|
|
|
|
|
by Brian Nichol
|
|
|
|
|
|
The period of the 2nd World War was one
of extraordinary innovation in group psychotherapy
in Britain. S.H. Foulkes experimented with
psychoanalytic small group therapy which led
on to the group-analytic method. Wilfred Bion
developed the theory and practice of a therapeutic
community. As we will see in this paper Maxwell
Jones, Harold Bridger, Tom Main, Bierer and
many others made important contributions to
the development of group and social psychotherapy.
Because much of the literature of group psychotherapy
comes from America the histories of group
psychotherapy tend to reflect an American
background and do not attach much significance
to the innovations of these British pioneers.
The purpose of this paper is to redress this
situation for the student of group psychotherapy
by bringing together key accounts of the exiting
developments of the 1940's which where to
shape the future of group therapy in this
country. Group-analysis is an important
force in the development of group psychotherapy
in Europe. In Britain the Institute of Group
Analysis is the principle provider of training
for group therapists through its membership
qualifying course in London, the training
programs established in many European countries,
and the introductory courses organized at
several centers in Britain. The Group-Analytic
Society organizes regular events, workshops
and scientific meetings. "Group Analysis"
is a British journal devoted to group therapy.
However, the influence of group-analysis is
mainly in Europe at this time; there are few
group-analysts working in the United States
where group psychotherapy is more substantially
established than in this country. The contribution
of S.H. Foulkes, the founder of group-analysis,
to group therapy has not always been recognized
outside his immediate circle, even in Britain.
The paper concentrates on the work of W. Bion
and S.H.Foulkes during the Second World War.
Their paths crossed at Northfield Military
Hospital for a brief period in 1943 when Bion
was given command of the training wing for
the rehabilitation of soldiers. Curiously,
Foulkes was unaware of Bion's work until the
following year (Foulkes 1964, p185). The events
which occurred at Northfield were momentous
for the development of group psychotherapy
and therapeutic communities in Britain. It
is one of those episodes in history when a
number of very able people converged to generate
a remarkable and creative synthesis. This
paper sets out the Northfield story and in
particular the distinctive contributions of
Foulkes and Bion. Although Bion's 1943
paper in which he set out his ideas on group
psychotherapy predates that of Foulkes and
Lewis (1944), it is evident that Foulkes had
established a group psychotherapy practice
before he met Bion. Foulkes may be regarded
as the first intentional practitioner in Britain
of small group psychotherapy as we now understand
it. Bion's genius lies in his original analysis
of social behavior which initiated the radical
change at Northfield and which has had such
a profound influence on the manner of group
work in this country. In 1944 a group
of American psychiatrists visited Northfield.
Although by that time several methods of group
psychotherapy were well established in the
USA - the American Association of Group Psychotherapy
was formed in 1943 - nevertheless, these visitors
were so impressed by the originality of the
work they witnessed that on their return they
arranged for an issue of "The Bulletin
of the Menninger Clinic" to be devoted
to the work at Northfield. Before we
look at the work of Bion and Foulkes at Northfield
it is important to look at Foulkes' initial
work with applying his psychoanalytic training
in a group setting.
|
|
|
|
This landmark paper in the history of group
therapy was actually written in 1942 although
published two years later. It is a report
of Foulkes' first work with groups in Exeter
in the early war years and is based on four
groups with a total of fifty patients. Foulkes
had been introduced to the idea of working
analytically in groups through reading Tigant
Burrow's papers in the 1920's which had impressed
him a great deal. Other less direct influences
were in the air at that time from which he
singles out two plays, Pirandello's "Six
Characters in Search of an Author" and
Maxim Gorki's "The Lower Depths"
(Foulkes, 1964, p13) Both plays contain the
themes of groupness and leadership, Gorki
evokes the unconscious power that is in groups,
the events on the stage are "driven by
a strong anonymous forces" (op.cit.p.13).
Fifteen years elapsed before Foulkes' first
group session in Exeter. In America the term
group therapy had already been coined and
group therapies of various kinds were already
being developed although it is probable that
Foulkes was not aware of these developments.
He reports his sense of making history when
he came home to his wife from his first experimental
group session. Over a period of two
years Foulkes and Eva Lewis jointly conducted
two men's groups and two women's groups. Altogether
there were fifty patients, nearly all of whom
had been in individual therapy previously.
The groups met weekly for one and a half hour
sessions. Individuals also had separate interviews
with the therapists but to no consistent pattern.
The therapists did not rule out the possibility
of conducting mixed groups but did anticipate
that such groups would be more complicated
to work with. Patients attendance was not
regulated at this stage, they "arranged
the period of treatment to suit their needs".
(op.cit.p21). (A more permissive attitude
towards regularity of attendance than Foulkes
subsequently held.) In the paper Foulkes,
at this stage, had limited ambitions for the
new method. He did not think a group could
approach a full individual analysis, but a
group might be able to restore normal functioning
to the patient so that he could get on with
his life. In the event the outcomes impressed
him. The process was economical of the therapist
time and appeared to speed up treatment. The
patients solved their conflicts in ways which
were well adjusted to reality. The groups
were so effective that Foulkes was suggesting,
even at this early date, the educational potential
for ordinary people. Groups carried out along
his lines could make; "a desirable
contribution to their education as responsible
citizens, in particular of a free and democratic
community". (op.cit.p 21) They
treated the whole range of cases that presented
to the psychiatrist, psychoneuroses, mild
psychoses, more acute psychotic conditions
and those organic conditions which were known
to respond to psychotherapy. Diagnostic category
was not a principle of selecting a patient
for a group. Their selection principles are
rather vague in the paper, they made their
judgment on the basis of the patient: -
possessing a personality which "seemed
to qualify" for a group,
- having
reached an appropriate stage in treatment,
-
not having any "peculiarities in their
personal situation or condition" which
might disturb the group,
- reacting
appropriately to the idea of joining a group.
Because
most of their group members had previous experience
of psychotherapy the explanation the therapist
gave before the first session was quite direct.
The patient would be reminded that he/she
now had an idea of the mental conflicts which
caused their troubles and symptoms. They would
be familiar with the existence of and power
of the unconscious. By now they would know
about the various ways of making contact with
unconscious conflict, through free association,
interpretations and dreams. And they would
have experienced the way changes in themselves
happen, symptoms become modified or would
disappear. When they joined the group they
were encouraged to join in and speak freely
of anything which entered their minds. (Although
they emphasized the free association principle
they report that these early groups were more
of a discussion.) With patients who had no
previous treatment they offered a less elaborate
explanation, simply describing what took place. We
can only gain a hazy picture from this paper
of their method of working in these groups.
They claim that the basic principles of individual
analysis were used but did not go into much
detail. "We cannot enter here into
elaborate rules of technique, details which
are anyhow a matter of intuition based on
experience" (op.cit. p24). They
recognized the following important differences
between the group and the individual situation: - The
group reacts as whole rather than just the
sum of its parts.
- Transference reactions
in the group are different to the individual
situation.
- At times the collective
resistance of the group was the focus of their
analysis.
- The therapist (and patients)
could observe the effects of patients on each
other in contrast to relying on the patient's
own reports.
They do usefully
contrast the role of the therapist in the
individual and group situation in relation
to transference. The usual reserved position
of an analyst could not be maintained because
sitting in the midst of the group he is so
much more visible. A consequence was that
the group would be less likely to approach
the deeper levels of the unconscious. They
did not consider there should be restrictions
on the conductor behaving in a similar way
to the members. He/she could make their own
associations, encourage, nod, smile, bring
out a theme or control a conflict. Foulkes'
analogy of the conductor directing an orchestra
is used for the first time in this paper.
They did find it preferable for the therapist
to keep his/her personality in the background
in an approximation of the analytic situation. As
to the actual events and interactions in the
groups they provide little detail. They do
give several case descriptions of patients
which make reference to episodes in the groups.
They report a number of topics which emerged
in the sessions; the fear of going mad, anxiety
about loosing control, various phobias where
spoken about, some people related their dreams,
the relations between the sexes, and a fear
of homosexuality. For a fuller record of his
early groups we would have to turn to, "Introduction
to Group Analytic Psychotherapy" in which
he reports groups from the Northfield period. As
to the effect of the method they claim them
to be generally good, there was scarcely a
participant who did not benefit from the experience.
Twelve cases of individual group members are
described. Their paper concludes with
a review of the therapeutic factors group
therapy brings in to play. The group retains
the fundamental agents of individual therapy,
in catharsis, in transference processes (although
they are not such a strong feature), and in
bringing what has been repressed into consciousness
by interpretation and analysis. There were,
important additional factors. In the group
individuals can identify with or model their
characters by reacting against other individuals.
The process of projection becomes transparent
leading to important insight into the self
and relations outside of the group. Individuals
are brought out of their isolation to join
with other people in a continuing relationship.
They come to feel that they are understood
and in turn can show their understanding of
others. Their realization that other people
can have similar morbid thoughts, anxieties
and impulses provides a relief for their anxiety
and guilt. Other peoples suffering puts their
own into perspective. Group members are helped
by the simple process of exchanging information
and explanations about everyday experience.
Foulkes introduces important concepts for
phenomena peculiar to the group situation.
It is easier to recognize other people's problems
and to consider ways these might be resolved.
He calls this the mirror reaction. Such reflective
identification acts as an analytic agent in
the patients own person. There is what he
calls resonance, a particular tone in the
quality of the relationship with that other
person. In the general discussion of the group
there is a loosening and stimulating effect
on what the individual is prepared to speak
about. It is easier to talk when a particular
topic has been broached. A profound insight
of Foulkes was his sensitivity to the unconscious
group process. He identified that group members
were helped by an unconscious communication.
At a deeper level of interaction he recognized
an unsettling but therapeutic process occurring.
Dreams, symbols and associations become pooled
in the group. "It is as if the
'collective unconscious' acted as a condenser." His
openness to the identification of the unconscious
process of the group was an important step
in the development of group analysis. That
he would have the perceptiveness to recognize
these subtle and illusive movements in those
early groups is a singular achievement. This
early formulation in conjunction with the
Gestalt based principle of the group-as-a-whole,
Foulkes elaborated in his later writing into
the concept of the matrix the most distinctive
element of group-analytic theory. It
is evident from this paper that Foulkes had
by 1942 developed a comprehensive framework
of ideas for the study of the therapeutic
effects of the small group. A number of his
observation would by that time have been familiar
to therapists in the USA where various forms
of group therapy were being practiced. Such
therapeutic factors as, universality, bringing
the client out of his isolation and the function
of catharsis had already been recognized by
other workers. The novel ideas that Foulkes
contributes in the paper are: -
The group reacts as whole rather than just
the sum of its parts.
- The conductor
uses the basic principles of psychoanalysis.
An important part of the therapeutic process
for the individual in the group is the bringing
into consciousness what has been repressed
in the unconscious.
- Group members
are encouraged to free associate in the group
discussion.
- Conductor's personality
should remain in the background in an approximation
of the analytic situation.
- The recognition
that transference reactions in the group are
different to the individual situation.
-
The identification of the collective resistance
of the group.
- The analogy of the
conductor of an orchestra.
- The way
the group enables the processes of identification,
contra-identification and projection to be
observed by both conductor and patients.
-
The identification of the mirror reaction
and the associated concept of resonance.
-
The identification of the unconscious group
process in stimulating shifts at an unconscious
level in the individual with the associated
hypothesis of a condenser effect.
In
1943 Foulkes with this considerable expertise
in small group therapy went to Northfield
Military Hospital where he had every opportunity
to develop his pioneering work.
|
|
|
|
Foulkes (1948) gives his account of his part
in remarkable developments at Northfield Military
Hospital during the Second World War. It is
a story of the coming together of a group
of talented people, each with his own ideas
about psychotherapy already developed, collaborating
in this one center to invent a therapeutic
community. These men - Bion, Main, Bridger,
Rickman, Maxwell Jones and Foulkes himself
- left Northfield by 1946 to embark on individual
careers which were to largely shape the theory
and practice of group therapy and therapeutic
communities in this country. Foulkes tells
of the transformation from a drab traditional
hospital culture to a vibrant therapeutic
community. Northfield Military Hospital had
been established in the buildings of a former
mental hospital located some five miles outside
of Birmingham, isolated from the community
in its own extensive grounds. The patients
were soldiers who suffered, mainly, neurotic
disorders of one kind or another which had
not responded to ordinary disciplinary measures
in their units. Most of them wanted desperately
to get out of the Army and their symptoms
were quickly recognized as the ticket to an
early discharge. Northfield at the beginning
of 1943 was organized in two separate sections,
the hospital and the training wing. In the
hospital the soldiers daily life was administered
in a more relaxed laissez-faire way; there
were nurses and medical staff, the soldiers
slept in beds with mattresses and sheets.
Those who were fit enough were required to
do physical training, games and fatigues.
The men were ingenious in dodging these activities
to find their way to "Jones'", the
local cafe, or the NAÏF. When the patients
were sufficiently cured through the hospital
treatment they move into the training wing.
Discipline within the hospital was upheld
by the military police. The training
wing was run with conventional military discipline
by training instructors to prepare the patients
to return to their regiments. The patient's
day was spent on drill, marches, games and
fatigues. The living conditions were more
severe than the hospital, they slept on palliases
with blankets. Whereas they had worn a blue
uniform in hospital they wore khaki on the
Wing. In this period the soldiers used all
their wits to resist treatment so that they
could escape back to civilian life. By
1944, sometime before the Second Front in
June, the divisions between the two sections
were lessened. The psychiatrist were now required
to visit their patients in the training wing
and the patients of a particular psychiatrist
were grouped together in the same living accommodation.
The atmosphere was charged by the nation wide
sense of emergency. The range of educational
social activities had been enriched to include,
carpentry, model building, etc. In the hospital
wing a new type of patient direct from active
service, exhausted and ill, began to arrive.
The terrible experiences of these soldiers
won for them the respect of both the staff
and the existing patients. The nursing sisters
had been encouraged to become more active
in the treatment of the men in the hospital.
Through a differentiation of the psychiatrists'
roles the administration of the admission
procedure became more efficient so that newcomers
were more quickly placed in their ward groups.
Those patients whose prospects of rehabilitation
within the Army were judged poor were discharged
quickly so that their demoralizing influence
on the rest of the patients was lessened. Foulkes
observes that in this phase the officers of
the training wing were assimilated "to
the psychiatrists". Working relationships
and communications between all the staff were
strengthened. A consequence was a heightening
of the staff members' anxieties through their
involvement in the day to day decision making.
However, staff meetings at which differences
and problems could be worked through developed
confidence among the staff in working together. The
next phase in these developments which Foulkes
calls the "Northfield experiment"
was initiated after the Second Front, towards
the end of 1944. [A notable omission in this
account is any reference to the work of Bion
and Rickman in 1943] New staff were selected
who had acquired an understanding of the "psychiatric
point of view" (ibid, p.48) from their
previous experience with the War Office Selection
Board. Foulkes comments that this helped all
the hospital staff to understand the task
of the hospital from a common base. The
whole purpose and philosophy of Northfield
Hospital underwent a major revision. Although
Foulkes does not attribute the responsibility
for this transformation to individuals, the
changes he describes have such a coherence
that it suggests that those responsible had
a clear vision of a therapeutic community.
The hospital and training wing were brought
together as one unit. The former task of the
training wing were diversified into all sorts
of activities - artistic, entertainment, recreational
and educational - so that the desires and
urges of the patients could be given expression.
Groups of all kinds were encouraged, clubs,
billiards, ping pong, etc., and committees
were set up to organize all the activity.
A newspaper was established and dance band
was formed. The hospital was allowed to grow
into a self-governing community in which the
patients were expected to take a self-responsible
part. The ward meetings changed to involve
the patients in the administration of the
hospital. Representatives for each ward were
elected who attended a weekly meeting of ward
representatives. The patients assumed
greater responsibilities for the organization
of life within the hospital. One example of
this was the formation of a group to introduce
newcomers to Northfield. Members of this group
acted as guides and to assist in this function
they organized the production of a pamphlet
"Introducing you to Northfield".
The following extracts are taken from the
pamphlet: "This magazine has been
compiled as clearly and concisely as possible
to give you some idea of why you are here,
and the facilities and entertainments available
during your stay at this Hospital. We are
going to try and solve some of your difficulties
in the light of those we have experienced
ourselves. ".... further information
can be obtained from the Group Activities
Office in the Hospital Club Corridor." "As
far as treatment is concerned one might well
say that everything we do here is treatment.
It is for this reason that our treatment does
not consist of bed and rest, or the usual
bottle of colored medicine. Besides interviews
with our Psychiatrist, we spend much of our
time in various forms of exercise and activities." "Those
of us who work in Groups have what is called
a full-time activity - these are activities
which require teams to carry out the job in
hand. In these circumstances we have an opportunity
of tapping the resources of Birmingham, as
well of those of the hospital - the `Mercury'
(Hospital newspaper run by the patients) is
an example." (quoted in Foulkes, 1948,
p49) The newcomers would read this pamphlet
and then be taken on a tour of the Hospital
by one of the special guides. On this tour
they would observe the many groups and activities
taking place, for example; the Hospital Club
run by patients, the newspaper being produced
by patients, the sports ground with games
taking place, model making, stage scenery
being painted for the next production, the
making of furniture in the carpentry shop.
The whole atmosphere of purposeful activity
was in such marked contrast to the Hospital
as Foulkes had known it when he arrived some
eighteen months previously. Links were
forged with the local community. Ice skating
and golf were encouraged. Employment opportunities
were found for the men with firms such as
Austin, the car manufactures, and with neighboring
farms or the local agricultural college. And
individuals were "free to do nothing". Nevertheless,
the ordinary army discipline and procedures
continued to provide the framework for the
new tasks and activities. The Commanding Officer
was a regular soldier and at first he was
resistant to these developments which were
so out of character with the usual military
hospital. As Foulkes puts it, over a period
considerable common ground was established
between "the old army tradition and wisdom
and the new experiment" (ibid. p.49). Foulkes
describes his work at a later stage of the
Northfield experiment when he was given a
ward on which the moral had slumped. This
was the second occasion he was given the responsibility
of a whole ward. The other time had been when
he first arrived some 2 years previously as
a newcomer to the Army, knowing very little
about life in a military hospital. The main
difference was that then he had spent most
of his time with individual patients and his
only contact with the ward was through the
formal morning ward round. He characterizes
the initial conditions he was faced with in
this ward of some 80 soldiers and how he patiently
observed the social relations within, and
between, the various sub-groups. Gradually
he took measures which resulted in a dramatic
change in the atmosphere and attitudes of
the ward. Within six weeks it was changed.
(Coincidently this is the same period of time
that Bion achieved his transformations in
the training wing in 1943). He tells a splendid
story of how this William Ward, which had
such a poor reputation before he arrived,
eventually organized a football team which
won against all the other teams in an inter-ward
competition. His account of his work on William
Ward, as we will see, holds considerable similarities
to Bion's account of taking charge of the
training wing. With the end of the War
in Europe, Northfield entered yet another
phase. Many of the staff had been posted and
the new staff had to learn the group based
therapeutic philosophy about which, understandably,
they had their anxieties. Patients who had
assumed key positions in the activities programmed
not surprisingly improved and were moved out,
dislocating the leadership structures that
had grown up. There was little enthusiasm
for the Japanese War and many patients were
fearful of an overseas posting. Much of the
heart went out of the group activity. The
innovations of the past year was in danger
of losing vitality through becoming institutionalized.
It seemed to the soldier entering the hospital
for the first time that much of what took
place was imposed rather than a reflection
of the patients' wishes and desires. Foulkes
had assumed new responsibilities for the social
activities programmed and he was able to help
the course of developments. Using his expertise
with groups, by encouraging the people to
reflect on the changed circumstances, he brought
the experiment back in touch with reality
and to breath new life. Foulkes' employed
group methods right from the beginning of
his time at the hospital. Initially, with
the permission of the Commanding Officer,
he introduced groups on his ward but they
were restricted to his own and the patients
free time. Nevertheless, they were well attended
and participants made considerable improvement.
Other staff became interested in group methods
and experiments were also made with psychodrama
methods of Moreno. Now let us turn to Bion's
account of his work at Northfield to appreciate
his contribution.
|
|
|
|
Bion's influence on the developments at Northfield
was considerable. All the more remarkable
given that he only served there for six weeks.
He arrived with Rickman in 1943 to take charge
of the training wing which at that time was
not functioning effectively. They wrote a
paper, published in the Lancet in November,
1943, "Intra-Group Tensions in Therapy:
Their study as the task of the group".
It is a stunning paper. The vitality of the
ideas and the clarity of insight stand out
in marked relief against the other papers
and histories of the period. Whereas I was
accepting a version of history that what happened
in Britain was an interesting elaboration
of work already well established in America,
Bion's work is so much more original than
that. Bion was guided in his work on the
training wing by the idea of group therapy
as a "planned endeavor to develop in
a group the forces that lead to smoothly running
cooperative activity" (opacity. p678)
He contrasted this with a more restricted
idea of small group therapy in which the focus
is developing an explanation of the individual's
neurosis. The small group provides reassurance
and an opportunity for catharsis through public
confession. In the second part of the article
Rickman describes how he organized such groups
on the wards of the hospital. The real interest
of the article, however, is Bion's transformation
of the training wing. He set out with the
conviction that change in the soldiers moral
could be brought about through the study of
their own behavior and, most importantly,
through the individuals experience of being
a member in an effective group. In individual
psychotherapy it was a necessary condition
for the individual to accept his neurosis
as the problem. Bion reasoned, therefore,
in the treatment of a group the neurotic basis
of the group's difficulties needed to be displayed
before it could be accepted as a collective
problem. His aim was help the soldiers in
the wing to face up to the way their behavior
spoilt the quality of their community life. In
his preliminary analysis of the task ahead
of him he concluded that the leadership and
organization of the training wing had to change.
He likened the problem to the situation of
an officer in a charge of a battalion in a
war zone. Under such sever conditions, holding
responsibility in the face of issues of life
and death, the officer could not simply rely
for his authority on the routine organization
and rules of the Army. He had to develop a
discipline which the men would recognize to
be in their own interest and which he could
and would back up. On active service the officer
also lived a closer, emotional relationship
with the soldiers. He had not to be afraid
of either their good will or their hostility
towards him. [Bion was only too familiar with
active service. He had served as a tank commander
in the 1st World War and had been one of only
three survivors of an entire Regiment (Pines
1987).] Bion set out with the aim of
producing "self-respecting men socially
adjusted to the community and willing to accept
its responsibilities" (op. cit. p678).
The soldiers of the training wing needed to
recognize the neurotic behavior of the group
as the "common enemy". The consequences
of their behavior had to become apparent to
them. The neurotic individual does not often
want treatment. Only when his distress reaches
such a pitch does he looks for help. In the
case of a community there is even a greater
resistance to seek out treatment. "Society
has not yet been driven to seek treatment
of its psychological disorders by psychological
means because it has not achieved sufficient
insight to appreciate the nature of its disorder."
(op. cit. p.678) The organization of
the training wing had to be such as not to
get in the way of developing insight. It should
be "designed" to show the way the
soldiers' neurotic behavior affected their
communal life, to destroy happiness and efficiency.
He reasoned that if their communal distress
was seen as a neurotic by-product then the
neurosis itself would be recognized to be
worth studying and dealing with. He
imagined the training wing as a building with
transparent walls through which an observer
could watch the behavior of those that lived
within. If those individuals are unrestrained,
then what they do, where they go and the activities
they take up, will be an expression of their
will and aims. The therapist would gain considerable
insight into the character and motives of
the patients under these conditions. Bion's
brilliance was to arrange the circumstances
in the training wing so that the men themselves
became the observers of their own activity. "If
it [the organization] could approximate to
this theoretical construct it would enable
the members of the training wing to stand
(as it were) outside the framework and look
with detachment and growing understanding
upon the problems of its working". (op.
cit. p.678) We have in this image a
development of a principle from Bion's earlier
work using leaderless groups in the selection
of leaders with the W.O.S.B's. The use of
this idea was a critical incident in the development
a new perspective on social relationships
in an organization. To translate his
vision into action Bion set down the following
rules and brought the soldiers of the training
wing, about 100 men, together on parade to
explain. - Every man would do 1
hour's P.T. each day.
- Every man was
to become a member of one or more groups,
designed to study an educational, craft or
organizational topic.
- Any man could
form a new group which catered for his particular
interest.
- A man who felt unable to
go to his group must go the rest room. The
rest room would be in charge of a nursing
orderly and would be kept quiet for board
games and resting.
In addition
there was to be a parade each day at 12.10
p.m. for 30 minutes. Bion kept to himself
that this meeting was to be the time when
they were to step outside the framework to
study the behavior of the community. In
the first days little happened although he
was aware that there was much discussion of
the new regulations. At the daily parade there
was some questioning to test the sincerity
of the new orders. Then, after a few days,
the groups began to form rapidly. One of these
groups was a programming group. On the walls
of its room maps and flags flourished showing
the location of the various groups with their
members. It became Bion's custom as
he went around observing the group activity
to detach one or two soldiers from their groups
to take them with him. What he noticed at
first was that there was very little happening
in the groups. There might be one or two soldiers
present in the hut or room and a the semblance
of work but this was hardly a group activity.
At one of the daily meetings he spoke of what
he had observed. He described it as a facade
and compared what was happening to the complaint
that they would often make about the "eyewash"
in the Army. He turned over the discussion
of this contradiction to the community and
did not take any action himself. Bion's
observations to the soldiers must be one of
the earliest large group interventions of
which we have a record. A carefully judged
communication to encourage the group to assume
responsibility for what happened in the community. Surprisingly
rapidly the training wing became self-critical.
One of the earliest complaints by some men
was about the dirtiness of the wards. An orderly
group was formed to assume responsibility
for the upkeep of the wards and in a short
time there was a marked improvement in the
standards of cleanliness. On another
occasion some men complained that it was only
a minority that were pulling their weight.
They judged that 80% of the men were "shirkers"
and they wanted them punished. Bion did not
act on their demand but instead encouraged
discussion to deepen the analysis of what
they were observing. He generalized the issue
to the problems of a society with its active
and apathetic citizens. This example illustrates
his function in helping the community to become
aware of neurotic behavior and arrive at a
more complete understanding before deciding
what needed to be done. On another occasion
the men skeptically challenged the good faith
of the new scheme by proposing a dancing class.
Instead of the rejection they expected they
were encouraged to work out a definite proposal.
The men approached their officers and the
ATS staff for help. In a business like way
they made the necessary the arrangements for
a lively and useful group activity. In
the space of a few weeks the moral of the
training wing was transformed for the better.
Men were busily engaged in group activities,
even after normal hours of duty, and there
was little absenteeism. The soldiers' appearance
improved and they became much more responsive.
Soldiers from the hospital wing became keen
to be transferred. "There was a
subtle but unmistakable sense that the officers
and men alike were engaged on a worth-while
and important task ..." (op. cit. p.680) The
daily meetings became more and more an occasion
in which the men faced up to reality and examined
relationships between themselves. Bion comments
that at about this time there were important
advantages in supporting the community project
with small group therapy. He was critical
of the psychiatrists' attitude to the experiment
and believed they needed to change. He was
doubtful whether a hospital was the appropriate
setting for this kind of work and envisaged
a new kind of psychiatric training organization
to break away from the model of the treating
a physical illness. Bion summarized
the characteristics of a good group: - Group
members share a common purpose.
- The
boundaries of the group are recognized.
- The
group has a capacity to absorb and loose members
without a fear of loosing the group's character.
- The
group is free from the detrimental effects
of exclusive internal sub-groups.
- Each
member is valued for his contribution to the
group.
- The group has a capacity to
face and cope with internal conflict.
- The
minimum size of a group is 3 members.
In
a very short time Bion and Rickman brought
about a transformation at Northfield in which
the training wing's task was understood to
be the study of and training in the management
of interpersonal relationships within groups.
A statement of the task which is still used
in present day human relations training program.
The echoes of Bion's early steps can still
today be heard when attending a Tavistock
Institute working conference.
|
|
|
|
It is impressive to simply summaries the principle
ideas contained in this article published
in the Lancet in 1943. The Glass House.
The training wing visualized as a framework
with transparent walls, outside of which an
observer can study the behavior of the soldiers
living and working inside. Reflexive
observation. The soldiers could be encouraged
to be come observers of the behavior of themselves
and other members within the organization. The
distressing consequences on the organization
of neurotic behavior needed to become apparent. Social
systems, like individuals, can suffer pathological
disturbance. Design. The organization
and its processes can be designed to a purpose. Participation.
The participation of the soldiers in a continuing
dialogue of the purpose of the organization
is fundamental to the realization of that
purpose. He resisted decision making by the
leader in favor of joint decision-making which
was crucial to individual and group development. The
character of a group can be developed, a leader's
style influences that character, a leader
needs to have the resilience to accept a group's
anger and hostility. The characteristics
of an effective group; individual members
are valued, a common purpose, clear boundaries,
absence of the destructive effects of sub-groups,
the capacity to deal with conflict. Membership
of an effective group can bring about positive
personal change. Intervention. Bion
introduces to the leader's role a new repertoire
of interventions which includes feedback and
the interpretation of behavior within the
group.
|
|
|
|
The value of looking closely at the early
writings of Bion and Foulkes is to disentangle
their distinctive contributions to the development
of group therapy and organization development.
Bion had been working on leadership and small
group behavior in relation to the selection
of army officers prior to developing his techniques
and theory for a therapeutic organization
at Northfield. After the War he went on to
make important contributions to our understanding
of groups and organizations through the Tavistock
Institute. In later years he turned his energies
away from small groups to work as a psychoanalyst.
His work in 1943 emphasizes groups and individuals
reflecting on the processes in which they
are caught up and developing rational solutions
to problems. His frame of reference was the
small group in relation to the larger social
system of which it is a part, a mainly social
psychological perspective with no evident
psycho-analytic presuppositions. Foulkes,
on the other hand, started with small group
therapy, became involved in the invention
of the Northfield therapeutic community and,
after the War, devoted himself to developing
the theory and practice of small group therapy.
He always retained an interest in the application
of group-analysis in fields outside of psychotherapy,
such as organizations and education but he
was not directly involved with these developments.
Although his frame of reference was primarily
the small group and the individual, he has
always emphasized the importance of the `total
situation', that is understanding the individual
in relation to the groups of which he is a
member. His understanding is suffused with
a psychoanalytic view of the world, supplemented
by Gestalt psychology. He appears to have
been among the first to have experienced and
deliberately worked with the unconscious process
of the group. In this account we have
seen an intermingling of ideas from the study
of leadership, organizations and small groups,
with those developed in the context of therapy
and medicine. They reacted together with great
synergy to advance management development
and organization development as well as group
therapy and therapeutic communities. The achievements
at Northfield arose out of a marvelous confluence
of ideas and practices. Although this paper
singles out Bion and Foulkes, in concluding,
it is important to acknowledge the work of
Rickman, Bierer, Maxwell Jones, Bridger, Main
and others who contributions we have not examined. Finally,
both Bion and Foulkes recognized the educational
as well as the therapeutic potential of their
work. It would be reasonable to assume that
they saw an essential relatedness of the learning
and therapeutic processes.
|
|
|
|
Reading between the lines of the different
accounts it would seem that there was a conflict
over who originated the ideas. Foulkes repeatedly
in his publications lays claims to a principle
share of the credit for what happened at Northfield.
In his writing he seems angry with someone
or other for not recognizing him as the innovator
of group-analytic therapy nor according sufficient
significance to small group process in the
whole experiment. "Group-Analytic psychotherapy
is a method of group psychotherapy initiated
by myself from 1940 onwards .... ....
No such form of group psychotherapy existed
at the time, neither in this country nor on
the continent of Europe, or elsewhere, including
the U.S.A.... .... only two analysts
who to my knowledge had begun to practice
at the same time or perhaps a year or two
earlier, were Louise Wander and Paul Schilder;
but their practice was nothing like my own...."
(Foulkes 1975) He claims for himself
a principle part in the achievements at Northfield: "As
to the Northfield Experiment, my own function
happened to be a rather important one. Firstly,
I was the only person who observed it actively
all the way through. I was at Northfield for
over a year before there was any Northfield
Experiment, except on my own ward, so to speak!"
|
|
|
|
Abse D.W. (1974) Group-Analytic Psychotherapy,
Wright-Bristol. Bion W. & Rickman
(1943), Intra-Group Tensions in Therapy: Their
study as the task of the group. Lancet. Foulkes
S.H. & Lewis E. (1944) Group Analysis:
Studies in the Treatment of Groups on Psycho-Analytic
Lines. B.J.Med.Psychol., 20, 175-84, reprinted
in Foulkes (1964). Foulkes S.H. (1946a).
Principles and practice of group therapy.
Bull. Menninger Clin. 10, 85-89. Foulkes
S.H. (1946b). Group analysis in a military
neurosis centre. Lancet, 1, 303-310. Foulkes
S.H. (1948). Introduction to group-analytic
psychotherapy. Heinemann. Foulkes S.H.
& Anthony E.J. (1957). Group Psychotherapy:
The Psycho-Analytic Approach. Penguin. Foulkes
S.H. (1964) Therapeutic Group Analysis. Allen
& Unwin. Kraupl Taylor F.,(1958)
A History of Group and Administrative Therapy
in Great Britain. B.J.Medical Psychol. 31,
153-73. Main T.F. (1946) The hospital
as a therapeutic institution. Bull. Menninger
Clin.10 66-70. Pines M. 1987. Bion:
A Group-Analytic Appreciation. Group Analysis,
20, 251-62. Mullan H and Rosenbaum M,
(1962) Group Psychotherapy, The Free Press
of Glencoe. Pines M. (1987), Bion: A
Group-Analytic Appreciation. Group-Analysis,
20, 3.
|
|
|
|
|
|
© 2000 All rights reserved. You may
copy or distribute this article in its entirety
with this copyright notice and full information
about contacting the authors. The author is
Brian Nichol (919)303-5848.
|
|
|
|
|