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Bion and Foulkes at Northfield:
The Early Development of Group Psychotherapy in Britain
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.

 
"Group Analysis: A study in the treatment of groups on psycho-analytic lines." by S.H. Foulkes and E. Lewis, 1944.

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:

  1. The group reacts as whole rather than just the sum of its parts.
  2. 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.
  3. Group members are encouraged to free associate in the group discussion.
  4. Conductor's personality should remain in the background in an approximation of the analytic situation.
  5. The recognition that transference reactions in the group are different to the individual situation.
  6. The identification of the collective resistance of the group.
  7. The analogy of the conductor of an orchestra.
  8. The way the group enables the processes of identification, contra-identification and projection to be observed by both conductor and patients.
  9. The identification of the mirror reaction and the associated concept of resonance.
  10. 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.

 
The Northfield Experiment
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 at Northfield
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.

  1. Every man would do 1 hour's P.T. each day.
  2. Every man was to become a member of one or more groups, designed to study an educational, craft or organizational topic.
  3. Any man could form a new group which catered for his particular interest.
  4. 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.

 
The Principle Ideas in Bion's Paper
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.

 
In Conclusion
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.

 
Note
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!"

 

References

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.

 

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