better right away

to start

. I don 't you do it . He may also be skeptical about the value of “ just talking " ; or the notion of sharing attention and “ letting himself go ” in the presence of other patients may add to his turmoil . For the person entering treatment care how

of mind , individual

this state

in

. It

psychotherapy

usually

is

; this en

a of his tension and instills in his mind the idea that talking is worth while . Improvement in behavior might have been e I more marked after a few months of group treatment , but

advisable courages

my

.

one moderately

woman

up

My

ill

secondary consideration

is a

'sjob

“

leads to

him

, life ”,

that

rapid easing

declared

.

The verbal communication

on

go

diffi

a

of

to

an

I

.

also

her

help would make effort surge beneficial Some persons experience

culties and notification that

her were

't

I

.

Her expec reason why she

getting help was not the only

changed her mind

to

I

“

decided

my team

.”

I

on :

she remarked

have someone

of

tation

later that

enter

treat

the

choice

of

majority

,

perhaps

,

in to

.

a

is

crucial issue Mild neurotic conditions gen psychotherapy respond favorably analytic

or

erally

patients

,

For many not

setting

a

.

relief when they make their arrangements ment

to

of

working now

,

week

a

ment

.”

in

“

I

it

today just can during her first visit but gave work any longer this condition When she entered treat

.

would be able

to

.

he

he felt that

he

replied

;

had not

,

He

he

.

I

if

an

I

a

a

group whether given individually no young man who complained that his emo analyzed tional disturbance prevented him from driving auto mobile asked him had taken any driving lessons

Patients and Treatment Settings

was able

recognize for himself

He had

license

weeks later

of

co

more vehemently

his

,

probably

,

punctured

been

by

of

so

a

; ,

Had been treated would not have explored n thoroughly but his fantasies his unconscious circum venting the normal routines and tasks life would have in

group

a

'

operator

he s

he

lessons and obtained

some driving

few

.

this attitude had been

became

.

that

eventually

unconscious to

acquainted

irrational

his

so

well

could get on intimate terms with his

.He and

his unconscious how

if he

them

he

drive without

121

,

illness

the choice

emotional

procedure

is

and psychosomatic

of

For those who suffer from serious forms

of

.

patients

im

,

a

In

"

“

similar

those

to

in

is

,

.

situations

to

his sessions

he

him

to

expose

a

. in

”

“

of

patient cannot natural living Obviously over his whole life treatment The objective in

live

"

"

effects

to

.

a

an

portant and may even spell the difference between un psychother favorable and favorable outcome sense reliving apy represents undo the harmful controlled

, is

That

-

only

one other stemming

experiences can usually

's

.

is

patient most intimate

maxi

created with

when

why knotty problems

person from

a

present

rule

,

intensity

emotional

re

symbolically

Some situations are mum

possible

.

as

efficiently

as a

,

as

modified

so

of

developed his inappropriate attitudes and patterns which behavior that these may be clearly reactivated and

he

or

,

to

.

in

resolved more efficaciously individual treatment significant situations may be difficult revive

be

Other

are

re

be

,

a

as

,

,

as

or

.

to

as

only pallidly relates the therapist Family problems such sibling too intense rivalries conflicts pinpointed and modified with both parents can rule vived

if

for

the

.

to

be

It

in

more easily the group relatively easy right setting would select persons with serious disturbances they always conformed

of just

some

setting which

.

the do

,

another

to

I

or

one reason

For

They outlined not respond poorly them

have

.

the

major criteria

to

do

The Analytic Treatment Process

122

theoretically

,

I

periods

an

.

,

I ob to

are

of

cannot assimilate much

gives

them

too rich

interpretation

, of

prolonged

all

-

adult

diet

.

from

They require limited dosages

interspersed

a

.

talk

about

in

them

the treatment

or

for

to

them

exciting

The

that they had similar ideas and feelings helped talk freely about matters which had been too

to

discovery

their group treatment

.

agers during the course

-

teen

of

in

.

,

in

silence From others their group however they can assimilate great deal own more communication eight Dramatic personality changes occurred these age

with

a

,

.

.

the fact that they

apt

one relationship various explanations

to -

rise

individ

them

Youngsters

,

communication

the one

given

; of it

it

attribute

has

treated

results

a

which

an

slow

servation

in

headway to

,

make

disappointing

with

often make more

of

whose therapist had previously ually

example

in

a

treatment

for

supervised the the shared experience group seriously disturbed teen age girls

of

progress

often

.

and adolescents

,

Children rapid

process are factors which

the other direction

to

to

the therapeutic

the balance

in

tip

approach

,

,

.

in

is

more desirable and then substantially better the other one Age special trans ference situations atypical reactions and too intellectual

twosome

itself

effects

to

group

of

, .

,

of

which they had resisted talking about perhaps out feelings about the family pride They developed warm

retarded members

,

.

.

of

on

to

tionally

to

they were able the therapist Subsequently parents better terms with their own Two emo

attachment get

a

,

.

and these tended counteract the adverse their faulty home life Besides functioning well together with her peers each girl also formed healthy

the group

also benefited

sub

Patients and Treatment Settings

123

the opportunity

stantially from

it

afforded

them

identify

to

with other girls of their age.

, an occasional adult with problems responds severe emotional to the catalytic effect of the group after having bogged down in individual treat Like

therapist

beside the point

,

's

.

is

it

that

more adequate meet this have bogged down but The patient may have found

been

might not

;

special needs

he

adult

to

ment. Had

his

the adolescent or child

ex

to

, ,

is

a

in

up

.

for

or

to

difficult face the therapist without undue anxiety hos tility Another reason notably among persons failure brought cold atmosphere their inability emotions unless they can induce these analyst who never develops their treatment partner With less inhibited

it

sup

to

tends

since

,

a is

,

a

.

group

patient

or

of

anger induce strong feelings affection Their emotional reactions gradually release the inhibitory effects the therapist own atti

in

easier

-

of

.

's

co

patients

from

him

anger

In

own

such

to

is

press his his

for example

,

feelings

,

angry

he

.

an

in

perience strong

get

to

in

others

to

to

the reactions

know

to

clear on

to

,

friends get

.

acquaintances

The to

-

the one

life

On

.

duplicate

in

time more profit in

harder

and

to

which

,

as

to

his intimate problems

neighbors

is

ably concentrating

cultivating some new making the effort

usually spends his

suggest

these

people

so his

do

better terms with person who can

such

contact with

on

or

,

a

social difficulties joining simply club

one relationship

questions

good by

sufficiently

by

is in

his he

up

,

alert

com

and respond read

him

of

sufficiently

said

stop talking

Affirmative answers that

I

a

what

grasp

is

he

when

he

to

?

Does to

?

ily

pany

try plan for treatment some person handles himself socially For

does he function without undue anxiety

Is

,

example

well

.

how

?

of

Before drawing idea

a

up

.

tude

the

,

has

in

to

believe that

in

ease

what around him behavior generates others

a

usually

the reactions his

he

I

and obtuse

is

goes

,

social situations

that he

,

not very alert

ill

get the impression

on

I

if

to

other hand ,

at

The Analytic Treatment Process

124

strong need for the group

liant and highly

Andrew

This

I

bril ties

the rather exceptional case

otherwise

.

have decided

.

,

I

,

a

though

of

did

instances

few in

so

In

.

experience

-

a

of

he

net

in

or

,

of

of

.

a

,

life

egocentric man without family history social had fifteen disappointing years profit individual psychotherapy The had garnered from thousands hours spent with succession com petent and well known analysts was the consolation that his treatment had prevented him from getting any worse last analyst decided that they had worked long enough

His

together

that Andrew might benefit from

and suggested

he no

.

at

group treatment that point He himself expressed for one procedure the other he said that my comply would with recommendations Smiling feebly he remarked For shipwrecked man like me any life raft

to

investigate

why

,

.

it ”

poorly

I

had

in

so

individual severely depressed treatment He was and further incapaci frequent anxiety attacks He appeared tated have

a

to

.

to

to

demonstrate superiority assertions that his former analysts had talked that

success

had

sincere relationship

any

getting into

he

gave me the impression a

”

fully fought

of

outwit me and

“

repeated

garbage

to

His

need

off him

terrific

.

by

.

had done

problems

,

on

spent exploring

his

he we

care who else

During the hours

is

a

't :"

don

I

.

will

do

.

,

;

or

preference

with

lead

cure

,

,

to

not

ex

does

unforgive to

basic

those persons who having unpardonable has

attitude

as

of

was some parental

one

some cases

perienced

that attitude

explains why transference

.

in

ness which

onstr demonstrated

He

Andrew

of

.

them

Patients and Treatment Settings

125

defeat and leave the first analyst with re - experienced

whom

. Indeed ,

that attitude

is some patients do not exhaust this need until they have deprived more than one analyst

of the

satisfaction of curing

The Promised

Land

is

already

failure occurs,

transference

complex .” Patients who suffer from

ment ; their hostility

, usually

them

in

so

I

of it as

think

.

late in treatment

clear view when such

it often do well

in

a

a “ Moses

group

treat

the analyst is diluted by the presence patients of other . In Andrew 's case , however , I decided that his deep - seated problems required individual attention . After he had reactivated his attitude of concealed super to

had analyzed it together , it became clear that it was the outgrowth of his intensely

iority

my

on

couch

and

we

rivalrous relationship with his father. In addition

to

the need for individual exploration

in

this

case , there

were two other reasons why I would have hesi tated to place Andrew in a group . He lived in the clouds of high finance , and it would have been difficult to find and intellectually stimulating treatment

emotionally

for

him

spent his leisure hours lying

. Andrew

and indulging

in

sexual

fantasies , but not because

resources for sociable people came to his executive

suite

bed

he lacked

in

fact , many large corporation .

a

was that the limited store of energy available his emotional state was drained off by the respon

problem

on

go

from

to

a

delegate

civic affairs

.

active

in

be

to

has also learned how

re

He

sufficiently

Many who

do

sponsibility

well

.

as

schedule

has been able full social

enjoy

to

on

,

his

recovery sibilities of his post . Since responsibilities take added and

to

to one in

he

His

part in

day , in

living. Every

individual

to

no ners

group treatment

wholesome family and circumstances the restricting

in

or

force

of

social life

by

are persons who are cut off from

The Analytic Treatment Process

126

fluence

or

illness . There are others who , for various

of their

reasons , start

group and then enter individual treatment

in a

during the same period , usually

experiences

have both

though not necessarily with the same therapist . They prise

a

either setting

,

settings

for

patients

less rapid

is

provided

that

of

category

,

Group

deep -seated

sequence ,

in

.

itself is ,

in a sense

,

in

than

in

both

combined

treat

his

psychotherapy

, and

or

simultaneously

combined treatment

—

whom

effective

com

psychotherapy

,

in

,

,

in

,

regular and systematic

person with

psychotherapy

his own interests and those

this nature

number basis

severe disorder has

and

.

on

few

be

to

to

individual timed

group

sessions

treatment

a

The transfer

a

of

are rarely conducted

of

But individual

the group

from

carefully

of

.

adjunct

a

are

the group to

an

entering

to

him

to

in

prob ment . The prospective group member explores private discussions with his therapist lems some extent and may also consult alone from time time after

the other patients

he

"

of

a

first group when

to

of

of

entered individual treatment with

me

.

I

illustration

:

give one

a

place would hesitate my problems Donald like those with

To

in

group any person

he

it .

”

.

to

undergo great deal will join He may have hot nurturing house before he can withstand the more rigor ous group climate and derive the desired benefit from

to

other

harmful

re

intolerable

the offender

to

this sort

group members and exposes

is

Behavior

of

,

so

do

silences

.

longed

to

I

Were the patient would probably oscillate be tween monopolizing my attention and sinking into pro

.

prisals

”

"

a

of

,

to

of

,

in

group which he sampled some Some painful hours curiosity ago please his wife taught months out and committing one man that there are undesirable ways

Patients and Treatment Settings

action

treatment , as to any other course

of

oneself to any form

127

of

.

When Angus,

me about

he told

basketball

a

coach

this illuminating his mid

in

individual psychotherapy

his

from

state

a

had been

two years .

with me nearly

was emerging very slowly and depression .

experience

- thirties ,

of

,

in

He

severe anxiety

him

a

.

he

?

enormous satisfaction

.

to

gave

their marriage

of

of

expended most his energy acting out his im gestures and the twistings and turnings his he in

he in

Since pulses

answer

him

children with Betty during the five years

Getting me

to

a

had wonderful and unwilling have

been

of

when

had

so

know

And why

he

?

loving wife

,

wanted

,

women

into amorous adventures with other to

leading

he

they

be

of

,

his

of

on

After opening session the couch each week with perfunctory account current activities Angus often plied me with questions which reflected his perplexity and worry about the waywardness his feelings Why should

.

of

in

. of

to

,

spare for the recall lean muscular body had little memories He customarily indulged the kind small an

talk which fills

inexperienced

analyst with despair than usual the day after his

OC animated more

He was much

an

I

,

't

I

but

I

,

so

, .

to

go

go

to

't

a

little

just sat

I

ever

saw

one

loathed

them

henpecked

specimen

if

open his mouth

-

. 't

husband didn

a

.

.

-

to

the timers One woman rambled about the hard time her little boy was giving her Her

I

on

back and listened

her She talked old

please

.

,

out

to

it,

's it

to

try

to

—

to

I

“

:

. .

in

a

marital group Angus told me had interesting experience last night finally went with Betty you know the that group for husbands and wives one she been begging me with her You didn recommend but you didn tell me not decided first session

both when his wife described

The Analytic Treatment Process

128

the wicked beltings she gives the child . It reminded me

all ,

terrible beating my mother once

me for

gave

of

a

no reason at

do

it .

on

to

to

I

I

't

,

I

,

.

to on in

's

of

my father mousy attitude about everything that went our home Other things that went there came back me things could never remember tell you couldn talk about them last night but want and

of

“

to

a

could endure

.

he

.

by 's

stirred

util

the processes

facilitate

.

”

his memories was more than

his wife

were not

being The tension up by his fears when he felt growing urge recall and communication

for

. to

talk

any

of

that

ask

not

the many memories to

therapeutically

satisfy his

up

to

afraid

did

he

seemed

in

He was

Watching

sessions

the other group members —

ized

at

;

the disclosures

group

any rate

is ,

to

Consequently

,

.

give any

.

did

of

Nor

presence

more

the other members

information

he

for

and listening hunger

a

Angus attended

few

.”

now

clammed about

talk

He insisted .

.

enter individual psychotherapy

him

to

emotional origin which had prompted

.

incapacity

of

It

a

on

leaving the group after month Betty never knew why was still her impression that he suffered from some sexual

made Angus more depressed and had

This experience

asking

his

many questions

.

He stopped

.

individual treatment

so

:

to

.

,

other adverse effects After these were dissipated one plus factor emerged The group episode gave impetus

mutual consent had brought their respec He came understand his

,

though

he

,

athletic meets

other cities

loved

, .

even

few

though

female companions

his

,

He

acknowledged that

to

during trips with his teams

behavior in

repeat their adulterous

transgressed more discreetly with

a

tendency

to

.

to

tive love mates into their home

he

,

parents who

by

.

m

in

He became more interested his memories and spent more time recalling them He talked about his rearing by

wife

Patients and Treatment Settings

were in many ways more attractive to

the other women

.

him

of

pulled

out

I

he

understands why

his

of

did

when

Now

.”

,

not for me

.

the group

vowed

he

Angus

again

”

Never

“ It s

“

with

He realized that he was afraid to discuss the situation Betty , particularly her lack of physical appeal for

'

.

him

129

at

a

in

ready for

it

is

group when

he ,

so

did

he

entering the marital group not approve the congenial time and agrees that membership

would probably

accelerate

.

his progress

en

social

or

their behavior

long and intimate peculiar

give me clues their daily work

to

with

few

one person

a

of

,

with the significance

of

in

relationship

those who are are

especially

,

overcharged

ities

some patients

the couch

in

On

up

by

,

in

,

an

.

's

.

counters This was true Nila withdrawn young commercial artist who entered treatment shortly after her father death Her mother had died childbirth and Nila and her twin brother were brought their emotionally

ex

to

of of

It

.

an

and domineering male parent was any real awareness perience which blinded her

temperamental

other

therefore group

complete her psychotherapy

a

.

people thought and felt

know

suggested

She

agreed

an

opin

her own With

and domineering

.

convictions

egotistical

of

no

.

.

manner plain that she had strong convictions On

on

She quickly made

it

if

as

she acted

in

them

she herself had

she

she had

been highly respectful She had humbly solicited my

ions

as

as

soon

Alone with me

,

.

got together with other patients

up

's

.

that this might beneficial objectionable Nila behavior showed

to

getting

I

involved

.

growth

in

,

so

immature

be

she

For one what other that

in

agency where she worked

.

advertising

of

on

in

on

,

.

In

her weekly sessions during three years indi vidual treatment she scarcely touched her lack friends getting and her difficulties with her associates the people

The Analytic

130

came up , and she attempted to impose

treatmentmates .

on her

to Much as she tried , though , they did not allow her TO trol and drive them . They usually her have her

let

JI con

;

the change

expressed frank agreement

on

.

to

.

excited and

with their

times

criticism

she

even

.

it

anticipated

one was

Nila herself At

,

also

with

wore her down her the gradual im

.

impressed

eventually

complimented

her behavior but

in

provement

func

on

due time

they

attitudes

her

or

democratically

tion more

and pressure

criticism

as

their

as

The impact

no

of

spelled out her arrogance and distorted

and then

say

In

every subject which them

Treatment Process

at

,

”,

.

in

.

go

to

to

a

I

I

“

I

-

a

an a

so

to

was unnecessary

mania

sur elo for me

who had met with They argued

activa

quently for this diagnosis that

of

one up

woman

operativa

the case

as

sized

.

geon with mania

They

it

passiva

a

operativa

in

.

different opinion

up

.

conscious plea for more merciful treatment Others had

un it

to

's

as

a

.

her

need

references

patients

-

one

Her

Nila

on

debate

co

interpreted

lively

gastric ulcer

by

been

another for

operated

of

up

."

opened

on

to

had

my

and putting

could

the hospital order for affairs

worse

This

be

that

my will

or

I'm

making

words

sweet

few

getting ready

I'

now

use them

better

digest better with m

will

.

a

of

it

but

to -

be

's

"

Let make this kind Nila night she said the beginning your session know deserve criticism

or

:

but that ended the matter

.

which was rather stormy

.

However

a

she underwent

, it

year

,

For about

a

,

She sounded disappointed

She reported week operation ion

not need

.

two

.

consulted

later that both had assured her she did

a

Nila

.

.

diagnosticians

an

of do

more than propose my customary settlement for disputes this nature consultations with one more competent

leveling

experience

was not too

shock

Patients and Treatment Settings ing for her.

Her childhood

131

had conditioned

little tiffs with her father into

her to blow

up

explosions

and

tremendous

hysterical enjoyment from them . I evalu night over ated her occasional reports that she had cried some unkind remark made about her session within the

of

that conditioning

a

in

all

even to get some

Actually

no

.

.

or

at

by

,

she was not harmed the many barbs directed her because she had diffi culty talking when she was tense angry context

strongly

to

reacting

can

be

he

is

if

to

.

I

a

crucial consideration patient being damaged

of

a

?

alert

or .

he

is

emotion That possibility that mutely instead

am

a

an

I

to

have make distinction between normal growing pains and the psychological damage which incurred through such experience Can the group member talk freely when gets angry labors under some other strong the

withers side

some verbal

.

swipe

at

he

re a

was mildly

, a

or

.

a

of

his

two of

,

agree with anyone who criticized

however

to

,

of

a

in

a

.

him

with

position authority someone feeling Out worthlessness he

remark from

floored

to

tended

Although

friend

of

usually

and

,

he

disparaging

one

my groups

the company

in

convivial person

of

in

him

put

I

quest

treatment

in

,

an

,

engineer had been group Thomas analyst another before consulted me

unfavor

him

.

unjustifiably

responded

si

of

a

to

Thomas from

individual psychotherapy until

ventilate his emotions freely

he

in

It him

bit

remove

him

.

.

kept

I

. to

the

group

criticism

became necessary

which

gravely

,

However deeply the

him

never got angry was able

to

he

censure which felt was merited some aspect his functioning which

.

concerned

depressed into expressions hos

of

and

related

to

tility

to

, .

retreating able remarks about him lence He seemed especially sensitive

or

Thomas customarily

by

In

,

the group

-

to

,

cases

even

bound to delineate sharply the difficulties

,

some patients have about in

is

intensify

talk

Psychotherapy

and

The Analytic Treatment Process

132

considerably

,

,

so

a

by

in

her favorite restau

I

to

modify my pro often have cope with such extreme attitudes

individual treatment

.

to

In

rant and then not eating cedures

do

of

.

expensive dinner

. , it

like ordering

an

be

't

.

his

.

to

talking One man complained that having was ruin ing analysis The opposite point view was voiced stop talking To woman who couldn she felt would

complete

his

to

was too depressed and confused

treatment

a

-

One man who entered psychotherapy after electric shock

fear

that

about himself

disclosures

to

we got

the

his uncon

would

as

scious

conflict

emotional

he

heart

,

of

his

.

When

recognized

be

and plays and various other subjects

him

to

;

I

”

"

,

of

.

I

of

respected sentence during his first year treatment need for prolonged periods silence these alternated with periods during lecture which talked about books

,

of

I I

a

the tempering effects each other Interchange

on

of

-

is

,

to

,

,

.

overtalkative member

their

turn tends inhibit any The objective not time sharing in

;

his presence

.

which have with more gregarious persons oils the tongue silent partner

talking

too

because

group members

situation where

process resolves

of

.

Group

in

rarely placed

length

problems automatically

.

it

of

am

I

,

at

talk

him

to as

in

did

he

, .

to

have

group leader to

I

a

As

to

.

,

life

in

for him treatment However the more talked the greater his urge talk me Though did most the talking during the years during first two most his third year

traumatic

they already had been

be

to

,

be

a

,

prefers

impoverished

is

the therapy group

emotionally

,

is

The outstanding beneficiary person whose outer life

of

.

he

,

reserved

as

.

or in

on

after session mathematical basis but versatility talking The group member should able voluble

session

the

either

-

Patients and Treatment Settings

133

.

because he lacks social contacts or does not enjoy them An isolated or friendless person , one who drifts from job to job

or

on

life

'

doesn t

at all, usually

work

gets

a

the group . The real or imaginary

in

foothold

better

stigma under

in the group setting . training ground forensic

which he labors disappears

in

a

countering

in

where

in life can verbal thrusts and parries .

anger at someone else when

he feels like

-

.

a

of

“

a

experiences

,

The encouragement up

.

isolation

patients buoys

-

their

other

feelings about many things they tend of

or

sense

from

.

-

that they have common

similar co

get from

,

When group

first rate antidote for loneliness

their

,

to

lose

feelings

interest and warm

members discover interests

it

.”

a

-

-

in

in

Expressions patients are

-

the

of

to be

him

butt of another person 's anger , gives importance much needed feeling The give and take great deal words well functioning group affords blowing exercise off steam or

a

real argument

a

has never enjoyed

become proficient To explode

a

or

who

as

of of

serves

also

own

their

they

confidence

in

It

person

by

.

is

getting well Another bracing tonic the realization that exchanging thoughts and feelings with one helps others one

receiving

a

while

",

give

is

blessed

to

most

in

is

It

"

.

them

group session

I'm

"

feel helps you

,

I

telling you what

.

have

a

a

as

functioning entity gets The group itself meaning for persons with few social contacts

to

."

first class person

-

it

a

a

. If

nothing any more makes me

it :

.

in

of

-

.

a

woman declared Being helpful often enhances the self esteem and dignity persons group treatment As one man put not

Between

of

sessions they

to

a

.

,

at

-

co

think about the most recent disclosures members wonder how they are faring and what they will report They feel the next meeting need their

The Analytic

if

they have no pressing

fever

en

.

When

I

high

higher was

or

100°

ar

.

take mine

a

.

a

of

Dud One woman

.

a

didn

't

I

,

said

group

was afraid

,

to

expression

it .

I

.

saved them

provoked

lively argument

.

My statement

a

.

I

.

pointed

the time

out that had lost most the cancellation money only some was the financial loser

I

would not

had not been

.

elsewhere

if

,

I

very important for me

explained

,

the meeting

have canceled

I

repeated my original apology

annoy

their

It

full

at

I

.

give

by be

Later

them

to

ance

.

I

invited

session

to

a

of

I

At

.”

it

was the meeting following the one had canceled group m members complained about my having deprived them to

find out what

“

home she

stay

to

cue

temperature

town

my first

and not always then

office one evening with

her that

reminded

out

sessions unless they

missed any

:

at

rived

my

ill ,

We were physically

when meeting

gives

sessions

I

the members never

a

of

Most

cancel

to

me

gagement forced

this

I

of

got my first inkling

of an

security

.

sense

of

a

problems to report. The regularity them

the

even

of -

and listen to each other

talk

Treatment Process

of

134

Several group

.

a

absence

,

pay

,

”

for

.

have already

that

not

to

their emotions

illustrated

,

I

group members

,

to

she

them

as

Some

remind

communicate

,

.

them

have

to

they have come only

that session you missed

leftmy office

I

time

as

me

of

to

to

"

she called back From time on

one

stated

addition

Fork over some money

act

de

.

the fee

in

it

, ,

member told me When she was absent another one was bad enough missing the session but she had

to

sanction

whole

, ”

We didn

“

. .

otherwise

your

as

not attend unless the group

't

did

he

session

cided

a

to

of

't

to

pay me didn fully com members felt that not having CC was as pensate them for the loss the session Reference made the group rule that member paid his fee for any

Patients and Treatment Settings

135

want to convert the test materials in the laboratory of ver bal interchange into the stuff of real life.

It

is

made dear that contacts therapy

fere with

,

also taken place

my

of

few

Some group members form

marriages have

, , “ but

I

tell them

won 't make you better .” social relationships anyway .

they are ruled out because they

A

inter

riding home together

be enjoyable ,"

contacts may

and other

outside the sessions

. “ Kaffeeklatches ,

though not among

of

a

. .

in

to

at

,

or

.

a

,

,

groups However patient mine oc reports that he has telephoned another group birthday card member sent him visited him home my Violations also have come attention other ways members casionally

together

to

me was ad

cop in

the

the group

who

stops

? ”

a

ticket

of

A

like without

'

't

man

do

“

:

asked Don know and warns you and then lets you

incident

gohe s

forget

.

such

you

patients

it

reported to

who

other

her

vised

by

A

woman

an

.

my office

or

of

,

example

a

group member who faithfully obeys the report seeing leaving rule will some the others arriving

For

'

if

.

I

do

to

of

,

?

I

Could more about the group members defiance refusing the regulations Not very much short con might treating conceivably tinue them this these

to

,

a

am

I

All

I

them

improve the rules

course

,

I

don

' . t.

. of so

to

do

no

to

the therapeutic process beneficial conduct

of

general guides

. of

As

the

At

.

in

'

to

to

S .

its

group contribute members recovery the way that traffic laws contribute public safety a

rules

no

it

if

of

My

part

Sa same

lives for

understand them and help them analysis their reactions

of

is

their functioning

wanted patients

my

. to

is

to

want

do

in

I

rules down even running not interested

'

lay

.

I

I ,

to

or

as

violations were consistently destructive for the group longer function whole indicated me that could way enforcing the therapeutically Otherwise have

The Analytic Treatment Process

an

or

,

in

's

's

to

's

.

re be .

feelings

who will

to

intense emotional reactions

a

.

in

together persons

his

each

other

.

,

unconscious

and understanding

put

I

a

checked most

of

.

to

develop

group

shocked

treatment

his

to

no

but

place his

to

the letter

communicating

forming to

his

own

Herman

fraternization get

feelings Blind compliance was one In

skill

of

illegal

”

“

of

this

obeyed every rule

able

,

of

.

ego

.

his

,

,

of

-

co

gave

great boost

group member who appeared

sistances

his host

the visit gave me wonderful material for analysis

The disclosure

He

session

avocation Herman had not mentioned

patients

report

the next

on

thusiastic comments ceramics

of

.

to

them

at

one

one group rule another lonely young Herman

the other members his group his apartment The visitor en

to

felt inferior of

invited

breaking

be therapeutic

a

who

to

out

has turned man

the

, though ,

times

a

136

,

in

,

to

who easily check

As

those

a

,

as

,

excitable

arouse excitement and others who tend they stimulate each other different ways

interchanges

it .

calm

represented

,

,

the

the

diverse personalities

among

group members function efficiently

to

other and

each

for

possible for

to

With

on

.

go

to

relate well

com

reasonably

and occupation

education

it

usually make

with

blended

in

-

example

unit

structure

backgrounds —

in

personality

patible

.

in

in

.

The sexes get equal representation The patients are usually respects alike some and different others Divergence

group process

that if

also

get

have just

out

would

emotions

the formula

be

impression

therapeutically

I

have the

churned

up

I

.

is

mobilized

,

a

In

”

dogs

group

of

a

form

in

to

top

personalities

“

gressive

fascinating —

would

be

It

.

backgrounds

highly

ag

of

.

group could lined were reversed other words com posed persons with similar personalities and different

various fields with

Patients and Treatment Settings

conflicting interests .

A

police chief interacting

137 in

a therapy

a gang leader , or an industrial tycoon with the labor union , could certainly stir up a great deal of

group with head

of a . If

also developed love for each other and prevent any learned how to of their feelings from seriously interfering with their functioning in the sessions, I would

hatred

they

know that they were having a therapeutic experience gether . This could be the supreme test of the power group psychotherapy .

to of

[6 ]

An Afternoon in

My Office .

which

minute important interlude

-

an

is

,

ten

rarely mentioned

period

precedes

for

the

less

proper

complement

is

hour ,” but

its

GREAT DEAL has been written about the " fifty -minute

A

Neverthe

the session analyst

both

and

.”

even

.

read

analyzed

I

I

the

door

a

taking

the pleasure

those interludes You spoiled

it

.“ .

telephone

he

.

,

myself before you opened

or

to

, , or

callers ”

by

his recovery

inviting me inside once told me the torture chamber But learned

to

all trip

of

.

He attributed

beyond the reach

,

could not recall working relaxing brief walk without company discovered

who

being alone

free

him

,

,

-

in

room

“

.

meditate

the waiting

ex

from

ahead

of a

That was where one busy executive

the couch

of

himself

the session

to

He relaxes

on

ternal realities

to

necessary transition

by

affords

or

,

the latter

a

For

it

.

analysand

That started my great deal about

My Office analyst , the ten -minute

Afternoon

interval is to

inning stretch

seventh

time for

a

personal needs . his

attending

chair his

.

-

it gives

Physically

139

In

, planning , and

contemplation

a

For the

in

him

An

is

.

recent discussion analytic hours

and preparation

,

-

,

note taking

letter

the

.

case

change

to

in

pace

thirty

the late the day

's

signals

preparation approach

in

.

a

evening

solitary

session

of

or

afternoon

group

Its

the interval

a

lengthen

minutes before

of

I

thoughts

to

devoted

Oc

for

But by and large the interlude between next

.

a

on

-

special delivery a

of to

or

read

afterthoughts

patient

him

the interval between sessions a

to

call

,

,

at

is

the patient alone with

take advantage

telephone

a

detailing

disturbing

's

make

a

to

be

apt

casionally

I

to

is

he

of

a

,

he

rarely changes behind the couch during session position because any movement his body though scarcely group noticed when his desk conducting seated

CON convey

of

. a

of

I

of

recapitulated

two hours

is a

of

,

of

,

time

them

the day

emotional inter long series

in

. a

The

some

of

summon

a

To

in

.

the nature

are

or

interviews one and half a

into

To

.

me ment

one

person

to -

pressed

procedure

of

changes that have gone person

their handling summoned

toward the end

,

and taxing

,

well on

together physically

cases and thoughts about

my mind as

in

patients together

spent considerable writing summary

of

Comparisons

the differences and similarities

more vivid

the

last treatment session

activity

sextuplets

,

practice

.

's

the day

my

at

time after my

presence

welcome antidote

of

the early years

a

,

have become routine

octuplets provides

In

or

”

child

and

"

.

By

a

in

or

—

,

six

.

activity After hearing my office bell sound just once hour eight rings after hour succession tap out new message more insistent and challenging that time my intimate and relatively controlled meetings with the only

the combined

and

com

group treat

Ice experience

with

consultation

two individual patients

col

junior

and one with

,

,

in

's

I

included

league sessions with

activity

afternoon

a

.

office

a

my

It

,

shall describe

a

the analyst

for

an

The Analytic Treatment Process

140

.

group

My

his his

impending

's

Annette

,

regret

.

from

his casual

withdrawal

the

from

he

.

.

I

had been rather amused

a

.

group

his to

To

reference

creating some

That had become apparent

by

in

Practicat

our first discussion

asas

to

.

Dr .

Felix believed difficulty his practice

his

his first

in

me only Anne Annette good looks were good that

group She was known

,

he

since then

him

in

had happened

attractive young secretary

an

with

few

.

.

a

what

and wondered dealings

to

I

to

I

as

a

,

young psychiatrist first appointment was with whom shall introduce Dr Asa Felix Before arrived thought back our first consultation weeks earlier

problem had arisen which

thought

for her

. .

unwise

to

s

:

had replied

me

She has told

continue She intimates that

love with me Many women have expressed love for me

I

”,

.

her

Why

doesn

bother me

person

She

't

.

for

a

exist

as “

.

.

Felix had replied

It

one woman worry you don

had told

helped their treatment ? ”

,

tell

't

know

can

Dr I

because

”

't,

doesn

I

"

It

should the love

of

I

as

“

.

As far

it

“ him

she has

."

in

fallen

would

is

It '

“

be

with her

was

but hers

it

problem

,

what

not my problem

he

Asked

his

.

was insoluble

just

think

has

feelings

of

don

't

“

you

she

?” So

.”

transferring feelings

love

for

is

She

.

she

has

transferring

to

a

? ”

They were both killed

an

had said

great longing in

he

,

”

them

love them

She has always had “

't

She did

.

“

she really

“

Didn

me She just thinks for her parents

.”

her feelings

.

“

Not

.

for

you

know

automobile

Office reality

she has

for

the

say

“

?

Why not You

I don 't deny

.”

't

,

accident when she was a child . her love but she doesn love me

the

141

of

My

An Afternoon in

same feelings

you

an

as

't

I

.

I

.

at

demonstrate

This

more

is

.

I

is

a

.

I

.

a

seeing her socially

can deal

like

it

-

,

,

in of -

if

a

don

cup

with

transference

hatred

”,

. It “

sounds more

him

"

her

love than

making

.”

for

a

little feeling

transference

out

she

them She the mud because coffee Now she

stick

the group

by of

drop

to

't

threatens

with her over

sit

wouldn

me

calling

But hinting

to

least

at

propositions out

started

know

for her parents strong transference

I

,

all

there was

if

so

personal

“

that was

or

glad that she developed such

quickly

by

would

but

actual

since she really doesn

just conveying feelings

is

,

all she be

at

me

”

,

had asserted

me

she knew

't

he

"

might feel she loved me

person

if

I . ”

now

had

told

of

on

Is

do

you

feel

between

the

But how

going

"

something

advances

But

insisted

.

had

.

feelings about Annette

Felix

he

Dr

.

impossible

,

was

's

no

This

relationship

?

of

about her advances you

two

?

to

continue the analytic

.

it

is

,

?

to

't

to

Isn

your analytic she trying knock you out you role She came for treatment and now she making personal demands that would make impossible for you

He

had

was concerned a

to

as

he

"

it,

when

Dr

he .

done

so

had already

few

he

."

to

m

if

was wondering his

I

."

I'

“

for

.

of

be

trying about my suggestion that she might make fool him mentioning Thanks had remarked our going investigate the possibility discussion ended

,

to

I

“

.

“

She protested

at

said

.

he

,

to ”

up

on

.

A

Felix arrived for consultation minutes later spoke subsequent developments briefed me her before the next group session and asked her what she was first that she really loved

The Analytic Treatment Process

142

me;

I

threats .

for her

that was the sole reason

she gave in .

“ You

pretty

looked

'

. I

thought her little game had gone far enough budge from that position . " Finally

I

told her

didn t

vulnerable

to

It

.

so

.

to

,

to

was wonderful

she

,

her treatment

have

an

to

I

up

break

kick her

to

I

,

.

but she wouldn

me not

Then she asked

She still thought

't

,

said

understood

the group

.

to

out

of

be

glad

as

—

it

?

'

did

to

in

I

see

'

a

'

to

you appealed me, she told me. I could that my cap would have been get you say feather you figure this out But how She seemed relieved about not rejected had expected her feel but

to

on

Now that

.

have such

I'm

idea has been that

feel sup

allowed myself

interfere with her

,

“

analysts have different views

experience

is

”

My own

.

this subject

told

I

,

you know

him

? ”

't

these

just

to

I

. " If

added

,

actually him

that

he

to

.

,

“

.

see

get

could

This had disturbed

this girl wouldn

As

treatment

them

for

to

have feelings

Felix went

could

supposed

't

analyze

My

he

posed

patients

”

his he

thought he wasn

ings for

because

“

Dr

very attractive

did find Annette

on

defense

, ,

his head was out

assume that

the sand

ostrich

of

an

away with

naïve

he

have been

.

He must

he

.”

affair with Adonis himself

that feelings

help

it

re

find that

your patients

I

it

rule unless patient know that

,

, a

let

I

.

for

him

have particular feelings

to

my

as a

my feelings reveal any general strategy of

't

don

is

.

asked

of

part

them

reveal hostile feelings

you

to

Do

“

"

I

Felix

for

will

will help you understand the therapeutic experience they need

Dr . .”

and give

them

believe you

your patients

? ”

your feelings

I

,

lated against acting impulsively

'

to

. If

.

in

analytic work What interferes with rather than hinder you are tendencies behave improperly well insu

did tell one woman

My Office

An Afternoon in

this morning cigarette

probably

that she would

choke on her next

statements to her , not to express but because they are helping her resolve her great

. I make

hostility , terror

143

of sudden

such

death

.”

The idea that he had

right

a

to have feelings

patients ,

for

as long as he acted

in accordance with what was best for UTO DI analytic process , would make him feel more comfortable in working with them , my young colleague remarked . He

was fast learning

that

they

developed

often

things besides understanding

other

treatment. It disconcerted

him

“

of

I heard

When

my

practice

work

with

'

wasn t cided

such

serious

as

to

, I

hear

to

them

the

so

in

fre

.

that way at the beginning wonder how it was possible to

used

to

, though ,

as when

told him

.

“

they said they had

That

de

that too . But their attendance

did

of frustration

relationship

,” I

people

unreliable

drop out. Some

feelings

say

patients talk

records improved fantastically as dling of them . When they feel free analytic

relief

and emotional

quently that they felt like leaving treatment

for

desires

and

I

improved

in

my han

to discharge

in

language

resentment created by the that they rarely need to

, I have found

these feelings in action . Still, it no longer sur prises me if a patient who never misses a session reveals that

discharge

he feels like giving up. ”

During

slight

the next

dark

divorcée

-haired

, spoke

she was with teaching

resentfully

the marriages

in

sat behind the in

couch while

her middle thirties ,

a

a

recent

about her closest friends. When

said , she pretended that her , filled her life but she explored her prob treatment . She wanted to understand why

them

career

lems honestly

hour I

woman

, Mabel

of her

associates

her own had failed . happiness . All her difficulties

were successful and why

of their marital would be resolved , she felt ,

She was deeply jealous

The Analytic Treatment Process

144

if

could find a man who wanted the love she could , there was was some Certainly offer . someone in the world for her , she

but where was he ? She paused suddenly

asking that

after

question

as

if

she asked me: “ Can

thought had suddenly struck her . Then

a

't

you help me find a nice husband ?” asked her to describe the person she was looking for .

I

She

mentioned several traits which she regarded as desirable . Exploring her specifications with her , I asked her

. Eventually

some impatience

You know

.

with

want

man like you would

my queries

she brushed

the kind

person

I

questions

of

of

be

series

“

a

off

in a man

,

?

a

her

.

to

and would appeal him

who was marriageable

In

.”

.

I

be

him

go

I

.

A

fine finding How would about her opinion that acquainted with man would not be too difficult must

try

to

will

be

Finally she gave

interposed

.

.up

tackled the queries which

I

,

?

I

to

How would introduce her Shemade various suggestions about how they might meet and earnestly

a

Her

self

esteem

in

.”

do

my

a

She was

her ability mounted during

-

.

lengthy

man for myself to

.

That statement

who had little confidence herself

find

was encouraging

a

trouble

less

to

It

.

get about

it

“

.

.

of

She would think more suitable plan before the next session But she changed her mind before leaving the office For

woman

things

for

serious and

She felt more capable on

Mabel

about the patient who had just

He

'd

-

room

my afterthoughts make

a

associations

entered the waiting

.

series

of

of

a

with

me

.

of

.

to

rely She resolved not handling the mission herself my bell linked The ring

mobilized her resent

.

ment

I

.

a

satisfy her request immediately on

to

ure

to

,

it

which made clear her that worthy liked her and felt she deserved husband My fail consideration

wonderful husband

An Afternoon

My

in

Mabel , the

for

dismissed

it

Office

occurred to me. Then I better job of selecting a hus

thought suddenly

. She would my

band without

145

do

a

. Daniel ,

interference

manufacturer

a

in

his early forties , was close to recovery from a severe de pression . For the first time in his life , he entertained thoughts

family ; but there was little likeli hood that he would solicit my help in finding a mate . As I opened the door to admit wondered whether he and raising

a

he

.

himself

settled

in

active

his a

convention

a

had been

of

.

which

in

association

had addressed he

he

his

cheerless attitude became clear

hours earlier

few

A

glumly

.

.

an

the reason for trade

gave

His mood was bleak He talked hour about chronic problems his business before

the answer

half

the couch

for

sighs

deep

as

His

that afternoon

attitude about himself on

demonstrate his healthier new

or

bid for sympathy

fresh

a

would make

I

,

him

of marriage

before

the meeting had hoped make business colleagues dramatically improved functioning aware But was convinced that had bungled the opportunity few persons had

.

,

at

A

.

him

tell the two most amusing

",

of

he

“

,

on

,

It

.

to he

he

to

his

of

he

politeness the talk but only out badly organized had been and had neglected

complimented said

speak

to

invitation

his

an

accepting

he

.

In

illness

anecdotes

for the

saved

to

the

,

some

re

.

be

to

.

soliciting

me

an

of

man

you

this seemed

to

said

talk

your

."

him

surprised

at

.

I'

m

prominence and experience The vehemence with which

important

“ A

you gave such reproached

.

say

I

preparation

I

to

you mean

without

He appeared

? ”

from

before the meeting Daniel

them

.

at

sponse “

and rehearsed

that point

paused

Do

.

he he

a

.

his remarks

.

Other speakers made much better impression thought about what had happened The more more miserable felt He should have given some thought occasion

startle

The Analytic

146

.

him

he had

The last thing

expected

times

it

'

this

I usually my

was

. . “ Some

.I

.

You trusted to luck and you were

'

didn t

I don 't."

do better when

. “ Well ,

signal to proceed

one time when you muffed it . Let this be

is

;

criticism

you be surprised ?” he countered ne s much better to speak extemporaneously

counterattack

you

to

than enough

should

prepare this talk because

His

me was

from

he thought he had given himself more “ Why

Treatment Process

a lesson

rank failure .”

a

" Come now , never said it was as bad as that . After some people praised me Daniel self esteem was rising they

you were

weren

sensa

.“

to

you get involved

re

:

my business

you just beg for him

gave

fresh

.

.

insight into gloom was gone He left behavior office pleased and invigorated with new understanding

my

of

His

.

It

.”

this interpretation

his

.

you feel better

you and now

Daniel agreed with

it

;

is

to

be

.”

'

?

to

it

“

I

gave

blew

your bowels

in

?

did

uproar Why

get

.

I

.

, an

"

in

such

up

counterattack he

became more and more heated Finally Enough enough What have done anyway You just my analyst All you ever want attacked

have

It

.” .

His

retaliated

.

I

,

attacked

he

to

a

?

time

Each

to

indignant Who wanted The question made There were other speakers would poor hog been taste for me the attention sensation

be

him

? ”

say

't .

“

.

on

But

a

's

I

.”

,

went

Did anyone

either

.

so

enthusiastic

tion

cronies

"

old

few

a

“

Just

-

all ,

I

these obstacles had

my

exaggerated

already

reflection

.

getting angry been

me Since most

removed

his case

his toxic attitude made

it ,

from

To

the obstacles

remove

.

them

have

more depressed

in

of

which prevent

them

at

successfully

of

them

,

treat

patients like Daniel

learned from

usually makes

to

I

the first lessons

that sympathy

I

is

One

of

.

himself

,

this new

rewarded

with

him

he

;

,

instead

of

pattern

behavior emotional

irritation and annoyance

engaged

It

the maneuver

.

induced were mobilized

which Daniel

I

for

The feelings

in

of

.

interpretation

it

me After

was fully established

that afternoon

an

turned the attack

I .

him

147

maintain

to

difficult

My Office on

for

An Afternoon in

.

he

of

I

.

my

in

.

response

He

place and

not join

did

to

far he

a

he invited

this

helpless

from

me

treatment

by

's”

“

to

I

understood

attacked himself

,

on

was

putting

act quickly

him

That was the

he

it

,

in

,

.

of

did

I

,

His knowledge that

hour

.

in

which would start half light the modern chairs stacked

,

my the wall The group in

of

I

made my usual preparations

session

six

for the group took out

departure

,

's

After Daniel

an

I

and return

criticism

felt like saying helped him

to

he

.

usually made this possible

would accept anything

I it .

to

.

relationship

face my

that

rational grounds of

at

came Moreover started

while

his unconscious need get mother love

that session when not continue my chiding unless counterattack immediately The quality our had

to

,

I -

in

that late stage

his self attacks unless and

.

,

counterattacked

cue

him in

that

successfully

winning the argument Even

Now

feelings when

as

to

demonstrate

order

he

my him

,

I

used

quiet study

:

to

he

to

prove was helpless making her sorry for problem

display

source

as a

These had served only

information during the many hours figured out the key his personality

of

.

feelings for

therapeutic

been

I .

him

it

would not have

to

,

,

,

with himself

my

in

Early not have been convincing without them very his treatment however when was sick and irritated

would

.

them

on

in

had

year

.

the week for about

a

and three men who

of

three women afternoon

sat

of

,

to

closet and moved my couch closer ing the chairs around my desk brought into focus the that

The Analytic

room

-

a

his

minute

,

,

her case acting

,

to

up

,

that was

to

brought Edna

.

This

closer

to

Frank

so

I

to

meant

disap

and

but

him

edi

during the recalled how she had jumped exchange places that Inez could

last session and offered next

form

next

in

. .

certain

wed

,

-

,

Being true

impulsively

sit

art teacher might

.

the

waiting

-

He was thirty five newly

to

Edna

an

, .

.

torial office pointed

sit

chair nearest

the only one vacant when

arrived late after making the cross town trip from

two

less

took

Treatment Process

he

often

was usually

or

It

Carter

the

148

Kent but

.

in at

at

.

broker

teen age

-

A

acknowledge that

he

beginning

Edna

frail

distance a

a

easy hearing

shouted

jealous wife and to

he

her right

had the

the

.

just

forties with

was problems

,

at

she were out

his early

son

sat

of

as

times in

who often

if ,

Frank

a

of

.

I

.” be ,

to

I

“

:

him

A

of

more aware her presence little later ought she exclaimed have my head examined for spending my time coming here each week should groups two looking for husband did not make

,

a

.

do

about her loneliness Her attitude the other five members was gentle and somewhat

find out what

toward

to

to

-

of

,

Hortense who usually took next chair was college professor who was trying middle aged widow

.

get

She

a

to

for

,

.

in

without women The three the group irritated girl Friday Inez theatrical producer

,

with

or

do

lawyer who couldn

him

Kent

't

sat

,

her

a

Next

to

.

maternal

had

little

.

it

do

't

which had shut out the

scenes

and sounds

of

I

,

't

to

.

along well with time left her family couldn her husband and didn know what about pulled back the drapes Once the chairs were arranged

the outside

To

.

-

-

,

of

world during most the day further brighten my seventy office where one five watt bulb had glowed dimly

My

lamps

.

to

set motion minutes returned

I

myself for the

my

Then

ventilating

Having thus prepared

my

desk

to

several

,

in

a

few

149

.

I

equipment was room

on

turned

,

day

Office

in

all

An Afternoon in

the

prepare

.

session

it

to

they

co

-

.

recognized

deliberately

the as

reversed the situation

inform

myself

the session

my

this was

not

did

about

.

call

that

I

,

was not asked

intention

and

unconscious expres

an

a

had intended

I

Had

enthusiastic

seemed

off

Since

session

that

them

but Hortense to

,

and

skipping

his

's

week

all

a

taking agreed

patients about Kent had canvassed holidays They recess over the Christmas

session

.

in

the

I

last

.

,

I

forward with special eagerness that after group noon because the had not met for two weeks Early looked

I I

,

of

,

of

?

I

no

of

their resentment about frustrations they were undergoing way knowing had course but sion

it

.

to

in

or

action the great need

The resentment

of

the rule

,

the

to

was associated

, I

eliminate me along with

taken

it ?

,

not

a

talk

.

just

they

had

physical contact with feeling They felt

:

,

felt about

the group members

with the group rule sessions

wondered

no

the minds

In

I

me how

I

ask

of

to

,

but why

myself

trouble

at

; . ' I s

to

.

W

on

often operated the assumption that they knew what was planning This assumption gave much more meaning Kent proposal and the eagerness with which was ac having cepted was relieved not cancel the session

Inez

.

She would not

wished

to

of

.

life Now she talked

example

he

For

this attitude

had talked about her

,

to

.

no

the suburbs

she

him

consequence

.

house

treatment

she were tied

of

he

were

in

buy

a

if

as

husband

if

the beginning as

At

about herself symbolized

.

disclosures

for

or

Her

I

:

a

,

.

a

.

more extreme form Like the patient Dr Felix had discussed just few hours before she expressed the atti tude Love me will leave the group took

budge from their

The Analytic

150

centrally

be forced good

,

apartment

located

and her daughter

. Living

change schools

to

for her . She preferred

enough

“ Why do you

mention

said ,

to remain

hood where she had lived as a child

been

it was good

so

the neighbor

in

.

many things

so

would not

the city had

in

for her parents , Inez

enough

Treatment Process

your

from

past ?”

Edna had asked her . “ I'm talking about my future , and it's about time I started working on it . Jack can move out — alone . I hope does .

he

We don 't

I

any more . want getting me from one.

agree on anything

divorce , but the group is keeping want action , and that means leaving

a

I

the group .” you ,” said ou want to blackmail us into being nice to , always Edna who wanted Inez to leave . Hortense , whom Inez ignored when

, wanted

she was

her

of

need

in

so

remain

to

ominous feeling . Frank didn 't good for the group

be

.

The idea of her leaving gave Carter an

treatment

share

if she left .

it

.He

thought it would

He'd like

make sure

to

a very good - looking girl to take her place . Kent use speculated that Inez might be talking about leaving because

got

cottoned

to

her.

'

He added : “

to

.” .

of

if

leave because

You

know

you

approved

up

”

.

it ”

Frank spoke

.

me

but Edna

's

statement

,

Frank

the group

you leave

.”

”

it,

'

,

Edna asked

prove she Carter

said

does approve

even planned

I 's

ignored

the

I

“

? ”

Did you

Spotnitz

he

.“

“

.

Maybe Dr next Maybe

it s

'

leave Inez until

,

't

shouldn

can

'll

Perhaps she just wants knows we against re

" she

rules chewing

“

since you feel so free to ignore you stop that vulgar gum

Maybe

the

There s not much point to your remaining

.

he hadn 't

it,

they

question

gave

,

I

to

.

,

of

opportunity wanted talk reminded Inez that verbalizing her feelings during the session she instead

me

An Afternoon chewed

My Office

in

whenever

gum

151

felt

she

.

tense

That

“

typical of

is

on

“

.

I

,

”

You

what

ll to

out

it

he '

how so

I'

“

how

found out

work

to

.

I

know

.

she contradicted

,

have

”

“

I

Yes

handle my husband

ve

.”

't

,

to

all

your defiance here , but that 's right went accomplished have leave even though you haven you came for

.”

leave me

,

in

I

at

.

might leave

real member

and up

unless you make this group

try

."

to

your mind become behave like one

a

:

I

accepted the idea that she

should not remain

You

“

I

her

told

might that moment that nothing the group but the situation required

of

her know

that

I

let

I

had the feeling say would keep her

,

,

be

:

“

on

I

's

"

good

candi

."

this group break

up

a

he

let

has

.

I

,

several alternatives

One

,

on

.

I

,

it

in

it;

increased her determination

session

the time she was not my opinion would have might leave the other

she withdrew

decided against

that

.

me with

of

the end at

aking

to

,

I

never at

leave

had presented

.

I'm

.

.

,

to

That

remark reflected his own resentment

tell her that

return

sure

'll

,

formal

-t

's 's

sardonic

recalled to

He

take her place

Inez was

Hortense

if

Frank

went

.”

I

't

to

"

date

shook her head

,

? ”

As she

what thought Don worry

:

I

on

into staying

,

to

.

.

”

to

to

"

persuade her Please remain Hortense pleaded not realizing that this would have the opposite effect Carter seconded her request Deferring them asked Inez Could you talked

if

by

her good

-

responded

to

.

changed her mind

I

to

it

it .

all

a

,

,

to

hand have asked her remain That would have given triumphant moment but her would also have made humiliating the more for her return later she with equa

remembered

how

glumly Hortense

looked

at

I

.

nimity

the

un

The Analytic Treatment Process

152

occupied

chair

the circle at the beginning

in

of

the next

session . “ m glad she s not coming ,” Edna said with of triumph . A moment later , to the great surprise of

I'

'

one but myself , Inez walked in and “

Well ,

,

I

here

Edna would have baked

coming . Don

'

ask

“

of casualness .

a show

'

if

cake

a

note

herself as usual .

seated

she spoke with

am "

a

every

I was

known

she d

I It

.

I

up

."

in

Dr

The

dream a

was was

Spotnitz

, ”

think my uncle was

to

Be careful

.

“

:

.

,

and started

room him

.

I “

.

and

continued

Later she decided that the

”

see

about the group

to

She whispered

her

Inez

,

to

will

others

another

to

followed her

uncle

make love

peculiar

very

then became

dream

us . .

Her

I

. he

;

Her

't

uncle hadn seen for years came California teaches psychology

and relatives greeted me

An

.

of

.

d

I'

a

up

.

it

ll

;

I'

I

,

by

on

-

to

t me The morning after you good horrible feeling woke with said dawned me that left the group That night dreamt about visiting my parents The house was full friends explain

she

up

d

so

punish

harder for me

to

making

I

if

he '

had hoped it

I

.

by

.'

'

him

or

couldn

,

saying

't

I

All

the next day and asked said was yes He sounded

was very disappointed

I

m

by .

bored

me

I

come back

.

could

called

he

Anyway

,

“

.

added

't

.“

.

said last

.

the group

."

be a

of

Dr . ”,

lot

a

I'd

signified

to

to

.

feel loved

.

she pleased made

her

do

Spotnitz

that she wanted affection from me accept her and the man who was willing what she felt like doing Permitting her come

dream

as

go

let

and

You haven

Carter urged her

member one

symbolized her

her

.

Her

to

I

made

never really been my mind return and

that up

—

“

? ”

us

why you really came back Tell thought about something

week

I

asked

.”

I

punish you should single session

I

“

a

“

Why

missed

I

.”

comeback

My Office

re

'

“

to

analyzed

I

had

it

not volun

she had

habit suggested that

.

to

,

The fact that

.

the

up

tarily given

not

the group

to

"

of

.“ .

Since the others

after that later references this were addressed specifically Inez She chew with grim determination following her

to

continued "

grati

,

communication

only occasionally

resistant behavior return

the

,

by

a

early

them

in

I

had told

practices interfere with smoked

frustra

Inez

during the sessions Some relieve your tensions instead

gum

gum

to good deal

.”

do

to

chewing chew

responded

smoking

treatment You what you want about this outside but here these

, ”

of

by

fied herself

you smoke talking free

group members

group process or

of

While other tions

153

to

An Afternoon in

.

successfully

.

Eventually they

from

ceased

it ? ”

stop later other

to

up

'

offered

mem

CO comment

of

wife but

“

I

't

:

next impossible

't

couldn

about my

talk

for me

to

either

his

,

to

up

explain

I

you could talk

”

I

"

What would you

us ?

feel

you people how

to

now

if

difficulties

It '

it

Inez spoke

talk about

.

had quarreled with

can

Carter

the various

the first this problem looking very depressed informed

s

meetings

the group that

. At

the last four sessions reflected approach

,

these

my

. say . ”

notes

changes

he

My

on

.

her defiance

in

on

sessions she gave

disapproval

of

,

expressions

bers went unheeded

to

few

She

to

.

Kent

after

she seductively

about time

without

,

,

the effort Though

anxiety

to

but

agreed that she could please

your

it s

't

Don

you can handle

a

if

.

ever she felt anxious

find out

when

into her mouth

gum

you think

to

told her that she slid “

I

Once

asked

.

."

urged

as

Inez

I

gum

this moment

at

I

s

hate

”,

piece

you

,

Take another

her handbag

.“

at

me

of

“

She glared

It '

.

her

she opened

The Analytic Treatment Process and

“

.

he

all

"

.

I

it

on

a

of

.

“

. Did you

't

at

I

to

the

.

.”

the

in

to

in

to

,

I

gum

stimulate her

was though simply her from the need chew

free

me.

throughout

chew was trying

to

I

shouldn

take some more

't

you

me

looking directly

God

sense

a

. to

of

In

? ”

do

her

can

if

I

, see

you

"

,

't ,

,

"

't

“

occurred

urged Inez

She supposed that

the opposite trying process

in

he

-

”,

,

to

I

it

don

session to

chew

I

the session

in

Later

Why

Hor

Even

she said

reminded

Hortense replied realized that you aren

then

said

? ”

",

"

" "

But

started

it

"

I

Frank

realize what you were doing

After

we were

guess

.”

was doing something for Inez

Your first rebellion

be doing

and smoked

barbaric

so

s

,

it '

who thinks

. en to

,

to

Kent was the first remark collaborating with Inez and Carter tense

All but

cigarette

momentarily

sympathy

they chewed

as

the

I ,

lighted

piece

first time they had deliberately the same pattern resistant behavior

in

,

That was unit

as a

, .

gaged

recalled

of

;

.

them

gether

taking

join her

.

co

,

Carter accepted gum from her stead An unconscious bond gripped

,

it patients

from

a

After extracting her gum for herself she invited her

to

154

the

,

"

”

.

to

not

in

chew this group vas you what tell me That was

or

chew

not going

do

to

free

to

.“

she said

'mI

"

I

to

have

be

.

sessions

.

the only subject she discussed that afternoon

,

an

in

I

,

pointed out but The others had helped her chew gum they had not helped her talk emotionally significant

.

I

asked

, ”

to

me

strange

she

that

it

'

chewed

together

“ It s

we

that ever happened

.

the nicest thing

gum

smiled

is

This

as

“

.?

”

gum

different approach May have some “

When Inez took out her too

radically

:

took

I

later

a

A

week

I

.

way

7

An Afternoon in

My Office

I

today .

happened

just

decided

I

little while ago that

a

.

lonely ” , important true that was information , and the feeling

If

of companionship

.

155

I feel so

chew gum because

it

.

Chewing

which Inez conveyed seemed to confirm with her , which helped to resolve her

gum

of loneliness , made me aware that this feeling was, , for her an obstacle to co - operative communication which feeling

. Inez made Edna feel jealous

to

and inferior . She complained

worked further on the prob telling Inez that her gum

I

.

to

during the next session chewing still worried me She wanted

.

Use just because

”

it

, . ”

I

,

on

"

important

doing

something

started treatment

.I

't

won

chew

you

'll

”

,

”

help me

Inez com

be

."

. I “I

to

want you want

what

but

it .

to

't

I

I

feel worse than when

"

do

do

find out why you insist don want you

plained

said

“

thing

voluntary

Frank declared

I

a

is

of

I

"

't

,

don

This

she said

to

want her

know why she should stop You are demanding too much her “

"

didn

't

I

just because

.

beginning .

. For

.

if

a

lem

That was

and handed me a and chewed simultaneously

,

's offer of

I smoked

her . She

cigarette

by

refused Inez a moment

I was neglecting

that

gum

to

attention

gum

my

it,

be cleared away usual ,

do

to

As

is

had

, she

.

,

I

her younger

sister

of

it

with memories

.

birth

of

the

this feeling

at

that

She associated

your

because she to

was impossible for people

was convinced

fright

she said

,

,

Inez chewed when she felt lonely

permitted

?

wave

hostility

"

have you people

of

by

a

gripped

in

so

Why

“

:

I

asked

be

selves

to

.

group

love her

.

to

helped through understanding was supposed through personal gratification explained Perhaps not felt lonely because much hatred was expressed the She

her rage and

156

Her

attention

of

by

her

in

guilt and hostility generated

love

lack

the group

.

because

of .

her Now she felt that she was not deserving

of

feelings

implanted

birth

that

consequent

of

'

sister

's

her

attention

feel unloved

.

made her

over

in

guilt

in

resentment

the loss

it

time because

her parents

of

She resented

at

The Analytic Treatment Process

in

her

't

don

to

.

I

,

permitted

why you

know

to

I'd

“

",

, I

like

You have

object

at

senior

a

Inez said

, ,

gum

chew

,

started

to

She had

as

”

it .

on

go

explained

doing this and

all

is

"

with defiance to

. of

it

to

.

to

to

so

my giving Inez Kent and Edna objected much Coming my defense she said dividual attention was doing because she had asked me help her you who consistently behaves Inez the only one

.

of

.

,

.

in

school

of

The other girls her class most them enjoy older than herself drank and smoked She did not doing either Chewing gum became her own badge high

asked

.

I

didn

”

it ?

,

security

. ." 't

of

feeling

the

Even

stated

in

Inez

two women more

a

the

on

them

,

It

made her closer group she felt superior

,

your relationships with boys to to

helped you

a

gave you

in

It "

“

It

.

sophistication

level

.

with the men

.

I

, ”

“

.

,

so

.”

us

us ,

”

's

“

on

“

,

If

you had good relationships with the women you would feel their level too said That your fault Inez complained The way you you hating treating are have women each other They might not have expressed much hatred and

little tension

,

's

Inez

the sessions

.

in

.

was

in

it

of

evidence

the release

compulsive

course

,

experienced

time

that

to

clear away the obstacles feelings On the other hand

to

their hostile

of

had not been working primarily they

The only recent chewing She

gum

.

I

, if

it

was true

of to

up

,

resentment

An Afternoon in My Office

157

of difficulty verbalizing hostility ;

still had a great deal primarily , I suspected ,

was hostility originating in her relationship with her mother . I would have to continue to work on this . But the time had come to work chiefly on the

's

group

it

resistances to the expression

The bell had already arrivals

;

Having

would

soon

reviewed

my

it

objectives

, I now

of positive

sounded

be time for the

to commence

session

notes and formulated

had to consider how

I

. two

feelings

out the message of

my

.

immediate

function , kept quiet the members of this session . When I group generally mobilized a great deal of hostility . When I should

during the

was more communicative, they usually becamemore affec tionate . Hence, a good deal of talking might be in order . Mo But the exact amount of verbal feeding to be provided depend

would

attempts

on

how

much

establish contact with me would determine spoke at length or said little . To the extent to

which they made it possible

would focus primarily

feelings

. Their own

to

I

whether

I

they wanted

of

for me to

on

Sea securing

love .

It was time for

participate

. I opened to begin .

the session to begin

my waiting - room

— the

signal

, I decided ,

the verbal release of the door

to

walk in were Hortense and Edna . They talked about missing the group and being eager to see the The first

others again visits

to

Carter

to

. Edna ,

just back

Mexico

from

,

described

her

the women

on

art galleries and silver shops .

, earlier

than

usual, complimented

'

regret that he didn t feel saying what he was . He described his visit to his family up old

their appearance but expressed

't

Kent

Inez

,

was talking

,

While

,

.

married

he

.

a

of

he

.

-

state as an fashioned holiday His wife had complained neglect because had spent much time there visiting boyhood cronies Maybe he was guy who shouldn have

and Frank

The Analytic Treatment Process

158

entered

rapid

in

and took their

succession

. His

Frank said he was depressed

testicle . Only twelve , the boy had already

an undescended

chalked up enough operations annoyed

ter no longer

,

him

for

lifetime . Edna ' s laugh

a

went

Frank

he

'd made it clear

on

. He was

now

woman he 'd met for dates , though her that he was married . But maybe his

thinking about how he could help her . a cocktail party kept on calling him

at

places .

usual

son required surgery for

to

A

rocks anyway . " Why don 't you work out your feelings here? ” Edna asked . “ It would help your marriage if you concentrated on loving one of us .” on the

Hortense seconded the suggestion to stick

the straight and narrow

to

you to stay away from But you

.“

asserted

women

woman

weak

are

'

shouldn t ask you

for me, but it would

,” Kent

irresponsible

and

Inez showed she had guts when she came back

His

the

so

I

,

I'

d

a “

.

better

con

and

all

.”

gift

we

turned

opinion

,

's

Carter

to

.

Frank reminded her with some derision

,

encourage

the

.

out feelings Sexual satisfaction from each other poor substitute what they really wanted for

a

be

to

and Inez all

the greatest

She offered herself talk

I'm

.

.”

't

didn

in

”

,

you down

souvenir from

get anything for the men of

You offered

brought

for Hortense

I

why

but thinking about

depressed

't

she had

us

“

centrate

on as

,

Mexico

sympathy

him

for

“

:

of

I'

's

.

why

That

m

I

son

would

lonely

voice makes me feel

him

Edna was sorry she hadn

men

she

? ”

“

.

”

sounds

sad

,

but Frank

Frank reacted quickly Thanks things myself think can take care

my

to

work

.”

to

you

she said

,

breaks my heart

on

given

I'

"

up

ve

so

to

up

the group , but she' s very unreliable . And why is ing hard set alliances with Frank and me

close

help

.”

.

“

such a

.“I

he

marriage was

Afternoon

in

My Office

159

needed ,

All

pin

kinds of gifts were described the and earrings

.

She

of

't

:

'

.I

m

she asked me

:

"

to

ve

I'

“

.

to

I

wanted

at

was ready deal with that mo reply been thinking about the

I

There was nothing

,

Then

?

"

so

.

if

Hortense inquired that was true Why are you quiet today

ment but

affection

love

."

I'm

to

talk

you

? ”

of

my

talking about tokens

?

“

leading this group

Don

of

Why not

a

'

us

re

,

Interrupting her impatiently Kent asked leading realize you into mess chitchat

“

.

in

brought

Edna commented

the two parcels she had

in

An

.

I

.”

in

which you arrived today That was the first thought that had entered my mind during the session The two women whom knew longest

order

The sequence

which the others

in

first

.

in

had come

fol

of

the duration their relationship with me the intensity their desire for my affection This statement was misinterpreted the latecomers reproach They volunteered explanations they took reflected

by

a

as

.

about canceling

which made me aware that they felt guilty

but

not com

why the women thought about

.

A

week later

it .

to

No one

paid any

's

he

communi Kent

Inez

outside this office

“

.

if

”

't

,

as

at

isn

said

."

why you never think

us

tell

arm

looking people he really

when

us

"

a

He has way cating with them

of

him nim

who would tend of

attention

physician

broken

ankle and scoured the city

cracked

last

..

for

to

vain

a

dreamt that he had

a

.

meeting The first was about

a

'd

.

to

members the group between sessions He wanted port two extraordinary had since the dreams he

the

re

understand

he

of t

'

He couldn

about coming that afternoon

enthusiasm

in

had

.

.

studied their reactions

,

Kent

them

no

on

.

I

the last session

ment

; .

of

,

it

,

and perhaps

did

lowed

The Analytic Treatment Process

are you

he

Kent

him

denied that

,

”

,

irritable was and Frank and Edna argued the

put

Inez

Kent

some gum

into her mouth

and

Edna

You

That

did

”,

asserted

.“

he .” 's

are asking for

penis

always take things personally Kent annoyance again He could have warm even

they irritated

practically psychotic

him

's

.

.

voice reflected feelings for people

?

women

if

Why

rejecting you

because his

's

.”

I

“

feel lonely again

said

:“

.

point with

you

from ? ”

.“

Frank intervened

feeling

some

Why

,

to

so

'

" She s trying

get

160

.

.“up

. it.

m

I'

? ”

,

",

.

him

Why

You

all

.

take care

any loving

? ”

to

do

't

,

loved but don

people who really love your feelings He runs

of

dreams demonstrate

be

to

Dr .

.”

feel loved

around looking for someone want

Spotnitz

your complaints about being unloved

.

's

Kent

about this

by

“

.

.

You don

't

m

I'

"

said

in

Edna looked bewildered

you

not

want from her

your thoughts

interested

She objects

But

.

“

What

You

My wife

do

I

are

I

certain what

I

to

s

.

It '

to

,

re

'

I

to

really

try

. .”

alive

.”

, 're his ”

troubles with you

right Kent Carter spoke does the same thing hard for me take my leaving her when have work “

think you

by

I

of

of

at

.

can

I

let

to

understand him know you

a

,

”

of

re

'

“

“

Then too hard

“ . I

Inez said angrily me and hope you hate me My skin would crawl the thought being loved weakling like you You remind me my husband You know you think the same

.

? ”

? be ”

to

,

it

Frank

felt

needed love because his son

, is

;

faced

an

.

loved

he

of

I

,

.

to

“

't

“

is

Where stuck our love Hortense asked you But don want loved too Inez put the question me What interested me was their feelings told her that being unloved and their need for feeling their feelings

My Office reason

.

They

can

I .

't

,

“

,

”

I'

d

to

about getting the feeling love they wanted like love Frank interrupted but "

Carter

and

had some problem on

of any

it

't think

couldn

,

crippled

he felt

because

do

Kent

of

,

operation

161

all

An Afternoon in

Are

supposed

love unend

to

asked

“

,

Kent

:

Wearily

we

."

demand ? ”

ingly

from

please him

instead

to

him

demanding affection

don

is

substitute

1

,

"

Kent

spoke

always feel crippled when

I

.

can

't

demand love that

I

I

.“

so

it

their request for makes me feel even more want crawl away from them because they to

.

I

them

,

say

defective

I

“

But then your de

.”

on

“

Now know why they love me They

animatedly give

do

“

.

to

”

.

to

I

explained

mands them make them feel more inadequate That statement gives me great insight women

want

men who have the same need for

"

do ,

that you

Why

? ”

Inez said respond me

,

't

man who can

You attach yourself

affection

.”

it

is

always pick out

like my husband

a

“

really

in

.

of

He

what

out your resent

I

gum

you really want You are defiantly acting expressing ment instead words

as

chewing

a

that

is

demonstration

for

?

“

't

to

Why you feel you are entitled her emotional responsiveness for yourself This another

asked

:

I

.

him

SO some

“

said

.

for what she had

of

to

try

She would

apologize

to

Inez wanted

.

of

“

.

I

“

”,

.”

I

.

a

's

;

on

even less

't

like man My wife doesn make such demands me that why stick with her saying You are that she makes you feel more adequate you have some problem about love pointed out All

make me feel

.

.

to

.

on

to

1

This understanding and the emotional experience resolved her need chew gum compulsively Two weeks later Inez announced her arrival that she felt much better and would not chew gum This was her first voluntary statement that effect

The Analytic Treatment Process

162

You hunger for it

anything

but

can

't

now

the situation ."

'

“ We ve been

busy

'

digest it . You don t assimilate

'

.

but understanding

That s the complexity

,

feeling

of

Edna . “ Maybe

hatred ” said

I

this blocked us from feeling love . But must have felt love for two people here since I thought about them last week

I

and bought gifts for them . hope the love will last.” “ You 're supposed to talk about love here , not buy gifts, " in these sessions is

,

to

feel and talk about love become aware in

of

chair

from

discuss this further and feelings love and their to

.

my

arose

indicate that the session

to

giving love had coincided enabling me work let

with

simul ag

and

shut

fifteen minutes

.

the discussion until the last ten

love

myself

had

or

thought about how

I

I

verbalizing

to

the resistances

also

.

gression

on

taneously

it, of

of

about how the problem getting the problem

, of

thought

I,

As I

.“

a

.”

was over Have good week rearranged the room after their departure

out

how

you are

be

W&

understanding

of

.”

I

its

increase effects

it

to

exposed

induces

This group needs

you when

to

and the reactions

it

develops

it

.

important for

of

the feelings

on

dissipated when you

you

other

each

is

The love you feel for

It

said . “

act

I

I

.

I

.

as

as

on

that afternoon

that they felt the significant

communication

realm

was going

my

of

the

on

was also within

possibility

during

the

one mind

other ways

be

to

In

at

another

in

from

to

transmitted

,

between

.

psychotherapy patients and myself other human contacts messages appear times

session in

It

them

that telepathic as

coincidence

with them

had been thinking about and were learning how

express

SE

start working

?

to

I it

Was feelings

simply

a

I

had decided

to on

did

,

I

not talk much had thought might That was because the group members functioned well without me tackling their own initiative the very problems that True

than

An Afternoon

in

My

163

Office

senses . My

patients often tell me that I take right “ out of” their heads . It is generally agreed that intuition figures prominently in the treatment process , but whether our " hunches ” based only may also involve extrasensory per sensory impressions

.

-

to

no

I,

to

it

of

in

it

on

it

to

be

I

,

,

a

I to

,

it of

pleasant

.

rep

activity with individuals

,

.

practice

spring

His words and

his

,

,

He

the same feelings and

from

,

's

of

sounded

invests the fund

his emotions

of

own translates observations incomprehensible into understandable lan in

He

whether the

of

on

.

guage

diverse

'

and

the unknown

has

occur

that afternoon

.

,

memories

such

are

during that group

his patients behavior thoughts his

:

,

attitudes analytic data

one analyst

highly

who

the session

and speculations

the course

though

telepathic

of

in

and groups

or

a

sampling

is a

,

my afterthoughts

resent

I .

or

note

in

was coincidental

for

leave the

because

with

Regardless

take

going

observers

them

had been aware

session

The interchanges

.

,

.

I

”

of

“

to

.

therapy

attempt

accept the they seem

prefer

that preoccupation

rences interferes with

minds

when may

evaluating

with

been my experience meeting

However

phenomena

these

directly concerned

treatment

his

investigation

that Generally

communication

session

a

the course

of

of

that telepathic

longer

processes

When patients share

me about

question

rest

it

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as

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;

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prove the validity

much debated topic

that telepathic

have assumed

psychotherapy

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For many do

mental telepathy

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tions that will neutralize harmful life experiences and help people produce healthful ways the chemistry love

[3 ]

I Shall

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found

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" ONE OF

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.

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Angelico angel peering through prison bars made me smile but Amy White shall call her spoke utter sincerity is a

young clinical psychologist who consults me regu about problems which arise her group therapy practice Usually we discuss the total significance dis in

larly

in

.

her group sessions But during the consul write she was concerned about some

.

,

was new one individual psycho

of

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.

depression

.

state

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entered

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after more than

He had

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therapy

the last session

group

her privately

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had joined

it

he

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it

formation being withheld from

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closures made tation

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.

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She

I Shall See

“ Whatsoever

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well

doing

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or

165

individual treatment with Miss White

in

,

good start in the group

a

he had become

de

he

him

.

more anxious

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her alone

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it;

,

had arranged

denied

make

.

of

seemed see

Then

concern

to

he

expressions

was troubling

to

if something

him

and uncommunicative. When other members asked

pressed

consultation

, .

his therapist

me He

told

had

an

a

procurement officer

.

,

his thirties

on

official agency

an

for

man

in

Nicholas was

a

took place shortly after that meeting

.

She was

a

in

religious

who took

woman

honorable record civil servant manufacturing representative new concern as a

.

bid

a

's

in

his

for

pay

to

he

highly

psycho

enter

had agreed

her son

of

A

was advised

His widowed mother

treatment

pride

his worries

to

.

therapy

himself became depressed and worn

a

down

When

,

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available

he

to

.

,

he

to

ailing wife and three small children support modest salary Though they lived frugally gone heavily had provide his wife with the best medical treatment debt

.

at

was impressed

for their families

with

And they

how

never

get

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trouble

by

He could

in

.

and the facts ever came out

assented

to

.

He feared he would

he

prison

if

in

up

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disgraced and end

a

.

to

,

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than

a

as

he

;

at

.

but

get into any trouble risky situation Nevertheless was

seemed

what he

judging

his holier

off

provided

.

well

, ”

allusions

.

-

a

practices they hinted they

day

ern concern

Nicholas was known man who never always rake He had frowned the corrupt

thou attitude accepted

besides

,

;

every

The

-

veiled

his debts

asserted

“

,

his colleagues

'

of

some

the award he

doing was done

contemplated

secretly

consideration

to

probably merited

“

.

The handsome offered him would pay off many

"

privately

of

White

by

"

",

a

's

ding for agency had proposed contract from Nicholas making the award well worth his while he told Miss

say felt

to

he

?

.

I

her

the

is

.”

.

of

his

.

fairly good relationship

individual treatment

He

con

seemed

he

in

the course

asked

corruptible you are but she doubted that the man was find out how

They had developed

of it

aware

before the fact

position

;

he

”

it,

to

.

I

an

be

be

to

so

has

in

and

been professed

know

he

?

his depression

feels that family

These

a

give

. .

to

contributed

He now

to

.

to

,

him

luxuries

feel

.”

I

I'm

vulnerable

to

temptation glad wa any important warned him not take decisions before discussing them with me very

to

ings make

all

,

few

to

denying himself and

the opportunity live better his debts his frugality and his failure

his family

realize that

his

really resented the emotional price

got

of

he

',

unwind

‘

began

to

“

After

he

in

.”

.

he it

that

by

said would never enjoy anything honorably could not come How did she account for the change him

meant

in

.

,

for high moral standards

I he

treatment

in

Early

life he

I

.

person

He

especially

,

esteem

do

he

to

but Nicholas

he

great

He

an

upright

went

she

of

learn

doing that

considered

not

him

why motherly tempted was behaving like analyst would that any patient mine was involved

some shady business such

was behaving

.

instead

hear what

implore

of

,

shocked

to

to

in

horrified

realize now

him

explain why

the group to

a

I

her primarily

strong urge

to

“

I

.“

on

with

so

was

I

so

strangely

t'

,

.

had come

had

he

fident that could tell her anything without getting trouble Besides hadn done anything corrupt yet

he into

,

That was possible

you

? ”

an

trying

putting

a

be

of “

He may

accessory

the group

from

he

“

find

you

to

Did you

out why

in

should conceal this information

guilty about not everything that with him that

agree

?

to

.

't

it

talking about required Wasn occurred him Did Miss White

making

he

;

group

he

the

in

this

talking about

yet

The Analytic Treatment Process

166

I Shall See or Hear "

She had responded

167

objectively

Nicholas

to

.

Miss White continued

's

,

disclosure

him

quietly she After listening to he think some more about the matter

had suggested that

,

“Whatsoever

do .

to

,

.

session

it

with her again before attending another group Meanwhile she was undecided what What

and discuss

him

I

,

break

issue

a

.

at

Some analysts

time

any

to

I

,

on

go

: If

. of or

full

a

let

in

I

understands

his

,

how

Do you want doing the verge

of

on

is

he

mind

present

have

lot

not

.I

.“

least

a

? ”

that

in

until

these alternatives ?

.

in

or

,

if

possible

replied

feeling for

have put him

at

, no ”,

Oh

of “

crooked

con

the adverse effects

step aside and him make his delay engaging halt the

With

now

him

she

to

discharge

patient by

the possible

proceed with this man

to

in

engage

it

,

conduct

would you prefer something

to

,

.

,

I

.

impulse

to

questionable

aware

he

to

the facts help him

own decision

influence

anti social behavior his treatment Once

I

possession

him

At

of

it

would have

make

trying

-

sequences

she asked

of

.

prefer

of

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,

threats

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“

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that your approach rarely Instead

Very

? ”

.

it

,

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in

or

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if

.

is

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this effect That

is

patient reveals that engaging questionable activity engage some intends you they tell him with this will stop treating you to

warning

had the right

them

he

.

off their relationship

discharging to

Either one

treatment

justified

in

assured her that she would from

with Nicholas further

work

of be

she did not want

to

If

?

alternatives lay before her

help him get over his want punishing depression Wouldn worse than society discharged would him because told me what got over the shock practically tempted Once my up questions made mind this But have other First pretty want reassure myself one point

,

s

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.

I

.

on

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.

is

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he him

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I

to

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all ,

of

to

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do ?

to

if

I .

to

and

't ,

him

to

report

.”

required

law

not

I am

clear in my mind that what Nicholas tells me

by

The Analytic Treatment Process

168

? ”

profession

,

,

"

m

he

to

should old

don

.

,

few

a

s

is

.

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,

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.

if

they would react

months

enough

the members well he

of

some

how

I

,

I'm a

in

,

the group

psychi What

treating this man under doubly privileged

sense

about though only

uncertain

in

handled know

so

“

.

I'm

really

communications

be

in

she replied Besides atric supervision

the disclosures made

privileged

't

of

Under the code me treatment sessions

“

to

you

my

are

that clear

to

“

is

Why

predict

how

talking about what he told

began

divulge what good the sessions but psychologist try force them react the way want suspect that one them the women would feel was to

on

too

re

I

it

me that he

the

told

it

about

in

to

him

talk

to

al all

be

d

confessional why did she think

he

the danger

he '

.

as a

,

becomes one

He

,

was aware

's

's

to

use the group

guilt

.”

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sure that his he

.

crook

afraid

strong

blurt out everything

if

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be

him

of

he

that

might

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punishment in

And

for

have

getting

in

to

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't

protect

him

had been trying

to

that

she

said

,

,

her

she

.

? ”

in

is

“

Why would you protecting more interested protecting from this than he himself The question startled Miss White hadn occurred

him

be

.”

“

.

Miss White answered himself punished

'd

satisfy the great need

he he

?

do

To

.

I

force

themore tempted Since would

can

to

, ”

she said

But a

't it.

ready feels like

He

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about

feelings won

"

who talked about being

.”

in

you encourage

Certainly not

talk

anyone

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to

inform

something criminal

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group

being

of

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to

involved

supposed

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to

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duty

her

not

pride myself to

;

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They understand they

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“ Whatsoever

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See or

169 a

be

it

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.

rule

course

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'd

use the group

should say

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that

him

she replied

I

.

to

,

agree with

it,

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to

fears might make punish himself

this information the group thought this would advisable

about

talk

it

let

know

him

undesirable

she

I

why

of

giving any

from

asked her To

"

I

him

to

be .

ask

her

himself .” The very fact that I could this was clue that she was becoming more involved with Nicholas than discourage she would like Nevertheless ought she

I

to

to

could peg the whole discussion with him the group rule 1 help him n understand have his conflict about talking to

be

Of

.

course not

getting

's

.

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directly

to

respond

know now how

I

to

to

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do .

was tempted what

get on

danger

that

want

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of

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”

.

in

was

him

.”

handle

him

to

I

,

and tell few

need

discourage

this dirty business myself He been relying justify expose himself and need

group rule punished and

to

the

involved

realize that

I

helped

advisable

she asserted

,

me

'

what you mean in

I

"

You

see

ve

from talking

him

would

? ”

you still think

it

Do

“

.”

about himself

of

an

him

to

.

to

him

-

he

.“

I

by

,

A

weeks later Miss White gave me account her why asking discussion with Nicholas started out he thought should tell the group about the rake off obey the rule offered He was just trying talk

,

?

he

help the members

well

get

My

.

,

the rule was question was this

to

a

of

a

.

he

,

about everything said Why was there such rule Well therapy group since this was assumed that the purpose

next

?

him

make

up

he

't

;

.

maybe help

,

their reactions might help

him to

be

a

of

:

How will your talking about this matter your group get well help you and the other members We talked about that for while He couldn see how this helpful thought disclosure would the others but

he

that discussing the matter wouldn

helpful

decided

of

But finally

any

to

-

Treatment Process

be

his

about taking the rake

mind

't off .

The Analytic

170

He made short shrift

lose his job

could

even

to

he

. If

exposure

if

,

.

to

he

,

the facts became known

wide open

to

and would leave

members

of

that question The dis very disturbing the other

be

probably

closure would

would be harmful

it

he thought

him

.

it

discuss

asked

if

Then

I

“

.

them

was

he

it

and

Talk

stated

:

him

Then

of

."

it

bring

no

had

telling

intention

Miss White continued He would have for himself Thus far we had been consider “

.

,

”

.

,

to

,

.

be

I

to

'

.

not

do

I

I

whether the disclosure

health and that

improve his emotional

would

Wehad

the other group members

agreed

.

of

“

“

to

decide that

ing

telling

reminded him again that

what

him

me

You

understand

it

assume that re

to

realistic

helpful

would not could harmful

ing about this matter

up

be

Miss White told Nicholas that she agreed with

.

.”

turned down the bribe

of

"

'

"

talk because

take the

wanted

rake to

not

.

in

me

to

tell

them

I

“

I

was tempted

to

the others would

off maybe

;

no

have

.

said

Obviously

,

re

right You talking business about this the group

.

this point Nicholas interrupted her

, I

he

At

? ”

self and the other group members

to

he

.

he

.

I

to

what

.

it

he

be

be

helpful But that might not would not accomplish anyway suggested that wanted thinking investigate stealing we next his motives Was and talking about stealing because wanted harm him that most likely

me into not taking The only thing could myself accomplish would get punished take

I

get I

.

't

be

to

I

it

if

Amy

family

,

about

, ”

in

talk

now

life

begun

the group

his

He

to

continued

sure they wouldn

.

discuss

's

White

won

behaving very well

.“

"

Nicholas

enough

it ”

trouble

.I

meinto

well

them

't

know

is

't

don

to

be

it .

frighten

I Shall

“Whatsoever

or Hear ”

See

171

and said something about his war experiences some thoughtful comments

.

He's made

about matters raised by other

group members . But nary

a word about the rake -off. By , way the he told me he hadn ' t yet made up his mind what to

do about it. I suggested that he make himself fully aware of what he was doing and why before he did anything . I' m pleased about the way I handled the treatment situation ,

I'd

but

like

think I also helped him you think I ll ev ever know

to

. Do

decision

the right

make

'

that

he took

if

bribe? "

. again

too involved

ll

I

getting

I'

eager to know ?” up

I'm

She smiled . “

so

.

you

see

“ Why are

's

.“

why

now

.

the beginning way

rather wonderful

He

the

last

virtue

tri

s

on

know

at

while

They at

.

for

out He very good terms

she started

he '

,

a

in

it

acted

strangely

talked about

and

group members a

the other

”

,

Nicholas

over his depression so

he

with

postscript

on

's

Here

getting

a

.

high spirits

"

in

.

it

,

I

a

,

.”

just deal with whatever he brings for discussion year nothing For more than heard more about this problem The next time Miss White mentioned she was

“

.

I

commented

he

umph

happy

, ”

You sound

Did

? ”

"

.”

session

“

TV A

the

of

.

. 's

of

.

in

by

”

.

it,

“

explained Let me tell you how she said woman the group talked about being shocked being very quiz scandal One the men accused her George quoted naïve He Bernard Shaw remark about on

,

problems

,

his

to

.

honorable solution

.

an

find

felt like talking about

it

he

and

he

to

,

,

he

had helped him

it

varying with the strain put Nicholas said though disagreed himself was sorely tempted not long ago take the same cynical attitude His treatment honesty

in

get

to

to

'

his

have given

been afraid on

't

he

,

If

and bring

hadn

up t

,

.

he

, a

he

.

to

of ,

said

he

,

initiative

.

:

job didn

Later problems about their and feel got realize that had

ideas

lack

he

on

to

he

to

,

inadequacy

serious shortcoming

'

up d

Nicholas told the group that for several months he Hasn

the job which has opened

get more money legitimately

him

money illegitimately his

experience

also given ?

to

opportunities

to

get

:

been asking himself

't

“

might

prison

exchanged

take

the only way

in

.

expenses

he

when they

of

meet his family the way wanted

up

of

because

enough

ending

ings

needed

in

pay him

his children

was was

record was shortly after

This seemed

he

could get the money

money

only time

was greatly tempted then

contract

a

on

-

a

he

He

work

but the

be

entered the group

Treatment Process

to

he

.

in

of

,

went besmirching

real danger rake off

in

he

ways

his

'

“He d had opportunities underhanded

his

The Analytic

172

The

me the gave

idea

At

's

.

he

.job ,

.

.

of

congratulated

him

.

said

all

he

a

He

had sowed

co

members

-

his

expressed pleasure that

that point

he

them

know that

to

him

this statement

. of

One helpful

spotless record

his mind

, . ”

After

to

great relief in

was

a

it

about leaving his old post with his wild oats

of

a

s

to

he ' a

at

;

a

-

for

in

fresh confidence own ability said He been looking about paying better One has just come through join going management con firm higher salary sultants much Nicholas was cheerful

had found them

,

”

the

to

do

rake think

was very aggravating

.

.

It

of

out the whole thing himself

to

telling what about questions and forced him lot

of a

d

I'

,

.

attitude Instead off asked him

him

.

to

he

?

do

I

a

if

“

.

I

,

“

posy too would get you happened But what think Nicholas told the others about coming me when was grappling with his conflict He complained about my

wondered

Miss White continued

He

“ Whatsoever

I

Shall See or Hear "

might have come

173

the wrong conclusion because

to

I'd made

stand on his own two feet .” Ethical problems like those which confronted Amy White in this case are raised by other psychotherapists who my own practice Analytic psycho consult me, arise unique therapy emphasis the daemonic nature

to

erupt

disturbances

,

,

1

”

even

fight the control behavior Conduct sympto

destructive

into

erupted

makes some patients

or

emotional

,

of

some cases they have already

of

of

reason and threaten

matic

dangerous

drives which

emotional

In

:

forces

potentially

soul

recovery

.

explosive

verbalizations

road

is

-

The

.

as

Thomas Mann has observed

paved with

to of

night side

.

the

“

investigating

thein

on

its

in

for

is

its

passion

.

in

and

him

vul

to

he

to

,

of

for the

be reconciled

.

than

outgrow

I

,

renounce patient ultimately

more apparent

my social obligations

anti social

-

help

seem

his

of

these conflicts

temporarily a

I

If

to

so

.

real

powerful social

personal judgment

To me many do

to

of

of

?

,

on

the basis

and society which have

has

respond

These are issues involving proper regard

patient his family

treat

or

should

to

he , he

How

continue

by

to

Should

may

retould reprehensible behavior

cendencies perverse acts surrounded disclosures

taboos

he

In

.

.

saged

in in

has engaged

so ?

in

who

his civic duties

incipient tendencies

may appe appear

other considerations

do

someone

-

operate with the social mores and putting the welfare legal authorities

the patient above

be failing

co

uphold

the constituted

all

citizen

to

a

as

his

to

.

to

to

social ostracism even criminal prosecution practitioner The who treats them has resolve conflicts responsibilities between his professional obligations and nerable

:

(

Lowe Porter New York -

. T .

H

by

.

191

translated

1933

),

;

Knopf

.p

,

Past Masters A

Alfred

.

1 In

't

.

in

tendencies and function more creditably the community Retaliatory punishment for past transgressions won cure

The Analytic

174

of these tendencies ; often

the offender

Treatment Process

. His

it damages him

he

of

person become the kind would like learning experiences emotional training may make disclosures this training

.

as

,

it

or of

see

I

I

.

,

of In

be

if

what should

by

to

,

have their medical charts

illness before any curious an

Anticipating

unfavorable nursed their anger The privacy some our in

conceal

or

resentments are

,

create

,

to

They tend

of

of

.

be respected but buried

preserve

of far

is in

,

has

is

he

and

of

is

an

is

-

.

,

psychological treatment confidentiality significance integral part Self revelation

large

If

recovery

.

's

a

on

to

confidentiality by

ailments

incidental the curative processes bearing patient little direct

, ,

bodily

and

treatment

of

the

In

.

.

not among them mental illness

as

,

.

,

feelings deserves

such

To

having

they usually

not healthful to

This

is

to

.

upset

complaints

were pained their gossiped about

be

I

them

reaction

or

.

of

stranger greatly

their

psy

observed

,

.

or

other attendants

dangle the particulars

general and

in

and resident

Some patients their privacy

intrusion

nurses

of

.

-p

in

an

of

as

intern

hospitals

any

was impressed with the value

bodies uncovered for examination by

my

outside

the doctor atient relationship The im my this principle was repeatedly borne out

experiences chiatric

I

student

a

portance

silence

as

of

"

,

in

As medical confidentiality

by

with men

intercourse

, .”

not

my

shall

published abroad au ,

on

be

profession

whatsoever profession well

my

the course

in

hear

divulge

to

Hippocrates never

his

- of

the

.

I

about actionable conduct exercise my legal privilege privacy respect doing this communications also uphold that well known stipulation the Oath

to

he

the course

,

of

—

him

help

give

I

to

In be ,

duct and

him

emotional disorder cannot be treated on the basis of moral judgments . To motivate him to give up his offensive con

greater

the psy

I Shall See or Hear” chotherapeutic process . Knowledge

“ Whatsoever

his

175

. .

to

,

is

not helpful and feel that he might get is

.

person

,

,

a

to

possible

to

detrimental for

him

It

is

usually

help

if

is

's

sec second

his

is

his

that the privacy of recovery respected greatly facilitates disclosures patient His The physician first job not harm

the he

psycho reveal about himself favorably developing therapy Even intimacy one one relationship often anticipates being harmed to

a

of

,

talk

about this

I

the fact that

am ? ”

to

educated

to

He has

really have

be

say

him

Do

to

hear

“

.

some disclosure

.

I

by

to -

.

in

has

in

for what

I he

punished

to

confidentiality has

of

flexibly

the

applied

of

the principle

certain respects

In be

, .

,

trustworthy and why

,

In

of

the

of

it

,

an

an

suicidal tendencies

they believe This

that

he

.

family

has homi

sometimes done without

is

's

patient

if

to

committing him from act respect his confidence Some practitioners

.

or

cidal

than

a

inform

lives others arises from time emergency naturally becomes more

prevent

to

.

violence

own life

or

such

In

time important to

dangering

his

a

to

.

in

in

more treatment emotional general medicine psychiatric practice disorders than protect seriously disturbed patient from en the need

up

I

, if

to

I

,

so

would permit me danger

. If

in

to

in

to

she was

in

I

,

in

treatment

from

cases the

usu

pa

.

a

tientwas admitted The successes and failures

;

deterrent mental hospital

,

sobering

few

discharged

a

of 's

of

do

being

to

as

?

The threat

ally served

or

talk

,

,

,

tell the man ship

me

prison violence and end would point continuing what the our relation to

going

a

'

you

re

suggest that send her telephone her and warn her that

practice

man who talked about

for example would actually

he

his

wife

my

do

thought there was any danger that killing

in

Early a

this

.

do

have never had

to

I

.

his consent

resulting

from

this tactical

176

When one

treatment

of

language violence to

.

a

's

,

”

or

“

talked out within six months Warnings the patient consent therefore be with without

usually get

,

do in

,

to

on

securing the release focuses these impulses from the opening session any tendencies

family

ag

's

of

the

a

possible

.

early

as

as

gressive impulses

in

destructive behavior

Treatment Process

more certain barrier against patient verbalization

devise

—

approach helped

the

me to

The Analytic

of

his

.

perhaps

year

or

this was resolved

,

After

a

in

of

for

to

.

acute conflict

,

.

my ears alone would have meant patient the while he was the throes

some information been harmful

it

”

I of

“

not know about this control work while This gave me some qualms conscience but be endured Knowledge that was disclosing

on

was going they had

to

,

cealed

a

did

.

a

by

made

analyst

,

followed the general practice trusted consultant some the disclosures identity was always con patient Though

he

of

a

beginning

sharing with

I

As

.

come unnecessary

could inform him about the consultations with out causing distress He would usually express pleasure important the thought that considered him his case

colleague about divulged

information

him

who con

psychotherapists

them

by

,

me with

a

I

entrust

own practice

to

me

consulted

had

.

so

I

,

sult

that

my

in

so

interesting

Similarly

or

.

at

I

,

two later

,

,

In

individual treatment however breaches

of

.

their own patients

confidence a

a

.

to

of

deliberate

overthrow

of .

as

's

represents

confidentiality

the

ethical problems

of

,

Undeniably

the

.

Some believe that the principle

the principle a

the letter

the patient immediate family appears violate the

treatment

of

well

spirit

it

group

,

comparison as

By

,

involving physical safety

in

,

or

.

They involve are relatively circumspect and unavoidable similarly privileged colleague more extreme case

psychotherapist

I Shall See

“ Whatsoever

take

Issues of personal

confront

177 in

groups.

ones

which

he treats patients

dimensions when

new

on

Hear ”

or

are not the only

conscience

. He

has to gamble to some extent on his ability to protect his group members from being harmed by him

of any

or malicious disclosure

gossip

facts they

reveal

in

He has to anticipate their reactions disclosures , and resolve any obstacles to

their treatment sessions.

various types their functioning to

of

therapists

as assistant

safe, the psychotherapist

each other

to

.

himself , for a group member to talk about some actionable type of be havior in the presence of other persons suffering from

Will it be

for

sirable

ask

and , in any event , not legally

privi confidence ? Will it, moreover , be de

emotional disturbance leged to respect his

may

to hear what he has to

them

,

say

will

or

it

well

to

group

get

safeguard

?

its

maintain enough confidentiality in members from harm and help them

the

interfere with their own progress ? In the group therapist 's judgment , to put it briefly : Will it be possible for him to

-

in

the idea that private relationship to

educated

absolutely

, of

an

been

his

Having

confidentiality requires

,

,

.

it

for

.

enthusiasm

co

questions suggest the risks inherent operative why practitioners They suggest treatment too some lack These

of

climate

con

created without

. it it

engage

an to

.

be

could

advocate

a

a

I

.

was not

doubted that

,

-

in

self revelation preserve the privacy their

of

, ,

to

me would fight

burying their resentment over having share time and attention and listen each other disclo sur they did not release these feelings language dur sures

to

's

in

.

If

to

,

illness

by

notably

I

growth

Strangers meeting together seemed

idea

but

to

emotional

the

sake

to

to

ducive

own

to

aversion

privacy for

its

own initial

;

I

it

if

a

,

patient they find the idea sharing with communica tions with other patients distasteful not repugnant conquer my must confess that took me long time

The Analytic Treatment Process

178

ing the sessions , they would be unable to develop understanding and profound feelings of love that it

the

mental health .

My doubts

I found

were not fully dispelled until

to resolve the obstacles to the verbal expression feelings in the group and , in this way , to create

develops

a

of

climate

experience

,

It

members

.

its

for

confidentiality

out how negative of has

a

The atmosphere

other

each

of

say

.

hateful things they

to

to

,

on

go

,

in

taught me when patients seated together small circle talking hour after hour about their true feelings neither withdrawing nor coming blows over the most mutual trust and acceptance which comes into being when to

be

the

to

to

of is

to

co

of

resistance train group

of

to

to

having

adopted this approach

.

I

practice since

forced upon have practically it

instead

of

.

of

my

secrecy

mem

Problems involving confidentiality out

violate

course

to

,

of I

it

in

a

to

the natural

as

I

,

be

made

thought great deal about the possibility patient might divulge some information that would

him

I

a

,

Before then a

it

.

to

.

find

the conclusion

confidentiality

res any kind disclosures This training process permits them

into relatedness

dropped

that

group

possible

respond appropriately to

of

them

climate

and precautionary

came

dealing with tendencies special forms

functioning

that have evolve

approaches

the field

obstacles

disclosures

operative bers

create

the

By

to

resolve

to

that the way

in

res employed measures

group

produce basic

change

After exploring various

treatment

utilized

.

personality

this way can

in

they operate

of

pledge

of

oath

or

extract

an

Some psychotherapists

se .

.

of

A

as

I

.

to

.

I

get investigated the safeguards com into trouble monly introduced protect the privacy group com munications few these seem desirable and necessary Others rejected not consonant with my own approach

"Whatsoever

I Shall See

or

Hear "

crecy from

members

of

their

179

is the

out

be

his

groups. Any one who

.

to

of

to keep word may then weeded group For the therapist who does not wish work with

unable

to

have this option

to

is

it

advantageous

.

a

,

person such discharge him

, .

am

is

to

.

a

if

to

to

which they

train

to

I If

in

are able

willing

cannot meet

they begin their treatment Edu when they give and not

.

easily when

word

it

.

of

group members

to

another

group stress

con on

,

betray

him

perhaps

the

treatment may

to to

never he

asked

A

.

he would

if

course

the group may

be

that

”

asserts

divulge what went

of

glibly

in

who

on

person

“

on

it

I

.

violate

it

at

stimu find more salutary ask how they feel about keeping things confidential and help them explore their own attitudes the subject to

the start

it,

. .

to

confidentiality

late

That

members not the pledge too much

without

rule

of

suggestible

.

negatively

pledging

doing

is

in

in

is

he

implants the idea

Telling

of

Even

some underhanded

's

in

or no

fidences

.

objection

to

irresistibly

something so

to

do

is

There

Demands made give them apt

flaunting society some way negative man unconscious

if

procedure

are

on

patients for special commitments the impression that they are engaged

not

.

secret society

are

not

a

as

therapy

,

of

poses

.

to

-

a

in

of

in

to

training

,

it

when they cannot keep

of

keep their

,

to

are

it

to

Some

they enter they stress

patients

my office

secrecy

are both aspects their function more effectively life swearing The introduction ritual seems undesir able me for other reasons The group operates for pur to

give

undesirable

pledge

out requirements

willingly and cating them

to

oath

control their behavior carry

their word when

exposed

CO

them

patients

the treatment relationship

or

for

asked

swearing

keeping

an

or

were

on

of

strain

either incapable group would

be

a

puts

it

that

my objections

of

One

The Analytic

180

Treatment Process

keeping secrets from the public . As tendencies to comply blindly with the rule or to violate it are investi gated , members get to understand why privacy of com

believes

in

munication is desirable . One important safeguard

is built into the treatment proc require ess . It does not that the group member disclose his name , address, place of employment, or any other bio graphical data . In some special groups , whose members '

sexually aberrant behavior makes

vulnerable

them

, badges

to

prose

the

cution with fictitious names are worn during the sessions. Members of my groups address each other by standard procedure

groups

presence

are

to

I

to

be

and

as

a

I

is

so

group

he

has treated to

this policy from time professional acquaintances

together

not object

.

a

I

in

to

to

rotate among several groups before assigning them

regular basis

to

.

at

is

of

or

neighbors the first group session One way coping with this eventuality permit patients

quaintances

on

a

.

of

's

other

in

Thus far plight have been spared the the therapist practicing small community who finds himself introducing social ac each

the treatment sessions

to

them

for

.

who

persons

do

treat

permitted

one that follow practitioner whose

or

me

In

.

I

persons

new

private of

.

as

are

Some

either ask

primarily

make exceptions to

.

time

strangers

remain possible As

composed

,

individually

assembling

them

consistently groups

in

;

encouraging

the members will

plan

any way they please

to

of

themselves

The policy

name introductions when

first

group gets under way identify

the future

a

even

strangers

a

with

complete

-

dispense

as

out treatment

to

;

in

,

to

.

to

As

—

in

most privately group members get know and trust each other they usually drop many clues their 2CO principle they can function through actual identity but their first names

conducted

one

I Shall

in

fosters confidentiality

other

acquainted

in

opinion

if

to

of

group

that the

ana

the members

free association

of

the spirit

in

or

,

my

; of

to

then

obviously

would

strictly

it

's

mind apply

telling

a

.

.

-

to

to

about whatever came mind operative treatment Consequently

in ,

co

the extent possible

association

adversely affected

did

a

was

not function spontaneously in

, is

talk

The fundamental rule —

to

-

, it be

.

However

lytic process would that

free

one

one tried

if

bedlam

to

that

considered

it

I,

of

-

of

comes

to

everything

group

the de

impede

subject their communications

self censorship

treatment

lead

be

,

or

to

dispel

.

of

At

be to

for patients

psychoanalytic

situation

of . .

of

is

in

tend

velopment total group intimacy my group practice the beginning any form

uneven

groups

sub

into the sessions feelings

These introduce crosscurrents separate intimacy which

undesirable

If

have outside associations during the course

apt their progress treatment social ties encourage the formation

Their

ways .

when the group starts

-

, ,

to

of

or

two or moremembers treatment

prefer to be their pres

the fact that most persons strangers and are less inhibited

ence , this policy

function

181

to

from

with

Hear"

in

Apart treated

See or

are

“ Whatsoever

-

of

group members were told that the withholding any formation about themselves constituted unco operative be

re

."

,

the kind

"

to

predict

of

impossible

was

overimpulsive persons the instruction tell everything

especially

to

,

them

too literally

to

It

Some sponded

of

.

havior

disclosures

they

strong

disapproval

horror

.

with expressions

or

of

;

would make some made statements which were received These

They inter reactions were undesirable development fered with the even the members feelings outsiders

stimulated impulses

'

to

and

other

.

tion

each to

for

of

.

intensely negative

divulge

informa

of

the

for

The Analytic Treatment Process

182

,

to

,

,

.

an a

a

to

,

example initial phase her group treatment apply for govern one young woman said she hesitated ment position for which she was highly qualified As college student she continued she had belonged In

which the Attorney General later listed subversive She feared that she might therefore debarred from federal employment harassed she submitted

an

to

the

The warning came report you

ll

.“

group

I' it.”

'll

regret

.”

in

another woman

from

FBI

you

the

,

or

. you dare

Don

't

“

application

if

or

.

be

as

organization

,

excitable man talked about

with his wife

.

kill her

woman to

. .

I

.”

a

to

I

't

“

.

feel

? ”

so

:

's

to

he

if

,

,

a

as

talk about everything

,

.

so

Instructing the is

to

, of

have done

may produce fact like playing with dynamite which will interfere with the group forward It

.

's

Unless

members

have been

conditioned

to

.

movement

group

its

explosions

could

,

of

entering

they a

a

charge

precautions

matter

seriously

episodes did not create substantial damage but Се warning dynamite set off without advance

These

or

taken

to

therapy go

a

intervened

of

' is

do

a

re

? ”

I

to

to

to

him

his

“

the police

mental hospital sick enough behave that way growled say what The irate husband Can without being

He

the statement said she intended

“

?

A

could

.”

mad

I

so

embroiled

in

a

by

me

very

name and address and report Why are you trying protect his wife Have you forgotten that you member group All you have convince him

patient

of

.

in

“

:

She makes

who felt threatened

like

the

.”

group

another new

find out

the

our midst

argument he had been

asserted

There were references

to

infected

,

In

“

informer

but shemeant

out her threat

the group with the spirit

hunt for some time

witch

an

It

the time

.

at

it

The speaker did not carry

I Shall See

" Whatsoever

or Hear "

183

properly to information which stirs up intense feelings, these disclosures are not invariably therapeutic .

my

groups

instruction

give

now

I

the

your

of

”

“ Tell the story

life ,

respond

equably

.

-

of

.

I

in

from

-

severe

disorders they told

ag

with

Often they felt everything this

.

suffering

persons

tended

forming good relationships

of

gravate the difficulty

free associate

to

served that the instruction

to

of

of

-

,

initiates self revelation more This modification the rule free association developed out my experience individual psychotherapy had ob

;

to

"

in

less

"

if

”

Tell the

:

this effect

and

study how

ll

,

any way you wish

I'

invitation

to

I

issued

life

your

in

, if

found

of

I

,

do it .

Since everyone undergoing psychoanalytic eventually tells the story his life naturally

ther

of

you

,

words was bound

what he he

he

, if he

educated of

The patterns

great significance

to

.

-

slowly

.

to

at

;

was being

free association

cation proved

was

done the day some other non threatening subject

of

demands

of

,

Meanwhile

had

not talk

could

felt that

first

in

he

,

before his lunch

even

talked about what or

, he

if

an

in

-

co

reassured

significant way

emotionally

operating

him

This approach

be

to

do .

to

and

and

feelings

do

,

his

through behavior being patient just the was invited spontaneously

,

apy

he

talk

story

an

.

a

“

go

crazy that they would requirement intensified their panic and hopelessness about getting well Such patient has difficulty starting

meet the

his communi

understanding

Since my experience with these difficult cases indicated

my

be

eliminated

,

through this approach

the

now

I

psychotherapy

generally

it

employ

could

practice

.

beginning

stagnation

in

of

that unnecessary

at

.

him

an

spill out everything

at

pressure

to “

no

ber experiences

.

it

;

-

In

group treatment the life story concept has addi confidentiality group tional value facilitates The mem

The Analytic Treatment Process

autopsy

first visit

recruits

,

.

suddenly that to

his

on

feel like medical student Consequently the raw

room

not apt

is

,

the other hand

confronted with startling disclosures

gets

to tell the story so

listens

,

he

.

life When

on

acting on the instruction

is

a

be

he to

his

of

when he

”

to

once

he

184

the the

from

a

of

outside community are not bludgeoned into suspension social conventions and their individual

serve

's , a

also

loving

the spirit

of

spontaneously

other

undergo “

enables them

operate

to

and

of

to

process which

intimate

each

as

and

”

some awareness behavior They

customary

desensitizing healers

become psychologically

acquire

.

motives

time

to

gradually

in

Given

they

.

biases

,

,

mol moral judgments

to

a

.

mis

expresses

review

any leakage

of

,

harmed

by

be

he

consider whether the disclosure that time we withheld for while

If

.

a

patients

-

his

that the information should

at

co

too upsetting

to

be

would

We also

be

agree

that

.

the possibility the information

in

.

communication

me privately and

to

are responded

givings about divulging some fact about himself we

would

,

at

,

other obstacles comes

to

of

or ,

exposure

to

to

patient

fears

,

a

If

at

in

Threats

the same way

self

They

test out the group climate until they feel internally and externally discuss any

secure

as

.

subject

slow

year

the treatment engage

members are encouraged stages and about the same pace

.

are helped sufficiently

the first third

covers

least

in

Group

process

revelation

for

fostered

of

which generally

reserve

is

of

atmosphere

to

An

.

medical privacy

. If or

in

up

a

,

is

"

be “

the questionable subject may talked around intermit tently for many sessions before the disclosure made problem can be handled absolutely necessary indi

,

.

of

is

.

it

to

I

,

,

in

,

,

brought vidual sessions but prefer have sooner later for discussion the group Timing not exclusion the essence this approach

Hear "

185

has been created , group

of

capable

responding

the disclosures that have

in

thera

a

made

to

peutic way to

of

are generally

members

in

climate of confidentiality

a

all

After

or

be

I Shall See

“ Whatsoever

to

.

it

to

treatment sessions Then seems natural them scien tifically investigate behavior which would be unmention

really

"

,

.

if

:

to

m

I'

its

a

in

of

.

to

,

a

of

to

“

:

referring

he

Was

this

incest

some experience

he

sister

The

about themselves

trying find out What committing want me talk about

of

with my

that group

to

you

reveal

everything

? ”

Do

the

Jerome one psychiatrist

ask the

is

young man went

on

were supposed

members

to

some limit

't

there wasn

solicited ad group

practice

function session

a

,

members remained after

group

years ago

few

sensitive disclosure

to

a

young psychiatrist entering

vice about the handling which had just started

conducted

a

course which

“

training

I

a

In

.

able elsewhere

;

,

or

.

to

childhood was asked Such revelations are usually accepted with equa nimity sometimes they stimulate fantasies other helpful

they throw

did

me out

, ”

do

of ,

as a

I

?

We sort

drifted

into

before these people group the even report

.

talk about

or

Wouldn

too ashamed

again

,

I 't 'm

and

might not happen

of

it

, I

know

to

.“

replied

it

mind talking about things kid Jerome But this happened just two years ago and how

it

don

't

I

“

.

memories

they

would handle

such

situation

act

. of

't

of

by

a

a

in

who have

of

.

tioner

the field

illegal committed any kind don general group conducted private practi IOT That was the opinion several members the

Persons

belong

how

their own group

The animated discussion which followed reflected

the various opinions and approaches

in

.

practice

therapists attending the seminar in

asked the other

a

I

? ”

me

186

The Analytic Treatment Process

,

reconsidered

them

of

would

two

conduct

actionable

take into account the nature

also

the wide range

to

their attention was called

they

;

After

of

of

.

seminar

the crime com

a

or

of

a

.

or

dropping from mitted One woman advocated excluding group any patient whose disclosures would arouse great

or

someone whose disclosures would concern incest adult some other act hedged around by powerful

an

as

,

on

,

a

or

.

in

deal horror revulsion other members She would accept kleptomaniac homosexual she went but not social

.

taboos

and incest

an

on

individual the laws dealing with

each case

regarded

antiquated

Some

of

homosexuality

He evaluated but

.

added

as

,

basis

which the doubtful candidate

law

he

he

, .

had transgressed

to

he

.

his attitudes about the

by

a

of

The majority those present favored more liberal One stated that was guided some extent

approach

the thera

were dealt with only

in

to

patients

.

their

from

that they instructed withhold unduly sensitive

-

formation

their groups co

members

of

pists attending the seminar indicated

communications

Such

.

in

individual sessions The young man whose question was the basis for this discussion was not withdrawn from group treatment nor

was mention the subject about which warning foreclosed throughout the group of

he

given

had

.

.

your

no

's

If

,

“

,

”

,

it ? ”

it

to

'

it s

I

?

with

about discussing “

talk about

your sister great urgency there why not bide your time until you think safe for you talk about certainly would prefer that Jerome replied but

relationship that

to

be

you and the others for the time being

to

it

“

't

:

.

's

decided

to

's

existence His adopt my own approach Jerome misgivings were discussed with him privately He was asked Don you think might detrimental psychotherapist

See

or Hear ”

187

the

won 't that interfere with my treatment was that I talk about everything .”

I thought

tell everything

the rule every

of

? ”

.

to

“ Does rule require you body immediately

?

to

I Shall

“ Whatsoever

the

the

he

an

In

.

“

"

For many months the therapist took soundings group attitudes opportune moment reminded

that they were supposed talk freely about themselves during the sessions But how would you people someone here started

to

if

,

inquired

“

”

,

feel

he

“

.

to

members

talk about

be

.

a

”

man keep things confidential when

to

you agree

Didn

't

.“

her

get better

by

re

us ,

a

“

is

group where we are supposed This talking about anything that bothers

to

.

tip

to

a

, 't

in

? ”

in

S being involved some illegal activity group which talked about She wouldn remain anything illegal one woman declared Shemight tempted off the authorities

we

couldn

't

he

would depend leisurely probe

say

advance how

what was disclosed

.

.

It

react

that

on

he would

stated

of

Another man

in

? ”

started

situation

which

of at

?

the

how

,

or

At

?

?

?

it .

would recall

revulsion

discussion continued

each

he

them

horror

As the

romance

first mention

in

,

ever one

expressed

discussing

of

of

,

the members

thought

An illicit office

Incest

a

Perjury

act

fire setting

-

Homosexuality

?

cussing stealing

or

.

-

a

This opened their attitudes about specific anti social acts How would they feel about dis

had

.

in

impulses

at

.

to

been tempted behave the same way Similar admissions recognition usually followed The that they had all had in

they could deal with any information

.

confidential gained general acceptance

revealed and keep

it

,

.

to

commit the same acts some time their lives Eventually desensitized them further the attitude that

The Analytic Treatment Process

188

while

,

ended

,

Before it

the probe became somewhat group

three

academic

in anti- social behavior . A woman who plained about her unhappy love life volunteered the

com

themselves

mation that

flitting

about

.

another

He feared

a

her husband and then they were unhappy together.

woman

from

said , because

,

information

about his relationship

talk

that the group

sensed

made the disclosure

,

he

When

composure

After

with

accept the

could

painfully but with

had finished what

who had talked

or

group members

her

.”

I

.

,

about

:

broke the momentary silence She murmured thought was the worst criminal here Other

And

I

abortion “

wanted

say

the woman

.

again

to

.

considerable

repeating the pattern

group therapist privately

not consult

started

of

he

did

that he was on the verge

Jerome before

.

A

her, he

deserted

sister

one homosexual relationship man branded himself as a " wife thief .”

stolen ”

"

illegal abortion . Another

an

his

had

infor

from

to

to

He

had undergone

he he

talked

she

.

implicated

members had

his

a

he

After

expressed

him

many

non judgmental

of

responsibility

loyalty

about helping

each

up

it

friendship

harm

even

.

them

,

secure

will not

a

feelings

,

develop

their sessions

,

the knowledge that their disclosures

They

I

,

in

.

they want

to

say

to

anything

can

group members without precipi pos Eventually they find

reactions

of

in

sible

have found that

be brought

sense sense

other When the group

.

divulged

tating undesirable

has

to

difficulty which to

usually

be

any kind

of

,

.

in

problems which were investigated way during the group experience Through the approach just illustrated

understand

was one

a

.

It

and resolve his emotional disturbance

of

they helped

-

,

about his incestuous wishes

to

.

In

.

shock revulsion they later sessions demonstrated that they had dealt successfully with these reactions When Jerome talked

I

“ Whatsoever

Shall See or Hear "

gets

to

other

's

them

; it is also the way

189

for

a real meaning confidence not only

have

,

them

they respect each

of

this is expected

because

.

they want to operate

Even though most patients feel free

about any

talk

to

me,

subject when they are alone with they are not encour to start off with their most intimate disclosures . Early

aged

my

,I

used to feel hurt if they asked if I would divulge any information they disclosed to me privately . Now I accept whatever attitudes they express about my

practice

of my reliability

object lesson for a person who figure too much for inclined to take the phantom

overly

serves as

.

granted

I asked

Inan who had been duped repeatedly because Se onee man

on

his

of

an

he

is

for research . An investigation

as a subject

trustworthiness

of

in

, In far

,

his

in

home

me

as a

know

much confidence

both glad

to

?

't

up

got

to

,

he

-

it .

timewe were

how

We followed wher to

“

how

case

why

?

,

In set

. .

that

know

forget about

conduct

such

an

usually much easier

to

.

-

.

in

is

It

understand

to

By

,

and

me that the loud speaker place

didn

-

In

?

I

would Was my waiting room Central Park Eventually fancy ever his took real person

He

far ”

go

'd

ever heard

that the loud speaker

't

just wouldn go ?

I

but

he

in

up

? ”

he

the craziest thing

.

by

a

't

I

-

a

“

do

't

he

strangers how blind reliance the word knew get talking wouldn into hot water again with me you know How don have recorder under my couch and loud speaker hooked Times Square blar Laughing ing out everything you say said that was

investigation at

to

As

these

worries

-

evaporate

,

.

confidence

co

or

of

,

a

in

group since members are inclined the nurse fears patients betray start that one more their will their they

talk

with

spontaneity about their current thoughts feel ings and memories Some find respect more important

,

to

it

.

,

increasing

The Analytic Treatment Process

190

'

each other s confidences

of

those

than

I

their own spouses .

.

my opinion would

in

,

.

.

The enlightened testimony

rule out such

of

code

judge

privileged

.

communication Another violation

who advocate

practice

a

a

is

question which has recently

psychotherapists

,

in

,

of

This

as

by

protect group members against such

ethics governing group In

in

by

as

argued

been

order

in

be

legislation

leakages

which one group member

to

Would

other group

witness for one the parties divulged given the other party during treatment a

a

information

serious

about some years ago

heard

proceeding

divorce

appearing

One

I

psychotherapists volved

by

confidence have been reported

trust

?

violations

.

as

of

them

have never betrayed assistant therapists Amazingly few

.

in

place

group members

,

My

the

climate

I

have observed that the psychological climate of a therapy group frequently gets to be more intimate than the marital

In

.

numerous prisons

in

.

H

Raymond

of

.

Dr

personal experience

of

of

by

a

by

in

incriminating information divulged Vas further was reported the guilty It

case session

decade

inmates

.

therapy

did

only one

treatment

a

after more than

the group

go

”

Corsini

was reported

the

.

party himself

“

.

”

to

.

its

.

128

.

1957

p

,

.

the future

York

:

New

(

Psychotherapy

),

Group

Company

,

Methods

Book

for

present and lessons Inc .

:

? In

Hill

human beings whose past aberrations are explana

for the

tions

They cease judge and condemn members understand each other The black souls

of

emerge

get

to

they

as

as

kinship

of

is

by

a

to

-

,

co

operative functioning With proper leadership and 1 therapy group tends therapeutic commu evolve into nity which hermetically sealed the psychological

McGraw

[8 ]

The Meaning of Recovery I

long telephone conversation

one evening with a , physician friend a about the health of his sister - in Since the death her brother the previous week she had been having severe vomiting attacks the first had taken place the midst the funeral services HAD A

visit could be put

.

off

if

evening

.

ing

he thought the

,

could

come

their asked

her

Since that would have been extremely him

friend felt that asked me the at

I . .

,

if

husband

He

difficult

,

see

helpful

any

.

's

to

of

.

home that evening

My

and other of

not responded

was desperate

the patient

recom

had

,

she had

them The situation psychiatric attention might

behest

They

to

,

;

but

by the

including anesthetics

mended numerous drugs medical measures

examined

to

and several specialists

.

physician

be

family

bed and had been

to

She was confined

I

in

of

;

.

law

of

of mine , himself

until the follow

,

Ruth my

,

me

seated

and smartly

poised

to

.

them

,

.

was

One

a

,

a

the sofa

She was introduced

He

found several men of

-

manner

woman

dressed

where

room

.

I

had expected

conversation

on in

relaxed

in

engaged

the atmosphere

es

,

me However

I

living

the

to

corted me

and

home the next evening

as

's

greet

was decidedly different from what and women

'll all ,

I

,

there

the patient

.

my friend was

dangerous situation

her

see

arrived

so

'

it s a

.

I

When

has

be able

suppose she

.”

I

to

would like you

. “ After

answered

whole week

a

for

he

for another day But

it

take

to

to

been

on

going

do,”

will

guess that

at

I

"

this

The Analytic Treatment Process

192

“

.

,

”

friend

soon

in

to

't

you

cancel

!"

to

which followed

me

she informed

the

in

.

an

't

ask

for

see

to

didn

come yourself how you cured her You certainly earned this fee

the pro forma consultation

bedroom

,

's

come here

to

.

agreeing

During

delighted

so

You ought

all

anyway

.

We are

patient

't .

.

-

,

the visit

me why we wanted

I

she

a

as

psychiatrist was coming here told Ruth that stopped vomiting She hasn had attack

her twenty four hours But don

by

my

said

see

we

surprise for you

a

“

We have

As

.

patient

that she had vomited

.

frequently during her early childhood She also disclosed she began vomiting again after her brother soon

always had

so

I

as

,

I

heard

feel fine

a

I'

about

ve

Now

.

to as

,

on

”

,

.”

she decided later that she

might come

wanted

talk

to

suggested that she

to

I

,

leave

to

my office

talk

stop

psychiatrists

to of

rose

if

I

As

for

she went

good

. .“

,

I

's

deathly fear

ever being able

and stopped

But that you were coming really nothing there “

of

had despaired

stopped

to

she

,

death

's

that when

me

.

further

.”

she

answered

with

absolute

finality

.

”

,

worry

never need you

ll

I'

“

“

't

Don

The Meaning of Recovery

193

Apparently , Ruth knew what she was talking about . In the eight years which have elapsed since I made that visit , physician

friend has

suffered no recurrence

me, his

assured

sister - in -law

has

of the vomiting .

off

my

a

I

in

to

session

is

.

to

a

do

to

treatment

a

quietly

listen

to

throughout

is

be

as

is

It

disconcerting almost discover that practically nothing patient needs permitted talk To

all

but

is

.

of

.

"

"

,

Fear of me may have induced other patients to put seeing me but this was the only case which effected enough cure before seeing the patient This deflate any psychiatrist the ego

what

is

It

.”

-

to

,

his

,

,

the if

of

the verge

at

someone

as

talking

on

of

as

.

to

water

chary

thirst She entered treatment the age considerably Her husband was irascible man

.

mental hospital

Belle was the stepmother

a

in

her life

ended

of

whose first wife had

,

older than herself

,

.

an

.

from six

-

of

I

were doling out drops dying

was

I

for many hours of

Belle

a

With

twenty

.

his

patient whose recovery depends upon silent and understanding listener

a

have

presence

of

I

time

of

he is

a

to

to

“

of

my colleagues call baby sitting especially some repugnant any relatively inexperienced analyst who feels interpretations strong need demonstrate through worthy that fee Nevertheless from time

two malad

.

justed children

a

.

I

her in

“

,

of

psychotherapy she talked first year just listened Once she later expressed it .

”

,

let as

During her self out

she

"

me know that she thought my silence was very but these comments were purely provocative She talking and made went right real effort establish My questions her hurt seemed rare contact with me my you your office talked hour week and to

in

she was close

to

give me any

information

or

she said when

to

try

”

,

't

“

.

the week

You didn

a

in

to

the rest

recovery

of

I “

mind

an

.

to

on

no

.

, ”

funny

.

while

The Analytic Treatment Process

For the first time in my life , willing me talk to just someone who was disoriented

was hard

that

figure

disjoint

in

out what she was saying about herself She spoke edly and frequently drowned her thoughts the torrent The improvement year was phenomenal before

though

got

as

.

who

had

She had mentioned her

brothers

Even

.

and sisters

a

.

to

,

,

of

to

It

problem

.

,

I

,

understand that this was not her getting was rather one word Although totally unaware edgewise and being listened

fundamental in

child with

a

embroilments

her

as

.

trouble getting along with people

the second

person

a

,

first presented herself

Belle had

the

well woman

remarkably

a

a

,

year she had left treatment

tually

the end

;

.

of

end

her condition

in

ble she sounded

at

the more logical and sensi of

she talked

,

.

words But the more

of

so

first Belle was

. it

At

I was with

.”

let

ideas about myself .

to

194

to

of

simply

the presence

of

verbalizing her thoughts and feel ever

willing

ne whom listener

-

in

ings

an

quire insight

by

.

to

to

.”

a

in

,

“

:

I

of

me the first clue the situation large family was the youngest child What she needed most was the opportunity learn how assert herself She was one those persons who can ac this herself she gave

when she said

she

meant outgrowing worked with Martin for many

recovery

a

to

at

release

angry

witness his

in

the

I

,

in

acquire capacity hours helping feelings words but was not hand

his

swallow anger

to

case

him

to

tendency

simple

I ,

one fairly

.

In

.

was confident would understand her

him

.

stantaneous cure

for the first time while making hospital burly young man with pasty complexion and his

of

a

.

rounds

A

I

encountered

less than

two

to

to

at

years

He had

.

ment

in

,

.

he

I

weak smile listened quietly while talked some stopped ward mates Then me his bedside talk about his gastric ulcers the reason for his third hospital confine heard that ulcers could

The Meaning of Recovery

psychiatric treatment . Would I be , and would this mean that he

up through

,

and

the young shipping clerk times week we worked

willing

was

,

arrangements were made and

psychotherapy

entered

to

of

a

verbal release

could

Three

clear away the obstacles

the angry feelings with which

the

to

.

The necessary

try

the hospital permitted

operate

to

We

told him

.

in

case

.

I

he

if

co his -

could do without an operation ? Sometimes this was possible ,

he

he asked

if

him

it

be cleared

willing to treat

195

attacked

The

day

aftermath

still stunned

and

told him

Martin said Then myself eat death “

.

.

I

to

to

and wanted

it

I

,

his own mistake knew

, "

-

felt awful about

me for word

I

the boss fired

every four letter

in

to

had told the other man

.

After

“

I

off

what

,

he

at

by the

his explosive behavior

,

ashamed

,

aghast

he

boss

me Martin was horribly

lost his job after violent reported the incident

of

later

a

he

half

,

argument with

.

a

year and

his

A

.

his stomach

.

but

you

at

,

no

had

I

to

iron stomach

ruination

indigestion

.”

It

.

of

we

had

.

new

his ulcers and then

to

all ,

to

.

giving vent bilities and learned healthful new emotions Above Martin resolved the underlying

sensi to

of

developed

ways

flict which had led

the

that too

his treatment

he

conquered

,

,

months

the course

of he

In

next

six

.

contend with the depression which took their place

to

diffi

his stomach

In

recurrence

could leave treatment

,

.

culties

is

's

it

no

.

there has been But before Martin

,

episode

head

In

all .

that killing me feels horrible eCO This dramatic recovery from his ulcers was apparently permanent the many years that have passed since that

But now

my

my .

me

must have given

used

be

these sandwiches an

of

-

a

to

went delicatessen and ate three suicidal sandwiches pastrami hot double deckers with sour pickles and beer One

his

con

his psycho

196

,

his

as

as

us ,

.

his

,

general

his

of

-

in

He was satisfied

life abetted

.

another recovery

.

my most

experiences can defeat

a

.

the vicissitudes

,

of

I

described

.

The story

my first group illustrates depressed widow already have related her early history and

Edith this point

,

unfavorable life

strenuous and time consum

achieve basic personality change

to

the

efforts

more difficult

-

for some

Consistently

her

treatment

discharged

After being

a

to

be

she

support herself thereafter and

retain

her life

.

of

command

enough

her

saw

,

I

from the mental institution where first developing good relationship and after with me

well

of

patients

is

reason

.

process

came

treat

He married

pleasant home and social life

year after his case was closed

For one

ing

family and friends

.

had

well

,

a

He

sufficient understanding

adjusted person

of

.

ment

within

well

and

a

,

with his work

a

satisfy both

had become

,

that

or

he

to

himself

He achieved

.

logical disturbance

of

The Analytic Treatment Process

.

flex

and

discharged her from treat good attachment her niece

.

to

to

lower my called social

-

so

to

I

in

a

of

,

integrated

which was forced substantial emotional growth case

treatment

I

a

.

,

m

sights from

effects

Tragedy stalked her stabilize her improve

,

Eventually ible personality ment after she had formed

sturdy

,

really

to

that she was unable

ment and become

But hers was

her died

be sufficiently

.

to

someone else close

persistently

she seemed

to

,

woman

without the bolstering

a

so

Then

do

improved

to

-

sensitive and mixed

up

Whenever reality was not too unbearable for this very

.

important way station the road The person who reaches that point on

an

is

This recovery

to

.

recovery

complete

gets

along

he is

,

of

in

.

,

fairly well thenceforth under normal circumstances but may break down again should his life become unduly stress ful Though not well the true sense the word

The Meaning

of Recovery

able to accommodate

197

himself

to the immediate

demands

of

to

.

severe psychoneuroses

two

years

to

conditions require from two

;

in

earn

himself

from

achieve social recovery

was

treatment

those

usually psychotic

with

five

.

Persons suffering

generally

now

he

his it . If

,

to

for

pay

is

ill

, . all

job

a

he

able

private practitioner

enough money

it

by

discomfort

easy and may even enjoy and relatives have been paying for

finds work

now

severely a

work with some degree

of

had managed

to

he If

he

,

in

his situation . If he was too incapacitated to work at earlier treatment he now holds without difficulty

recovery spells substantial emotional growth may and immunity against the recurrence the illness take five years severee neurotic condition and psy suffering possibly twice long for the person from It

.

,

,

of

A

.

who

those

.

clear

the emotional

against further

illness

and

to

,

the patient toward failure

to

up

to

is

to

a

in

words

,

him

but

treatment

illness

treatment today produce curative case

,

.

other

that are leading

tendencies

immunize

two

simple psychoneurotic

years

objective In

ultimate change

increase his

for happiness and self fulfillment -

capacity

.

inner

life

one rarely enter

suffer from

My

to

the first few months usually responds

emotional damage during

stemming from

of

condition

,

chotic

a

as

a

in

to

up

of

Complete

he

res

relieved

as in

that

he

.

all ,

is

.

a

he

or

all

on

charmed future wholly favorable outcome does signify

guarantee A

Their

has been

his problems that will not encounter new ones CUT Analytic psychotherapy not cure nor does a

to

of

later

.

does not necessarily mean that

olution

individual resistances

.

show

psychotherapy They are resolved emotionally significant verbal communication

and group

it

life always

up

functioning

in

The tendencies which have interfered with efficient and pleasurable

has

and

resiliency

, of

.

considerable

He

has suffi

of

to

to

himself and others serve there deal independently with con

his own analyst and ordinary magnitude

as

in

of

to

and

ones with

cient understanding after

,

,

normal situations traumatic

behave appropriately abnormally meet the impact

feel think

to

the

ability

all

The Analytic Treatment Process

198

,

.

or

,

, is

.

That

socially

he

.

outcome

versatile

desirable

the

in

to

an

to

such

aspect

good functioning

. .

the recovery process Feelings facilitate behavior

doing something helps

an

promote

is

which

of

to

respond appropriately behavior and feelings people The development

.

of

apply

emotionally

act spontaneously

other

of

ways and emotions

to

has the capacity

is

The mature person

to

one may wish

term

,

of

is

other

In

an

of

.

flicts other words the case closes emotionally mature personality with the emergence my own concept That cure recovery whatever

therefore

important

The fact that we feel like

,

is

,

It

it .

do

to

if

.

at

;

us

do

all

of of

when

we need

. If

it

give into

as

,

to

us

for example much working easier work when we feel like than when we feel like loafing times We often struggle against the feeling laziness but we are sensible we also rest and relaxation

we

insist

,

to

us

of

.

realisti accom

learn

to

much harder for them Accordingly they have

to

dominates their to

it

,

a

instead

to

his

As

.

the extreme feelings

early

of

,

out

life

started

indicate

in

he

bogged immature person tends the basic and essentially gross feelings with which

emotionally

in

The down

be

.

.

plish their objectives heed their feelings

result

,

functioning and makes

laziness

As

.

occasion

it

on

cally indulging

it

against the feeling

habitually

of

I

in

of

.

is a

to

on

working when our feelings cry out stop our work suffers the consequences That serious handicap many my patients They fight which have observed

transference reactions his childhood still trouble

The Meaning of Recovery

. If

him

199

the parent he talks about

not “ very good ,” he must

is

be “ very bad .” At the beginning of treatment , alone with me or in a group , he plays the same tune over and over again , like an old -fashioned music box. One woman complained at first of an absence of feelings. She was incapable of feeling love for others or their love

of

dis

,

uncertainty

of

,

emptiness

being

in

the sequence were feelings for my mental abilty Later she

.

feel that you won

't

Then she acquired retaliate

me out

kick

the feeling

she dared

that

get angry

;

to

I'

me

came in . ”

feelings

that

me

would welcome her love

.

Not

beginning

long

to

to

awaken

feel

of

As

.”

“

I'm

after that she announced Now very warm inside loved myself feelings which the hierarchy

:

.

spend more time with

were the next

—

next new

I

me

,

she loved

accepted

it

that

, I

and

me Her

, .

feeling was that she would like

Feelings that

to

that she felt attracted

said

to

while she

.

,

after verbalizing her anger she felt hatred for me After

a

.”

harm

me as it “

to

identified

respect

me could trust me not

here

she

and

Next

just beginning

or

of

:"

said

m

confidence

of

.

and anxiety

them

of

being suspicious

to

,

,

pain

of

turbed

she

another ,

,

new

years . She described each of

to

became aware of many One after

and introspective person , she feelings during the next few

scholarly

A

of

she said .

if

for her ,

emo

characterize be

to

.

.

the

,

tional evolution develop the personality becomes more richly textured This enables patient more discern ing and sensitive His original gross feelings are refined and

. .

of

-

of

pertinent

feelings

feelings enormous repertory produce the feeling tones as

an

commands These appear appropriately

more discriminatory to

progressively he

distilled into Eventually

,

I

.

's

to

to

much the instruments the produce precise orchestra combine the tone combinations which the score and the conductor baton call for like each occasion

The Analytic Treatment Process

200

of the

to think

emotionally

.

personality

orchestrated

mature personality

if patients

Recovery would be much simpler

the well

as

could shed

,

per their troublesome feelings in response to suggestion , , coaxing philosophy suasion or a little cracker -barrel . Personal influence often does dispel these feelings tempo rarily ; but this

-called

is so

transference cure , which may not

any longer than our relationship . For permanent im provement, the undesirable feelings have to be understood

last

modifi

their

outgrown and displaced a

disturbed man

him

,

on

.

his

own One seriously

of

member modify self the product

group

'

of

.

more appropriate feelings The impact other patients feelings often helps

by

cation and

of

the course

in

are

, until, refinement, they through

and worked

,

I

.

I

.“

,

”

felt very

members

.

acceptance

.

true Later

divorce

once felt destitute without

said

.

, ”

I

told

divorced

feelings should displace old feelings

important that

lead

.

be

'

resented his parents

himself might

chronic

feeling

to

his

of

;

had greatly

also

the

dream

.”

in

of

Changes

in

in

with

.

new

't

isn

It

"

“

and feared that

he he

the group that But

deal more successfully

and business anxieties functioning the reverse in

changes

group

other

new feelings

family

him

is

These helped family

concern

and him

distill

me

.

a

affection

to

The

;

.

feel myself weeping because they were divorced

groan My wife has often told awoke with same thing that my mother told my father that helped

sad

I

could

.

he

he

he

“

.

in

had done the best

he

could

was about

told the group Mother was telling had never done anything for her defended

now

that

said

the dream

he

I I

him

I;

I

the age father that

his childhood

he

am

been divorced

In

a

,

a

.

a

,

broken home was bad terms with his wife when his group treatment began He reported dream about bitter quarrel between his parents who had

my

The Meaning

of Recovery

201

mother . Now I am independent of her and happy with my wife . We get along much better now .”

Many persons cling to the feelings with which they are most familiar; however troublesome, breaking the attach ment seems even more painful . Coming out of a depression , told her group , was “ horribly upsetting " ; she she were losing her best friend . Those who have

one woman

felt

as

if

experienced

unbearable sensations

of other people

feelings

their unhealthy

also

in

response to the hostile

struggle

against

giving

up

defenses against feeling anything , especially

hostility . After they have unconsciously prevented them acting destructively by numbing their feelings selves from or counteracting them with other feelings , it is difficult to recondition themselves to feel and express their own hatred

.

but

strong need

some change

some superficial

or

”

“

no

Improvement may mean more fying some psychological need alleviating

.

provement

a

approach

im

satis painful

than a

their status quo

as

They generally feel

it

.

,

in

therapy

for

Few patients commit themselves fully to the frustrating process of curative inner change when they enter psycho

.

symptom

Patients whose lives are drab and lonely characteristically

and emotionally

,

Financially

his work and

pleasure

him

his only

.

it

.

is

to

designed take the attitude that the group experience satisfy their intense hunger for excitement One man called

in

.

,

”

at

he

accomplish

.

wanted

to

the

On

beginning what else

he

,

“

.

It

.

of

it

;

kept petty was unrewarding immersed monot onous tasks The excitement the group activity helped keeps me going he said Other him function better va uncertain than dealing with his fatiguability was the

.

to

to

,

other hand those whose activities keep them hum ming want utilize the group sessions chiefly relieve their tensions One woman arrived each week with some

The Analytic

Treatment Process

current problem to get “ off her chest ” as hastily After unburdening herself , she would benefit

other members

for

of

the

becoming

the

problem

she fought against having feelings group

the

from

. For some time, however , for

of her

ensuing discussion

possible .

as

of

202

their feelings

.

or

her Most new concerned with being fright feelings relieved their painful symptoms such compulsive rituals headaches insomnia bodily tension They start off with the plea Makeme feel better right away aware

to

they want

,

of

as

, . .

or

,

proceed

leg

escape from

whatever way will bring

the

them

.

most speedy relief

trap

a

off

to

animal that gnaws in

Like the

a

:

,

,

, of

patients are primarily

of

a

be

little significance

for the final outcome

on

focus consistently

I

;

to

real conflict interest be symptoms directly relieve their

.

is

alleviation

can

not try

of

I

tween

do

,

that score there us .

On

so

do

a

,

.

of

or

-

,

.

by is

If

the emotional conflict this dealt prod with therapeutically the symptoms and the other ucts the conflict disappear sooner later Some after the basic disturbance has been resolved the way blighted leaves fall off tree that has already recovered from symptoms are treatment especially

frequently

,

in

disappear early

in

is

generally un treatment superficial disabilities disappear

early

of

.

If

Too much relief symptoms

desirable

or

too

.

in

or

greatly alleviated the group setting

More

,

process

disease

.

some

.

fort

to

in

struggle

much

so

nor

for more

to

try

I

neither

the struggle

so

.

incentive

-

discomfort

give

,

to

of

a

have

mild

to up

will

state

tempted

no

that

will

he

that he

be

keep him

in

is

to

so

he

.

I

to

's

,

getting too rapidly the patient interest the roots evaporate his problems tends structure the treatment sessions that will develop real concern about whatever necessary achieve permanent inner change little

com

The

Meaning of Recovery

He may “

You

don

203

chafe at the discomfort .

't

I

care how

the end result. That

feel .

One man

To you

:

complained

the important thing

is

's important to me, too , but I don 't want to feel good . I want to feel good now ,

wait that long while you 're treating me. Today .” to

This attitude

is

harder to contend with

individual treatment

.

. His

he

him

ing

problems

;

his

quickly to the group setting perspective on

,

Typically

in a

group

than

in

patient responds more

a

co -patients give him

ew new

a

these also seem less overwhelm on

to

before

a

it .

,

to

,

was

impressed

on her

of

virgin

so

than

terrified

of

Helen who appeared im my first the other members

case

”

the

rapidly “

The

.

more

group

in

This happened prove

he

fully understands the his conflict and what can be done about

words

other

of

:

too early significance

in

of

.

,

is

as

as

.

to

listens their reports their own diffi may culties He not feel much urgency about tackling greater his emotional conflict For that reason there danger that the group member will drop out treatment

with

of relief and improvement that she insisted leaving the group after months However she was unable gains stabilize the she had made Later she entered psychotherapy She had made flight into health type ,

— a

-

re

a

powerful to

cura

the

symptoms which

preoccupied

them

when

they

in

.

tive process When patients acquire this wish they lose interest

long

a

a

I

part

though

This

cue

work of

.

cured

not

,

,

,

them

is

of

be

create the wish

some

is

.

With

.

leave treatment to

represents

which

most patients find out to

,

Feeling better time

”

“

a

superficial improvement analytic work

obstacle

to

of

.

.

to

.

six

first feelings

alto

in

,

in

.

treatment Some stop talking about the symptoms gether Early her group experience one woman quently discussed the phobia she had about riding

.

the

entered

fre the

The Analytic Treatment Process

204

and the inconvenience it caused her . After she be in understanding her emotional difficulties

subway

ca came absorbed

her husband , she rarely referred

with

her phobia

to

. Half

a

year later, she casually mentioned that she had been using the subway regularly for months . “ Didn t I tell you ? " she

'

asked when one of the other patients expressed surprise

.

Some patients get to feel

of

a great deal worse in the course before they begin to feel better . One

their treatment

group member perfectly

a “

himself

introduced

guy outside

contented

his

to

my

co - patients

as

office . ” Aside from him

irritating slowdown in his work , nothing troubled He told them during the first session that felt fine Later he

on

he

.

he

.

an

he was

ing

, it .

a

very much better considered demonstrating his improved function

to

I

repeatedly

he

and

himself the more miserable

understand

time when

a

.

felt

At

he

experienced

him

he

he

,

became aware that had serious family problem and evidenced growing concern over The more pressure

.

to

at

lose

,

still feel like 205 pounds

“

.

”

For

the physical change

and appearance gave her little year her feelings lagged behind

,

.

satisfaction

health

nearly

a

,

her improved

I

130

ever

.

at

a

A

year and

205

half later she tipped the scales pounds and maintained her weight that level How

.

75

pounds

.

I

a

I ,

had never felt worse severely depressed woman who weighed treated pounds when first saw her She said she wanted

told the group that

she often

out

that

about

to

I

the new

is

exploring the unknown

life

Its

.

recovery

feelings they have

tell them that they are approach brings frightening prospects —

of

close

to

.

Some people cling desperately grown They seem stunned when

to

.

lamented

sessions

a

I

have

.

his behavior

evidence his

recovery

in

's

patient

is

The most direct and trustworthy

on

.

begin

During

The Meaning of Recovery the final

of

of his

phase

pressures

205

treatment

, I

subject

him

to

of

.I

investigate his ability

cope with the kinds of situations which caused

to

themost

him

. He reports

what

close associates are saying about his

.

;

behavior their comments are discussed

By

family

or

his

difficulty when he entered psychotherapy

of

variety

determine the extent and the permanence

to

the progress he has demonstrated

members

a

the time

he con

his

to

,

I

evaluate

.

-

co

patients

De

my own

.

a

less subject

he

feelings about

he

a

is

ready decision that our relationship may create

in for

group assessment

is

in

to

analyze more persons and group assess progress

individual treatment

The quality

his

.

that

of

.

of

is

easier

patient may figure largely

discharge

. of

-

to

having

a

of

functions with

in

.

In

error

find

probable

also

of

,

I

,

is

It to

well

how

handicap

situations

he

-

the

spite

life

have only

functions with me The group setting additional and often more impressive direct

affords me evidence

course

patient

a

well

how

a

he

,

individual treatment

it

In

the various situations

in

well

larly

in

co

a

in

wholly operative and realistic way ducts himself usually capable his therapy sessions behaving simi

.

a

me strong emotional conviction that has recovered even though his behavior does not indicate much improvement

a

to .

,

.

.”

by

“

a

of

to

-

the judg for many

usually react reassuringly

;

on

.

to

to

is

they

when they note some

improvement The group member under examination

.

,

hand sign

of

patients usually add validity They have witnessed behavior

Their eyes and ears are quick detect changes Evi backsliding not apt escape them the other

dence

of

.

hours

behavior much more clearly Besides the jury the benefit trial The im his

.

ment rendered

more severe test and

co

pressions

of

group gives

his him

also delineates

patient

his

group members subjects

a

a

,

In

the group behavior becomes more important touch stone than my personal impressions Interaction with other

The Analytic Treatment Process

206

is less inclined to quibble about any doubts I may express

on

his fitness to terminate treatment when other members of the group

my opinion .

share

they are harder to

Sometimes

thehis

of

.

,

It

various facets means democratically with

for example

realistic behavior has

patient functions recognizes the right

that

patients

He

- operative

a

co

he

of

; ,

concept

co -

My

and

satisfy !

his

.

he

to

of

.

to

to

of

group gives each member talk and listen belonging some evidence that he recognizes the value the group His behavior demonstrates that has derived some benefit from talking about own emotional prob SO

them

The only point them has

of

with

that each

under

on

,

agree

is

may

able

which

the

right

disagree

to

The attitudes group also

the

but

treatment

,

of

different

of

.

I

achieved results

the course

as

of

them

have just mentioned

the five other members

changed substantially

brought

group which was conducted

as

and behavior

of

achieve the objectives

a

member

in

a

Paula was

of

.

to

he

.

stand and respect these differences

to

and attitudes which

exist among the group members and he

is

aware

.

the different perspectives

of

is

of

.

he

;

of

as

as

lems well from listening while other members the group talked about theirs has also profited from the dis cussions which have followed their individual disclosures He recognizes the universality emotional problems He

each

the difficulties which to

. I

is

.

Paula

of

at

.

story

of

into treatment shall not attempt describe development simply their concurrent What follows the them

jet

.

,

,

.

made her appear coarse rather than attractive

,

-

slim

on

the harsh look

with good features and black hair defeat her face and her tawdry clothes

,

was tall and

of

she

,

-

When she entered individual treatment the age twenty seven she was tearful sullen and gloomy Although

The Meaning

An

of Recovery

only child

207

, she described

herself

close and stormy relationship

A

as

alone in the world

.

with hermother had ended

with the latter 's death two years earlier . Her father, though still living , was in a comatose condition following an oper

no

,

.

few

for a brain tumor ; he died a months later Paula hated her employer and the secretarial work she was doing ation

for

.

of

.

of

job confidence that she could get the kind she wanted She got along poorly with her office associates and bemoaned her lack friends

but she had

the

was insatiable craving relationship ference shebehaved

for

lem

.

a

to

's

It

her parents tortured her took her long time understand and accept the fact that she felt hatred along with love and grief Her fundamental prob

.

mixed feelings

Paula

In

.

as

a

,

I

,

's

on

a

.

,

as

,

an

trans she had with her mother domineering woman who had difficulty raising her During Paula sessions the couch envisioned her most un comfortable infant keeping very quiet until her hunger be attention

of

's

.

to

came excruciating and then wailing incessantly for nour ishment Apparently responding her mother feelings

,

guilt and irritation while feeding her the infant

be

again

maintain

to

her and Paula

.

to

,

had been

psycho

comfortable

herself and other people Her her

her tolerance

frustration

.

by

giving her graduated doses to

build

up

to

,

silence

this pattern

did

of

I

responded

to

.

it

of

provoking attack neurotic pattern was one manding attitude and then running away from

de

.

She had not learned how logical distance between

overcloseness

equally intolerable

by

from

death

a

mother

to

her

her

Until separation

's .

came excessively quiet

Since

,

in

process

of

,

essence

a

in

treatment was

,

Her

an

as

.

reasonable

to

,

to

not get the attack which she had been conditioned however much she persevered her demands she came recognize me ally who could help her become more she

The Analytic

208

growing up from

impulsive baby, intolerant of frus

a very

of what went

tration and totally unaware a

disciplined

IT

person with

of

some understanding

first she was excessively

, to

on around her

of other people.

needs and those

At

Treatment Process

preoccupied

her own

with

herself

,

withdrawn and moody . She wanted me to dispel her trouble

idea that

effort

.

her

for

great deal

a

The

quickly by some hocus - pocus and help her bettering an ambitious program life on

carry through

of

some feelings

her part would be slowly She was a

.

in

as

.

do

,

a

in

involved favorable outcome sank most recalcitrant patient defying instructions and showing little respect for my opinions She said she would she Although

for

her

.

pleased between her sessions

-

unco operative attitude made slow complained about Paula which she frequently experienced considerable relief after two years She talked

,

.

,

progress

her first visit

.

attractive than

on

.

-

.

a

freely about her feelings She had become more outgoing and self assertive person She looked younger and more

in

to

.

After

she was

a

her

She would part with

.

-

Three love

caused

,

few weeks later

as

Immersed

a

,

report

she was

in

,

and then again

.”

” on

forever

the affair was

with married men

anguished soul searching

“

"

a

of

,

one after another

great deal lover

she was less successful

.

,

In

her personal life

affairs

other

posts

.

of

in

her business acumen charge sales promotion

saleswoman

,

a

record

demonstrating placed

it

.

to

outstanding

in as

an

making

found

distributing vitamin products She decided grow with the firm She started out

down there and

settle

by

Paula eventually

. .

new

she wanted

do

work firm

a

kind

of

in

in

Her forward movement individual psychotherapy was primarily energetic reflected the and determined way she improving went about her economic status and finding the

that

the excite

The Meaning

ment of

off

a

of Recovery

209

or the throes of

reunion

a

, she

departure

cut

her

normal social contacts with unmarried men and women of her own age. She pleaded for further help in learning to discipline herself . She said she wanted to get self

married

I

from

.

recommended

complete her treatment

that Paula

in

a

primarily because I believed that it would help her understand the social implications of this repetitive behavior . group

why

There were other reasons

I favored

the transfer

. Paula

individual treatment for about five years . It began with weekly sessions ; when she became financially secure and more involved in treatment these were increased had been

in

two or three

to

a

. While

week

she complained about the time

was taking , she unconsciously

it

or

. I

permanent relationship

less

place her

in a

wanted to make

it

considered

it a

more

advisable to

situation where she would have to takemore

responsibility for her progress . It was likely , too , that con tact with other patients would give her the perspective on her own personality which she lacked .

Paula said .

“

,

so

" a

“

.

”

,

social group you not

”

it .

a

a

am

two

women

and three men

-

—

group mates

for

I

“

.

's

Paula

but training

had found

I

't

I

“

.

substitute

if

I

answered

Maybe

is

him

Love and marriage make you part recommending What

“

had

,

and

-

,

.

or

all

had some individual psychotherapy with other analysts myself Emily thirty three recently divorced was

,

I

the group

need any group

But wouldn who loved me and married

she said man

on here

.”

forever just to love told her that she might get

I would have stayed

the

,

to

her

of

to

get

great shock

other people

polish off ” her treatment in the new group that she join ; but the proposal came as a

in

“

recommended

of

.”

I

it

She agreed to

and the understanding

The Analytic

210 a

small blond woman who operated

a

Treatment Process

. She

kindergarten

had

difficulty talking about feelings which troubled her. Harriet , a laboratory technician , had trouble talking about any of her feelings . She was forty , unmarried, and absorbed in her self . Raymond and Peter were bachelors

Raymond ,

engineer

an

, hoped

their late thirties .

in

that the group

experience

him become and awkward with women . , a lawyer and cynic , generally concealed his feelings . Arthur, a few years older and the least controlled of the three men , was an insurance executive , married , and the

would help

less shy

Peter

He worried

father of three children .

his work and friction with business associates. Though emotionally group process

through

more spontaneously

varying

degrees , the

to

learn

speak

to

about themselves

. As they

and to behave more naturally

began to interact with

Paula , her

emotionality

made

pallid

seem

.

them

to

of

five of them

constricted

well -disciplined persons . They hoped

еге were

all

in

about slowing down

She spent her first month

in

the group campaigning for doing What was she there anyway She knew too much and the others knew too little about feelings so

,

patient stage

had

.

Her re

patient

never during her

a

always

the

:

maining trouble was very simple bride She had really outgrown

analyze her

, .

try

to

permit them

to

not

she would

a

,

?

.

special status

; be

to

edgewise

You talk

so

.“

? ”

in

a

can

Emily asked her

.

you then get word

And your hollering

headache

,

feel

”

say whatever

I

able

to

be

very proud

to

.”

a

me

I'm

“

.

of

.

don

much we gives

to

on

a

mature person

Why

't 't

“

act like

to

.”

“

all

.

It

individual analysis been thorough and gone deep top that remained was stuff She should therefore telling the story excused from her life She wanted discipline herself and learning how concentrate

Paula

The Meaning of Recovery

of me

.

is proud

it

.”

in

That was to

you

.”

.”

ll

high

you take our hostility

can

't

? ”

? ”

not why

,

re

you

'

“

If

.“

“

or

a

I' ,

're

“

If

you you dope and sicker than you think Stop this nonsense quit Paula was now dudgeon How dare you call me sick and dopey

in

to

do ,

.

think that the leader this group will your ground make own rules Peter asked

really

permit you

? ”

“

Do you

of

.

"

at

I

of

my analysis the things accomplished screaming everyone You mean who talks Arthur was contemptuous

one

? ”

, “ and Dr. Spotnitz

asserted

for

211

Ray

top

and

.

of

.

mond questioned her more gently The frustrations the group situation had revived her neurotic pattern with surprising rapidity Her battle for

.

. of

“

Talk

un to

by

.

their

.

she

she

,

reactions

be helpful Stung would sulk and grieve say

that she was only trying

to

understand favorable

't

contradict what they were saying She didn why she grated their nerves and protested on

to

,

lems

or

billing waxed waned through many sessions She cut off other speakers with naïve explanations their prob

.

to

.

a

By

, ”

, of

to

to

would when they tried draw her long silence shifting from one extreme the other Paula provoked the attack through which she learned discipline herself Group process eventually moved her someone else

out

a

of it .

.

of

,

to

to

or

.

,

to

a

.

more moderate position learning Nevertheless function appropriately was painful experience for many reasons One was her violent objection being criticized attacked She could dish hostility out others but she herself hated the taste into

,

of

,

understand

rather them

tame happy day Some than

”

other

to “

each

,

for

get

.

them

feelings

we words and

to

negative inn

all

to

.

it

be

a

expressions steady She wanted diet love and she thought would Initially she took the atti therapeutic group tude that the members were working overcome

The Analytic

Treatment Process

they would

convince me that

212 in the

future

,

she believed

,

I

felt only love and then

they

discharge

would

as

them

" cured . ” Instead of quietly accepting the angry feelings she provoked , she would act in such a way as to invite further Come enr enraged and attack . When it came , she would become threaten to leave .

, 'Im

did

“

drawing

.

,

Besides

anything

here without

quitting

revolution

But she

sadism

say

constructive

this

can .” t'

to

take

I

't a

enough

. If

isn

't

isn

strong

blood starting

not blackmail the group into permitting her The other patients took her threats

.

have her own way

Don

by

leave

door

the

's ,

:

told her

she was leaving

she said

.

Arthur

On one occasion when

't

.

calmly

“

to

My ego

This group lacerates me,” Paula complained .

“

The window

.”

much nearer

more subdued moods she would

for the

a

In

of

.

apologize

.

.

a

,

"

”,

if

on as

session

in

which she announced she was through she would leave my office forever The fol lowing week her arrival would take the appearance sudden renewal Actually she never missed session her a

After

scenes

patients

”

,

she said juggle

“

to

.

of

Act out what you

she advised her

other

Paula liked

,

”

,

parents

each

treatment

-

.“

during the early period with analytic concepts

symbols

co

here just

as

“

We are

to

.

she made

feel toward

and then

your

your

un

living and dying

't

"

:

ask “

and giving

Can

up

I'm

realize that

my

?

parents

analytic

"

you

,

.”

In

with which she delivered them won her the title painful moments she would career woman

of

of

of

.”

conscious will meet your conscious The melodramatic flavor some her pronouncements and the earnestness

-b

to

of

.

to

It

get took her many hours know what the other oxing patients were like When her fantasies shadow

began

to

parents faded

to

she

with good

213

,

and

bad

The Meaning of Recovery relate

them

in

As

.

of

in

.

more realistically She first recognized that her provocative behavior generated distinctively different responses each her associates Then she recognized the changes their

and they expressed

of

, .

operate with

.

them

,

to

them

The

the easier

of

-

listening

being the

share time and attention

Paula claimed the distinction

off

discussing her

the in

Shewas forthright

of

.

the group

experiences with men Each paired with the same man

.

intimate usually

of

girl

sex

”

"

,

Unconsciously

she

.

to

became for her

to

for

her attempts more satisfaction she got from it

appreciation

to

what they had

in

more interest

co

.

she became

,

say

their comments about herself helpful

to

her

more perceptive

showed She found many

attitudes

other women

.

,

in

the most attractive to

command attention and

topics which bored her

from

most attention

a

the

in

her

her She worked group away

.

paid

to

be

seemed

zealously

to

session

Whichever man to

.

nately

”

“

group situations feelings but Paula distributed her tender more indiscrimi

steer the

She became impatient when

.

?

"

a

,

of

“

's

of

.

of

two the men explored their feelings about homosexuality What the value such discussion she asked them During one her disclosures about her love life she

. ,

week she

that

said

a

”

in

to

must have been highly gratifying

Paula

.

.

of

“

having sex mentioned that she enjoyed three times night The response the three male patients the group

The following

ra found the group sessions very thera

she

vitamin products

of

on

's

met while arranging agency

relief for

She was

a

a

the executive

of

.

,

He was

in

contribution

problem

she had recently

first regard her affair

.

agency whom

focused

She did not

.

a

him

Walter

of

with

as

relations with

Paula disclosures exclusively almost her

his

her current difficulties

the group

at

her first year

to

During

in

peutic

, .

marry marry

to

I

.“

,

asked

.

? ”

Emily

nswe Paula answered

intend

a

s

,

”

a

to

'll

"

I

.

so

.

he

feel

for

and think

she

"

,

,

checking his

!”

I'

,

get

Everybody wants

stay this way

.”

I

. If

basic thing

ll

voice was cool

.“

's

.”

's

Paula the

a

his controlled way

in

up

.“

change

bitch

orgasms That married

.

a

for

? ”

.

a

." to

“

“

What

Thank you

“

stop feeling

you stop thinking and feel

Again Peter spoke anger

He

Peter sounded weary

When

flared

bed and

says

up

are you going

When

confident

.”

he 'll

.

I'

m

terrific

never give me

change

.”

.“

is

change his mind sure

he '

a

go

a

again Here we different Paula sounded

snorted

This

“

is

bachelor by choice

Arthur

with man who tells you peculiar way get husband

entangled

in

Getting

up

“

.”

Walter

told you

I

I'

“

ve

"

't

do to ”

.

when the affair started Don you want get married

loved her principle

”

bachelor

by

and she thought

was

“

warned her that

a

,

,

reported

he

He had

she

him

love with

he

The Analytic Treatment Process

214

changed her mind

.

,

Tearfully

she

she pleaded for com

way

neurotic

and

love him

she said

.

my own

,

“

.” I 'm .

passion

In

.

had quarreled and parted

Walter ”

later Paula

off I

A

month

to

,

to

,

her wonderful

't

,

on ”

.

year

,

.

activities

In

“

the affair was her problems

orgiastic

that

she couldn

all

when

the solution

to

fantasy

but

“

,

went for nearly

a

a

sex addict

,

of

m

preciation

weeks later she was seeing

,

's

was Paula would

marriage

few

she was it

And

so

Maybe

be

him

It

give

again

.up .

man

”

.

discipline herself

A

I

“

mature enough break destructive relation ships For the first time she said she really understood what meant about sublimating her sex drive and learning But

that

ap

Walter

of Recovery

215

all ,

of

give her everything baby

sex

.

a

being

to

-

a

—

she

would become an attentive husband wanted above the privilege twenty four hours day

big

and

The Meaning

I,

be

it

.

It

.I

it

her

When she began talk about her wild life suggested might m ight delaying her that she curb told that my improvement has been observation that sexual prom was incredi

no

be

.

I

crazy

of

;

. I

life

-

co

.

I

go

I

't

it;

didn mean must man would ever out with her again These were some her responses which studied during that period patients were genuinely concerned with helping Her

;

ble

Paula reacted

It

interfere with psychotherapy whenever made this suggestion

.

apt

defiantly

to

is

iscuity

,

to

,

;

.

to

They tried persuade her her manage her behave sensibly more she was advised and lectured for example

me

, to

to

it

,

.

.

,

on changing her tactics with men My concern meanwhile wa was wholly with the unconscious conflict Were she marry before this was resolved seemed pretty certain on

.

in

responsiveness

more

,

their needs often attracted

,

.

her physical appeal With the two women

them

too

also

be

and warm

,

to

attractive

, .

,

example that though they found her very they hated her incessant clamoring for attention came clear her that her sincerity genuineness to

,

, ,

to

the She discovered

.

,

recognize

It

for

m :

,

hatred

,

,

a

,

and rage Later she got many different feelings she aroused them shame

,

of

variety She experienced emotions for anger the three men love jealousy humiliation living

—

of

that eventually convinced Paula that loving baby was not successful formula a

thrilling

for adult

group members

the other

the men

,

a

being

with

,

especially

each

.

was her interaction

.

It

in

.

I

of

in

be

back treatment some day com problems clearing marital concentrated away the various obstacles which prevented her from func tioning healthfully the treatment setting that she would

plaining

Paula

than

un

The Analytic

216

Treatment Process

derwent many emotional episodes . She frequently terrible chill is going

A

Emily

once exclaimed when

wrestled

me,”

through the

.“

with jealousy

captured

spotlight

she

from

.

her

.

she

attitudes helped her

primarily wanted

to

's

to

the men

men

from

,

Getting understand modify her own What

”

.

:

the direction from

in

.

of

.” operated

which she had

the mature woman

a

is

of

.

one direction

But none

.

a

would act like straightforward move

--

on

operating high way the she functioned her office squalling baby again Recovery never in

efficiency

like

a

unconscious

's

,

to

she told the group

good lay

—

.

Suddenly

,

,

to

be

to

move her back

of

level

this

Walter

time Paula

to

“

'I

time

her She was too trading When kind

from

something more than

want

started

continue

her affair with

ended

From

genius

men wanted

in

she finally

a

worthwhile

person

a

felt that was

she

a

all

.

to “

,

Paula told the group was intimacy tenderness and com panionship She had tried sell sexual excitement because

the

backward lasted very long and finally the balance stopped shifting backward and forward She becamemuch

.

;

spurts

.

But her claims

.

,

live

”

to

beginning

complete recovery were

she

of

"

to

as

I'm

.“

near

to

the

in

asserted

drew

her most infantile attitudes the end her second year just

feel cured

group

”

and outgrew

Paula began

,

demanding

less

not seri

until she had demonstrated efficient func COU group encounters variety atients Her co -p

.

of

a

tioning

in

ously entertained

.”

learn about other people

, re

'

,

,

“

.”

still have

What

something

you to

's

said

you

Emily

“

me

feel that you

any more

statements

:

just said makes

Paula

Well

:

one

of

run this group

on

commenting

supported

them

Peter remarked

,

certainly

not trying

to

.

others rejected her claims

Some

of

her treatment

.

the final stage

of

expressed many different opinions about her behavior during

Paula was told that she was taking

The Meaning of Recovery criticism

me and

went until all of

it

each other

them

that she had achieved

a

not

year after she had

During that last year studied her myself closely the sessions and asked various

I

,

feel cured

in

behavior

take place until nearly

.”

“

to

But this begun

with

so

of her treatment .

goals

did

the

spirit . And

better

in

agreed with

217

.

questions about her

?

in

?

Did she express her emotions spontaneously and clearly Did her mind and body function unison Did she appear

of

?

as

?

,

case

af

a

of

as

in

could have given yes answers

to

its

purpose

.

am

I

,

?

Paula

's

In

fully served

the first

.

questions when she entered the group She was highly

verbalizing her thoughts and feelings Even

.

proficient

in

two

can answer questions such these the usually satisfied that the group experience has

I

When firmative

I

ciety

as

a

of

?

to

at

in

all

thoroughly group situations Had she become ease her objective enough the other members see herself group saw her Did she respect her own worth and theirs Did she have realistic view herself member so

,

when they pained her deeply

she poured

out without

them

when

she had

,

of

,

recalled the time several months earlier last

I

.

any hesitation

started

:

superficial cry

,

Paula

such

to

about

talk

it

.”

for 't

,

Feel your feelings and don things Criticized harshly

“

to

,

of

he

,

to

.

to

made the her many threats leave the group Failing recognize how upset Raymond was and how ea earnestly major problems discussing was one his she said him

and

groaned

“

.

Emily

Tell

what really

me

to

That

's

made

love people was terribly de

.

so

,

”

and now

'

,

to

“

it s

you

ve

worse

'

pressed today

I'm

unhappy because hard who are hateful me Paula declared

I

it . for “

."

“

? ”

Another threat bothers you

us

.

said she was quitting

why

The Analytic

I want to

Treatment Process and

218

. I know

depression come what my panic working through here from but much trouble them give you love Arthur went can the time baby s

normal

. ."

,

have mixed feelings

to

't it '

I

't

,

,

and she

't

don

even

just make

she was

when

so

to

who had the right

of

.”

other women

her that she was not the only member

Peter reminded

a

.

"

why

guess

away from

them

to

That

continued

she

,

want men any more play for them take

“

.

,

In

became hostile

I I

or

.

later she resented every man she went with

one situation another they wanted only love and admiration

the group

her problems Paula

I ' s

or

.

Sooner

of

that this was one

now

“

She knew

say

people

said

“

:

can

you admit that

? ”

for

Why

all

so

on

's

it

,

leave

to

try

why

have been

I

.

That

's

“

.

think

explain

talk about

in

.

treatment

She never

She

She

to

,

excellent taste wearing clothes that

about her gave the impression nothing

advantage she

wanted

hide

.

that

Everything to

good

.

figure

to

off her

in

but

dissembled

about her presence

harmonious wholeness

dressed simply showed

said

naturally

.

and

her

conveyed her feelings

. .

.

created

a

spontaneously

were closely attuned

sessions

did

the

emotions Everything

and

made

she

she

in

ments

,

.”

long and still feel this way Her bodily movements general behavior and the state

,

so

makes me sad

you

when

me

and outwit

outsmart

It

leaving

But

I

me you

she answered

to

,

agree

”

, “I

.

bothered

.

psychotherapy she had been very She had kept her legs crossed and held

over her chest

When

.

her arms stiffly

her individual treatment

she began

to

the couch

.

on

rigid

of

product

During the first year

in

was essentially

a

it

-

,

it

The other group members took for granted that Paula always synthesized appearance but possessed had this well

make

The Meaning

of

Recovery

some real headway

; and

she

disappeared

,

this rigidity

of being well adjusted

.

or

bit

be

times

to

to

inhibitions

their pockets

told

,

frowned

,

in

kept their hands

they

the localized

They were irritated

at

-

.

their nails but they found her observations investigate habits She stimulated them which

.

to

of

,

slouched

helpful

,

She

her

herself

she gave many signs

patients

co

of

understanding

in

entered the group was especially sensitive

when

that

219

.

under any

was frequently pointed out

the tongue

to

.

verbal attack

that she provoked

she

She functioned inefficiently

her

,

?

of

form

Not until

criticism

to

tivity

ease interaction with the fully outgrew her hypersensi in

always appear

she

other patients

It

Did

at

.

they had not been aware

and

lashings she received

,

of

.

that these constituted socially acceptable reactions During the last half year treatment Paula handled

. -

.”

to

co

.

-

as

himself

and has

was never able

say

why

to

.

that she was qualified

.

but

for example

to

,

group

,

maintained

perspec frequently others She

that she had to

demonstrated how her actions appeared

,

tive

on

Paula repeatedly

no

.

,

of

his

to

to

him

objective hope that

compare and evaluate their percep

with own perceptions making benefited from the comparison tions

be

,

demonstrate her smartness patient leaving group treatment patients see him see himself his

learned how

of

he has

a

I

like enough

she took

I

trying

instead

and inferior

She made

longer made good naturedly

Since criticism

“

of

her feel isolated

attention

it

for

.

demands

to

few

listening

no

,

or

herself well whether she was talking

leave the

Confronted with

,

.

she had behaved

. rationally

a

she was asked

heaven

in

When

infallible messages from

if

her feelings

as to

of

objective evaluations her need for further treatment she cling would the idea that she felt cured She experienced

.

in

in

,

She would

.

then

more out some

reminded

hor

.

she had talked about

”

rible mess

any

"

side the group

be

.

,

herself Besides she did not behave that way

of

she asserted

to

,

them

always would reply that things the group and why get practice disciplining

”

“

did

She

she

,

specific group situation knew when she did nutty

she

The Analytic Treatment Process

220

in

of

of

The other patients helped her recognize the unreliability

as

to

regard her feelings

her

clue

that

al

some

,

she realized

something going she

trustworthy

be

,

her own mind Hence

.

in

only

on

be

, it

on

ceased

of ,

of

.

By that time

though her feelings were always going

few

stop short and reconsider

action she contemplated

might

months

that her feelings often misled

reminder

her

cause

last

guides

to

mild

During the

to

a

,

treatment

her would

them

a

solicited

to

often

.

of

.

her own impressions her actions She showed CI creasing appreciation their opinions her behavior and

of

of

, , ,

in

as

-

.

her

ac

it

,

to

as

of

all

them

.

,

a

self centered

Rather quickly patients Initially

had the same problems nce Concerned she was about be hard more controlled person she found

she was convinced that inte interests and objectives coming

the group

.

to

.

She was almost

months she attached her own feelings first

attitudes

she entered

-

during

other people when

six

her

individual psychotherapy

them

.

does not agree with

Paula was oblivious

respects their

and

to

even when

understands

co

He

he

.

members

-

co

for

is

to

.

,

havior and becamemore reasonable ready The patient who leave the group usually has respect his own worth and appreciation that his

.”

selfish

the feeling

—

,

indeed

all

-

We are

“

stated

the assumption

personalities

,

were self sacrificing

them

-

she repeatedly

operated

on

but

Some

:

.

new ones

of

to

-

cept the idea that they were relatively well disciplined per explore their feelings and develop sons who were there She also that she

The Meaning of Recovery

221

to accept her point

could persuade them

of

if they

view

knew how much she wanted them to agree with her. After she got to know them better and developed them

, for

Paula . Their

feelings helped

anticipatory her

discovery

the

Thereafter

grip

,

she

getting along with people generally group mates her many ways in

.

that they benefited from her emotionality up

The

,

.

attitudes and feelings

had fewer difficulties

Psychologically

her from

release

to

fed

of her

one reason or another things which co -patients also became important to

.

in

in

interest

were important to her

an

to

led

.

on

to

his

to

in

herself Her efforts her confidence build help Raymond improve posture and diction

helped

accepted

an

she functioned

as

the group

,

in

months

few

.

-

on

.

many discussions about her advice such matters His frequent comments her good grooming and other praise given her made her feel more worth while During her last

.

equal

and

made

new

a

her group

She joined

club

friends She registered

art and current events

own horizon

con

Group psycho

or

ing

therapy

had

.

tacts becamemoremoderate and variegated

first

social

,

became more significant

her

in

and then

seek out people

her own

to

As in

the group

Recognition

the admirable qualities

and

people generally

did not have about her notion that she was was

she

her

businesswomen

for evening courses

pos

. .

mates encouraged her

The fact that they

.

of

shortcomings and

for

.

.

brilliant woman

her

an

exceptionally

life counteracted

to

aspects

on

man many

of

-

co

patients about herself and her knowledge experience sessed and

more discriminating

of

realistic

of

became more

,

Paula

gradually

eased

the impulsive little baby whin

I

.

an

“

.

I

”

all

“

nothing into attitudes befitting adult group becoming She told the that she was more choosy fought hard for any jerk when about her male friends

The Analytic

222

couldn 't stand the

said . “ Now what

that

idea

I want

Treatment Process

I might not get guy who

is a

a

husband ," she

really love

me.”

, handwritten

and

will

half years after she left the group , I received a blue -ribboned announcement of the birth of a baby . The family name engraved on the announcement

About two

and

was unfamiliar to signed by Paula

baby . We are

a

a

me; but

, was

on the back

this cheerful note

happy

family

. My

calm and loves people , especially known a long time but never

:

tell them

it

. I think of

them

me.

A

is

, of

is

serious and

real man , one

I've

thought was important.

I'd

like the others

often and wish

how much they helped .”

Performance in life emotional maturity .

This is our first

husband

Thank you for your help and patience . to know about

“

course

,

the ultimate

I

could

test

of

Part ·

III

THE PSYCHOTHERAPIST

191

Group Therapist

A

in the Making for

sooner interchanges

.

essence

and the ideas that guide performance

. :

his

proclaims

,

background

,

,

Nevertheless talking

abstaining from

he

by

,

countless ways

the

any main

if

,

personal identity

anonymity

his

his

, .

about himself personality

In

does not preserve

his

privacy

his of

tains

the

;

.

,

sessions The therapist the other hand says little thing about his own experiences the phantom figure

he

on

and

later

or

revealed

through their personal disclosures

in

therapy

,

group

are

THE LIFE EXPERIENCES which make people candidates analytic

him

.

or

be

to

to

he

is

in

His life history implicit The very fact that treats patients together and looks help them each other through the shared experience as

of

that

he

accept the notion

curing them

.

assistance

He does

in

.

teamwork

to

a

as a

might interpreted inadequacy confession indicating need increase his own effectiveness through

can use their

Awareness

'

one s limitations

of

of

an attribute

is

the

The Psychotherapist

226

of

is a

to

is to

.

of

a

,

prerequi mature personality and mature personality psychotherapy The easiest site for the skillful practice way spend the formative achieve emotional maturity years

who provide

loving parents

life with

gratification

,

if

employ

our per

:

our

—

we know

under

and

motives and the effects

, ,

well

our feelings

is

.

understanding

of

of

our

others

.

in

-

.

and our first lesson

the foundation

is

Self understanding

0 ourselves

training

,

to

on

behavior other people That why before serving analysts others we undergo individual psychoanalysis

of as

way unless

therapeutic

stand ourselves

consistently

,

a

sonalities

we cannot

—

fortunate in

are

so

in

all

.

in

to

exquisite balance and frustration foster our emotional growth and ripen our personalities However even our upbringing was ideal respects and few human beings

,

we

up

of if

.

,

If

of

In

to

our personal analysis we learn how any counterbalance adverse effects our own rearing and later experiences these were very damaging the rectifica may process tion demand more time and effort than the course

,

a

great deal our practice

, ,

it

supplement

and

our own the initial

self analysis

-

carrying

most

sealed

of

as

We generally

of

investigation

signed

of

need

have

finished

much knowledge on

we

by

as

identity

that

ourselves

.

to

delivered

we .

not consider

do

us

of

varies with our individual needs When

is

.

,

of

were brought with the psychological equivalent the spoon scope retraining silver Hence the our emotional

Some

of

their rejected

,

far

.

to

they

figuring out the kind predicting the effective turn down for training

candidates have

.

do

of

person they should turn out those they turn out

ness

Thus

of

either

the field

emerged

as

success

for

or in in

have not had much

personality

, or

”

ideal

“

define the

.

throughout the years Psychoanalytic institutes have tried for many years

out

A

Group Therapist

in the

Making

227

; others

standing psychotherapists

who underwent the train

ing process relatively quickly have become competent and upright practitioners but without much intuitive perception of the problems of severely disturbed patients . Knowledge suffering and experience in mastering their own difficulties equip some persons with special aware

's

capacity

recovery

and

.

so

do

human organism

for helping

facility

a

of the

ness

for

through

it

acquired

,

or

is

needed

to

emotional preparation

required

.

,

be

will probably is

of

higher degree

,

.

,

Eventually this too

experience A

a

of

of

.

,

as

is

,

gen Individual psychoanalysis successfully completed erally accepted adequate personality training for those growing recog entering group practice However there group training nition the desirability treatment con

a

re

to

called

-

his

with

countertransference

If

.

of

him

feelings and attitudes which developed whom his patients may remind

child for persons

as a

he

:

actions

the

appropriately

so

,

In

.

in

in

group than duct analytic psychotherapy comfortably individual practice both settings the analyst has understand and deal

to

he

is

In

dealing with

cur

powerful emotional

by

problem

say

additional rer

of

.

,

he

recog his own psychoanalysis was successful able interfering nize these reactions and prevent them from group process practice with the treatment has the

.

or

to

or

by he

as

resists in

,

and

He has

to

the group

,

by

, him

and behavior

.

,

,

feelings

the

his

ability

to

' the

impulses

in

control the various tendencies induced members

unconsciously

he

,

.

consciously

the instinctual forces operating other words must recognize analyze

In

group

or

six

be

—

to

currents being swept along these

velop

,

of ,

eight rents stimulated the similar strivings persons what might called their common neurosis He against has understand any tendencies swim with

perceive their feelings and

de

own and

yet be sufficiently insulated

the

The Psychotherapist

228

communicate

to

responses

from

the time

fifteen years

to

.

group

it

to

in

he

of

,

begins his profes

analytic feels reasonably secure assuming course that conducts

before

treatment

reach

individual treatment Close

he

pass

in

personal analysis for the practitioner sional majority

he

years

his

takes

to

usually

ten

It

.

they need

effect

.

character change

us

of

re

.

whom have

their own specialty

are likely as

the psychotherapists

in

,

.

psychiatric social workers who meet together the major professional associations the field

and large

of

of

colleagues most

,

other degrees

clinical psychologists

members

medical healing We are for diagnosis and

or

or

-

.

be

By to

a

as

Our non medical

treatment

doctoral

form

legally and morally responsible

in

garded

,

as

psychotherapy

of

in

.

of

Technical knowledge and skills are acquired through professional training various kinds Those who ar psychiatry physicians specializing group are administer

fall into

.

these three categories They also work together

in

of of

new

in

learned

I

a

of

clinic teams

,

.

in

colleagues who have served

my

in

social relationships and my medical handling them Like many on

on

skill

example gives the psychiatrist

problems in

creases

his

perspective

the psychological a

for

,

and social sciences

with persons trained

,

Working

.

the team

all

to

in

of

.

”

“

as

clinic teams the mental hygiene clinics and other agencies which provide treatment knowledge The pooling and exchange the course these activities give valuable experience members

great

they

co

partners

as

his

on

off

member rubs treatment

team

.

each operate

in

of

.

of

-

in

psychiatric social deal from associates treatment workers and clinical psychologists Some the knowledge

evidence that the physician

training ,

hand ,

professions

on the other tions for this role . Acquisition

is

dynamics

group

, ,

of

of

profitable

that

or

possible

each other

their

for

theoretical

and especially

field

's

of

and practical knowledge

;

superior qualifica

gives them

But

in

is

of other

representatives

than

virtue

a better group psychotherapist

as

no

of hismedical background ,

be

yet

229

, by

us .

is as

Making

of ,

There

in the

all

Group Therapist

all

A

to

.

a

for

she had entered treatment

and

a

Two a

,

herself and her friends

psychotherapist

.

about her choice earlier

dispute between

a

arbitrate

of

me

to

I

by

to

individual treatment factors harder define seem more important than our respective professional training IS CO young woman who asked was consulted recently

half

years

serious emotional

disturbance with known medical psycho analyst unquestioned competence After treating her individually for few months she said that had placed

,

a

his

analyst recommended

,

a

.

her by

-

she

a

,

ward

of

couragement

in

groups She withdrew after year dis improvement Shortly over her lack after entered group treatment with non medical

.

one

of

in

her

he

.

of

an

internationally

acquaintance

just

to

an

.

.

.

me

,

she told

,

excellent man

get anywhere with him

”

an

s

he '

doubt that

't

I

.

.

I

'

made

up

They

'

analyst

my friends ve

upset

.

lay

a

to

I'

But

.

was really getting somewhere attitude about my going

m

a

I

by ,

I

.

of

,

.

I

that the other patients

he

didn

't

I

didn feel put me with gave me anything either Now things are different click with my present analyst and have real feelings about the other members felt that few sessions with them the group After

“

but

don

't

“

I

to

to in

.

in

to

She felt that she was making progress his group and wanted remain there Her friends were volubly insistent that she leaving her first analyst had displayed poor judgment They were urging her return him

.

I

with him

of

any

want

why she should

reason

not He had

.

She said she could

.

immodest claims about himself and had

,

,

a

lot

.

she added

;

She was not looking for magic she knew that successful treatment meant anteed results

not guar work for

of

no

they

."

a

if

she could think

leave her present analyst

made

;

neutral party

as

'Ill

I

advice

asked

a charlatan

stick

if

my

waste

your

by

being treated time and money

I

I'm

their minds that

say

The Psychotherapist

230

The name

the analyst under discussion was unknown

me but

of

of

.

her

in

it

,

I

,

to

found listed the membership directories among them the several national professional organizations Psychotherapy Association

Colleagues

.

inquired

no

whom

I

of

American Group

about the man gave me

information

.

a

decisive for his recovery

is

.

is

is

,

curative What

of

emo

him

in

give

can

tionally disturbed person intellectual understanding self but we have learned that such insight not

an

.”

a

the first unless you prefer

failure again Any qualified analytic psychotherapist

reason

be

no

I

.“

”

see

to

should return

told her

I

,

lay analyst to

a

sonal success with

why you

a

a

-

a

"

to

to

question his competence which might have led me personal You seem have choice between being analyst being per failure with well known medical and

itself

the emotional is

which develops when treatment conducted growth needs his personality These cannot be met without the development and ex change genuine feelings

.

.

of

meet the particular

of

to

relationship

basis

intelligence

a

in

is

on

not created solely and professional training Countless

.

the

channeled into emotional growth of

be

.

to

is

,

as

it

;

as

Antipathy well attraction even profound dullness may spark feelings but develop hard for these completely relationship indifferent The kind which can

Making

,

,

resources

Whatever the reservoir our develop thera

we

differently

somewhat

for

fre

example ex

, I

,

is

analytic

Though inter

unorthodox manner

.

operate

in

analytic psycho the only standard procedure supplement interpretation with other procedures

is

pretation

in

quently

an

.

peutic personality For one whose orientation

voice

even

of

,

to

”

'

school

own

and

functioning

our

.

influence may belong we

,

and mannerisms

hereditary and

them

to

cultural endowments

among

factors

personal attitudes

a

and intangible

231

tap

in

,

tangible

the

Group Therapist

A

I

,

therapy

developed

out

grew

in

aid

to

.

,

and experiences

My

in

about

of

interest

Boston

own early problems

a

my

in

.

' to

grew

formative years

explain up

.

living

I

experiences also help

—

one s

a

many people during group

,

is

to

Emotional responsiveness some extent inborn but lively childhood and by contacts with fostered by is

it

personal characteristics

,

This approach

of

.

tions

attitudes

as

in

as

,

of

on

I

.

in

operate flexibly individual psychotherapy the basis scientific principles but use my feelings my responses my percep freely well me

mile away

the smoldering

that afforded tensions which help area

tuber a

an

overcrowded

to

foretaste

in

class

of

culosis

—

from where Joseph Pratt was conducting his historic

vivid

breed

's

disclosure

his

of .

patient

in

or

I

on

notorious murder took place the street where overwrought people bite their hands rage saw

lived

A

. . of I

hood

A

about the de surroundings impact structive childhood reminds me the gang wars which terrorized my own neighbor emotional disorders

one another with lead pipes this crime infested neighborhood parents like my own struggled give their children opportunities which they

I

,

of my

of

.

enjoyed themselves oldest child guided the activities and arbitrated the quarrels

five

,

the

As

not

had

to

-

In

.

assault

sisters

The Psychotherapist

232

my

and brothers while

parents worked in their candy store

our home. In my memory they were always

below ing .

My

work

attitudes and feelings during a group session often to the schoolboy who had to act quickly in an

hark back

while maintaining sufficient detachment to the total activity of four siblings . The role of parental helper in a large family is excellent conditioning emergency supervise

for

group

a

therapist

. Working

and playing in resonance

with many feelings , became keenly aware of personality recog differences among members of my own family . my nized acute sensitivity to feelings when I started to work

I

severely disturbed patients

I doubt

.

that anyone chooses

a

physician

than

the

in

.

.

a

of

. I

to

,

teacher who

algebra problem

a

five hours

at

that carried over into

time

The phys

. .

an

solution

four

had

a

I

mathematics

spending to

working out the

School

or

love

enjoyed

of

in

.

a

Public Latin

me with

my work

nour conventional still primarily

investigating how people tick

Boston

I

At spired

.

instantly agreed

this way was sedulously

ished during my boyhood but thoughts medical practice never appealed me interested

my mother

.

, ”, ”

,

explained

am

germinated

in

idea

be a

doctor

The

to

going

Yes

's 's

the profession

he

“

He joining

I was

family doctor examining me satisfy my curiosity

,

then about five years and my baby sister obligingly helped

curing the patient.

to

heart tick

if

illness .

, I was more inter

stethoscope

a

old

ested in hearing a

used

she he

I

But the first time

“

become

to

is not interested in helping people recover from

in

with

he

I

I

,

at

a

as

'

ical sciences and philosophy also attracted me But after reading Sinclair Lewis novel Arrowsmith freshman Harvard College became more and more enthusiastic

A

Group Therapist exploring

about decided

the Making

in

some unknown

be a medical

to

I

When

233

entered medical

frontiers

.

scientist

school

1929 ,

in

I

medicine .

in

I

turned

to

neurology and psychiatry , not because I expected to be come a practitioner , but because severe mental illness was then opening up as an important area of exploration . While Berlin

, I worked

research assistant at the Kaiser Wilhelm

as a

voluntary for

of

attending the University

Institute

Brain of

,

me

gradually

drew

when

learned

into

the

psychotherapy

,

in

the course

of

I

of I

in

first became interested my neurological research

it

practice

Institutes

.

of

Psychiatric

and

,

at

on

.

of

I

,

Research where studied the microscopic structure the brain My investigations nervous and mental functions which were later carried the New York Neurological

.

,

as

,

and found

treatment

nowhere near

es

pharmacologic

with

.

of

—

experimented

have

pecially insulin shock

it

I

—

's

,

talking cures the rationale physical Speech affects the mind and through the mind chemistry structure the nervous system the the body

effec

It

.

in

get

to

of

,

as

at

my hands psychological medicine tive least would probably take hundreds years compound the exqui chemicals which

,

an

in

to

it

produce

those chemicals

infinite number

To

patient and situation

is

,

on

and findings

's

CU concern

-

and art

.

advance the producing psychological stimuli the the research minded practitioner started my neurological training Freud theories

science

each

.

for

mind body relationships greatly interested

-

dosages

When

can

employed

create different psychological effects and control

I of

the

stimulate

of

ways

to

The personality

be

tries

to

;

,

attitudes

his

.

its

each

of .

precise

to

patient needs well and stay well But his body has own chemical psychotherapist through laboratory and the words and sitely

The Psychotherapist

234

me.

I

psychoanalytic literature avidly at medical few classmates, I experimented with psycho

also read

school . With

a

a method of probing the most obscure aspects of mental functioning .While walking or lunching together , we took frequent excursions into hitherto unexplored areas

analysis as

of themind

'

each other s

My amateur far from

so

ventures

self - analysis

in

home, had

a

dividends

years spent

value above and beyond that

. Discovery

I

accrued

of the origin

or

of

some

signifi

usually brought an irrational feeling or impulse insight and energy . States of fatigue or tension were

of

cance

me new

'

back beyond the day s activities to nostalgia loneliness for my family and close friends from whom

often traced and

, during

exercise . In the process

most intellectual unexpected

and our own .

I was

separated .

As

I thought

and of being loved would surge

always

easy

circumstances after another

maintain

to

, but I

did

, feelings of love through me. It was not

about

them

objectivity under the one emotional obscurity

scientific resolve

. And I became

convinced

that psychoanalysis

façade and get

The psychiatry

taught

pene

to

tool helped me

know the those days

of

human being behind

,

in

courses

this

psychiatry

forbidding diagnostic

it .

trate

my a

In

to

was an effective tool for investigating the mind and under standing human behavior .

to

.

to

;

is ,

to

the classification mental diseases and diagnosis and custodial care rather symptoms that psychological treatment But the academic descrip than was oriented

of

a

health

me

put together

an

Such clues often helped

to

.

in

broken down

he

.

a

of

patient under study whetted my appetite for ex tion ploring his thoughts and feelings The psychoanalytic ap proach transformed his hapless behavior and disorganized fascinating story why and how statements into had accurate

Group Therapist

A

in

the Making

history of an emotional

I began

disorder when

had

,

235

I

to practice

“

had

patient and

hopeless

an

,

I

to

In

fact

was regarded intense

help him

't.

he

who

to

work with the prove that wasn

.

psychotherapy

to

standard methods than

disturbed person

”

a

inaccessible

severely to

from treating desire

to

a

.

to

someone who responded

from

as

I

It

.

in

an

ing

although

psychoanalysis

to

not yet undergone formal train had find that was heartening facility helping patient instinctive for resolve the ob stacles healthful functioning But there was less learn

psychiatry

,

on

.

a

my

Because

take

over

the

committed

to

respond

the institution

,

during her first three months

to

her failure in

well

bleak outcome the case Her mother had suicide and her schizophrenic father had died

.

to

suggested

a

treatment

history

as

family

,

Her

as

.

case

I

in

the

by of

schizophrenia

to

catatonic

was invited psychiatrist who had been treating her

interest

it

acute episode

.

, of

an

a

,

a

in

as

I

in

my first which embarked pyschiatrist intensive case mental institution Chloe young beautiful brunette had been hospitalized following That was the spirit

in

to

clinic But she had improved sufficiently

,

a

secretarial job

of

up

function well for several years

in

psychiatric

.

a

at

,

.

a

in

mental institution Chloe herself had started out life with many emotional problems for which she had been treated intermittently during her childhood and adolescence which

attached

to

a

but any

significance

no

she

great emotional

;

.

to

which

with some incident

was connected

on

suspected that

I

later

it

.

at

young she had given the time her marriage engineer Her breakdown had occurred about five months

and

soon

developed

such

to

intense challenge

a

her condition

an

treatment under I

understand

Chloe

;

started

's

I

.

it

her devoted husband could give information might precipitated difficulties which have

The Psychotherapist

236

to

It

me that she To show

help her

.

to

I

if

day five

I

my

surprise

earnest attempts

to

my

To

.

ments

made

seemed

great effort

a

laughed whenever she made humorous state

,

interest

the case

,

my

I

spent several hours

.

week

would respond

a

a

days

six

or

cure her that

to

on

strong drive

establish

.

some emotional contact with her proved unrewarding

but

direction

She

little information

gave

.

ash

my

in

hurled

trays

.

.

't

“

:

Don

.”

York

in

his

contributed

a

New

Menninger

, ,

to

Dr

.

some made

by

,

great need destroy herself simply and tried understand

.

me

,

I

,

whatever she said Even throwing me off track and

,

of

a

.

the

dramatic

to

highly

in

the meaning

she stopped

of

in

sincere interest

tually

.

enraged her but however badly stood my ground and maintained

presence frequently

she mistreated

her

to

laughing

,

her

as a

of

the case especially the her laughter and wisecracks resistance to

to

stopped

,

me

laugh when

feel that you are ridiculing her

my understanding

verbalizing

I

to

great deal recognition

My

will

during later visits

room

of

hotel

said

she

suggestions

Similar

of

,

patient laughs

After hear your

there with their cases to

my report he , , or

ing

I

to

I

a

at

.

the psychiatrists

assisted

,

About two months after started treat Chloe dis CUS Among present cussed her case staff conference those was Dr Karl Menninger one the distinguished psychia trists who frequently visited the institution and informally

began purge herself the fought telling guilt against secret which she had me her about abortion she had undergone about month before her breakdown As listened her without displaying any you knew

was sure d

.

tell you

I' I

me

to

want

if

't

“

didn

have any use for V

't

V

U

you wouldn

out

:

she cried

I

I

.

,

emotion

to

a

an

:

,

session

killed

,

,

.

the story

time during the sessions that followed behind her breakdown was assembled Chloe and facts

a

few

at

A

!”

my own child

Group Therapist

the Making

in

her husband had agreed , wait a year before bearing

. Before

to

to

reluctance

have her undergo

.

child

a

an

him

she

accused

His

,

that she would the year was half found out that she was pregnant. Enraged , she tricking her and decided have abortion

insistence

at her

of

over ,

237

it

A

con

increased her

.

viction that he had tricked her Later she became furious

Her

suppressed

anger

guilt

at

as

as

,

at

her husband for having given his permission well herself for having impulsively gone ahead with the abor and

I

Chloe began

I

in

better contact with reality each time to

, ,

began

,

improvement

was exceptionally

her

others

wishful thinking However .

was accused

imperceptible

so

the change was

talk

saw

rapid

, ,

which

to

session

of

I

clear when deliberately

at

the cathartic

she was

that

made

not aware spoke with

she was

.

.

After though

He also

actually

he had not impregnated her in

that

him

it

herself

them

him

it

of

concealed her feelings from

;

it

.

precipitated

it

remorse

,

.

,

about the acute schizophrenic episode Her husband had not connected with the abortion because she had tion

first

once her probably

;

because her illness was recent and acute rather than chronic extensive

treatment

in

,

moreover

her

earlier

years had

I

.

to

,

I

.

I

,

in

in

to

to

psychotherapy made her readily amenable attributed my progress getting her success her talk out her hostility understanding her behavior and making her aware that did The more understood the more rational

,

recurrence the illness Chloe four children and socially prominent

.

she

.

patient now

her

was

There is

a

work with her

recovered

of

no

the hospital

the

com

therapy

because they

be 't

that schizophrenics

't

's

psychoanalytic

dictum

can

respond

to

,

Parenthetically Freud

don

.

of

has been mother munity

from

as

discharged

in

had started

to

months after

I

Six

.

she became

The Psychotherapist has

238

of

.

of

a

of

by

drawn into an effective treatment relationship been growing number contradicted the reports ana my lysts this nature first case with the success But

those who suffer from

the study and treatment

hand my practice Every young psychotherapist

.

to

an

the

resolve

he

or

,

it .

do

understand

and

,

able

it

until

is

he

them

study

well has

get

will Should make concrete about improving their behavior

how

it

should

people

help

he

suggestions

he

crucial issue

of to

in

in

urge

to

intense

diseases have

these

who starts out with

to

,

Since then

gone hand

them

.

meet the special needs

of

of

to

,

to

to

strengthened my determination help make schizophrenia and other baffling illnesses comprehensible and learn how

them

my

of

"

in

some extent

treatment

urge

I

,

was

cure

,

support inspiration

her

of

could exert and explained the inability

.

I ,

,

,

case

to

in

strong

Chloe through suggestion persuasion and any similar influences which These got me nowhere

this

on

had

a

.

I

intervened

,

Menninger

psychotherapist

a

Before primarily

Dr .

.

Chloe

reflected

."

,

”

were

to

Both

“

as

to

of

?

in

,

educate

to

improve their own function suggests ing This question two conflicting tendencies psychotherapy which are sometimes referred the field therapeutic the attitude and the analytic attitude

eventually

her

ap

I

,

to

.

I

so

to

of

.

to

first psychiatrist make headway with her After was helped understanding her my recognize the value proach was different stopped trying help her hard

choanalytic

to

approach

health

Her

inherent

in

the healing possibilities

.

demonstrated

restore her

.

perience which would

to

of

to

.

I

to

analyze her instead and began devoted myself pri marily figuring out why she had broken down and giving her the kind understanding and emotional ex response the

psy

Group Therapist

.

it

to

live

good

his

to

's

ability

resolve

solutions conflicts The shortcut the psychoanalytic

.

to

for

life

One analytic

patient

instruct

even

,

a

patient

own

tempted

process and suggest how

in

a

be

therapist may

his

confidence

difficulties and find

him

239

takes considerable time for the young therapist

it

develop

to

Making

to

Usually

in the

his

A

group therapist

considered

telling

patients how

rules and directions

,

The

of

.

inexperienced

enthusiastic about the value

be

can

”

also

carried

practitioner

be

.

extreme

attitude

of

is

who

undesirable

analytic

his

an

to

,

the other hand the

“

to

as

,

its

his

list

he

of

a

until he found out that thought they should conduct them understanding selves was less helpful than conveying implications and permitting them their behavior and they wished On the freedom utilize this knowledge issuing

psychoanalysis may

's

a

to

taught there and

These were important to

in to

which the proce work effectively

to

in

be

to

,

to

in

order determine the extent dures would have modified order

ascer

for me

to

limitations

primary motive and test out the clas to

to

learn

procedures

.

tain their main

to

at

the Institute was

sical psychoanalytic

devote myself entirely

My

.

Institute and soon decided psychoanalytic psychotherapy

know

. .

shortly after treating my first schizophrenic student the New York Psychoana

became

lytic

studying

analysis

is

he

achieve

therapeutically

therapeutic

at

I

,

seeks

a

,

In

1940

patient

to

share his understanding

The golden mean

to

but also how

to

to

.

or

is

to

of

impart problems understanding patient before the latter able assimilate such interpretations hopeless about himself without feeling more confused psychotherapist analyze The has learn not only how tempted

transference

the major

Freud

's

and

treatment

on

.

I

to

no

resistance

base

-

concepts

any one method

of

work

of

I

,

.

with patients suffering from severe emotional disorders Today longer attempt operate within the frame own

The Psychotherapist

240

but

niques will help to implement these concepts. I the individual patient needs and treat

out what

have heard myself described

of

his

,

follower

a

as

to

I

.

I

,

or

of

as a

follower Stekel Theodor Reik Wil

Reich and others was referred Rogers Carl before had any knowledge

helm

ac

of

,

,

,

,

Rank

find

him

,

I

.

cordingly

Freud Adler Sullivan

tech

employ whatever

to

—

try

of psychoanalysis

definition

concepts

.

procedures

is

will bring the best

as

,

,

an

If,

is

in

to

beneficial

competent results just organic medicine gives the drug that most upper respira his patient for example

.

cedures

practitioner

pro

employ whatever the

growing tendency

to

a

manifesting

In

.

of

many schools and Effective methods are the product man psychological many minds medicine the practitioner

,

.

is

less

of

a

time consuming

-

is

his disposal

with modification established tech psycho procedures introduction new gradually becoming less rigid chosen restrict myself the classical method

.

that

I

suppose

psychotherapist

of

group

I

,

psychoanalytic principles

would not have become

a

applying

to

to

.

is

,

of

,

.

I

Had

doing

them

However

and the

therapy

methods

of

to

,

is

niques

The number learn any one

much

the youngest branches at

one

of of

in

works

medical science

limited and

draw

effective each time

.

of

extensive because

process

instruments

the psychotherapist

. he

The armamentarium

of

to

, 't

thousand

will be most

operation

of

performs

he

with perhaps

chooses those which an

,

from

to

,

neurosurgeon

a

is

is

is

it

,

or

tory infection pneumonia doesn respond one anti given another perhaps several while biotic the patient determined which drug the best remedy for him The

Before

various studies

,

in

on

.

I

I

,

so

group processes and results also investigated the special demands which group treatment makes the therapist connection with my conducted

Group Therapist

the Making

in

activities. The next

group

psychotherapy

career ;

but

truly

is

was probably

in which to study the

.

,

I a

of

is

.

,

to

their benefit grave emotional disorder

treatment

person

A

,

I

mu mutual

my individual

other

usually

who eager

is

as

as

to

group psychotherapy long before

practiced

formed my first group since some patients had been indirectly sharing each

be

ill

excellent laboratory well heal the patient an

getting over

psy

to

We

experiences

research

a

explore severe mental illness thirty have learned since then that the therapy

ago .

a

for

to

group

sense

to

the course of one

in

inevitable

years

is

leap

a

was to

CIU structure

's

it

chiatrist who started

In

's microscopic

the study of the brain

From

step

.

field of practice myself

enter this new

ness

241

of

A

training and supervisory

impressions

to to

I

to

is

often stimulate me

may talk

cases

.

in

some

recovery my problems other close

His

making my own decisions

in

over with

when

of

him

;

other patients

he

.

to

a

he

.

to

some service others who suffer from one The knowledge that can make contribution their prog ress tends facilitate his own He wants hear about

.

about these cases

.

respond

one

and exciting but paralyzed with fear

,

is

if

person

aspects

it

in

a

challenging

case

did

was likely

Some patients

. .

he

if

of

at

practice when

sessions with many frightening

disease

a

a

will

the next intervention Too much anxiety blocks effective treatment Before recognized that my anxiety was not the patient opened problem but my own case with the feeling that a

discover that

I

was rather shocking

change the had

to

good results was

to

to

do

secure

to

.

patient

to

had

It

I

all

I

,

I

's

.

.

to

about how

his

a

patient and wondered

little fright makes impossible help he to

A

Schizophrenia

is

new

my

the beginning

physical violence is

do

scrutinized

to

I

There were times

The Psychotherapist

242

change myself too

of

Some feelings and attitudes , such

.

the illness or the patient , hamper his treatment

;

as

fear

it also

became clear to me that there were others which he needed to experience from me- for example , real feelings of hate and love , and the security of knowing that he was with

was genuinely interested in him and com fortable in his presence . When I satisfied these needs , he relaxed and worked more constructively on his problems; someone who

illness

had

to

organic

myself

I

from

a

way to

other external remedy has

feelings

out feelings

.

suffering

drug

to hand

or

gives

an

cian

is impossible a

But it

the

and my fears and anxieties evaporated .

physi

someone

develop

those

to

.

.

at

of

in

grow into The psychotherapist patients person give the kind who can his the right feel ings the right time

[

]

10

Some Group Leaders Talk Shop who does psychotherapy in a child guidance clinic talked with me one day about the “ confus ing things we say we do ” in working with groups . “ When I read reports of therapists whose training and YOUNG

A

PSYCHOLOGIST

use

methods differ from my own , what goes on in their groups is often a mystery to me, ” said Wanda Green .” “ The jargon

we

.

to

.

we got

together

and

exchange experiences

the psychotherapists

quoted

a

we

bet do

would like on

know

each other

to

as

'

re if

'

not

understand

far apart

as

op

re

subjective

regular

this chapter

are

of

1

The names

pseudonyms

we

some therapists

this Would you help

such

in

the way

find that

be able

I

we

we

hunch that to

least

'd 'd

,

notes we

At

,

. .

ter

By .

sound

have

because

us

But

,

.

I I,

is

erators

compared

,

suppose

inevitable

a

us

it

and our different philosophical approaches make hard for communicate clearly with each other This

basis ?

of

sort

A

, along

project

and discussion

research

,

some

psychotherapists

are reported

whose this chapter One

.

in

,

months later opinions and observations

six

the group

of

of of

? ”

of

your seminars and workshops The upshot that conversation was the formation

lines

the

The Psychotherapist

244

Their first

few

of

to

, ,

-

is

.

.

a

of

introduc

century

The main contribution the twentieth em development into scientific systems treatment

. I

of

that you are interested

understand

is

way

of

by

”

I

,

said

finding out more

in

their

an

to

”

“

many centuries

of

in

use for

“

.

tion

of

“

All

been

us

on

overview based

shop talks were devoted group the field treatment What follows reconstruction the records those sessions employ psychological procedures that have of

.

therapy

of

of

a

,

a

week

to

my office for about year they came Son discuss various group approaches among them some comm monly employed systems counseling and non analytic evening

.

about their differences and similarities

Those

among you

do

directive and family counseling conduct psy therapeutic groups activity chodrama group social and therapy might serve unofficial spokesmen for your own systems How would you like proceed

-

,

non

we

call

assume we know

,

Wanda Green

said

.

methods

pin

down the unique things we different names which really are

do ,

us

's

also those

by

to

“

and

that

is

scratch

from

? ”

to

start

nothing about each other help This ought

, ”

"

Let

;

's .

as

,

,

who

doing this

asked

Would

“

propose

.

you

I

"

How

? ”

do

."

similar

or

,

,

to

?

of

procedure be helpful for these sessions Do formal rules you want have theoretical discussions present cases

.”

directions a

to

as

democratically

friendly looking man with

-

calm

to

's

,

a

"

operate Let agree out tying ourselves down

as

? ”

what

possible

with

The speaker was

somewhat

academic

Some Group Leaders Talk Shop

“

.

to

him

I

,

”

, .”

-

is

of

for counseling service and

we

call

Gray

People

clients

them

.

us

to

hear

the client centered method approach social rather than medical

-

s

“

like

”

. It ' “

We

the non directive method

also called

Our

come

told

activ

you start off

don

.“

,

"

,

A

“

suggestion

firsthand account said

Why

someone commented

good

of

ity

Les

good introduction to your own

a

. Dr .

That sounds like

- direc

. Rogers.

R

? ”

center which

tive approach developed by Carl "

affiliated with

employed the non

'd 't

manner . Dr. Leslie a private counseling

245

psychologist, was

a

Gray , a

a

.”

I

— a

preliminary

oil

provided

this

Gray

an

in

.

Dr .

of

I'

ll

tell you about one them businessman shall call my Roger He has been groups one for about year

of

ex

,

-

in

,

.

he

from

might

the

coun

associate had suggested that

business

talking

over with someone

them

at

benefit

a

but that

he

, -

a

thin

:

information His saturnine man his mid thirties the company During his initial ecutive vice president consultation stated that his problems were not serious client was

he

year

he

-

and

a

.

New

to

from which drove York City He traveled

,

the heart

of

in

wife

suburban community

ten

-

co

in

.

son

his office

a

old

was married and lived with his

in

He

.

life

in

seling center Roger explained that was experiencing ordinating his business and domestic creasing difficulty

Dc0

.

great deal and was often away from home over the week end

Roger told are heavy tight schedule My wife home much She complains

,

't I can

.

we bicker my mind

and

frequently

.

that

and

my

neglect her and the boy

so

resents

being away from

”

very

.

live

,

responsibilities a

"

,

and

I

“

executive

Gray

on

My

.

Dr

if

,

.”

, ,

upof

to

't

.

a

I

my work get these aggravations out My suffers worries don add much but probably some professional advice would help me manage better After few individual interviews Roger was asked

The Psychotherapist

246

he

would

like

talk over his problems with

to

other clients

had similar concerns. He accepted the

some of whom ommendation

join

to

center by Dr. Gray . " In the first session

no directions, ”

group

a new

, Roger

Dr. Gray

being

formed

.

"

times what the members were supposed

He

I

do

,

gave

several

asked

to

rec

at the

surprised that

seemed

continued

,

what

and

on . He was accustomed to his opinion , meetings got nowhere unless there were rules of procedure which were made clear in advance . ' You

would

formal agendas . In

go

would like rules ,' I told him . “ You want to know how to WC work in this group , and you feel that rules are necessary .' That response , you probably know , is characteristic of my

.I

approach

'

paraphrase the counselee s statements

.I

questions

,

he

interest

I operate

work out the

ask

't

don

give

Dr Gray .

saying

group

responded

that she didn

consider

to

judgments

't

statement

eventually

I

pronounce

woman

will

." .

to

that

problems himself

in

A

,

advice

or

solutions

his

assumption

by

on

's

the

without expressing approval or disapproval show in whatever he says and accept it unquestioningly .

Roger

's

general

rules

very

.

to

;

important she could talk about her own difficulties with out being given directions He listened intently her and a

mation time about their disclosures but giving little information

,

to

questions from

to

asking

the other counselees

few

time

.

about himself

he

,

,

so

it

'd

he

a

be

this group but He proceeded

;

to

could

more difficult

executive tasks explaining how

,

his

the others could manage talk about

would

was expected

he . in

;

he

.

float around as

operate

It

a

to

to

.

to

if

for

had time him

never

as

in

to

or

six

five sessions Roger said that was accus organized discussions with specific objectives tomed disciplined person even mind He was child

After

he

planned

he

of

the other members

commented

them

that

had

the

very

risen

be

.

One

Various questions were

subordinates

his work by

about

him

group

of

to

of

247

.

the activities

put

his

Some Group Leaders Talk Shop

. he

by

of , a a

. or

de ,

Dr . in

a

To

.

,

”

,

,

.

-

Dr

.

by as

Steeple

being

own analytically

Their members were not put under any wn conform and were encouraged his own

,

by

.

about

.

freely

did

talk

-

their experiences the fact that the non directive therapist not

neutral attitude

to

to

a

It

in

developed

Louis his

Dr

groups

from

in

,

to

.

.

and safety created

.

of

The non directive ap

.”

impressed

that which

to

's

a

.

to

a

in

spontaneous

understanding

procedure

conducted pressure

Apart

of

he

In

about being

The climate similar

. .

,

'

his

to

up

without specific direction and this his mettle conform was hard lesson behaves much more relaxed way He feels operated

proach breeds spontaneity

Gray

business

Gray play never learned how group people the found that were accepted

again

he

him

now

secure

disobey

feel threatened and insecure making parents expectations him

he

,

they

.

“

he

clared

but

had made

temper

scholastic record and getting ahead fast

when

put

outbursts

on

“

lived

but

said

of

a

them

He

woman married

:

a

to

disappoint

violent

this

Roger spoke frankly to

.

to

given

brilliant

left there talking After about

great deal emotion parents rigid demanding

his

about

memory

the sidewalk

had

continue her shopping

memory with man

child He recalled lying alone

five

His mother

ab

about the

felt lost without rules on

of

,

at

the age

screaming and kicking tantrum

He

the group

disobedient

as a

fearful

himself

expressed anxiety

him

,

direction

in

of

A

as

weeks later

few

sence

he

.

,

he

in

quickly very able and efficient his firm and must Roger reported that feeling was better generally but was apparently becoming more and more uncomfortable during the sessions

The Psychotherapist

of

essence

client

statements

's

conveying the

go beyond

his

248

,

in

whereas the analytically oriented therapist made interpre tations what other differences were there the two ap

Dr

.

Steeple asked

experience

I

,

accepted

designed

help

them

get

me

The

move

for

scrutinizing and changing their own attitudes and regard their own solutions their problems growth rather than healer catalyst

I

a

a

.” .

as

to

finding

myself

.

.

because they

other and

of

ward

of

's

.

,

up

as

please

by

counseling

each

and

My

.

an

feel safe with

channels

by

talk

about whatever they

to

to

clients

the

transference and have just illustrated

produce them group process the

not asked

aspect

opin

to

group members important

they are not

of

are

.

the

but

Memories come

is

I

resistance

the past life

mind into particular principles

't

or

group member direct don apply psychoanalytic

Dr Gray

of

his

conduct

investigation

an

don

't

.“

I

ion

of

,

There were many basic differences

in

.

,

proaches

he

, ”

over

.

of

a

an

? ”

,

.

?

his behavior with

attitudes

put

the

damper

.”

't

.

.

Steeple remarked

unconscious processes

”,

focus but the kind

group structure

I

on

,

Dr

of of

asserted

,

.

Dr Gray

system

deliberately “

don

't

I

-

the non directive

get much emphasis

S

ICO gather that the unconscious doesn

”

"

'I

on

Their

Dr Gray a

identifies

first

his impulsivity

“

in

he

rule the roost

more constrained members

Won

atmosphere

”

in

such

in

he

“

.

replied

tries

Eventually

to

Sometimes

he

"

impulsive person run wild

personality

at

with the opposite type

had

an

of

.

in

.“

,

“

't

Roger was rigid and overcontrolled when started Obviously great said Wanda Green obtained deal your group What experience have you emotional release

have

,

.”

,

In

.

am

I

a

great deal described brings out emotion that sense studying what you call the unconscious actually Asked for further information about Roger his coun

Some Group Leaders Talk Shop

selor

it

said that

.

case

249

was too soon

evaluate the results

to

, freer

Theman was already more relaxed

he would

this

in

; an

emotionally

probably

months

:

In

client reminded boy eight His

another

of

an

incident related

of

, of

silent until

by “

.

.

to

of

.

to

.

in

six

be much more comfortable after the group He might also need some individual counseling work out his family problems give another illustration his Dr Gray was asked replied Roger own interventions He one session was other

of

in

,

of

up

.

of

if

to

.

.

a

it

up

a

at

he

,

of

fit

a

.

in

one

as

his own experiences rage picked father chair and hurled across Roger the room said looked the remains the chair and wondered his father would crush him the same way He ran reassuring his mother Instead him she him

I

:

.

'

to

pick ordered him the pieces the chair told him your violently saying You are that father behaved and that

and

his

's

of

the

go

did

present situation

, .”

memory

his

.

I

I

and

I

.'

your mother was very demanding spoke without emo beyond reflecting gist tion not statement did not explain the connection between Roger

,

“

.

's

.

Dr . .”

case

participate

at

not

the begin

Eventually however through

, of

,

group experience

Gray

man with both business and

.

his

of

family problems who tended

ning

as a

impressions

of

my

child

,

give

out that Roger was

a

I

I

was asked

pointed

his own home

to

experienced

in

sion

to

he

it

of

.

of

in

he

”

an

In

“

interpretation Dr Steeple said Roger might have been informed that had not been talking previous sessions because his fright and tension Hewould have been told that reminded him the fright and ten analytic

to

or

to

feelings about them express The opportunity meeting with censure rebuff was beneficial

.

without him

.

his

his

to

,

of

he

his own communications and those the other group mem developed intense emotions which led bers the recall highly significant emotional experiences with parents

He

The Psychotherapist him

250

, it

are

,

,

TO into

resistant

less

longs for freedom

too

,

;

difficulties getting

they

, he of . If, he ,

“

.

great deal

deeply resented

less tense

person for example discipline and domination

another

if

„

to

subjected

a

than

or

I

form

.

of .

,

to

",

one

various kinds Initially added to

"

People have

He was

for

to

his

anxiety was reduced

talk and had more energy for his work treatment

this

he

him

was not threatened with expulsion

.

refusing

talk

to

demands were made

was helpful Since

was

a

No

on him

.

behavior

his

got the impression that the group accepted and was vn concerned primarily with helping understand own

from

and

certain

of

it

,

.

case

how

.

d

tell

That

he

us

he ' him

”

counseling

,

if

.

what Jack Bush does Maybe respond Roger approached

sort

Miss Green

,

For example through family

this

would

's

a

of

.

it ”

hear how

through another procedure

handled

remarked

to

interesting

to

be

.“ be

to

-

It

would

“

would

a

may find the climate may take group very appealing non directive However adjust sometime for him responsibilities

immediate

for help with the family

.”

to

ll

a

,

I'

in

to

a

as

more

.

”

, .

,

.

She appears

well restric

.”

the morning and frequently misses the school bus

in

up

's

at

age who chafes mother neglect Ted has trouble getting

a

Ted

,

son

is

.

Their

to

marry her household responsi

,

.

few

pretty woman

merchandising

by

in

,

of

give

responded

.

's

his

developed boy

tions and his father

try

his thirties who

have

congenial neighbors

mother

overanxious for

an

be

bilities and the absence to

a

.

at

a

promising career She has resented being tied down

who gave

but

Dr Gray

has described his wife Ernestine up

“

Roger

is

“

My memory

man

like

wife and son your disposal

's

facts about Roger

Bush

,

Dr

exuded energy and optimism

.” “I' d

said

.

general idea

some imagination

his

require ”,

you

will

That a

“

.

problems Dr Gray just mentioned

Some Group Leaders Talk Shop

on

,

procedure

the center for

several weeks apart a

few

seling room

be

in

.

Roger and Ernestine with

While

series

the coun

playing with

room

.”

,

wife

counseled

other couples

Ted would another other children under observation

In

a

three would come

then

family

.

exploratory

to

All

sessions spaced

study

have been enrolled with his

,

.

and son

diagnostic

an

as

be

to

Roger would

either case

might

,

me following counseling might used referred

case

The

of

.

detailed

a

would have taken

she

personal and family history

a

a

;

social worker

Alfred Adler and would have been

or

's

.

by

interviewed

of

philosophy and methods On Roger first visit

treatment

his followers

be

I

I

should explain that

center

work , ” Dr. Bush began . various programs are based the

clinic where its

I

"

the consultation

to

in

and psychiatric

Roger came

he

'

" Let s assume that

251

would call

interview

His

the

to

I

's

in

“

on

brief

while

room

later

.

for

and

him

parents would

talked with the youngster

,

the

:

his

session

room

of

out

the

I

course

counseling

, to

of

visor would report

be

Toom super account The playroom boy me the behavior the

Bush continued

a

.

Dr

but

. .

them

.

problems and

The

then

weld itself into

a

I

it

to

to its

of

;

suppose

room

direct control

,

but

parents were

.

to

in

to

,

in

.

them

Bush explained

times during

think out solutions their own problems Their individual preoccupations were pointed out the group and later private sessions

encouraged together

.

Dr

,

counseling sessions

and lectured

at

.”

operative unit

Hemaintained

to

on

to

the nature on nse way common sense --S

helped

a

is

it

elaborate operation

first alerted

-

co

an

sounds like

family

in

This

their return the consulting would express my own opinions and counsel

is

Then

I

Roger and Ernestine

is

.

's

in

the other parents would remain and take part the discus problems with They would also talk over the family sion

The Psychotherapist

252

.

on

up , air

and

in

.

be ”,

to

's

let

our case Dr Bush went Roger and Ernestine would both asked the first ses get back

's of

“

" Now

.

to

give their impressions sion their difficulties their grievances about each other attitudes For example

him

to

in

,

.

, he

't

of

Roger might complain that Ernestine was bringing Ted improperly and couldn get him out the house the morning When Roger missed the school bus had

.

to

go

he

him

to

drive school which meant getting late the office by every day telephoning about Ernestine harassed

.

a

son

his

charges

.

these

that Roger behaved like

My

by

he

.

a

to

's

over his mother nagging and insistence that play with own back yard when he wanted

stay

in

he

's

.

'

it

in

a

interview with Ted would probably make clear that was adversely affected his parents preoccupations and chronic quarrels He might identify with his father attitude and express resentment guest

his own home

reply

to

to

?

't

on

would call Ernestine would lodge the countercharge

I

“

She

to

,

in

be

to

.

or

;

trivial matters the evening was much too tired out again bothered by wife and He was good provider Wasn that enough

chum

his just

.”

three blocks away

of

,

In

the later counseling sessions husband and wife would report how things were going and cite evidence changes

:

.

'd

he

of

.

that the excessive demands

-

gone self imposed Had readjusted his schedule had

to

he

admit

were largely

.

eventually

I

't

“

I

.

in

on

the better the home situation Dr Bush went would have explored with Roger his attitude that people nowadays don suspect that work hard enough

for

his

job

the office last to

I

?

he

them

have dinner

brief were they being motivated

to

of

week did the three

,

In

together

?

How many times

a

.

,

d

or he '

would hope bought Ted the baseball glove the boy had hear that asked for and that they had played together last Saturday

weekend

change

co ?

We would

familiarize

better plan

with our con operative children

them

.

-

be

child

a

is a

to

his

-

co

operative parents have parents may problem The child who

viction that

of

their attitudes family living

253

were they working out

a

and

Some Group Leaders Talk Shop

parents

.”

with problem

a

Gray

from

's

to

got

unable pretty sick

Dr .

's

,

the impression

that

I

?

to

At

.

least

to t

.“ be

consider the possibility that Roger might practical advice He seems respond be

we

man

'

,

a

,

of

.

,

When Dr Bush had finished Doris Bacon another mem ber the discussion group raised crucial issue Shouldn

.”

report

or to to

it

If

“

, are

,

,

and

or

,

that

assumes

improving his behavior

he

a

, ,

As

“

.

of

and the

different assumption about Dr Bush has just stated

The psychotherapist

patient

changing

The analyst assumes

,

As

of

, .

our help

reference

is

seek

.

who

frames

-

a

us

is

of

those

respective

of

by our

to

our initial orientation termined

By

of

,

a

deconditioning and reconditioning tell none simon pure operator but

process can

I

as

to

he

.

's

to

.

be

to

through

far

the therapist

that there are emotional the patient healthful functioning which have cleared away the way the Pavlovians would say needs undo the effects bad conditioning

obstacles that

mind the different

counselees just need guidance advice

client needs assistance

his attitudes

My

that they

his

.

of

:

that

direction

made

them

continued his

.

cases

assumes

the counselor

in

of

Each

keep

in

.” I

of

his

.

analyst

that the group

reference

I

I

frames

became

enter psychotherapy

basic assumption about the people counsel benefiting from guidance capable suggested

test

.

that

the

would not meet his needs

counseling

recommend

her

.

reminded

Bush

study

or

we would

diagnostic

is

Dr

evident that family

after

a

only

he

suitability

,

out

program

.

his

counseling

that Roger would have been admitted

”

"

I

mentioned

We

de also

The Psychotherapist

254

not

enough to refer cases

know

who can handle psychiatric study . further someone

or

them

, if

our procedure

necessary , for

this

to

suitable for

Dr

he

.

,

counseling

from

't

it

, he

,

a

himself and would

work for me

he

experience intolerable distress he

be

it

This

. . . If It 's so

, of

-

he it .

,

if

a

“

to

will

behave

person who has

problems he usually

has deep seated

benefiting finds himself incapable good advice may say but won follow

to

.

to

be

sought by

of

of

;

ways

learn new

great fear the unknown within rather not explore

tries

as

to

people Bush often appeals They are eager for advice

children

and direction they want type counseling may also

However

a

on

Direct counseling such

.

described

who were neglected

it ?

massage would cure

the type just

be

to

Who would want

him

tumor

by

for

;

will be most comfortable operated for brain

prefers the procedure which

if . a

he

't

he

“ Occasionally becomes necessary because the person who needs help doesn necessarily select the kind needs

This

he

emotional release

The

enabled

of

.

Dr Gray

.

them

.

a

to

great deal

release

or of

demonstrated

-

secure

him

by to

and eventually enable

non directive approach

Roger

of

,

in

,

of

.

unaware

or

pretty clear evidence that needed some pro uncovering disinhibiting deconditioning called put feelings cedure This would him control was

would

Those

,

at

of

of

,

, ve "

I'

confused

.

are

e

of

impressions

it

0

My

“

Dr Gray

.

said

.

“

I'

d

to

.”

,

you who employ the action therapy dramatic types people know that these too free their inhibitions least temporarily get some information about psychodrama like

man with expres

Pine

The essence

of

“

psycho

situations are exactly alike

.

No two

, a

Harold

spoke

.

as

.

is

,

sive features smiled spontaneity drama

he Dr .

doubt that

.”

don

't

I

“

.”

heard contradictory descriptions

Some Group Leaders Talk Shop

255

,

there are many modifications of the classical psy chodrama associated with Dr. Moreno . This is the form employed at the Psychodrama Institute and various large Besides

institutions, but it involves a large staff and elaborate . Simplified procedures are also used , with or with out a stage . We conduct psychodrama at our agency for

I

.

. ll

,

?

if

, .“

he of

to

tell the story

his life

the to

be

to

.

I

or

including

auxiliary

egosin in

significantly

his

possibly

to

speak and coach the the scene problems but when project time the

, ,

to

how

figured so

,

I

.

on

,

the people who

other words conflicts would players

's ,

would

,

We

the staff represent Roger

members

his

.

myself

of

them

set

assign

to

to

in

.

.

I

,

to

,

was unable light cope with would come dis Then these would cussed by the group and would make my preparations Roger dramatize these conflicts during the next session group might play would himself Other members volunteer might play the other roles his personal drama

.

did this the current conflicts

to

session

he In

I'

his deep voice covering many topics in

”

lively

Pine replied

invited

been he

would have group As

he

.

course

a

of

,

Dr .

"

help

Pine have worked

had sought such treatment imagine what he discussion

,

along this

,

To

of

to

.”

a

in

for example

the

Dr

psychodrama How would

with Roger

might experience

of

case

groups

or

a

of about twelve lead them with the help socialworker and few other staff members Wanda Green asked him outline the development

a

ten

staging

a

be

to

that she

day

Don

't

worked

“

do

hard

.

how

all

appreciate

he

't

didn

.

to

to

something for her would plead with Roger good father Ted The man would complain

or

, .

of

.

,

of

be

“

in

It

.

,

came they would improvise their own lines egos seems likely that the auxiliary this psycho drama would Ernestine and Ted We might dramatize maybe several quarrels one their them His wife

The Psychotherapist

256

me!' Roger might

bother

. Ernestine would misbehave . Anyway,

angrily

exclaim

become distraught

and Ted would that will give you a rough idea . Someone else might Te - 6 re enact the role of Roger while he watched ; through

procedure , we would demonstrate to him group members thought of his behavior ." the other

mirroring

then

this

what

,

discussion usually followed one of these psychodramas

A

Dr.

. At

Pine explained

this time other group members

Roger gave

more attention

them

or

if

.

him

would express their opinions of Roger 's problems ; they might recommend solutions to Someone might point out that Ernestine and Ted might be less demanding that

efficient

other

.

good husbands

do

,

to

be

and fathers Be tween that session and the next Roger would undoubtedly

executives managed

to

.

in

Some

of

.

of

the

aware

their feelings

neutral atmosphere

people

to

-

out sensitive life situations many emotionally deprived appeal

a

of

: . “

I

acting

who are

un

love the atmosphere

them

,

is

.

behavior true also

.

as

to

as

fresh insight well better modes participate perspectives get All who new This

may lead

of

of

addition

to

In

the spectacle itself the support group the and the sober discussion their problems drama

.

of of

-

of

a

of

thinking about his difficulties He would great deal report his reactions and the results his soul searching the group Psychodrama and similar procedures for the said

a

in

to

be

'd

.

in

,

.

of

the play and activity group therapies for children As you know Miss Green works with youngsters guidance willing explain what happens clinic Maybe she

of

a

be

many

,

.

“

.

son

,

about his good

candidate

Ted

ll

I'

,

consulted

He might therapy At least

but

",

do

we were

that said

for this demonstration

for

Roger won

't

“

.”

her groups

imagine

Miss Green group

activity

the boys accepted for activity

Some Group Leaders Talk Shop

257

kind of behavior problems and anx His first interview would give

groups have the same

iety that Ted seems to have .

us the

of

impression

that he was very much under the thumb

parent and that

socializing

experience

with other children in a tension -free atmosphere would benefit him . In the group he would bang things around , play games with a

a

, or do anything else he chose to do without interference. I observe and reply to questions but the others intervene

other or are likely to Ted would expect me to

to each

At first

“

he' d be mitted a

become dangerously blow up the building .

co

him

at the amount of freedom he results of this experience would show up after

. Our

-operation

course ,

Of

while at home and school.

'

; per was

and control

shush

surprised

. The

parents

don 't

violent

the children

unless

adult

we'd

his

solicit

attitude would be that his to spend more time with the

groups are essentially the same

explained

asked

.

Gray

we treat

“

Their Usually those for adults

. .

Miss Green

Dr .

? ”

together

talk

as

They

,

“

“

How

father

you work with adolescents ”

do

and guidance from

.”

his

mother should permit him kids in the neighborhood and that he needed more attention

intervene

in

.

don

't

groups

interview

I

in

.

do

.

adolescent boys and girls separately Mixed groups They very well create too much excitement these their discussions any

or

it

We

therapy

do

.“

said

Is

Dr

to

d

like

.

with

I'

,

work

counseling

the aged

,

's

hear about Miss Bacon

the age spectrum

”

covering

Pine

"

we

?

that

re . ”

Now

'

"

more than necessary

what we call therapeutic

,

”

in

of

“

,

“

social clubs Miss Bacon replied but these clients benefit primarily from companionship understanding and sympathetic their both

to

fifteen sessions they begin

,

but after

or

;

people

ten

.

problems They usually respond more slowly than younger feel

The Psychotherapist

mon

problems

way

of

a

worth -while experience

; feelings

of being useless

.

-

in

develop

They discuss

laws often dominate their sessions

healthier

.

in

other

each

and find useful ways

attitudes

com

They benefit

They help

to

listening and being listened

from

.

, unwanted , or to

'

they re having

the

258

spend

a

pretty good

Steeple

cross section

Wemeet various

“

said

.

”

,

group practitioners

are

us

we

that

Dr .

me

of

to

occurs

of

of

“

It

.”

their time

us be

so

.” ”

,

Green

per

what as

aware

him

dealing with the problem

he it

this does not turn out

of

a

. If

,

begin

Miss

consciously

."

is

in

his problem

person

it

;

but we

all

be

to

what

difficulty we make

his basic

presents

to

respond

the same way

as

.

start out

ceives and identifies really

undo damage people that will to

.

in

We

“

declared

us

to

But

of

all

“

it

by

caused

free

try

improve Still others previous life experiences behave more desirable ways

them

by

help

.

to

.

give guidance and tell human needs Some people how improve their behavior Others among

kinds

is

to

solve

is

about

it

in

is

;

.

on

go

.

work with him his problem How we relatively unimportant the important thing to

is

he

,

.

us

of

“

.

told her

of

I

, ”

I

always The patient the primary source our knowledge his emotional Directly and indirectly disturbance tells what wrong with him We use our personalities various ways "

agree with you

the

to

One

people seek professional

is

.

numerous

our approaches

explanations

this problem

give

that many different

assistance

in

kinds

diversity

of

rise

to

The

of

.”

problem

dealing with

these

disturbances

the basis

are

theories

—

treated

of

.

They

on of

that the causes and nature

still unknown

are

son

is

.

it

;

emotional disturbances and those who provide are also differently constituted human beings The other basic rea

Some Group Leaders Talk Shop are

259

.

.

of

in

,

social back

responsibilities

various

and

,

resources

influence their choice

, .

other circumstances

diverse professional backgrounds

personal qualities

of

of

The

group experi

temperament

,

.

material

,

,

Age

process

the treatment ground

mental illness

therapeutic

group that most appeals arouses some emotion that can be developed

It

them

drift into the type

.

to

ence usually

of

the treatment

Persons who feel the need for

a

be

valid

to

proven

for

assumptions — and these varied The methods generally employed today crystallize the assumptions that havee

those who render the various forms psychological assistance are reflected their commitment particular mode counseling They don treatment

.

theory blends with of

general framework

, . 't

;

”

book

or

of

Within

a

out the

“

operate

of

a

to

in

and resources

personality

their respective methods flexibility devising

, ,

they usually function with considerable

in

the differences

.

emphases

,

their major

the techniques

they

employed

.

dramatically

a

.

's

in

.

,

”

at

said

was pointed

.”

out

,

diminish under close scrutiny

It

to it

I'

in

the methods themselves

m

to

it

statement

not interested study the reactions

,

at

divergences

him

Steeple

in

the

give

it

s

it '

back though times

.

seemed

to

Some

followed

Dr

group member

mirror

. I

even

give advice of

I

-

,

non committal way whether

to

just reflect

a

't

times

interpretations

or

At

I

“

"

I

.

were often similar don limit myself

ac

necessary

Despite

to

others

complish their immediate objectives in

analyzed

of

as

borrowed

”

,

tive methods but

“

to

themselves

group

discussion

they

.

,

than

my

found out that they had more They did not limit they had recognized the techniques characteristic their respec

their procedures common

of

.

comfort When the members

,

responses consonantwith their personal judgment skill and

The Psychotherapist

260

for example , that the more intensively non -directive therapist

and extensively

the

or counselor applied himself to the

of his group members, the closer he ences analytic approach . Eventually , the differences the between those two methods would be almost indistinguish able . problems

emotional

are

in

of

If of

of

.

to our

. .

.

a

to

of

treat

with much more

how his illness

becoming increasingly

de

requires

.

experience

of

and the precise reparative

of

the method

ill ,

a

on

person became

personality

he

,

veloped

how

.

in

,

based

us

observations

theory on

of

analytic method much employed The

ment derived from that theory provides information

the

private relationship

the other approaches

the psychoanalytic

to

development

temporarily

the

not only with curing learning the most efficient way time money and effort The learn

facilitated

extent than

application

,

or he or

,

,

of is

also

is

process

greater

the basic

any

effective

,

but

this

today

concerned

with costly the least

it —

ing do

patients

better

cannot sustain the bene may continue his treat

consistently

the

We

group

by

are

our methods

in

None

groups

through

only

it

, is

of

in

of

another type

through

cases

The resolution

resolved

may be relieved methods patient not helped sufficiently fits his first group venture

ment

most

treatment though

a

to

.

be

in

or

Some types

stages

person

may

case

secured

of

.

at

person

varies from problem

results

group methods particular

others

than

a

all

of

the

Good functional

are

Car came to

in

,

of

It

is

create

a

.

to

of

we will

able

to

that

master keys that could

unlock those feelings

eventually

be

impression

keys

be

few

different

set

.

my

a

vides

is

of

,

an

of

is

It

any course clear that the development emotional relationship which produces feelings health and maturity the essen pro employed tial curative factor Each the methods treatment

wielded comfortably

and

counsel,

or

.

services

we

.

,

master keys efficiently

Until

indispensable

then

however

,

ones

.

our present keys may prove

on

After we

be

to

use these

our present

to

of

who need their

of

of

those

have learned how may discard some all

261

by all of the persons who treat all

effectively

behalf of

Talk Shop

,

SomeGroup Leaders

[ 11 ]

Looking Ahead I'D

RATHER BELIEVE that

okay

getting

"

than

that

recovering

man

I'm

from

I

was

sick

well and

and the world was is sick ,"

the world

a

severe mental illness said recently

a

.

“ Then I 'd know that everything would be fine when I got better . This way it 's a lot harder . I wish I knew what was

desirable attitudes But coping

cleared away threats

,

from

sick

sorts

the

of

him

a

un

thermonuclear

world was dilemma recovering many people which faced from illness He too would have face the unknown and create own solu future would bring

,

his

the security

knowing what

of

not give

the

him

.

could

him

to

I

.

tion

,

a

sick

.

.

with

a

warfare

parents

I told

such

in

:

would have

well

all

healthier world , of

obstacles

a

stay

to

to

To make this

be

world ? ”

be able

of

me. Will I

to

of

ahead

He might

or in

of

he

have enjoyed this security had lived ancient Greece and consulted one those oracles diviners whose remarkable predictions we become familiar

Looking Ahead

up

for

summing our schooldays . They had a genius cryptic destiny every person who few words the

with

all ,

of , of

in

a

in

263

, a

.

,

In

of

in

.

to

perhaps was Tiresias the turned them Wisest Oedipus and Nar prophesied blind seer who the doom cissus and the happier fate store for Ulysses few phrases unadorned Tiresias faithfully predicted the out he

a

of

psychoanalyst personality tendencies which mar study many must for hours before understands their come

the

crippled

we will have

he

to in

in

to

,

to

in

.

and

,

.

far

and

,

our ultimate objectives things the present

. so

in

shape

In

it

to

the

and influence

of

us in

the kind

beyond

meander

terms

of

that

usually

our present understanding

envisage what lies ahead Perhaps this will help

which he

but how will grow predict psycho difficult

,

,

we

is

in

us

the future

Hence

magic and omniscience

knowledge

especially

of

range

them

collectively

mental healing

to

of

,

In

the field

have given way therapy

rise above

foretell the precise direction

moving individually

benefit

move that alter his early emotional it

him

could

consulting

.

is

influence

or

harder

learned how to

currents

or

. .

We have

to

direction

no

out where they would propel prophet But today man longer forced

early

a

him

by

,

do

't

;

he

in

whatever emotional tendencies developed him although life couldn much about them find

sciences

times man was bound

is is

been

ancient

In

by

has

prophecy

behavior

human

.

of

The

of

art

.

significance

future that we would agree

.

was desirable

It

.

of I

a

in

.

of

at

up

I

The two psychotherapeutic sciences about which have my own lifetime When the start written opened the curriculum was student they were not included the medical school has taken another thirty years for

The Psychotherapist

these sciences are still crude

;

both

academic medicine

of .

of

But

recognition

gain

to

of

to begin

them

the

264

their bodies

few

of

.

to

theory and practice have yet emerge from infancy developments These one lifetime represent no more to

's

of

.

.

.

relative

of

.

effectiveness

was

psychotherapists

a

,

their

The majority

controversial issue up

in

's

to

ago

so

A

decade

Today and tomorrow these hearing Only then will using them

refine both

their real potentialities

know

or

to

we get

and Pratt started

group

a

in

to

shall have

to

his patients continue improve aids and our skills listen

we

Freud introduced the

free associations

relationship

-

the doctor patient

in

to

privacy

patient

a

the idea

was only yesterday when

listening

to

of of

,

dimensions

it

.

in

a

days

of

struggle the history mankind conquer understand and mental illness Within these broader

than

lined

of

,

.

.

.

largely

still based

Our

choice

one

personal preference

on

is

other

use both forms

of

to

,

learn how

treatment with more precision

or

extreme

we have

Meanwhile

The debate con

these are rarely voiced today

of

,

tinues but views

were numbered to

as

individual psychotherapy

as

IS

an

.

in

two opposing camps One believed that group treat expedient fad the other that the days ment was

the and in

I

.

to

of

the

two settings

I

,

no

yet detailed study making our selections

. of

guide

as

a

We have

The accurate delimitation and values

have

some psychothera Some make

the respective shortcomings task

for the future

Themost intensive individual psychotherapy

.

results

when

in

comparative

their welfare

will

group and complete their treatment

of

other setting

.

the

in

pists start patients

in

further contribution

group experience

is a

that

simultaneously

us

or

,

the impression

use both

a

the other setting

to

to

I

;

.

,

of

place convenience For instance most the patients groups have had some individual treatment transfer them

involves five

Looking Ahead

To

one and one

from

meet

the relative efficiency

determine

five hours

of

of

.

.

usually

specific conditions

the results achieved

individual treatment

of

through

treatment

Groups

,

one case

for

total

group

be

of

the settings

in

.

to

for

,

or

once

half

reported

has been

twice weekly four hours

No

week

a

treatment

of

intensity

a

hours

equal

265

of

six

or

of

in

,

I

is

.

it

.

a

of

-à -

the more

inti

,

to

continue

of be

will

Undoubtedly

agent for the corrective reliving

will

emo

infant the same kind

an

mother

.

as

give

certain cases

,

,

a

tional nurturing mate relationship

can

for

effective

tête any more than

substitute for the tête

father and siblings

no

There

from

question

be the more powerful

not the more

though

emotional disturbances

as

not serve

them

out

turn

In

to

understand

would

instrument

types

of

all

it

the essential therapeutic the earliest experiences

but more

.

treatment

and skillfully

of

of

will continue

Both

than they

present

use

.

at

are

combined

scientifically

,

ministered

will

therapies

ad

group

and

the psychotherapy be

.

the future are clear individual

be

the contours

It

other words

,

In

.

in

life

to

in

my mind that

obtaining information to

efficientmethod

people and getting treatment

of

a

such

less

made

far less intensity believe that the study would startle those who now regard

a

the

as

it

of

group treatment results

.

the great strides which have been

of

view

In

a

in

six

to

weekly would have compared with the progress persons group therapy thirty hours week

we know much more about the constructive our procedures psychotherapeutics than about their destructive potentialities These will undoubtedly com —

.

—

of

Today

may

else

be

”

dosage

someone

communication in

to

one

"

A in

person

larger dosage

psychological

or

a

him

in

to

which benefits

a

.

mand more attention

harmful the original

The Psychotherapist

266

dosage . Eventually the undesirable

will

and attitudes

reactions

to

our words

be studied much as the undesirable reac

the

as

toxipsychology

,

of

science

toxicology Just

the

a

development to

corresponding

of

I anticipate

.

the

na tions to drugs are studied in general medicine and pharma cology . As we gain more understanding of these reactions , latter science alerts

the harmful dosages and undesirable appli drugs cations and other medicine toxipsychology would provide safeguards against psychological toxic usages of

the

,

of

to

physician

With

as

the

or

to

,

contrast

in

treatment

which members belong But group psychotherapy will its

to

.

in

life

has never

artificial group which

have belonged the past shortly encompass the joint treatment

people who are

who are biologically related The direct treatment other natural groups their own settings also the offing fact few

,

a

In

.

formed

been

the

already

have

"

of

in

is

groups

therapy

"

those

in

,

in

especially

family

.

a

related in -

he

which

to an

it

, of

.

numerous other groups

co

their entry into treat

.

group

the past Actually exists only for the purpose in

belonged

joins

them

primarily

conducted

is

each

now

strangers

of

for

venture

of

,

ment

is

treatment

a

Group operative

a

.

procedures

public

. of ,

have acquired

a

unit

we

and

both

the investigations social family scientists about the effects interaction the family living patterns health members Studies which promote emotional disturbances are being conducted on

of

.

its

,

of

therapy

diagnosis and

as

interest the family reflects the knowledge

group

of

through

more

along with family diagnosis in

·

Growing

treatment

even

under way

an

already

on

family

is

a

treat

,

experimental basis

treatment

requires more skill than

in

Such

but

is

;

.

demanding

strangers to

group

one person

of

treat

treating

a

To

.

schools

Looking Ahead

267

by research psychiatrists

of family

systems

and appear to be culminating

diagnosis

, as well

therapy

and

life .

cational programs for the improvement of family

,

in

edu

as in

practitioners experienced

Meanwhile in group psycho therapy occasionally consider it advisable to treat the mem bers of a family together . I find myself doing this with frequency.

increasing

The trend toward family treatment is easy to explain . Most problems which bring people into psychotherapy are connected with their early family experiences . The rapid

tension

disharmony

and

of

of

Undercurrents

, .

of

,

as

as

era

,

this

economic , and technological changes of well two world wars have weakened the structure many families and transformed the living patterns social

create the kind

.

of

.“

. a

as

.

in a

,

,

.

by

and

Dr

The

.

W

Nathan Boston Their are presented the in

.

.

P

this field

by

in

.

of

1

and others developing

in

to

,

Our

father

own experiences

one artist told me

,

subject

”

a

as

,

a

mother

Outstanding contributions have been made Spiegel Ackerman New York and Dr John concepts

my

can determine

.

,

as

of

a

in

't

suggest such

hang

period

a

far

no

,

family

over

the happy mother and infant

one has spontaneously painted their offspring felicitous mood wouldn

search

family

happy

The theme many artists but

.

has inspired

strife

of

painting

the patient

of

on

is

room

-

the prevalence

my own unsuccessful

for

of his

identified

is

,

years

waiting

whole family the family

the individual treatment of

,

be

commentary

sad

living today

a

of

the

A

treatment

and

more effective than originally member who

unit may

of

equilibrium

I

observation

cases

as

upsets the

such

of

,

person often

In

,

to

precipitate mental illness home climate which helps The breakdown treatment and even the recovery one

of

.

)

;

in

:

,

:

: (

.

a

of

report conference sponsored the New York Academy Contempo Medicine See lago Galdston Editor The Family rary Society New York International Universities Press 1958

The Psychotherapist

268

growing concern of scientific

investigators with interaction

the family circle appears to be justified . Responsibility the intellectual training each generation has long been accepted by society but

for

for parents

training

was

of

,

became too complicated

with

children

over

taken

young

.

to

is

.

parents

's

a

and

en

far

a

,

training

for emotional

the schools

,

mentioned was the introduction

of ,

this direction

in

The first move

which

I

.

to

it

though

for each time they fail child The timemay not off when society be

.

entrusted almost entirely

task

accepts the responsibility trusts

,

, , of

blighted

be

to

a

task

too crucial

also

is

It

life

and other agencies

uncertain and limited The present high inci mental illness suggests that emotional education

difficult

is

too

organizations

,

youth

is

valuable dence

still

from

.

'

.

the schools But the emotional their parents responsibility The help they receive churches

the

When intellectual training

by

.

need

has

it

,

they

emotional

the

of

down training

fallen

providing

it

on

the job

new

is

in

of

processes

have already

group therapy

into the

all

in

emo

their

ad im

or

They

melancholy

,

,

as

is

concepts

they feel angry

.

intellectual

work with

healthful and socially appro these states The desirability

.

them

say and

feelings

their

to

handle

teaching them how

do is in

to

for

why

times and what to

priate

understand at

need

beginning with

.

how

them

my opinion

letters and figures and other

tearful

groups and classes

private schools

,

,

in

portant

children

or

to

public

mission Teaching

by

supplemented

tional training for

as to

to

ought

be

.

.

is

schools But more needed than treatment for children Therapy who have undergone some damaging experience

in

of

of

thinking and talking about troublesome feelings and the discharging them undesirability asocial behavior are

Looking

Ahead

269

lessons which

person should learn

every

distinction between

“ sayable ”

the

vital for emotional health , to

early

life . The

in

and the " doable ,"

so

is one which many adults have be taught today in the course of psychotherapy . Emo

at an early age

tional education

re -education

such

their energy

.

Children

would obviate the need

can

how

learn

personally and socially useful ways . Proper

in

instruction makes it second nature for accordingly and pleasurable enough so want to behave in other ways .

to behave

them

that they don 't

,

through

recall

memories

.

repressions

of

his

of we

lifting

on

the

we shall get to know much more about the curative factors in psychotherapy than we do at present . It was originally believed that what healed a patient was the goes

,

As time

for

discharge

to

that what was important was not the memories but what had prevented their recall The came

recognize

the ego and the achievement

insight were

At

integration

. of

of

.

to

Then

identified the decisive factors the pres ent time we tend concentrate emotional communica

.

development

have

talked

,

some time but we still know

around

practically

this

concept

nothing about

We know

to

,

,

that each human being has different needs

,

?

next

to

of

a

in

,

.

be

provided For example how much sti gratification and frustration love and hatred rest and activity does person require his formative years psychological development move from one stage the to

the ingredients

—

,

“

of

ingredients which they failed

for

early

up ”

I

,

emotional

”

their

Psychoanalysts

helping people grow symbolically through words and

.

the

them

“

with

so

,

providing

in

, , of

is

obtain

as or

,

In

attitudes

one

process

treatment

that

of

learning problems and the unlearning behavior expect that we shall define the the next decade

tion

to

old

to

on

as

subsequently

The Psychotherapist

270

have yet

but we should

us

enable

establish norms and

to

dosages

of emotional

patient

complete

to

words, to

other

.

These

sequence and

which would permit cycle the of human maturation satisfy his maturational needs . ingredients

, I believe

Eventually

variations

to determine the precise

will

we

that

know

a in

much about

as

the emotionally mature personality as we now , know about the breeding and growing flowers greenhouse These are fastidiously controlled operations

.

well ,

and shade products

.

his

of

by

each

at

-

.

nurtures

The

breeder

of

in

or

.

the flowers

knows how control color and size the ILI petals The flowers stems and the structure through such methods are hardier and superior

,

personality

as

cultivate

thoughtfully

of

We are not able

a

those grown haphazardly to

appearance

.

in

produced

.

of

,

of

to

varieties

length

to

new

he

encountered

seeds

insects and wind blown Ingenious devices his growth retardations

from

viruses

overcome inhibitions

by

,

disposal

required

them

fungi and

from

is

,

moisture and fertilizer He carefully protects

The

chance

knows how much sunlight

trained horticulturist

pollen

left

.

nothing are

course

plant

the blooms throughout the to

care

their growth

down

laid

the selection

From

of

the

daily

of

to

soil

and

and pathologists

.

geneticists

of by

which observes the principles and rules

a

in

,

of

say

creating

of

.

of

today because the science human maturation has scarcely knowledge developed Our the psychological needs

's

.

controlled environment

it

If

.

its

of

emotional

may the

have

to

later

eventualities

it

of

all

course or

to

in

the

sooner

sorts

:

a

transplanted

,

home soil to

be

growth

on

;

months but birth exposes incurs significant damage

it

a

it

is

the human organism still extremely limited The mother body provides with sheltered environment for nine

psycho

Looking Ahead therapeutic

have tries

to

setting

this

on

271

earth

.

This is about the only greenhouse we for human beings . The psychotherapist

the damage and provide whatever

repair

to ripen the personality

Though

this is

, at

.

best ,

a patch

-up

is

needed

job , it permits us to

make detailed studies of the responses of the personality to the regrowth processes . The studies are made with a view to perfecting the operations of the greenhouse itself. These observations

we

which

provide valuable source material through

also

eventually

should

tional experiences

which

to identify

be able

are

essential

the emo phase

at each

of

growth to produce themature personality . Our immediate objective is to learn what these experiences are and to provide them with the utmost efficiency through treatment – individual and group psychotherapy .

the

perfected

procedures

these

knowledge

,

however ,

be

to in

believe that skills acquired emotionally damaged individuals will applied

.

a

to be

rearing

utilize this knowl whole we shall

as

of .

-

a

stage

of

to

transi already schools are other While concepts and techniques in

a

this whole field appears Representatives the various from

developed

each

practitioners

-

non analytic

are

borrowing

by

.

society

group psychotherapy

somemeasure from

Today tion

How

healing

.

learn

non damaging way improve the health

to in

edge

in

them

I

of

we have

Once

and

combined

being

incor

into analytic group psychotherapy the non ana lytic therapies are being permeated with psychoanalytic

-

groups

.

of

is

the

psychoanalysis

classical psychoanalysis

generally

limited

,

which

of

present concepts based fundamentally and resistance and employ not only interpreta is

,

to

tion

impression that group on

This would transference

my

be

is

.

principles and terminology evolving into treatment

It

,

porated

The Psychotherapist

272

but whatever additional techniques have been changes

effect basic

the personality

in

developed to

and enable it to

mature . of

”

luxury

we

cannot always afford

is in

,

.

"

is a

knowledge

of

is

Its

Healing is a by -product of the psychoanalytic method . explicit goal knowledge about the acquisition emotional processes However knowledge for the sake view

,

a

.

working more healthfully

and

of

,

peacefully

in

,

and

function together The science growing will help find ways of

psychoanalysis

living

learn why their minds operate

.

when they

us

group

groups

enter

In

, of

do

they

to

to

people will as

be

.

need

of

of

for treatment As this need sub through stantially reduced the proper emotional education oncoming generations groups will oriented increas promotion ingly understanding the healthier age the pressing

.

natural groups

the family

,

especially

in

,

natural groups

in

taneous behavior

great deal about spon

a

Social scientists have learned

gang Weknow that people very differently therapy talk and conduct themselves groups but the dynamic processes operating the latter groups constitute almost untouched field research and the youth

. of

groups and suggest

fruitful

in

do

some of

to

as

,

in

for

one may reasonably

anticipate that can

the other hand

of

.

will provide knowledge which improve functioning natural groups

psychoanalysis

utilized

a

,

of

natural groups give

us

.

various possible com

purposes

the

be

the merits

Studies therapy

, .

On

for example how the presence psychiatric disorders influences

deepen our understanding research order people function they groups formed

therapeutic group

in

behavior

to

why

patients

of

clues are areas

on

binations

of

's

or

persons with specific group functioning

of

yet know

,

don

't

We

of

an

;

in

in

.

,

the work team

Looking Ahead

We expect

273

conflicting emotional

find out how

to

of

changes in the distribution

mental energy

states and

disorganize

behavior . Studies based on group - treatment experiences which approximate as closely as possible the experience of an individual in psychoanalysis would increase our under psychological needs which

standing

of the

function

unevenly

shall also

to

natural groups; we needs should be dealt with to

or inefficiently

learn how

cause people

these

in

improve their functioning . The controlled environment of group psychoanalysis would provide ideal conditions for observing

tribute from

various types of social experiences con personality disorders and how those suffering

how

to

,

them

in

, contribute

turn

to

of life

the deterioration

in

community .

Group

psychoanalysis

would

also demonstrate

disorders and social stresses can be avoided

would work out

the process of emotional evolution constructive approaches to the conflicts in

commonly

various ways

its

to

larger measure

of

tribute

-

to

they

recognize are

that maximum

the general welfare society will productivity and therapeutic

,

to

.

As

in

explore

and

adjusting themselves ever changing prove that modes behavior which emotional well being also enable people con

realities safeguard

desirable goals and mutually compatible concept product processes The mental illness unhealthy living will pervade society and our concern will gradually shift from the treatment individual cases

.

eliminate the need for his services

,

pox

and

other

dreaded

diseases

Just

,

of

a

. of to

will

be

wellness

diphtheria

have been

through vaccines improved sanitation

,

level

of

general

the psychotherapist

,

task

raise the

as

The ultimate

to

programs

of

illness

to

of

,

as

of

equally

.

living

community

arise in

of

which

.

these

Patients engag

life

ing simultaneously

how

-

the

small

conquered

and other preven

The Psychotherapist

274

tive

measures , diseases

treatment

will

In the course

which

eventually

of time

cease

respond to

psychological

to

be medical problems .

these conditions

will

yield

to social

programs, to be conducted through the home, the school, industrial enterprises , and other com and educational

munity settings . the responsibility of the psychotherapist to find out what prophylactic measures are needed and how they may is

.

therapy circle

, in

co- operation

his couch

in

learning

is

sit

what he is now with his allies : the patients who This

or

.

on

be applied

lie

It

his

SC

to

of

,

State Psychiatric

in

1939

He

neurology and psy

assistant and

,

Institute

to

an

,

University

neu

Vanderbilt Clinic Columbia adjunct psychiatrist and the

the

to

rologist

1934

Physicians

resident and research

a

took

the

the Neurological Institute and the New

as

York

which

as

,

chiatry

career

a

then started upon

worker

from

him

.

,

and Surgeons

Berlin

the College Columbia University

. D .

and his MED

in

from

,

,

Friedrich Wilhelms University

. D .

receive

to

in

Harvard

from

,

he went on

,

M

1929

1908 .

in

University

his

After

Boston

in

.

was born

SPOTNITZ

graduating

as

HYMAN

Author

the

in

Note about

A

of

practice

of

group

of

techniques

engage

the and

the private

in

of

He continues

.

teachers

principles

one

as

recognized

now

outstanding

to

,

Guardians

is

he

at

as

.

his

Hospital for Joint Diseases and Mount Sinai Hos pital Drawn into group therapy through work Consultant Psychiatrist the Jewish Board

individual and group psycho

both

he

,

to

on

therapy

The the

),

is

)

(

1947

and

than

fifty published

Dr

and

group

psy

Spotnitz lives

.

wife and three sons

in

,

psychiatry

.

his

1952

.

-

group

(

co

,

1961

more

and neurology

York City with

January

of

of

or

psychoanalytic

chotherapy New

Psychotherapy

Group Therapy author

although

books including Specialized

on

Practice papers

in

Techniques

author

chapters

professional

various

first book

,

has contributed

Spotnitz

's

Dr

.

This

. is

therapy

A

Note

the Type

on

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.,

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from

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,

Inc

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. . . H

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., ,

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